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PubMed2005

Intervention complexity--a conceptual framework to inform priority-setting in health.

Health interventions vary substantially in the degree of effort required to implement them. To some extent this is apparent in their financial cost, but the nature and availability of non-financial resources is often of similar importance. In particular, human resource requirements are frequently a major constraint. We propose a conceptual framework for the analysis of interventions according to their degree of technical complexity; this complements the notion of institutional capacity in considering the feasibility of implementing an intervention. Interventions are categorized into four dimensions: characteristics of the basic intervention; characteristics of delivery; requirements on government capacity; and usage characteristics. The analysis of intervention complexity should lead to a better understanding of supply- and demand-side constraints to scaling up, indicate priorities for further research and development, and can point to potential areas for improvement of specific aspects of each intervention to close the gap between the complexity of an intervention and the capacity to implement it. The framework is illustrated using the examples of scaling up condom social marketing programmes, and the DOTS strategy for tuberculosis control in highly resource-constrained countries. The framework could be used as a tool for policy-makers, planners and programme managers when considering the expansion of existing projects or the introduction of new interventions. Intervention complexity thus complements the considerations of burden of disease, cost-effectiveness, affordability and political feasibility in health policy decision-making. Reducing the technical complexity of interventions will be crucial to meeting the health-related Millennium Development Goals.

Condoms↗
PubMedDate not supplied

Quantitative assessment of recruitment efforts for prevention trials in two diverse black populations.

BACKGROUND: Prevention efforts to reduce the morbidity and mortality disparity between blacks and whites in the United States present a national health priority. However, participation of blacks in prevention trials has been low. The present study reports successful recruitment processes from two economically diverse black populations. METHODS: The two studies were independent projects, but both were part of a nationally funded collaboration on cardiovascular health. "Hip Hop to Health" is a 4-year randomized controlled trial aimed at dietary fat reduction and increased exercise among inner-city black families. The Fat Reduction Intervention Trial in African-Americans project is a 5-year trial to reduce total fat, saturated fat, and cholesterol intake among black families from a working class community. RESULTS: The two populations differed on demographic characteristics. Direct presentation was the most effective recruitment strategy in the "Hip Hop to Health" program. In contrast, telephone recruitment and neighborhood canvassing were the more successful strategies for FRITAA. CONCLUSIONS: Although both populations were black and at comparable cardiovascular disease risk, the differing demographics between the groups made different recruitment strategies necessary. This study documented the labor-intensive quality of successful recruitment, and results suggest that successful recruitment requires strategies tailored to the needs, experiences, and environment of the target group.

Adult↗
PubMedDate not supplied

Subclinical cardiovascular disease in older adults: insights from the Cardiovascular Health Study.

Knowledge about the epidemiology of subclinical cardiovascular disease (SCVD) in older adults may hold the key for improved opportunities for primary prevention of cardiovascular disease (CVD), a top clinical and public health priority. This review reports findings on the prevalence of SCVD and the ability of SCVD measures to predict incident and adverse outcomes from one of the largest (N=5888) and most comprehensive prospective observational studies on SCVD in older adults, the Cardiovascular Health Study. According to a composite index that combined SCVD measures from different vascular beds, the overall prevalence of SCVD was 37%, making it as common as clinically overt CVD in older adults. SCVD measures strongly predicted incident CVD, stroke, mortality, frailty, and physical and cognitive decline, even after adjustment for traditional CVD risk factors. Ongoing research will address the potential use of SCVD for clinical decision making in older adults.

Aged↗
PubMed2005

Prevalence of physical activity among Chinese adults: results from the International Collaborative Study of Cardiovascular Disease in Asia.

OBJECTIVES: Determining physical activity levels in the community provides a context for the development and implementation of programs aimed at increasing these activity levels. Therefore, we assessed overall, work-related, and leisure-time physical activity in a representative sample of Chinese adults, aged 35 to 74 years, using data from the International Collaborative Study of Cardiovascular Disease in Asia. METHODS: Being physically active was defined as participating in 30 or more minutes of moderate or vigorous activity daily. Work-related and leisure-time physical activities were defined as being physically active and participating in any moderate or vigorous activity at work or during leisure time, respectively. RESULTS: In rural and urban China, 78.1% and 21.8% of residents, respectively, were physically active; 75.8% and 16.5%, respectively, participated in work-related activity; and 28.9% and 7.9%, respectively, participated in leisure-time physical activity. In both rural and urban settings, younger adults, men, and southern residents were more likely to be physically active and to participate in work-related and leisure-time physical activity than older adults, women, and northern residents. CONCLUSIONS: Intervention strategies to promote leisure-time physical activity, especially among urban residents, should be considered a major health priority in China.

