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PubMed1999

Lessons from 12 years of comparative risk projects.

Can an analytical tool for comparing environmental risks and policy activities be used to evaluate their relative efficacy in ultimately changing the allocation of public funds? Some insight is possible through a review of comparative risk projects that have been carried out at the city, state, and national levels, as well as among Indian tribes, over the past 12 years. The lessons from this review should apply to the field of public health. For every comparison of environmental issues, such as clean-air standards with fish consumption advisories, there is a parallel discussion of public health priorities and strategies, such as antismoking and pregnancy prevention programs, immunization programs and disease surveillance efforts, or well-baby clinics and food safety programs. Lessons from comparative risk projects and processes may offer the public health community new ways of thinking about using stakeholder assessment processes in developing public health policy.

Environmental Health↗
PubMed2006

Discovering the research priorities of people with diabetes in a multicultural community: a focus group study.

BACKGROUND: Usually experts decide on which research is worthwhile, yet it is government policy to involve service users in research. There has been a lack of published research about involving patients from minority ethnic groups and people from deprived areas in setting research agendas. In this study we wanted to hear the voices of patients that are not often heard. AIM: To find out the research priorities of people with diabetes from an inner city community and compare these with current expert-led research priorities in diabetes. DESIGN OF STUDY: A qualitative study using a participatory approach with consumer groups. SETTING: Primary care within inner city Nottingham, UK. METHOD: Thirty-nine adult patients with diabetes with varying ethnic backgrounds recruited from three general practices. Six focus groups carried out in participants' preferred language, analysed using the constant comparative method. RESULTS: Nine main themes equating to research priorities were identified. Within these themes, information and awareness, service delivery and primary prevention of diabetes emerged as the main factors. There were no science-based topics and there was more emphasis on culturally influenced research questions, which differed from recent Department of Health priorities. There were several themes about service delivery, patient self-management and screening and prevention of diabetes that overlapped. CONCLUSIONS: There is some divergence between expert-led and patient-led agendas in research about diabetes. Patient perspectives have a significant influence on research priorities, and there are likely to be several different patient perspectives.

Adult↗
PubMed1994

Occupational health. Nursing in the workplace.

Occupational health nursing is a community nursing specialty that will assume greater importance in a reformed health care system. Maintaining a safe and healthy workplace is an occupational health priority, the goal being to reduce work-related injury and illness. This article describes the complexities of this role.

Community Health Nursing↗
PubMed2001

Recommended schedules for routine immunization of children and adults.

Vaccine recommendations continue to evolve as a result of new vaccines, safety considerations, changing disease incidence (e.g., polio), and public health priorities. The pace of discovery is accelerating and advisory committees will need to respond accordingly. Each vaccine, new or old, will be required to earn its place in the routine immunization schedule on the basis of public health benefit or cost-benefit studies.

Adult↗
PubMed1996

Leisure-time physical activity among US adults. Results from the Third National Health and Nutrition Examination Survey.

BACKGROUND: The prevalence of no leisure-time physical activity (LTPA) among US adults is estimated to be between 24% and 30%. Such information, however, usually does not include prevalence estimates for non-Hispanic blacks, Mexican Americans, and the elderly. OBJECTIVE: To assess the prevalence of participation in leisure-time physical activity among US adults. METHODS: Between 1988 and 1991, 9488 adults aged 20 years and older were interviewed in their home as part of the third National Health and Nutrition Examination Survey. A clinic examination in a mobile center was also included. Mexican Americans, non-Hispanic blacks, and the elderly were oversampled to produce reliable estimates for these groups. Questions were asked about the type and frequency of physically active hobbies, sports, and exercises. RESULTS: The prevalence of no LTPA for US adults aged 20 years or older from 1988 through 1991 was 22%. The rate was higher in women (27%) than in men (17%). Mexican-American men (33%) and women (46%) and non-Hispanic black women (40%) had the highest rates of no LTPA. Participation in moderate to vigorous LTPA five or more times per week decreased with age, with the largest decreases observed among non-Hispanic black men and women. In almost all subpopulations, gardening and/or yard work and walking were stated as the two top LTPAs of choice. CONCLUSIONS: Many Americans are inactive or irregularly active during their leisure time. Rates of inactivity are greater for women, older persons, non-Hispanic blacks, and Mexican Americans. Intervention strategies meant to promote lifetime physical activities among all Americans represents a major health priority.

