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PubMedDate not supplied

Tobacco industry links to faculties of medicine in Canada.

BACKGROUND: The tobacco industry uses various strategies to promote itself as a socially responsible, ethical industry, including establishing links with health institutions and medical research. The purpose of this study was to identify the relationships between the tobacco industry and Canadian faculties of medicine, specifically research funding and donations from tobacco industry sources, and faculty-specific policies regarding the acceptance of tobacco industry funds. METHODS: Information about policies and practices regarding research funding and donations from 1996-1999 was requested from the 16 Canadian faculties of medicine and their parent universities, as part of a larger cross-sectional survey-centred study that examined links between the tobacco industry and Canadian universities. RESULTS: All 16 faculties of medicine (100%) reported on research funding and 11/16 (70%) reported on donations from the tobacco industry. Twenty-five percent (4/16) of the faculties received research funding from the tobacco industry and 27% (3/11) received donations. No Canadian medical school had a policy that banned tobacco industry research funding or donations. INTERPRETATION: The tobacco industry have made donations and given research funding to faculties of medicine in Canada. This may present major conflicts of interest that undermine public health and have implications for the scientific integrity of the medical research enterprise. Faculties of medicine should consider developing policies that prohibit tobacco industry research funding and donations, with the intent of preventing conflicts and precluding ethical dilemmas arising from links with the tobacco industry. They should also encourage parent universities to establish similar policies at an institutional level.

Attitude of Health Personnel↗
PubMed2002

National plan of action for promoting breastfeeding: an outline.

The International Code of Marketing of Breast Milk Substitutes came into existence in 1981. The Innocenti Declaration was signed in 1990 for protection, promotion and support of breastfeeding. A significant development took place with the enactment of "Infant Milk Substitutes, Infant Foods and Feeding Bottles Act 1992". The establishment of the Breastfeeding Promotion Network of India (BPNI) in 1991 led to several significant initiatives in partnership with Association for Consumers Action on Safety and Health (ACASH) and several other NGOs and professional associations. After 10 years of movement, a meeting of the key partners was thought of to review the ongoing initiative to protect, promote and support breastfeeding. In the meeting the partners discussed objectives, key issues, advocacy and policy development, training and capacity development, communication and social mobilisation, community action and intervention, monitoring, evaluation and research. It was hoped that this would provide the necessary impetus for concerted action to be taken by different partners at all levels to organise "baby friendly communities" a reality in India where young children's rights to breastfeeding for survival, growth and development would be fulfilled in partnership with families and communities.

Breast Feeding↗
PubMed2006

Development of an integrated and sustainable rural service for people with diabetes in the Scottish Highlands.

INTRODUCTION: The number of people with diabetes is increasing leading to a greater burden on health care services. The impact of the growing prevalence is accentuated by remote and rural demographic and geographic characteristics. Highland is a sparsely populated remote and rural area in the north of Scotland, characterised by poor access to health-care services and pockets of marked deprivation. Centralised policy developments demanding local implementation compounded the pressures on a system that already had waiting times of over 90 weeks for some people with diabetes. A regional review of services, engaging stakeholders from all disciplines and geographical locations was required to develop acceptable and sustainable solutions. This article describes the extensive mapping process involved, how solutions were derived, and suggests a new service structure to encompass remote health-care issues. METHODS: Health-care professionals with an interest in diabetes were identified and workshops were organised to include the remote areas of Highland. Patient and carers views were ascertained through workshops and supplemented by written submissions. Using the redesign methodology the patient pathway was mapped, noting service deficiencies and good practice. The information gathered was constructed into a service-level map representing the patient journey. A conference was organised to develop solutions to the issues raised during the mapping process. From these solutions a new service configuration was constructed. RESULTS: Over 300 health-care professionals patients and carers contributed. Fourteen workshops were held across the region including the remote areas, providing 15 local maps of the patient pathways subsequently amalgamated into a service-level map. The current patient pathway in Highland follows a traditional and dichotomous cycle of care in the primary and secondary care setting, partly reflecting the rural nature of healthcare in the Highlands. Four main areas for service improvement were identified: a reduction in waiting times for secondary care out patients; an improvement in communication between health-care professionals; further education for both health-care professionals and patients; and the use and role of allied health professionals. Seventeen solutions were recommended, including the introduction of a managed clinical network, use of an integrated IT system, use of a remote access consultation clinic, and web-based peer education and group sessions for allied health professionals. A new service configuration was proposed with the patient at the centre of a non-hierarchical system using standardised referral letters with a seamless flow of information. CONCLUSION: Local processes for the implementation of government directives are imposing pressures on relatively smaller organisations. These pressures develop as a result of attempts to ensure local ownership and in overcoming the difficulties unique to the remote and rural setting. Further evaluation of the implementation of initiatives to solve the issues of service planning in remote areas is needed to clarify their level of effectiveness.