Adult↗
PubMed2001

The economic and social burden of depression.

Depressive disorders are a major public health problem. They occur frequently and produce severe suffering for those affected and for their families. They are ubiquitous and appear at all ages. The consequences of depressive disorders in terms of excessive mortality, disability, and secondary morbidity are grave. There are indications that the frequency of depressive disorders will increase in the years to come, for a variety of reasons, including demographic changes, extended life expectancy of people suffering from chronic physical disorders, and iatrogenic causes. The essential criterion for designating a condition as a major public health problem--that there should be an effective intervention that will diminish or eliminate the problem-has now also been met. Recent years have seen the development of a variety of new treatments that can be applied even in situations where highly specialized mental health staff are scarce. These developments make training in the use of new treatment methods of proven value and their wide application a public health priority and an ethical obligation. The presentation will discuss these issues on the basis of accumulated evidence and experience.

Comorbidity↗
PubMed2006

Guide to good farming practices for animal production food safety.

Food safety is now universally recognised as a public health priority. It requires a global approach, from production to consumption. This article addresses the first stage of the food chain and the steps farmers can take to optimise the food safety control of products of animal origin. This inevitably means controlling the health status of the animals from which food products are derived. The present article addresses all those hazards whose control at farm level can have a beneficial or even decisive effect on the food safety of products of animal origin (including: milk and milk products, meat and meat products, eggs and egg products, honey and apiculture products). It is organised in eight sections: buildings and other facilities; health conditions for introduction of animals into the farm; animal feeding; animal watering; veterinary drugs; farm management; preparation of animals for slaughter; and common measures for record keeping and traceability.

Animal Husbandry↗
PubMed1988

Microbiologic drinking water quality in Israel: standards, monitoring, and treatment.

Drinking water quality depends on standards, monitoring and treatment. Israel's microbiologic water standards are less stringent than those currently recommended internationally, and have focused primarily on bacteriologic levels. Compliance with routine monitoring requirements averaged 86% in 1985-86. However, compliance with retesting of contaminated samples averaged 49% in 1985-86. Compliance with treatment recommendations of district sanitary engineers has also been poor. Poor water quality continues to be a public health problem in Israel, and has contributed to a relatively high incidence of waterborne disease. Current international guidelines recommend filtration and chlorination, particularly for surface water and other contaminated sources. Israel should make this a major public health priority.

Bacteria↗
PubMedDate not supplied

Environmental tobacco smoke.

A healthy and safe environment is a national public health priority. Clean air, free from tobacco smoke, is particularly vital since researchers have documented the link between tobacco smoke and increased morbidity and mortality in both smokers and non-smokers. Specifically, target goals for the year 2000, as established in the document, Health People 2000 (National Center for Health Statistics, 1990, 1994), include increasing the proportion of schools that are tobacco-free to 100%, increasing the proportion of work sites with formal smoking policies to 75%, and increasing the number of states with clean indoor air laws to 50%. As part of their role in promoting the public health and welfare, nurses need to actively support and help implement smoking policies in public places.

American Nurses' Association↗
PubMed1977

An aspect of community medicine. The medical care implications of manpower and other resources, with the rural Black population as an example.

The problems and needs of the rural Black communities are very real--although circumstances and diseases among Blacks differ to an extent from those encountered in sophisticated, developed urban areas, they still require advice, education and treatment appropriate to their problems. Because the problems confronting the health services are so great and the costs and benefits involved so difficult to assess, this paper is concerned with the problems of the rural Blacks and the role of existing medical care in their alleviation, as well as the problems faced by health planners, which in turn are directly or indirectly related especially to the Black medical personnel in the field. Any improvements in health services can be achieved only if our planning is based on objective investigation of experience, periodic reconsideration and refinement of methods and training that are practical, adaptable and directly related to the health priorities of the area concerned. Recognition and understanding of impeding factors in the delivery of medical care are urgently needed to ensure that wrong planning does not lead to maladministration, which in turn causes misunderstanding, failure of communication and possibly rejection of essential health services.

Accreditation↗
PubMed2002

Prevalence and risk factors for overweight and obesity in children from Seychelles, a country in rapid transition: the importance of early growth.