Adult↗
PubMed2004

Rural healthy people 2010--evolving interactive practice.

The objectives of the Rural Healthy People 2010 project are to employ a survey of state and local rural health leaders to identify rural health priorities, to synthesize available research and other publications on these priorities, to identify and describe models for practice employed by rural communities to address these priorities, and to disseminate this information to rural communities. We describe these priorities; the content of Rural Healthy People 2010 products, methods, and target audiences; and the continuing evolution of the program. Rural Healthy People 2010 encourages rural support of Healthy People 2010 goals and invites state and local rural health leaders to share their successful models with others.

Health Status Indicators↗
PubMed2003

Development of a model for sustainable delivery of outreach allied health services to remote north-west Queensland, Australia.

INTRODUCTION: Development of sustainable multidisciplinary services in north-west Queensland, Australia, is challenged by large distances, culturally diverse communities, a prolonged wet season, a history of poor retention of allied health professionals (AHPs), and high prevalence of chronic disease. In 2001, the Northern Queensland Rural Division of General Practice drew on wide community consultation and recent research into the recruitment and retention of AHPs to develop a Model for delivery of outreach allied health services operating within a primary healthcare framework. AIM: to develop a Model of allied health service delivery using the principles of primary healthcare, to meet the needs of 11 culturally diverse (indigenous, non-indigenous and mixed) remote communities, in an area of over 373 000 km2. METHODS: The development of the outreach Model of allied-health service delivery occurred over four stages: (1) Formulation of a planning matrix as the outcome of a workshop to identify the core components; (2) Environmental scan including mapping of existing allied health services and identification of gaps in service delivery; community consultation to assist in the gap analysis of service delivery, identification health priorities at a local level, and provision of context as to how services should be provided; analysis of available morbidity, mortality data and screening data; (3) Desktop analysis of previous research into the recruitment and retention of allied health professionals, and determination of a 'reasonable' level of service delivery in rural and remote areas; and (4) Synthesis of information to develop options or a Model of service delivery. RESULTS: The environmental scan indicated the need for a raft of AHPs to address chronic disease and injury in the target communities, including the disciplines of physiotherapy, podiatry, dietetics, occupational therapy, speech pathology and psychology. The Model of service delivery sought to provide services in a form appropriate to communities (ie regular and reliable), with duration of visit providing opportunities for case conferencing and inservice education with resident health professionals and workers. A range of strategies were developed to support the recruitment and retention of allied health professionals, including working and travelling in functional teams; orientation to remote practice; schedules that recognize the need for time back at base, and utilisation of aircraft to minimise travel time; employment packages recognizing isolated and remote practice, professional development, postgraduate study, professional and clinical mentoring; financial subsidies for housing and childcare. A hub-and-spoke model of service delivery was developed with functional teams visiting each community on a 6-weekly rotation for 2-3 days/community per rotation, dependent on population. The duration of visit would promote opportunities for community development, training therapy assistants to promote continuity of care, and health promotion activities within the primary healthcare framework under which the service would operate. Integration and coordination with existing resident health and community services, and visiting services, was considered through the development of a 6 month calendar of service delivery, and Memoranda of Understanding with state health services to allow access to clinics and client records. CONCLUSION: The planning matrix informed and underpinned the final form of the outreach Model of service delivery. The process described enabled the development of a Model for delivering allied health services in a remote rural area that considered the burden of disease, context for service delivery addressing community concerns with visiting services, recruitment and retention of health professionals and integration with resident and visiting health and community services. The strategies employed provide a template for allied health service development in rural and remote areas internationally.

Journal Article↗
PubMed2006

The benefits of using the Neonatal Behavioural Assessment Scale in health visiting practice.

Health visitors have a key role to play in the government's public health strategy with its emphasis on early identification of vulnerable children. This paper raises the profile of infant mental health as a public health priority and outlines the vital importance of a loving early relationship between an infant and primary caregiver for a child's healthy development. It describes the Neonatal Behavioural Assessment Scale (NBAS) and the appropriateness of its use by health visitors. This tool has been underused in the UK, but is being used in clinical practice and research in many other countries, such as the USA. It can add value to the assessments already being carried out by health visitors and can contribute to partnership working with parents as together they observe how the infant interacts with and organises his/her world. The NBAS enables health visitors to demonstrate to parents an infant's strengths and abilities, together with any needs for extra care giving. This assessment has been shown to improve developmental outcomes by enhancing the infant-caregiver relationship, and provides health visitors with the opportunity to consolidate their relationship of trust with families.