Diabetes Mellitus↗
PubMed2003

Issues in environmental water allocation--an Australian perspective.

Environmental water allocation is a critical issue in Australia and internationally. It has been prominent in Australia for a little over ten years during which time major policy and scientific advances have been made, but little implementation. This paper examines current understanding of environmental water allocation across a broad range of disciplines including the biophysical sciences, social sciences, economics, law, and policy. Development of practical methods for assessing environmental water requirements and experience with implementation in Australia are discussed. The paper concludes with thoughts on future needs.

Australia↗
PubMed2000

Quality assurance for nursing and midwifery education: an analysis of the approach in England.

The main purpose of this paper is to discuss conceptual and policy developments for external quality assurance for nurse and midwifery education in England. The current framework was implemented in the academic year 1998/99, and is the subject of a three year evaluation commissioned by the English National Board for Nursing, Midwifery & Health Visiting (ENB). The methods which are being used to evaluate the quality assurance arrangements will be discussed within the context of nursing and midwifery education and practice. The ultimate aim of professionally accredited nursing and midwifery education is to ensure the development of practitioners who are fit for purpose, practice and award. It follows that the quality assurance processes should have the capacity to demonstrate the extent to which professional education meets this aim. This paper will discuss this issue, with particular emphasis on the collaborative review process which is being undertaken by the Quality Assurance Agency and the statutory body for nursing, midwifery and health visiting education. The paper concludes with a discussion of the changes proposed by the government for nursing and midwifery education, and considers the potential impact for quality assurance of health care education.

Curriculum↗
PubMed2000

The common risk factor approach: a rational basis for promoting oral health.

Conventional oral health education is not effective nor efficient. Many oral health programmes are developed and implemented in isolation from other health programmes. This often leads, at best to a duplication of effort, or worse, conflicting messages being delivered to the public. In addition, oral health programmes tend to concentrate on individual behaviour change and largely ignore the influence of socio-political factors as the key determinants of health. Based upon the general principles of health promotion this paper presents a rationale for an alternative approach for oral health policy. The common risk factor approach addresses risk factors common to many chronic conditions within the context of the wider socio-environmental milieu. Oral health is determined by diet, hygiene, smoking, alcohol use, stress and trauma. As these causes are common to a number of other chronic diseases, adopting a collaborative approach is more rational than one that is disease specific. The common risk factor approach can be implemented in a variety of ways. Food policy development and the Health Promoting Schools initiative are used as examples of effective ways of promoting oral health.

Adolescent↗
PubMed2006

Hopelessness, demoralization and suicidal behaviour: the backdrop to welfare reform in Australia.

