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PubMed2004

The relation of FIMR programs and other perinatal systems initiatives with maternal and child health activities in the community.

OBJECTIVES: To evaluate the association of the presence of a fetal and infant mortality review (FIMR) program, other perinatal systems initiative (PSI), or both in a community with the performance of essential maternal and child health (MCH) services by local health departments (LHDs). METHODS: Data were obtained from telephone interviews with professionals from LHDs across the United States. Logistic regression was used to estimate the odds of a LHD conducting each essential MCH service in communities with and without FIMR programs or with and without PSIs, adjusted for geographic area. RESULTS: Of the 193 communities in the sample, 41 had only a FIMR program, 36 had only a PSI, 47 had both programs, and 69 had neither. The presence of a FIMR was related to greater performance of essential MCH services in LHDs in six areas: data assessment and analysis; client services and access; quality assurance and improvement; community partnerships and mobilization; policy development; and enhancement of capacity of the health care work force. Similar findings were noted for the same broad essential services for PSIs. The comparisons of LHDs in FIMR and non-FIMR communities, however, showed greater involvement of communities with a FIMR program in essential MCH services related to data collection and quality assurance than were found for comparisons of LHDs in communities with and without a PSI. The presence of a PSI was uniquely associated with conducting needs assessments for pregnant women and infants, participation in coalitions for infants, promoting access for uninsured women to private providers and involving local officials and agencies in health plans for both populations. When both programs were present, LHDs had a greater odds of engaging in essential MCH services related to assessment and monitoring of the health of the population, reporting on progress in meeting the health needs of pregnant women and infants, and presenting data to local political officials than when either program alone was in the community. CONCLUSIONS: Local health departments in communities with FIMR programs or PSIs appear to be more likely to conduct essential MCH services in the community. Some of these relations are unique to FIMR, particularly for data collection and quality assurance services, and some are unique to PSIs, for example those that involve interaction with other community agencies or groups. Performance of the essential MCH services also appears to be enhanced when both a FIMR program and a PSI are present in the community.

Chi-Square Distribution↗
PubMed2001

Long-term care policy and financing as a public or private matter in the United States.

Effective approaches to assure adequate resources, infrastructure, and broad societal support to address chronic care needs are volatile and potentially unpopular issues that can result in many losers (those getting far less than they want) and few winners (those who gain access to scarce societal resources for care). In the United States, debates on long-term care involve a complex set of issues and services that link health, social services (welfare), and economic policies that often pit public and private sector interests and values against one another. Yet long-term care policies fill a necessary function in society to clarify roles, expectations, and functions of public, non-profit, for profit, individual, and family sectors of a society. By assessing and developing policy proposals that include all long-term care system dimensions, a society can arrive at systematic, fair, and rational decisions. Limiting decisions to system financing aspects alone is likely to result in unforeseen or unintended effects in a long-term care system that stopgap "fixes" cannot resolve. Three underlying policy challenges are presented: the need for policymakers to consider whether the public sector is the first or last source of payment for long-term care; whether government is seen primarily as a risk or cost manager; and the extent to which choice is afforded to elders and family caregivers with regard to the types, settings, and amount of long-term care desired to complement family care.

Aged↗
PubMed2000

Qualitative methods add quality to cardiovascular science.

Qualitative research methods are systematic approaches to knowledge development that do not involve quantification. Such methods are used widely in nursing to understand the lived experience and the socioeconomic contexts of cardiovascular health and illness. The evolution of qualitative methods through three phases - traditional, modern and postmodern - frames the discussion. Three common qualitative methods - ethnography, phenomenology and grounded theory - are presented. Applications of qualitative methods have contributed to an understanding of such phenoma as adjustment after myocardial infarction, the experience of an acute cardiac event, the experience of chronic heart disease, the family and the cardiac illness experience, family adjustment to heart transplantation, physical activity practices of working women and family influence on individual health-related decisions in response to heart health intiatives. Postmodern approaches are briefly discussed. Participatory research is presented as an example of a postmodern approach to knowledge development. It is posited that interdisciplinary and multimethod cardiovascular research programs that incorporate qualitative methods will strengthen knowledge development in the cardiovascular field by contributing to an understanding of complex issues related to cardiovascular health and illness for individual persons, families, communities and populations, and to program and policy development.