Child Development↗
PubMed2004

The magnitude of child injuries in Bangladesh: a major child health problem.

In recent times, many developing countries including Bangladesh not only have to cope with infectious diseases and malnutrition but also with new health problems, such as asthma, cancer and accidents. The emergence of chronic diseases and injuries has not been seen as an important health issue to date. The work presented here has the objectives of conceptualizing the dynamic changes in child mortality within the framework of the health transition, to provide a basis for projection of future mortality and disability in children in Bangladesh. This paper reviews a number of reports and published articles related to the causes of child deaths in Bangladesh. These include: 1) Year books of Bangladesh Bureau of Statistics; 2) UNICEF reports; 3) Reports of International Centre for Diarrhoeal Disease and Research, Bangladesh; and 4) Reports of Institute of Child and Mother Health. Bangladesh clearly has been progressing along its epidemiological transition. At the current stage, chronic diseases and injuries have overtaken infectious diseases as leading causes of child death. Injury has been identified as a major cause of child death in Bangladesh, and is emerging as the leading cause of child mortality, similar to what is occurring in other developing countries. For these countries, in the advancing stages of their health transition, more research aimed at understanding the dynamic change of child health priorities is urgently needed for appropriate policy and planning.

Adolescent↗
PubMed2002

Years of potential life lost and valued years of potential life lost in assessing premature mortality in Slovenia.

AIM: To determine the leading causes of death that contribute most to premature mortality in Slovenia; to classify premature mortality according to the cause of death, age, and sex; and to determine the age point before which premature mortality becomes a potential loss to the society. METHOD: Potential economic losses to society were estimated by use of years of potential life lost (YPLL), with a cut-off point at 65 years, and valued years of potential life lost (VYPLL) methods. We calculated the sex-, age-, and underlying causes of death-specific YPLL and VYPLL for residents of Slovenia who died at age younger than 65 years, using Slovene sex-specific life expectancy for 1998/1999 and age-specific weights of investment-producer-consumer model. RESULTS: In 1998, 4,558 YPLL per 100,000 population were lost to Slovenia. We found bimodal age distribution of YPLL, with the first peak in the 20-24 year age group and the second in the 45-49 year age group. Men to women rate ratio was 2.5. The leading causes of YPLL were external causes of death, followed by malignant neoplasms, and cardiovascular diseases. External causes, including suicides and traffic accidents, were the leading causes of death in men, whereas malignant neoplasms, including breast cancer and digestive cancer, were top-ranking causes in women. Among those, only external causes of death produced positive VYPLL, indicating a net loss to the society. CONCLUSION: In Slovenia, YPLL peaked in the 20-24 and 45-49 year age groups. Only external causes of death, most of which were preventable, accounted for the net economic loss to Slovenian society. We believe that YPLL and VYPLL, as specific mortality measures, can be reliably used in the evaluation of leading causes of death before age 65 and potential economic loss to the society caused by those deaths, and that they should be taken into account when setting public health priorities.

Adolescent↗
PubMedDate not supplied

Exploring decision-making for environmental health services: perspectives from four cities.

Increasing resources are being allocated to environmental health monitoring, especially for developing methods and collecting data to construct environmental health indicators (EHIs). Yet, little research has focused on understanding how communities and service providers make decisions with regard to environmental health priorities and the role of indicators in this process. This paper presents insights regarding local decision-making that arose from a project to test the feasibility of using community-based EHIs to facilitate communication between the providers and the recipients of environmental services in four developing-country cities. The results of the study indicate that decision-making for environmental health services is complex and iterative rather than rational and linear. Contextual and process factors play an important role. These factors include the morale of service providers, the extent of collaboration between service agencies, the priorities of different community groups and relations between service providers and communities. Scientific information, in the form of EHIs, did not appear to be a key element of decision-making in the settings studied. As tools, EHIs are unlikely to become part of the decision-making process unless they are integrated with local agendas and backed by strong local representation.

Cities↗
PubMedDate not supplied

[Priority in occupational health in the USL 10 area of Florence].

