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PubMed2006

The "geography" of child maltreatment in Israel: Findings from a national data set of cases reported to the social services.

OBJECTIVES: This article examines the "geography" of reported cases of child maltreatment in Israel by determining its frequency and rates according to nationality, area of residence, and size and type of locality. METHOD: The study collected data at the local level in Israel based on reports to social services of cases of child maltreatment during 2000; locality is the unit of analysis. RESULTS: The rate of reported cases of child maltreatment was 17.8 per 1,000 children in Israel in 2000. The rates varied, however, among different localities. They were lower in Arab localities (9 per 1,000 children) than in the Jewish ones (20 per 1,000), higher in large cities and other socioeconomic affluent localities (19 per 1,000), and varied according to the geographic area. CONCLUSIONS: This study demonstrates considerable variation in rates of reported cases of child maltreatment by locality and by population makeup. Thus, to fulfill the Israeli legislation of mandatory reporting of any reasonable suspicion of child maltreatment, the state should better develop policies and services that encourage reporting of child maltreatment among the Arab and ultraorthodox populations and in smaller or socioeconomic disadvantaged localities. Furthermore, the social services must build a bridge to the minority populations in Israel, developing their trust in these services and increasing their propensity to use them.

Adolescent↗
PubMed2006

The psychological autopsy: solving the mysteries of death.

The psychological autopsy is an important assessment tool used to identify aspects of a person's life that explain any lingering mystery that shrouds their death. In addition to answering questions of the past, the psychological autopsy has significant implications for the future. Statistics obtained from mortality data affect the course of health care research, the flow of resources, and ultimately public health policy. From a public health perspective, the misclassification of suicides as accidents or deaths from natural causes can negatively affect research funding and policy development related to suicide prevention efforts, making a standardized and accurate procedure imperative. Although the psychological autopsy was developed initially as a tool to assist the coroner in clarifying the cause of death, this procedure has transcended the confines of forensic science and has applications in the many arenas of litigation and public health policy.

Accidents↗
PubMed2006

Epidemiology of HBV infection in Asian blood donors: emphasis on occult HBV infection and the role of NAT.

Hepatitis B virus (HBV) infection is endemic in many Asian countries. Among many transmission routes, transfusion is the one that should be prevented. The first major success in enhancing transfusion safety came with the implementation of hepatitis B surface antigen (HBsAg) in the early 1970s. However, the studies quoted in this review demonstrate that transmission by blood components negative for HBsAg can still occur in the acute phase of infection during the seronegative window period, or during chronic stages of infection (i.c. "occult" HBV infection, OHB). OHB is defined as the presence of HBV DNA in blood or liver tissues in patients negative for HBsAg, with or without any HBV antibodies. Because of limitations in current blood screening practices, OHB is an overlooked source of HBV transmission. For policy development on screening for HBV infection in blood donors, it would be useful to assess the relative contribution of the above two sources of transfusion-transmitted HBV infection from HBsAg-negative donations. New screening policy should be evaluated on the basis of available data or newly designed studies. While anti-HBc screening can climinate residual risk of occult HBV transmission by transfusion in low-endemic areas, it would not be practical in most parts of the world where the prevalence of anti-HBc is >10% as too many otherwise healthy donors will be ineligible. On the contrary, studies mentioned in this paper indicate that nucleic acid amplification test (NAT) or new HBsAg tests of enhanced sensitivity would be effective in the screening of blood donors for OHB in highly endemic countries. However, the cost-effectiveness of blood screening tests is a major concern in Asia. We therefore have systemically reviewed the literature on prevalence and infectivity of OHB in Asian countries and the possible role of NAT for identifying blood donors in the pre-HBsAg window phase or in later stages of OHB.

Asia↗
PubMed2006

A survey of New Zealand's Territorial Local Authorities' policies, plans and programs promoting physical activity.