Cardiology↗
PubMed2003

Abortion: developments and impact in South Africa.

The article seeks to clarify the context of the Choice on Termination of Pregnancy Act, 1996 (Act No.92 of 1996), the factors that led to its adoption and implementation including the role of research in support of policy development, the expanded utilization of professional nurses, and the respect and promotion of women's right to life and well-being. The challenges that cropped up on the road to implementation and sustenance are also spelt out. It is important to evaluate the programme because this will assist South Africa to improve on the performance of service delivery. It will also assist other countries, both poor and rich, to progressively realize the promotion of human rights. Lastly, the article also seeks to identify areas that will lead to the improvement of women's lives, and ultimately societal development and health.

Abortion, Legal↗
PubMed2004

Evidence for public health policy on inequalities: 1: the reality according to policymakers.

OBJECTIVE: To explore with UK and international policy advisors how research evidence influences public health policy making, and how its relevance and utility could be improved, with specific reference to the evidence on the production and reduction of health inequalities. DESIGN, SETTING, AND PARTICIPANTS: Qualitative residential workshop involving senior policy advisors with a substantive role in policy development across a range of sectors (mainly public health, but also including education, social welfare, and health services). In four in depth sessions, facilitated by the authors, focused questions were presented to participants. Their responses were then analysed thematically to identify key themes, relating to the availability and utility of existing evidence on health inequalities. MAIN RESULTS: The lack of an equity dimension in much aetiological and evaluative research was highlighted by participants. Much public health research was also felt to have weak underlying theoretical underpinnings. As well as evaluations of the effectiveness and cost-effectiveness of policy and other interventions, they identified a need for predictive research, and for methodological research to further develop methods for assessing the impact on health of clusters of interventions. CONCLUSIONS: This study reinforces the view that there is a lack of information on the effectiveness and cost-effectiveness of policies, and it uncovered additional gaps in the health inequalities evidence base. A companion paper discusses researchers' views of how the production of more relevant public health evidence can be stimulated.

Evidence-Based Medicine↗
PubMedDate not supplied

[Health promotion: application of the Ottawa Charter].

One of the greatest challenges for community health today is to translate the health promotion framework into specific actions. An essential step toward integration of the strategies suggested by the Ottawa Charter for Health Promotion lies in a close scrutiny of community health practice by health professionals. In the context of our own organization, we have set up a series of policy development seminars designed to bring together staff involved in different areas of community health and to have them work through clear institutional positions regarding current public health issues. We examined the policy positions in the light of the Ottawa Charter. Some of the Charter's suggested strategies were not well covered by the seminar participants. This could be partly attributed to the traditional mix of disciplines in community health. In order to approach health as defined in the Charter, a novel mix of disciplines should be invited to collaborate with the already existing professionals. The Charter is a useful tool for better focusing community health practice onto the health promotion paradigm.

Alcohol Drinking↗
PubMed2002

Increasing transparency in partnerships for health--introducing the Green Light Committee.

Public-private partnerships have become central to efforts to combat infectious diseases. The characteristics of specific partnerships, their governance structures, and their ability to effectively address the issues for which they are developed are being clarified as experience is gained. In an attempt to promote access to and rational use of second-line anti-tuberculosis (TB) drugs for the treatment of multidrug-resistant TB, a unique partnership known as the Green Light Committee (GLC) was established by the World Health Organization. This partnership relies on five categories of actors to achieve its goal: academic institutions, civil society organizations, bilateral donors, governments of resource-limited countries, and a specialized United Nations agency. While the for-profit private sector is involved in terms of supplying concessionally priced drugs it is excluded from decision-making. The effectiveness of the partnership emerges from its review process, flexibility to modify its modus operandi to overcome obstacles, independence from the commercial sector, and its ability to link access, rational use, technical assistance, and policy development. The GLC mechanism may be useful in the development of other partnerships needed in the rational allocation of resources and tools for combating additional infectious diseases.