OBJECTIVES: To establish the prevalence of overweight and obesity and related risk factors in children from Seychelles (Indian Ocean), a country in rapid economic and epidemiological transition. DESIGN: Cross-sectional study with retrospective access to early life data. SUBJECTS: All children from all schools of Seychelles, in four selected school grades (kindergarten, fourth, seventh and tenth year of obligatory school) in 1999. A total of 5514 children aged 4.5-17.4 y were measured, corresponding to 83.5% of the eligible population. MEASUREMENTS: Overweight and obesity, using age- and sex-specific body mass index (BMI) cut-off points as defined by the International Obesity Task Force. RESULTS: Some 12.6% (95% confidence interval: 11.8-13.5%) of the children were overweight and 3.8% (3.3-4.4%) were obese. Weight gain (kg) during the first year of life was strongly associated with subsequent overweight (odds ratio 1.46, 95% confidence interval 1.27-1.67) and obesity (1.59, 1.29-1.97) in childhood, independently of birth weight. Increased maternal BMI (kg/m(2)) was also associated with overweight (1.07, 1.03-1.10) and obesity (1.09, 1.04-1.14) in the offspring. CONCLUSION: Prevalence of overweight and obesity among school children in Seychelles was as high as or higher than in some industrialized countries. If confirmed in other environments, the strong association between weight gain during the first year of life and subsequent obesity in childhood could affect the way optimal infant weight gain is defined in countries where public health priorities are changing.

Adolescent↗
PubMedDate not supplied

MAPP in action in San Antonio, Texas.

San Antonio was selected as an official Mobilizing for Action through Planning and Partnerships (MAPP) demonstration site by National Association of County and City Officials in 2000. The San Antonio Metropolitan Health District, under the leadership of Dr Fernando A. Guerra, agreed to facilitate the process. The MAPP process provided the San Antonio Metropolitan Health District, the local public health authority, a defined process for community health improvement, as well as a mechanism to help bridge the gap between public health and the community. The San Antonio Metropolitan Health District organized a Core Planning Team to lead the MAPP process in April 2001. By October 2002, the Core Planning Team was expanded to a full community working group named the Alliance for Community Health in San Antonio and Bexar County (Alliance). The Alliance identified six strategic issues, which eventually became the basis of the San Antonio Community Health Improvement Plan. The strategic issues are Public Policy, Data Tracking, Healthy Lifestyles, Promoting a Sense of Community, Access to Care, and Safe Environment. San Antonio's MAPP experience has been successful in bringing together the public health system partners, and establishing public health priorities collectively. The MAPP process has resulted in the development of many new initiatives, and, most important, has opened the door to many partnership opportunities in the future. The work of the Alliance, through the MAPP process, has helped to leverage resources for public health improvement in San Antonio, and has the potential to effect positive change in public health in the future.

Community Health Planning↗
PubMed2003

Drinking and its burden in a global perspective: policy considerations and options.

AIMS: To identify the policy implications of the magnitude and characteristics of alcohol consumption and problems, viewed globally, and to summarize conclusions on the effectiveness of the strategies available to policymakers concerned with reducing rates of alcohol problems. DESIGN/METHODS/SETTING: This summative article draws on the findings of the articles preceding it and of reviews of the literature. FINDINGS AND CONCLUSIONS: Overall volume of consumption is the major factor in the prevalence of harms from drinking. Since consumption and associated problems tend to increase with economic development, policymakers in developing economies should be especially aware of the need to develop policies to minimize overall increases in alcohol consumption. Unrecorded consumption is also an important consideration for policy in many parts of the world, and poses difficulties for alcohol control policies. Drinking pattern is also an important contributing factor toward alcohol-related harm. Although some drinking patterns have been shown to produce beneficial health effects, because the net effect of alcohol on coronary disease is negative in most parts of the world, policies that promote abstinence or lower drinking overall may be the safest options. Moreover, sporadic intoxication is common in many parts of the world, and policies are unlikely to change this drinking pattern at least in the short to medium term. At the same time, because injuries comprise a large proportion of the burden of alcohol, it is appropriate to enhance these policies with targeted harm reduction strategies such as drinking and driving countermeasures and interventions focused on reducing alcohol-related violence in specific high-risk settings. Alcohol consumption is a major factor for the global burden of disease and should be considered a public health priority globally, regionally, and nationally for the vast majority of countries in the world. The need for alcohol policy is even stronger when it is taken into consideration that the burden of alcohol estimated in the WHO Global Burden of Disease project includes primarily health problems related to drinking. From the limited evidence available, however, social problems related to drinking seem to impose at least as much burden. Moreover, the burden for both social and health harms fall not only on the drinker, but also on others. There is a broad literature on policy interventions to reduce alcohol problems. Effective strategies include controls over distribution and sale, taxation, drinking-driving countermeasures, brief interventions by health workers or counselors, and selected harm reduction measures. There is a need to develop the growing literature on comparative evaluations of cost-effectiveness of such strategies. In addition, international agreements are needed to support the effectiveness of national strategies.