OBJECTIVE: To investigate New Zealand's Territorial Local Authorities' (TLAs') policies and plans promoting physical activity. METHOD: Postal survey of senior planners in New Zealand's TLAs, undertaken 2004/05. RESULTS: Only 59% of respondents reported that their TLA had an overall plan or policy for physical activity promotion. Most reported policies and plans for open spaces (82%), parks (95%) and recreational facilities (89%). Those for pedestrian pathways were common (70%), but cycle lanes (56%) and shared use pathways (57%) were less so. Rural TLAs and those with more deprivation were less likely to have an overall policy (OR = 0.84, 95% CI 0.72-0.98) or direct involvement in promotion (OR = 0.94, 95% CI 0.89-0.99). CONCLUSIONS: Considerable scope exists for New Zealand's TLAs, especially those that are largely rural, low growth and with greater deprivation, to promote physical activity. IMPLICATIONS: Physical activity policy development and planning should be given greater emphasis; those with more deprivation and isolation need additional resources to avoid increasing inequalities. Closer engagement between TLAs and population health agencies, transport and education sectors would accelerate progress. Policy monitoring, such as we have described, is one way of tracking such progress.

Exercise↗
PubMed1994

Homework: a survey of policies in the United States.

Homework is a key area of concern in our nation's public schools, as well as a central element of collaboration between home and school. The purpose of the current study was to survey the policies of a national sample of school districts concerning homework. Specific foci of the survey included whether a homework policy had been instituted, if modifications were made in the policy for students with disabilities, the types of homework, the length and frequency of assignments given, and specific communication mechanisms between home and school. A total of 550 surveys were mailed, with a response rate of 48.5%. The results indicated that only 35.2% of school divisions did have a policy on homework, with 64.4% of those policies including modifications for students with disabilities. Findings in terms of frequency and amount of homework assigned, as well as home-school communication mechanisms, are highlighted. The results are discussed within the context of policy development and instructional implications.

Data Collection↗
PubMed2003

Emergency contraception: lessons learned from the UK.

CONTEXT: Since January 2001, women aged over 16 years in the UK have been able to purchase progestogen-only emergency hormonal contraception from pharmacists without prescription. This paper outlines the context in which these changes took place, including contraceptive choices in the UK, changes within the pharmacy profession and political pressures. OBSERVATIONS: We chart the multisectoral developments required to make emergency contraception (EC) available without prescription in the UK, from clinical research findings and results on the views and behaviour of health care professionals and users of EC, through to professional and policy developments, including challenges during and after this process. DISCUSSION: Lessons learnt from the innovative experience of the deregulation of EC in the UK apply to other regions currently considering similar change. We extrapolate internationally applicable lessons including the importance of stakeholder partnership, transparency and cautious pace of change, and the vital role of professional groups. CONCLUSION: Although this change brought a new element of reproductive choice to some women, significant barriers to access to EC still remain for young women and women unable to afford the high price ( 24/euro;37/$39) of pharmacy purchase in the UK.

Adolescent↗
PubMed1997

Paradoxes of GP fundholding: contracting for community health services in the British National Health Service.

The expansion of GP fundholding (GPFH) is central to the British government's attempt to maintain the revolution under way in the National Health Service (NHS). Evaluations of the NHS reforms have portrayed GPFH as an important mechanism for competition, and GPFH's bargaining power is reported to have secured significant changes in health service provision. However, these developments have been acknowledged to be less applicable in relation to community health services (CHS) than acute hospital services. On the basis of case studies of the process of contracting for CHS, GPFHs are shown to display ambivalent and sometimes contradictory views which have to be related to broader policy developments in general practice and primary care. Although this paper focuses on the British situation, many of the issues raised by reforms in primary and community health services have implications for developments in other Western health care systems.

Attitude of Health Personnel↗
PubMed2006

Existence and predictors of soft drink advertisements in Pennsylvania high schools.