In order to experience a method for the choice in Public Health, a list of the problems in occupational health in Florence has been characterized one, using for the definition of the priorities a "Minnesota Department of Health's Community Health Services Planning Manual--Guidelines for Local Public Health Agencies: CHS Plan Cycle 2002-2003". The following priorities problems of health are emerged in order of: exposure to chemistries in agricultural workers, fatal and serious injures among construction and agricultural workers, musculoskeletal disorders by biomechanical overload of the upper limbs, hearing loss. For everyone of they, has been indicated a possible strategy.

Humans↗
PubMed2003

Introducing touchscreens to black and ethnic minority groups--a report of processes and issues in the Three Cities project.

There is a need for people to have access to health information but this may not be readily available for some black and ethnic minority groups living in England. This study aims to improve access to health information for ethnic minority groups by providing this in their own language, in an audio and visual format through a touchscreen computer. The study was led by health promotion and public health workers informed by advisory panels of representatives from local black and ethnic minority groups in the cities of Nottingham, Sheffield and Leicester. Discussion within the advisory panels and local epidemiological data helped to identify groups to be targeted and priority health issues to be addressed. Other issues covered during development included interface design, language translation and identification of accessible locations. A number of problems were addressed in establishing appropriate touchscreen facilities, mainly relating to producing information in an electronic format for multiple languages and populations not necessarily computer-literate. Three touchscreens, containing information on 10 health topics, translated into five languages are currently installed, one in each city. They are being rotated through a series of locations including a library, GP practice, and a temple. Their use, and satisfaction with use, is being evaluated over a 2-year period, by statistical analysis of computer logs and the collection of qualitative information by bi-lingual interviewers with users, over an 18-month period. Health information can be made available for ethnic minority groups even if they are unable to read their mother tongue. Touchscreens appear to be a suitable medium for achieving this.

Access to Information↗
PubMed1995

Promotion of sexual abstinence: reducing adolescent sexual activity and pregnancies.

The prevention of unplanned pregnancies has become a national public health priority. To assure that every newborn child in America is planned and wanted, three strategies are to be implemented: expansion of school-based sex education, expansion of free condom distribution, and expansion of the role of school-based health clinics. Studies show that these strategies may not prevent unplanned pregnancies; furthermore, their implementation may be associated with public health risks. Sexual abstinence is not associated with public health risks and needs to be presented and promoted as the most effective primary prevention for unplanned pregnancies.

Adolescent↗
PubMed1997

Mortality by cause for eight regions of the world: Global Burden of Disease Study.

BACKGROUND: Reliable information on causes of death is essential to the development of national and international health policies for prevention and control of disease and injury. Medically certified information is available for less than 30% of the estimated 50.5 million deaths that occur each year worldwide. However, other data sources can be used to develop cause-of-death estimates for populations. To be useful, estimates must be internally consistent, plausible, and reflect epidemiological characteristics suggested by community-level data. The Global Burden of Disease Study (GBD) used various data sources and made corrections for miscoding of important diseases (eg, ischaemic heart disease) to estimate worldwide and regional cause-of-death.patterns in 1990 for 14 age-sex groups in eight regions, for 107 causes. METHODS: Preliminary estimates were developed with available vital-registration data, sample-registration data for India and China, and small-scale population-study data sources. Registration data were corrected for miscoding, and Lorenz-curve analysis was used to estimate cause-of-death patterns in areas without registration. Preliminary estimates were modified to reflect the epidemiology of selected diseases and injuries. Final estimates were checked to ensure that numbers of deaths in specific age-sex groups did not exceed estimates suggested by independent demographic methods. FINDINGS: 98% of all deaths in children younger than 15 years are in the developing world. 83% and 59% of deaths at 15-59 and 70 years, respectively, are in the developing world. The probability of death between birth and 15 years ranges from 22.0% in sub-Saharan Africa to 1.1% in the established market economies. Probabilities of death between 15 and 60 years range from 7.2% for women in established market economies to 39.1% for men in sub-Saharan Africa. The probability of a man or woman dying from a non-communicable disease is higher in sub-Saharan Africa and other developing regions than in established market economies. Worldwide in 1990, communicable, maternal, perinatal, and nutritional disorders accounted for 17.2 million deaths, non-communicable diseases for 28.1 million deaths and injuries for 5.1 million deaths. The leading causes of death in 1990 were ischaemic heart disease (6.3 million deaths), cerebrovascular accidents (4.4 million deaths), lower respiratory infections (4.3 million), diarrhoeal diseases (2.9 million), perinatal disorders (2.4 million), chronic obstructive pulmonary disease (2.2 million), tuberculosis (2.0 million), measles (1.1 million), road-traffic accidents (1.0 million), and lung cancer (0.9 million). INTERPRETATION: Five of the ten leading killers are communicable, perinatal, and nutritional disorders largely affecting children. Non-communicable diseases are, however, already major public health challenges in all regions. Injuries, which account for 10% of global mortality, are often ignored as a major cause of death and may require innovative strategies to reduce their toll. The estimates by cause have wide Cls, but provide a foundation for a more informed debate on public-health priorities.