Antitubercular Agents↗
PubMed1997

Access to assisted human reproduction services by minority groups.

This paper looks at the claims of lesbian and single women to have access to Assisted Human Reproduction (AHR) in New Zealand, discusses legislation, rulings and regulations, as well as the opinions of people who have been involved in this issue. These include clinics and health professionals who provide these services, ethics committees and other bodies, and public opinion. Some implications for policy development are also discussed.

Female↗
PubMed1996

Parents' perspectives on quality in family support programs.

Support services for families who have a member with developmental disabilities are a growing component of many state mental health systems. Family empowerment is a key principle of these programs, but parents and the staff who work with them are often challenged in their efforts to have parents participate in policy development, program management, and evaluation of programs. The use of nominal group techniques is described as a means of identifying factors parents believe characterize quality family support programs. Parents' identified factors are then compared with factors from a theoretical framework for quality. Parents stressed access to information, adherence to empowerment philosophy, and the importance of interpersonal relationships with staff. Parents placed less emphasis on factors generally found in accreditation criteria.

Adolescent↗
PubMed1986

Changing patterns of population distribution in Zimbabwe.

"This paper critically evaluates the causes and consequences of changes in population distribution in Zimbabwe during the colonial period and since independence in 1980. Five main aspects of population geography are examined. Firstly...the history of tenure policies is outlined. Secondly, the distribution of the African population as revealed in the 1982 census is described and major changes between the census years of 1962, 1969, and 1982 are discussed. Thirdly, changing patterns of settlement and land use within the peasant farming areas (Communal Lands) are examined in the context of increasing population pressures. Fourthly, trends in the...urbanisation of the African population are described. Fifthly, post-independence development policies directed at effecting changes in the distribution of population are discussed with particular reference to the land resettlement programme."

Africa↗
PubMed2002

Comprehensive risk assessment for adolescents in school-based health centers.

Providing comprehensive clinical services in school-based health centers affords the advanced practice nurse the opportunities for professional growth and fulfillment. Nurse practitioners are the primary clinician in the majority of SBHCs [1]. A substantial body of knowledge exists supporting the needs of adolescents, as well as methods by which nurse practitioners may assess, document, and intervene in order to improve health outcomes in this age group. To help move the field of school-based health care from innovation to mainstream, nurse practitioners need to continue to be part of the development of conceptual frameworks, appropriate methods, and evaluation of the process and outcomes. Educational achievement, access to care and reimbursement, and reduction of adolescent morbidity are indicators that have great significance in policy development. The extent to which nurse practitioners in SBHCs can provide evidence of making a difference will determine the success of this important health care venue for adolescents and demonstrate their own professional excellence.

Adolescent↗
PubMed2002

Geriatric assessment--lessons from personal experience.

The aim of this study was to develop a framework for comprehensive specialist geriatric assessment in rural settings. A protocol that used a number of standardised assessment instruments was developed and applied routinely. Data from two rural centres in South Australia over a two-year period were analysed. Study results offer important insights and have implications for clinical practice and policy development. They particularly reinforce the need for a comprehensive assessment irrespective of the information received from the referrer.

Activities of Daily Living↗
PubMed2001

OMERACT: economic evaluations and health policy.

The aim of this paper is to review how decisions are made about the delivery of health care. Limited resources and increasing health care costs have resulted internationally in a growing necessity to understand the economic consequences of health care delivery. Rheumatology remains underfunded because the societal impact of chronic conditions is not well appreciated in the current policy-making context. Although health policy development varies with the care delivery systems, economic evaluation can be used for incremental system-wide reform to prioritize spending across multiple diseases and interventions. It is important to understand how policy and funding decisions are made in order to see how they might be influenced.

Cost-Benefit Analysis↗
PubMed1998

Analysis of third-party certification approaches using an occupational health and safety conformity-assessment model.