The objective of this study was to describe the extent and locations of soft drink advertisements on high school campuses in Pennsylvania and identify factors related to extent of these advertisements. Surveys were distributed to 271 school foodservice directors in a random sample of high schools in Pennsylvania. These high schools were selected to be representative of the entire population of high schools in Pennsylvania based on chosen demographic characteristics. A three-phase survey strategy was used, involving distribution of a postcard reminder 1 to 2 weeks after the initial survey distribution, and mailing of a second survey to nonrespondents 1 to 2 weeks after mailing of the postcard. Two hundred twenty-eight school foodservice directors (84%) returned surveys. Linear multiple regression analyses were done using SPSS (version 11.5.1, 2002, SPSS Inc, Chicago, IL). Approximately two thirds (66.5%) of respondents indicated soft drink advertisements exist in at least one location in their school, with the most prevalent locations being on vending machines (62%) and school grounds, such as playing fields (27%). Slightly more than 10% of respondents indicated soft drink advertisements displayed in the cafeteria. Extent of soft drink advertisement locations was positively related to existence of a pouring-rights contract, subscription to Channel One, and receipt of incentives from soft drink bottlers based on sales, but negatively related to average daily participation in school lunch. These findings suggest that commercialization and sales incentives might interact to contribute to school environments that are not "nutrition-friendly." Schools' efforts to establish wellness policies as mandated by the Child Nutrition and WIC Reauthorization Act of 2004 provide ideal opportunities to examine school environments for advertising that might conflict with the healthful environments they are aiming to establish, and perhaps to develop policies to address these practices.

Adolescent↗
PubMed2003

Uncovering meaning: how nursing knowledge changes policy in practice.

What ethical values, assumptions, and beliefs guide nursing practice today? What is the purpose and intent of policy in relationship to nursing practice? What underlying assumptions, values, and beliefs are missed in policy development that is not informed by nursing knowledge? These are some of the questions the authors attempt to answer in this paper. They examine some of the ethical dilemmas that arise when nurses are required to enforce policy that conflicts with nursing theory. A description of how nursing theory informs miss-takes (that is, missed assumptions, missed understandings, missed views and values) highlights how nursing knowledge changes policy in practice.

Conflict of Interest↗
PubMedDate not supplied

Working on reform. How workers' compensation medical care is affected by health care reform.

The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies?

Health Care Costs↗
PubMed1995

Maintaining the confidentiality of computerized mental health outcome data.

The emergence of managed behavioral health care has increased the value of data describing outcomes of mental health treatment. At the same time, increased development of the national information infrastructure and other computer linkage systems has facilitated the flow of information among a wide network of data systems. These two developments create a dynamic tension between the need to share information and the need to protect the privacy of mental health clients and the confidentiality of their computerized records. This problem is exacerbated by the cost associated with potential solutions. Unfortunately, policy development in this area has lagged behind rapid developments in technology. The mental health administrator must balance the three components of this conflict (the increasing need for information transfer, the protection of confidentiality, and cost) without a great deal of guidance. This article offers recommendations that may help the mental health administrator manage this conflict.

Computer Security↗
PubMedDate not supplied

Tobacco use cessation within the context of tobacco control policy: opportunities for nursing research.

In this presentation, a brief review of tobacco control policies that are effective in decreasing tobacco use prevalence and consumption is provided, and the role of policies affecting tobacco cessation is discussed. An overview of existing coverage for cessation under different health insurance policies and a discussion of the implications that these policies have for nursing practice and research are also provided. Then, the need for nurses' knowledge of and involvement in tobacco control policy making is discussed. Finally, questions on how nursing research in the area of cessation policy development and evaluation can improve access to cessation services to a larger number of tobacco users in the population are considered.

Health Policy↗
PubMed1997

The potential role of unemployment benefits in shaping the mental health impact of unemployment.

This study looks at the association between formal systems of support (unemployment compensation or welfare) and mental health outcomes during periods of unemployment. It assesses whether unemployed persons not receiving unemployment benefits are at greater risk of reporting depression and suffering ill-health than those receiving some kind of unemployment compensation, independent of total household income. The authors performed a secondary analysis of data collected in the National Survey of Families and Households, 1987-1988. Outcome measures included an index of depression and perception of health status. Multiple regression analyses were used. The unemployed receiving unemployment compensation or benefits from other entitlement programs did not report significantly higher depression relative to the employed. Rather, the study found a significantly higher index of depression among unemployed persons receiving welfare benefits or no benefits, even after controlling for total household income and previous employment/unemployment history. Thus unemployment compensation may play an important role in ameliorating the impact of unemployment on depression. By contrast, means-tested benefits may not be sufficient to reduce the risk for reporting depression and suffering ill-health in comparison with the full-time employed. The implications of the findings are discussed in terms of social policy development.