Alcohol Drinking↗
PubMed2001

[Evaluation of the public health service law of the Saxony-Anhalt region--community affairs, transfer of power and loss of control].

AIM: In the state of Saxony-Anhalt, a new Public Health Service law came into force in 1998. Our study investigated whether this new legislation has led to an extension of duties performed by regional health departments and to a subsequent increase in expenditure. METHODS: Guided interviews at all administrative levels of the public health system were conducted. The catalogue of duties was systematized and a questionnaire was developed and distributed to all regional health departments (response rate: 17 out of 24). Data concerning revenues and expenditures of the regional health departments were analysed on the basis of the administrative districts' budget data. RESULTS: Regional health departments stated that there had been practically no change in their activities over the last few years. When questioned about the coverage of 58 specific duties, a considerable disparity was evident between departments. A core group of "classical" duties comprising environmental health and hygiene, child health protection, individual health appraisal, and public health supervision are carried out on an established basis. Some duties were handled by external institutions, others, mostly community health duties, were not performed on an extensive scale. When asked about the desired model for their health department, most departments preferred the model of being an executor of sovereign duties, however a corporate model was deemed to be almost as acceptable. The following fields will gain increasing significance in the future: environmental medicine, health reporting, preventive medicine, co-ordination of regional health care, and health promotion. Since 1995, staff has been reduced in all regional health departments (-10.4%; 1999: 2.92 employees per 10,000 inhabitants). In 1999, expenditures amounted to an average of 24.64 German Marks per capita (range 14.20-44.58 DM). The number of inhabitants and the revenue of the regional districts were determinants of their health budgets. CONCLUSION: Our results showed that no uncompensated additional expenditure by regional authorities resulted from this law. So far, most districts have not perceived regional health as a community affair offering possible competitive advantages. The federal state lost considerable influence at the regional level. Recommended are regional health priorities, conjoint staff development, and state guidance by a head agency providing leadership and support, while leaving responsibility with the districts.

Budgets↗
PubMed2004

HIV/AIDS, sexual and reproductive health: intersections and implications for national programmes.

HIV and AIDS have a myriad of effects on sexual and reproductive health and rights, and sexual and reproductive health services are critical for women and men with HIV and AIDS. Yet there has been a dearth of visible, in-depth mainstream attention to the links between sexual and reproductive health and prevention and treatment of HIV/AIDS since the early 1990s among major stakeholders internationally. This paper argues that access to essential sexual and reproductive health care should be provided in HIV/AIDS prevention, care and treatment programmes, and appropriate forms of prevention and treatment of HIV/AIDS should be included in all sexual and reproductive health services as a public health priority, particularly in sex education, family planning and abortion services, pregnancy-related care, sexually transmitted infection (STI) services and services addressing sexual violence. The paper analyzes existing barriers to linking and integrating these services, e.g. at country level due to the traditional training of health workers to implement vertical programmes, separate sources of funding for National AIDS Control Programmes and sexual and reproductive health services, and in international donor programme and UN agency structures. This paper calls for leadership to be exercised by donors, all the UN agencies working together, governments, health service managers and providers, NGOs and advocates in both fields to develop and implement these linkages at country level. Finally, it is crucial that UNAIDS, WHO, UNFPA, UNICEF, the Global Fund to Fight AIDS, TB and Malaria and those working to reach the targets set by the Millennium Development Goals come on board in these efforts.

Cooperative Behavior↗
PubMed2006

Risk and protective factors for meningococcal disease in adolescents: matched cohort study.