Adolescent↗
PubMed2005

Medical and social differences between French and migrant patients consulting for the first time for HIV infection.

The objectives of the study were to describe the medical and social characteristics of patients consulting for the first time after diagnosis of HIV-infection and to compare the medical and social characteristics between French and migrant patients. From 1 January 2001 to 31 December 2002, all consecutive adults consulting for the first time for HIV infection in two HIV outpatient clinics located in the western suburb of Paris, agreed to an interview based on an administered questionnaire regarding their medical and socioeconomic characteristics. Of the 203 patients (98 women, 105 men), one-third (n=70) was of French nationality. Delay (+/-SD) in access to HIV outpatient clinic after diagnosis was shorter in migrant than in French patients, respectively 7.6+/-29.6 months (median=0.5, range=0 to 196.6) and 23.8+/-51.4 months (median=0.9, range=0 to 199.7); p=0.005. There was no significant difference in the medical characteristics between the two groups of patients on their first consultation. However, most of the migrants were living in very poor socio-economic conditions with minimal resources thus sometimes delaying initiation of HAART. The development of social facilities for HIV-positive migrants should be a public health priority.

Adult↗
PubMed2006

Developing research capacity building for Aboriginal & Torres Strait Islander health workers in health service settings.

INTRODUCTION: Aboriginal and Torres Strait Islander health workers (hereafter called health workers) can play a major role in facilitating culturally appropriate health care delivery and program development through the acquisition of improved skills in the planning, monitoring and evaluation of these programs (RCB). However, many Aboriginal and Torres Strait Islander people and communities remain concerned about research and related activities. Health workers are well placed to assist communities to not only embrace research, but to be active players and promoters of relevant, appropriate and acceptable research. One means of achieving the twin goals of RCB and community acceptance and involvement in research, is through health workers undertaking research of health priority issues and evaluation of activities, such as program delivery, that are of direct relevance to their community's aim of improving or enhancing service delivery. This article outlines the development and content of a community-based RCB framework for health workers. The focus is on the major issues that enhance a proactive service delivery model using culturally appropriate research methods. Development process: The RCB framework described here was developed, over a period of time, through community workshops and consultations aimed at deriving general consensus on the key issues and components of a culturally-appropriate, community-based training process. The framework has subsequently been reviewed by Aboriginal and Torres Strait Islander community representatives from across Australia. The overall aim of the framework is to supplement current (institutionally-based) education and training resources for health workers with community-based research training modules. These modules can be tailored to provide research and evaluation skills relevant to health workers taking a more proactive role in facilitating health and wellbeing programs in their own communities. The use of collaborative consultation and participatory methods are intended to be a two-way education process. Course content: A visual pathway is used that encompasses the impact of health and practice in the community for health workers at a grass-roots level. This enables elements of the RCB process to be divided into a series of connected modules. These are: (i 'assessing' Existing Services; (ii) methods and measures for Identifying Need at various levels; (iii) important issues in Program Development; (iv) how the former contributes to Service Improvement; (v) resultant Outcomes that will impact on community and service provision; and (vi) Evaluation Methods and applying findings to service delivery. CONCLUSIONS: Active participation by the Aboriginal and Torres Strait Islander community is fundamental for effective research practices and outcomes. The aim is to provide health workers and community members with a working knowledge of research ethics and methods so that they can assist, monitor and steer the development of culturally appropriate research activities that will lead to provision of the highest quality services 'back' to the community. This RCB framework will enable health workers to be more proactive, self-reliant and self-sufficient within their community and healthcare settings.

Community Health Planning↗