OBJECTIVES: To estimate rates of suicidal ideation and attempts, and psychological characteristics of demoralization among Australian income support recipients. To provide information for policy-makers to inform the current welfare reform discussion. METHOD: Data from the 1997 National Survey of Mental Health and Wellbeing were analysed using sequential logistic regression models, comparing working age people dependent on government income support payments with those having other main sources of income. RESULTS: Three groups of income support recipients, unemployed, lone mothers and disability payment recipients, reported significantly higher levels on all psychological measures related to demoralization (hopelessness, worthlessness and dissatisfaction with life) than non-recipients. A similar pattern was demonstrated for measures of suicidal ideation and reported suicide attempts, with increased odds of between 3 and 9 for these high-risk groups of welfare recipients. The elevated rates of suicidal ideation, attempts and demoralization among income support recipients were in part explained by sociodemographic characteristics (socioeconomic status, age, educational qualification, experience of serious violence, loneliness, experience of psychiatric disorders), though the unemployed and disability payment recipients remained elevated on the psychological measures. CONCLUSIONS: Demoralization, poor mental health and suicidal behaviour are common among income support recipients targeted by recently announced welfare reforms. This needs to be considered in the design and implementation of Australian Government policies. Psychiatric epidemiology has a key role in policy development and evaluation.

Adolescent↗
PubMed1993

Implementing the Patient Self-Determination Act.

An interdisciplinary process action team developed policies and procedures for implementation of the Patient Self-Determination Act. Specific roles were defined for all involved in the process: Admissions Office, Unit Nurse, Social Worker, Attending Physician, Medical Records, Public Affairs, Patient Administration, Legal Office, Medical Library, Medical Law and Chaplain. An educational effort provides orientation for the hospital staff and the community on development of advance directives by patients.

Advance Directives↗
PubMed1995

Screening clients for an augmentative and alternative communication clinic: a multitrait-multimethod approach.

The aim of Augmentative and Alternative Communication (AAC) services is to support, enhance, or provide alternative methods of communication for individuals who are not independent verbal communicators. However, relatively little evaluative research has been conducted with adult AAC users. The establishment of Freeport Hospital's AAC Clinic for adults included the development of questionnaires to gather information for the selection and provision of services for its clients. The present study addresses the issue reliability and validity of three novel measures contained within the AAC Clinic's Background Information Questionnaire using a multitrait-multimethod (MTMM) design. Results from this evaluation are discussed in terms of clinical application and policy development.

Adult↗
PubMed2000

Home care pharmacy: extending clinical pharmacy services beyond infusion therapy.

A clinical pharmacy program was developed at an established home health care (HHC) agency to demonstrate the need for clinical pharmacy services in the HHC population and to explore opportunities for providing pharmaceutical care beyond infusion-related therapies. Initial experiences of this pilot project are described. Patients were found to be primarily elderly (mean age, 70 years) and to use a substantial number of medications. While only 11% of patients referred to the agency required infusion therapy, multiple opportunities for pharmacist involvement in patient care were identified and a variety of projects were undertaken. A drug information service was developed, a retrospective evaluation of patients with congestive heart failure led to an interventional study, a cisapride intervention was implemented, home vancomycin monitoring was assessed, pharmaceutical care services were provided to patients enrolled in a long-term home care program, a pain management initiative was begun, adverse drug reactions were identified and reported, and pharmacists participated in agency policy development. Preliminary data suggest that pharmacist involvement positively affected patient care. Drug information was provided on 232 occasions. Cisapride was discontinued in five patients with contraindications to the agent. Comprehensive pharmacotherapy assessments were performed on 29 long-term-care patients, generating 129 therapy recommendations of which 33% were accepted. Pharmacists working with a home care agency identified numerous opportunities for improving patient care. Many of the patients receiving home care services were elderly, took a substantial number of medications, and were at risk for drug-related problems and suboptimal therapy.

Aged↗
PubMedDate not supplied

National strategy document on HIV / AIDS launched.

The National HIV-AIDS Strategy document was launched on December 27, 1995, in simple rites in Malacanang with no less than President Fidel V. Ramos himself giving his famous thumbs-up sign as his way of endorsing the document for mass distribution and discussion. The 25-page strategy document was developed to "serve as a framework for both individual and community responses to the challenge of HIV infection and AIDS. It seeks to provide the appropriate context necessary for both independent as well as coordinated responses." The strategy presents nine major principles that need to be considered in developing and carrying out programs that aim to address the various dimensions of HIV infection and AIDS. These principles were presented, critiqued, and validated in several regional consultations held between June and September 1995, and participated in by representatives from government agencies and nongovernmental organizations. ISSA attended the launching ceremonies, having been an active member of the Committee on Policy Development of the Philippine National AIDS Council, which helped in the drafting and review of the document. Copies of the document are available at the STD/AIDS Unit of the Department of Health. It is encouraged that the document be discussed widely such that the strategy may be used to aid in the development and evaluation of programs on HIV/AIDS in the country.