OBJECTIVE: To examine biological and social risk factors for meningococcal disease in adolescents. DESIGN: Prospective, population based, matched cohort study with controls matched for age and sex in 1:1 matching. Controls were sought from the general practitioner. SETTING: Six contiguous regions of England, which represent some 65% of the country's population. PARTICIPANTS: 15-19 year olds with meningococcal disease recruited at hospital admission in six regions (representing 65% of the population of England) from January 1999 to June 2000, and their matched controls. METHODS: Blood samples and pernasal and throat swabs were taken from case patients at admission to hospital and from cases and matched controls at interview. Data on potential risk factors were gathered by confidential interview. Data were analysed by using univariate and multivariate conditional logistic regression. RESULTS: 144 case control pairs were recruited (74 male (51%); median age 17.6). 114 cases (79%) were confirmed microbiologically. Significant independent risk factors for meningococcal disease were history of preceding illness (matched odds ratio 2.9, 95% confidence interval 1.4 to 5.9), intimate kissing with multiple partners (3.7, 1.7 to 8.1), being a university student (3.4, 1.2 to 10) and preterm birth (3.7, 1.0 to 13.5). Religious observance (0.09, 0.02 to 0.6) and meningococcal vaccination (0.12, 0.04 to 0.4) were associated with protection. CONCLUSIONS: Activities and events increasing risk for meningococcal disease in adolescence are different from in childhood. Students are at higher risk. Altering personal behaviours could moderate the risk. However, the development of further effective meningococcal vaccines remains a key public health priority.

Adolescent↗
PubMed2006

Health visitors' perceived priority needs in relation to their genetics education.

There is a growing recognition, nationally and internationally of the need to increase the genetics education of health professionals. Nurses in primary care are expected to be an important link between people undergoing genetic investigation and regional clinical genetic centres. Core competencies in relation to genetics for all nurses, midwives and health visitors have recently been identified within the United Kingdom. This paper reports a study that sought to investigate health visitors' views on the components of these core competencies in genetics and their self reported educational needs in the area of genetics. A questionnaire based survey of 345 health visitors was undertaken in Northern Ireland, as one region of the United Kingdom during late 2003. Completed questionnaires were returned by 194 health visitors (56.2% response). Respondents largely supported the components of the core competencies now endorsed by the Nursing and Midwifery Council and reported their need for further education in relation to genetics. However, they had a limited view on their role in supporting parents of children undergoing genetic investigation. Further action needs to be taken to provide health visitors with the necessary genetic knowledge and skills in order that they are in stronger position to provide 'collateral' support for people undergoing genetic investigation.

Adult↗
PubMed1992

Deciding on access and levels of care: a comparison of Canada, Britain, Germany, and the United States.

Americans view universal coverage as a reality only if a minimum benefit package is explicitly defined, and discussions about expanding access take place under the slogan of minimum benefits. The policy environment is different in Canada, Britain, and Germany. There, health care costs are controlled and benefits provided under universal coverage plans. Yet the medical services provided in these countries result not from difficult decisions about rationing care at a "minimum" benefit level but from difficult political decisions about the structure of the health care system. Institutional factors rather than explicit policy influence the implicit health priorities in these countries. The United States, in contrast, develops policies that explicitly designate a minimum level of benefits.

Canada↗
PubMed2003

[Perinatal care and mortality in French Guyana. From 1992-1999].

BACKGROUND: The purpose of this study was to describe child deliveries in French Guyana and describe changes in perinatal mortality in different population groups between 1992 and 1999. MATERIAL AND METHODS: All deliveries in health centers and maternity wards in French Guyana between January 1, 1992 and December 31, 1999 were included in the study. Social, demographic, and clinical data were collected at the time of delivery. Infants with a birth weight of 500 g or term 22 weeks were included. RESULTS: From 1992 to 1995, the number of deliveries in health centers declined 5.7% and the number in public maternity wards increased 69.7%. The same trend was observed in 1998 - 1999 (2.4% and 85.7% respectively), an expression of the policy of antenatal referral implemented by the network of childbirth professionals. Perinatal mortality decreased significantly between 1995 and 1998 from 35.4 to 15.2 for the Creole population (p=0.06), from 46 to 16.5 for the Black-Marron Surinam population (p<0.0007), and from 36 to 10.2 for the Black-Marron French population (p<0.009). This drop in mortality in high-risk population groups may have contributed to the overall decline in perinatal mortality observed over the study period. The rate of preterm birth remained stable (at 13.5%) and the proportion of low-weight infants increased only slightly (12.8% to 13.7%). Mortality among preterm infants declined considerably, undoubtedly because of improved neonatal intensive care. CONCLUSION: Despite significant improvement, the perinatal mortality in French Guyana (18.9 in 1999) remains almost three times that in metropolitan France (7.4 in 1999). The mothers are young (17% aged less than 20 years) and the proportion of primiparous and grand multiparous mothers is high. With the absence or insufficiency of prenatal care, the problem of perinatal mortality remains a public health priority and challenge in French Guyana.

Birth Rate↗