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Severe acute respiratory syndrome: a challenge for public health practice in Hong Kong.

Severe acute respiratory syndrome (SARS) is now a global challenge affecting more than 8000 patients in different continents. The dictum of public health practice especially for infectious disease is "prevention better than cure". It is especially true for SARS as the treatment strategies remain diverse and experimental. Maintaining a healthy and hygienic environment can be one of the effective public health measures to combat infectious disease. The major challenge is that some of the most important public health measures are to be taken outside the health sector. The community also needs to be strengthened and equipped with the health skills to promote better health and hygiene. There is also the need to create a supportive environment conducive to health for long term sustainability. The WHO approach of promoting health through setting approach would be one possible solution to face the challenge. This paper will describe some of the public health initiatives in Hong Kong through "setting approach" and "community development model" in helping the society fight against SARS. With the emergence of SARS, this might be the time to globalise public health medicine as an important component of medical practice.

Disease Outbreaks↗

Health needs assessment in primary care: the evolution of a practical public health approach.

The purpose of the paper is to place health needs assessment in its primary care context. This is a dynamic context where changes in policies, staff roles and patient expectations have all to be considered. Given this complexity and the variations between practices, it is necessary to help primary health care teams (PHCTs) to understand their stage of development and how this will directly affect any health needs assessment. The technical and methodological aspects of health needs assessment have been explored and described by others, and that work will not be duplicated here. This paper reviews the health needs assessment (HNA) work of the Ribblesdale Total Purchasing Project (RTPP) and then sets this review against the political, organisational, professional and practical pressures that currently confront primary care. Out of this analysis emerges a diagnostic and development tool which links together, and emphasises the intimate relationships between, five stages of development needed for effective primary care-oriented health needs assessment work. The emphasis is on understanding the place of health needs assessment within the general processes and systems of the primary health care team. The paper concludes by suggesting ways in which public health practitioners and specialists might approach the task of supporting and influencing the evolution of the recently proposed Primary Care Groups and Primary Care Trusts. The overall intention of the article is to stimulate debate and action.

Family Practice↗

[Organizational and methodological approaches to using digital X-ray fluorography in the diagnosis of lung diseases in practical public health care of the Russian Federation].

On the basis of a great body of information, the authors propose the most reasonable and effective organizational and methodological approaches to further actively introducing digital lung fluography into Russia's practical public health care. The paper discusses a diversity of topical problems associated with the practical use of digital X-ray fluorography (DXF), such as the assessment of its use depending on the level (municipal or regional) of public health care, methodological issues of its performance, current relationships of DXF and film fluorography; a place of DXF in the screening and routine clinical diagnosis of lung diseases. Great emphasis is laid on the role of DXF in the diagnosis of tuberculosis and cancer of the lung. The place and role of Russian manufacturers of digital lung fluorographs in the further development of SXF in practical public health care of Russia are also touched upon. The authors emphasize that replacement of film fluorography by digital one will present difficulties if regional and municipal health administrators do not take an active part in this matter.

Adolescent↗

The crucible of public health practice: major trends shaping the design of the Management Academy for Public Health.

Public health leaders and managers need new leadership and management skills as well as greater entrepreneurial acumen to respond effectively to broad demographic, socioeconomic, and political trends reshaping public health. This article asserts that the need for such training and skills was the impetus for the conceptualization, design, and launch of the Management Academy for Public Health--an innovative executive education program jointly offered by the schools of business and public health at the University of North Carolina at Chapel Hill.

Entrepreneurship↗

The Turning Point Social Marketing National Excellence Collaborative: integrating social marketing into routine public health practice.

Social marketing can be an effective tool for achieving public health goals. Social marketing uses concepts from commercial marketing to plan and implement programs designed to bring about behavior change that will benefit individuals and society. Although social marketing principles have been used to address public health problems, efforts have been dominated by message-based, promotion-only strategies, and effective implementation has been hampered by both lack of understanding of and use of all of the components of a social marketing approach and lack of training. The Turning Point initiative's Social Marketing National Excellence Collaborative (SMNEC) was established to promote social marketing principles and practices to improve public health across the nation. After 4 years, the Collaborative's work has resulted in improved understanding of social marketing among participating members and the development of new tools to strengthen the social marketing skills among public health practitioners. The Collaborative has also made advances in incorporating and institutionalizing the practice of social marketing within public health in participating states.

Cooperative Behavior↗

[Weight-control intervention in overweight subjects at high risk of cardiovascular disease: a trial of a public health practical training program in a medical school].