Asia↗
PubMed1982

Commitment of national resources to health promotion: the Canadian experience.

The article "Federal Initiatives in Health Education in Canada" which was featured in the first issue of Hygie reviewed the historical developments and the federal-provincial co-operative efforts in health education. It described the events and aspirations leading to the establishment, in 1978, of the focal point on health promotion. The current paper by R.A. Draper, Director General of Health Promotion in the Department of National Health and Welfare, addresses itself to the modes of resource allocation and policy development. It outlines the programmatic considerations of health promotion which reflect the current status of health education and promotion in Canada.

Canada↗
PubMed2002

Life expectancy and mortality differences between migrant groups living in Amsterdam, The Netherlands.

There is an apparent contradiction between the high level of morbidity and the low level of mortality observed in certain groups of migrants living in Europe. This observation should have some consequences for health policy development and the targeting of resources in a city like Amsterdam. In this paper a number of hypotheses to explain the low mortality in migrant groups are discussed. An analysis is made of mortality in Amsterdam using data from the civil registry as to mortality according to age, sex and nationality group of the deceased. Standard demographic techniques such as the standardised mortality ratio (SMR) and life table analysis were employed. Life table analysis shows that life expectancy in Amsterdam is lowest among residents of Dutch descent (73.3 yr for males and 79.1 yr for females) and highest among those of Mediterranean origin (77.6 yr for males and 86.1 yr for females). This appears to contradict previous research based on the SMR, which showed high mortality in migrant groups. To find the cause of this contradiction, the SMR and risk ratios by age are studied. The conclusion of this paper is that on the basis of life table analysis it appears that some immigrant groups living in Amsterdam have a remarkably high life expectancy. Since the SMR is sensitive to demographic differences between groups compared, questions can be raised about previous studies using the SMR. It has been suggested that the high life expectancy in migrant groups is not really caused by good health but by 'spurious' phenomena, such as problems in mortality registration. However, in view of the available data it seems likely that some migrant groups do in fact have high life expectancy, although the morbidity in these groups can be quite high. These findings should inform health-related policy.

Adolescent↗
PubMed2001

Emergency medicine and public health: new steps in old directions.

Emergency medicine and public health have opportunities to interact in at least 4 areas: surveillance of diseases, injuries, and health risks; monitoring health care access; delivering clinical preventive services; and developing policies to protect and improve the public's health. Recent, cross-cutting initiatives and innovations in these 4 areas follow pathways first explored more than a generation ago and provide an important impetus for future work. An analysis of recent contributions also points to various obstacles and challenges that must be addressed to take full advantage of existing and rapidly developing ties between emergency medicine and public health. The connections between these 2 fields will continue to create important partnership opportunities and the strong possibility of achieving new benefits for patients, the public, and the professionals who serve them.

Emergency Medicine↗
PubMed2005

Pressure ulcers: guideline development and economic modelling.

AIM: This paper presents the development process for clinical guidelines on the use of pressure-relieving devices (beds, mattresses and overlays), with emphasis on incorporating economic evidence. BACKGROUND: Previous UK guidelines on the use of pressure-relieving devices to prevent pressure ulcers have not considered whether any recommendations made are cost effective. The routine inclusion of cost effectiveness evidence in guidelines is a recent policy development, and there has been little research into its potential role in the guideline process. METHODS: We systematically reviewed the literature to assess both the clinical and cost effectiveness of pressure-relieving devices for prevention of pressure ulcers. Where there was sufficient evidence on the comparative clinical effectiveness between alternative devices, economic modelling was undertaken to assess comparative cost effectiveness. A guideline development group (comprising both clinicians and patient representatives) reviewed all the available evidence to formulate clinical practice guidelines and recommendations for further research. RESULTS: Studies showed that caring for people vulnerable to developing pressure ulcers on high-specification foam mattresses compared with standard hospital mattresses significantly reduced their risk of developing a pressure ulcer. Cost effectiveness modelling indicated that, because of savings accruing through treating fewer pressure ulcers, high-specification foam mattresses are likely to cost less overall and are more effective. The resulting clinical practice guideline was uncompromising on the use of high-specification foam mattresses as the minimum provision in patients vulnerable to pressure ulcers. Significant weaknesses were identified in both the quality and availability of evidence for most of the other pressure relieving devices considered. CONCLUSIONS: Cost effectiveness assessment was an integral part of the guideline development process. It clarified the shortcomings of some of the clinical effectiveness evidence and helped in formulating pragmatic clinical practice recommendations.