Adaptation, Psychological↗
PubMed1999

Integrating strategies for podiatric public health, clinical services, and education.

Changes in the health-care system will continue to modify the delivery of podiatric medical care and podiatric medical education. Podiatric medicine and its educational programs will need to focus on the management of care, special populations, and disease prevention. Future providers will need to participate as team members and respond to new patterns of care, including the special needs of the older population. This article explores methodologies for professional activities, administration, incentives for change, academic issues, innovation, implementation, outcome measures, and health policy development. Podiatric medicine must be prepared to establish standards, protocols, and guidelines to serve as the benchmark for foot health.

Aged↗
PubMed2001

Capacity for research in minority health: the need for infrastructure plus will.

Cardiovascular mortality has continued to decline, but racial disparities in cardiovascular diseases (CVD) continue to grow. To build the capacity to address these racial disparities, two things will be required. First, a research and policy infrastructure must be in place to provide guidance on what to do and how to do it. Second, the will to implement and activate this infrastructure must be present at the community and policy-making levels. The Jackson Heart Study is an example of a research infrastructure with the economic resources, scientific expertise, and technical manpower required to monitor, organize, assess, and follow a cohort of individuals over time to study the burden, natural history, predictive factors, and level of care for CVD in an African American community. The creation of will within the community for CVD research may require additional strategies than in the majority community, such as community organization and local policy development. These additional efforts at the community level should create a fertile environment to develop research and, ultimately, test strategies for reducing national disparities in cardiovascular health.

Attitude to Health↗
PubMed1995

The Victoria Declaration--a unifying force.

The Victoria Declaration, the policy document which resulted from the First International Heart Health Conference--'Bridging the Gap: Science and Policy in Action'--is an historic document. Advances in cardiovascular disease prevention, intervention and research as well as in heart health promotion have been frequent and significant. At the same time, a lack of appreciation of the need for a coordinated effort between clinicians, researchers, epidemiologists, community health professionals and others in the health field has meant that we have not been able to capitalize on the opportunity for greater success. The Victoria Declaration highlights the fact that a comprehensive approach to cardiovascular disease prevention needs to expand partnerships well beyond the health sector into many areas of policy development both within and outside government and in the private and voluntary sector, among others. The key message of the declaration is that our best effort will be a unified, systematic effort that marries the preventive, clinical and research approaches with those of policy makers, governments, private sector and others. It is imperative that health professionals recognize this. The declaration outlines a comprehensive framework for cardiovascular disease prevention, advocating a public health approach, targeted towards the population at large and focusing on the reduction of the major risk factors. It suggests a number of key strategies and advocates a research agenda. The declaration is a document that has international scope and recognizes that global partnerships are necessary to assist developing countries (that are now experiencing increasing rates of cardiovascular disease) in the fight against this disease.

Cardiovascular Diseases↗
PubMed1999

Agriculture sector resource and environmental policy analysis: an economic and biophysical approach.

Agricultural pollution of the environment is jointly determined by economic decisions driving land use, production practices, and stochastic biophysical processes associated with agricultural production, land and climate characteristics. It follows that environmental and economic statistics, traditionally collected independently of each other, offer little insight into non-point pollutant loadings. We argue that effective policy development would be facilitated by integrating environmental and economic data gathering, combined with simulation modelling linking economic and biophysical components. Integrated data collection links economics, land use, production methods and environmental loadings. An integrated economic/biophysical modelling framework facilitates policy analysis because monetary incentives to reduce pollution can be evaluated in the context of market costs and returns that influence land use and production activity. This allows prediction of environmental and economic outcomes from alternative policies to solve environmental problems. We highlight steps taken to merge economic and biophysical modelling for policy analysis within the Economic Research Service of the United States Department of Agriculture. An example analysis of a policy to reduce agricultural nitrogen pollution is presented, with the economic and environmental results illustrating the value of linked economic and biophysical analysis.

Agriculture↗