OBJECTIVE: To evaluate the effectiveness of a weight-control intervention for overweight subjects at high risk of cardiovascular disease (CVD) at a worksite conducted by medical students as a public health practical training program. METHODS: A total of 45 men and women who were obese (BMI > or = 24.0 kg/m2) and found to be hypertensive (SBP > or = 140 mmHg or DBP > or = 90 mmHg) or suffering from hypercholesterolemia (total serum cholesterol > or = 220 mg/dl) in an annual health check up in November 2001 were invited to participate in a weight-control intervention program. Eight individuals agreed (intervention group) and other sixteen control subjects whose sex and age (+/- 3 years) were matched to the intervention subjects were selected. The duration of the program was three months (from July to October 2002) and a 2 kg weight reduction in that period was set as the goal. The baseline survey consisted of a dietary questionnaire and a health quiz. Subjects had two counseling sessions and received four personal letters in the three months. A semi-quantitative food frequent questionnaire, a photograph method (Diet Agent Service, Matsushita Electric Works, Ltd.) and three day food records were conducted for dietary surveys. Changes in bodyweight, BMI, blood pressure, and serum total cholesterol concentration from November 2001 to November 2002 were compared between the intervention and control groups. Food group intakes and nutrient intakes were compared between weight reduction achievers and non-achievers. RESULTS: Mean bodyweight changes from November 2001 to November 2002 were -2.3 kg (SD 3.3 kg) for the intervention group and +0.3 kg (SD 1.5 kg) for the control group, the difference being significant (p = 0.013). For the intervention group mean bodyweight change from July to October 2002 was -1.5 kg (SD 2.4 kg). For total serum cholesterol, the mean changes were -32.1 mg/dl vs. +0.5 mg/dl (p = 0.005), for SBP -9.5 mmHg vs. +4.7 mmHg (p = 0.083) and for DBP -2.8 mmHg vs. +1.4 mmHg (p = 0.438). These were thought to be consequences of weight-control intervention. From dietary surveys, weight reduction achievers increased fish intake and decreased fats, snacks and sweets. Those who answered the health quiz more correctly demonstrated more reduction of bodyweight. CONCLUSIONS: Effectiveness of a weight-control intervention for reduction of CVD risk factors was found in the present public health practical training program for medical students. Dietary advice based on various dietary surveys was indicated to be effective in the weight-control program. A population strategy to distribute health information appeared necessary for effective health education programs for high-risk subjects.

Cardiovascular Diseases↗

Many a slip between cup and lip. Process evaluation of a program to promote and support evidence-based public health practice.

The main aims of this study are to document whether an intervention for promoting evidence-based public health practice had been delivered as intended and to explore the reasons for its lack of impact. Process data from the implementation of the program and data from interviews with 40 public health physicians are analyzed. Although they expressed satisfaction with the service, the doctors experienced the program as rather irrelevant for their daily work. They did not perceive that they dealt with many issues relevant for the use of research information, and if they did, referring to research would not make any difference to the way others perceived their advice. There is a need to develop more overlying strategies for integrating evidence into decision making than addressing the individual level.

Algorithms↗

Searching for lessons from the New Orleans Health Department: implications for public health practice.

The National Association footline of County and City Health Officials (NACCHO) is the national organization representing local health departments. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.

Disaster Planning↗

Transforming a Master of Public Health program to address public health practice needs.

The future of the constantly changing public health profession is tied to the development of practice skills through competency-based training. In this article, we describe a program change in the Master of Public Health program at East Stroudsburg University in northeastern Pennsylvania. The first goal of the program transition was to ensure that all program elements included the relevant vision, values, mission, goals, and objectives. The second goal was to use continuous data input and evaluation to incorporate opportunities for flexible assessments. The change process helped the university faculty define the program's vision and fostered an environment of community collaboration that guides training for public health professionals.

Accreditation↗

Core function-related local public health practice effectiveness.

This article assesses the extent to which the U.S. population in 1995 was being effectively served by public health's three core functions (assessment, policy development, and assurance). A random sample of local health departments (LHDs) stratified by population size and type of jurisdiction was asked to provide their opinion of, as well as indicate performance on 20 core function-related measures of local public health practice. The article concludes that, in 1995, the nation fell far short of its year 2000 national objective, which called for 90 percent of the population to be served by an LHD effectively carrying out public health's core functions. Considerable capacity building and performance improvement is needed within the public health system.

Humans↗

Practical public health in a primary care setting. Discrete projects confer discrete benefits but a long-term relationship is needed.

Investigates a mechanism for delivering public health advice in a primary care setting--three West Yorkshire general practices--by seconding a public health physician (PHP) to each practice for six months, each practice receiving one day per week. Describes how the topics to be addressed--developing a practice plan for managing information; improving services available for Asian patients; and exploring "value for money" in fundholding--were chosen. Details the procedures and lists the main outcomes. Concludes that placing a public health physician in practices may not be the optimal approach for transferring public health knowledge, but topics important to the practice lend themselves to such an intervention, with potential long-term benefit for public health and primary care.

Family Practice↗