Bedding and Linens↗
PubMed2006

The power of ethics: a case study from Sweden on the social life of moral concerns in policy processes.

In this paper I report on an ethnographic study of an ethics policy developed by a start-up genomics company at the time it gained all commercial rights to a population-based biobank in the town of Umeå in northern Sweden. Tracing the interdependencies between power and morality, my research compares moral reflections and stances among 1) policymakers, 2) health professionals and 3) donors, in relation to the issues identified in the policy. These people seem to agree that trust and fairness are important issues and that 'something' needs protection in the face of commercial genetic research. However, their perceptions of trust, fairness and what it is that needs protection differ significantly. I conclude by considering the implications of variances in moral perspectives for the social study of ethics.

Anthropology, Cultural↗
PubMed2006

On the persistence of supplementary resources in biomedical publications.

BACKGROUND: Providing for long-term and consistent public access to scientific data is a growing concern in biomedical research. One aspect of this problem can be demonstrated by evaluating the persistence of supplementary data associated with published biomedical papers. METHODS: We manually evaluated 655 supplementary data links extracted from PubMed abstracts published 1998-2005 (Method 1) as well as a further focused subset of 162 full-text manuscripts published within three representative high-impact biomedical journals between September and December 2004 (Method 2). RESULTS: For Method 1 we found that since 2001, only 71 - 92% of supplementary data were still accessible via the links provided, with 93% of these inaccessible links occurring where supplementary data was not stored with the publishing journal. Of the manuscripts evaluated in Method 2, we found that only 83% of these links were available approximately a year after publication, with 55% of these inaccessible links were at locations outside the journal of publication. CONCLUSION: We conclude that if supplemental data is required to support the publication, journals policies must take-on the responsibility to accept and store such data or require that it be maintained with a credible independent institution or under the terms of a strategic data storage plan specified by the authors. We further recommend that publishers provide automated systems to ensure that supplementary links remain persistent, and that granting bodies such as the NIH develop policies and funding mechanisms to maintain long-term persistent access to these data.

Abstracting and Indexing↗
PubMed1990

A study of financial resources devoted to research on health problems of developing countries.

The Commission on Health Research for Development is an independent, international commission composed of 12 leaders from the fields of health research, social science research and development policy. Chaired by John Evans, the other Commissioners are Gelia Castillo, vice-chair, F. H. Abed, Sune Bergstrom, Doris Calloway, Esmat Ezzat, Demissie Habte, Walter Kamba, Adetokumbo Lucas, Adolfo Martinez-Palomo, Saburo Okita and V. Ramalingaswami. The Commission began its work in November 1987, charged with analysing the strengths, weaknesses and gaps in current research on health problems of developing countries, and making proposals and promoting action for improvement. The Commission is sponsored by a variety of foundations, bilateral donor agencies, and international organizations. The Commission's report was published in the spring of 1990. As part of the work of the Commission Secretariat, we have undertaken a study of financial resources devoted to research on the health problems of developing countries. The study which began in May 1988 has three objectives: (i) To describe the current pattern of funding for research on the health problems of developing countries. (ii) To provide a baseline against which future trends and/or new programmes can be measured. (iii) To explore the possibility of an ongoing information system on research on health problems of developing countries.

Developing Countries↗