The occupational health and safety conformity-assessment model presented in this article was developed (1) to analyze 22 public and private programs to determine the extent to which these programs use third parties in conformity-assessment determinations, and (2) to establish a framework to guide future policy developments related to the use of third parties in occupational health and safety conformity-assessment activities. The units of analysis for this study included select Occupational Safety and Health Administration programs and standards, International Organization for Standardization-based standards and guidelines, and standards and guidelines developed by nongovernmental bodies. The model is based on a 15-cell matrix that categorizes first-, second-, and third-party activities in terms of assessment, accreditation, and accreditation-recognition activities. The third-party component of the model has three categories: industrial hygiene/safety testing and sampling; product, equipment, and laboratory certification; and, occupational health and safety management system registration/certification. Using the model, 16 of the 22 programs were found to have a third-party component in their conformity-assessment structure. The analysis revealed that (1) the model provides a useful means to describe and analyze various third-party approaches, (2) the model needs modification to capture aspects of traditional governmental conformity-assessment/enforcement activities, and (3) several existing third-party conformity-assessment systems offer robust models that can guide future third-party policy formulation and implementation activities.

Accreditation↗
PubMed1989

Developing a mandate for change: planning as a political process.

The three main questions dealt with in this article are: 'why have community participation in planning?' 'what is community participation?' and 'how can community participation be practised?' Planning in this context should be understood in a strategic sense as social policy development and implementation at a regional level. In answer to the first question, two common approaches to social planning and their shortcomings are briefly discussed, with reference to a taxonomy from Alan Walker's book Social Planning, A Strategy for Socialist Welfare. Community participation in social planning is a key characteristic of an alternative approach which addresses or avoids altogether the fundamental shortcomings of the other two. Issues of the practice of community participation in regional planning are examined through a description and analysis of the planning process undertaken by the Western Metropolitan Region of the Health Department Victoria. Some general conclusions regarding current trends in policy formation and public sector administration are also drawn.

Community Participation↗
PubMed1993

African urbanization in metropolitan South Africa--differential urbanization perspectives.

"As a potentially important urban development policy consideration, attention is focused in this paper on differential urbanization trends in South Africa at the metropolitan level. Recent informal urban settlement patterns of the African population within the major metropolitan areas are contrasted against these differential urbanization trends to determine the implications of both for residential development in the metropolitan areas during the post-apartheid era."

Africa↗
PubMed1990

Impact of HIV/AIDS on African children.

In Central and East Africa, pediatric human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are becoming increasing threats to child health due to the predominance of heterosexual transmission of HIV, high HIV infection rates in women of reproductive age and high birth rates. This paper examines the potential impact of HIV/AIDS on orphanhood and under-five mortality in 10 Central and East African countries. The author estimates that, in the 10 countries studied, HIV/AIDS in children under age five will cause between one-quarter and half a million child deaths annually by the year 2000. Whereas the United Nations estimate (without AIDS) and target for the under-five mortality rate in this 10-country region by the year 2000 are 132 and 78, respectively, HIV/AIDS will cause the under-five mortality rate to rise to between 159 and 189. Increasing HIV/AIDS-related adult mortality is creating a large and growing number of children under age 15 whose mothers have died of HIV/AIDS. During the 1990s, HIV/AIDS will kill a total of between 1.5 and 2.9 million women of reproductive age in this region, producing between 3.1 and 5.5 million AIDS orphans--which means that between 6 and 11% of the population under age 15 will be orphaned. National and international government and nongovernment service providers in Central and East Africa need to recognize this potential impact of HIV/AIDS on children, expand AIDS-prevention efforts, and develop policies and programs to address children's HIV/AIDS-related needs.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Policy formation in gamete donation and egg sharing in the UK--a critical appraisal.

This article considers two key policy documents concerning donor-assisted conception in the UK, The British Fertility Society's Recommendations for Good Practice on the Screening of Egg and Embryo Donors and the Human Fertilisation and Embryology Authority's Guidance for Egg Sharing Arrangements. It discusses both the process and the evidence used in formulating those sections of the documents which relate to donor anonymity. The paper concludes that psycho-social policy developments in assisted conception, such as those relating to donor anonymity, should be subjected to comparable levels of rigour and scrutiny to those that are applied in the formulation of medical and scientific policies.

Access to Information↗