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PubMed2001

Incentives for mitigation investment and more effective risk management: the need for public-private partnerships.

A key question facing both well-developed industrial countries and emerging economies is how to reduce future disaster losses while still providing financial protection to victims from these events. This paper proposes a strategy for the use of cost-effective risk mitigation measures coupled with insurance and/or new capital market instruments to achieve these objectives. The mix of these measures will depend on the governance structure and the institutional arrangements in the particular country. There will always be a need for a combination of policy tools and the interaction among key interested parties from both the private and public sectors in developing a disaster management strategy. Two examples, one from US and the other from Honduras, illustrate differences between strategies that countries can adopt.

Disaster Planning↗
PubMedDate not supplied

The pharmacist's role in the medicinal management of depression.

AIM: To elicit pharmacists' perceptions of medication management for people who have been prescribed medication for depression. METHOD: A questionnaire survey of 103 mainly community pharmacists was used. RESULTS: People frequently approached pharmacists for information about a range of issues concerning antidepressant medication. Although pharmacists were knowledgeable about all aspects of pharmacological interventions, many felt their location in the commercial sector inhibited the amount of assistance they could provide. Barriers to providing information were identified, and the paucity of pharmacists' links with primary care teams exposed. CONCLUSION: The survey supports other studies that have suggested pharmacists could provide considerable assistance in helping people to understand their medication and its benefits. There is also discussion of the ways in which the future role of pharmacists could be developed so that they collaborate more closely with other healthcare professionals.

Antidepressive Agents↗
PubMed2002

How to build an information system application to the health domain.

Computer based information systems aim at improving knowledge, evaluation and management processes. Such tools are still developing in the non-profit sector. This paper aims at: a) reminding how to evolve from data to management information systems b) describing how to build a population based health information system c) describing the concepts required for conceiving a retrieval system and a system for inserting data d) documenting the importance of conceiving the system not only from a user driven perspective, but also taking into account the requirements of an information management system.

Community Health Planning↗
PubMed1982

[The client's viewpoint on genetic counseling. Acceptability of the service in an Oristanese community (Cabras)].

At Cabras (Oristano), a town characterized by a high incidence of thalassaemia and G6PD deficiency less than half the people between 18 and 35 have a fair knowledge of genetic diseases and of their prevention. The lack of information is higher among people working in the primary sector, housewives and generally, among those who are uneducated. The majority of the people we have interviewed are favourable to undergo analysis to single out carriers. Of these many have said to be unwilling to give birth to children if they belong to a couple at risk. Other have said they do not exclude of having children all the same but to be willing to amniocentesys, and to miscarriage if necessary. From a total calculation results that 88,03% of the men and 82,18% of the women we have interviewed would use, as a prevention, the information obtained from a genetic centre.

Adult↗
PubMed2002

Commentary: what contributes to a successful career in epidemiology in the United States?

The authors conducted a study examining perceived enabling factors and barriers to a successful career in epidemiology, the role of mentoring in facilitating one's career, where graduates are most often being employed, and key competencies for future epidemiologic training. During June to August 2001, they surveyed senior epidemiologists across the United States (n = 248) in four sectors: state health departments, the Centers for Disease Control and Prevention, the National Institutes of Health, and schools of public health. The top enabling factors were dedication to hard work and having an intrinsic curiosity and a sense of discovery. The most frequently cited barrier was balancing career and family life, except among minority respondents, for whom an unsupportive supervisor was the leading obstacle. Influential characteristics of a mentor were high integrity and the provision of inspiration and encouragement. The top competencies anticipated for the next 10 years were skills working in multidisciplinary teams and in using modern information technologies. Important competencies varied somewhat according to work sector. These findings may be useful in training and career planning among aspiring epidemiologists and for educational policy development among organizations promoting training and mentoring.

Adult↗
PubMed2004

HYGEIAnet: the integrated regional health information network of Crete.

The healthcare environment is currently changing and the health sector is being transformed to meet new challenges and to benefit from new opportunities. Priorities for the 21st century ought to be set based on emerging dominant trends in healthcare, including the shift towards shared or integrated care, in which an individual's healthcare is the responsibility of a team of professionals across all levels of the healthcare system hierarchy. In addition to the requirement for efficient and secure access to the Integrated Electronic Health Record (I-EHR) of a citizen, this necessitates the development and deployment of Regional Health Information Networks (RHINs), synchronous and asynchronous collaboration services, and novel eHealth and mHealth services, facilitated by intelligent sensors, monitoring devices, hand-held or wearable technologies, the Internet and wireless broadband communications. These further require the adoption of an open Reference Architecture and the creation of a scalable Health Information Infrastructure (HII).This paper discusses the challenges encountered in developing and deploying HYGEIAnet, the Regional Health Information Network of Crete, as well as relevant benefits for citizens and health professionals. Furthermore, HYGEIAnet systems and services are presented, with emphasis on the development of the HII and the implementation of the I-EHR service for providing secure, role-based access to validated content by authorized and authenticated users.

Computer Communication Networks↗
PubMed2000

Quantitative analysis of visual field and optic disk in glaucoma: retinal nerve fiber bundle-associated analysis.

BACKGROUND: A study was performed to evaluate whether visual field analysis using a perimetric nerve fiber bundle map gives information additional to global visual field indices and cumulative defect curves for early glaucoma diagnosis. METHODS: One hundred and four control subjects, 124 patients with ocular hypertension (OHT), 97 patients with high-tension glaucoma without visual field defects (preHTG) and 91 patients with open-angle glaucoma with visual field defects [30 low-tension glaucoma (LTG), 61 high-tension glaucoma (HTG)] were included in this study. Correlation analyses were performed between (a) global visual field indices and total neuroretinal rim (NRR) area; (b) local mean values of four visual field areas and the NRR area of the corresponding four optic disk sectors; and (c) local mean values of 10 perimetric nerve fiber bundles (PNFB 1-10) according to Weber and Ulrich (1991) and the four optic disk sectors. The correlations were adjusted for global mean defect and total NRR. RESULTS: There were no significant correlations between NRR area and visual field in control subjects or in patients with OHT or preHTG for all three analyses. Significant correlations were found between the global visual field indices and the total NRR area for LTG and HTG. Significant correlations between local mean defects and NRR area of corresponding optic disk sectors were found only in LTG for the superior and inferior visual field area and the PNFB covering these areas. CONCLUSION: The method used for visual field analysis and sectorization of the optic disk does not give additional information on visual field defects in patients with normal global visual field indices and a normal cumulative defect curve. The nerve fiber bundle-related visual field analysis allows the topographical determination and quantification of glaucomatous damage.

Adult↗
PubMed2001

Filling the gap: strategies for improving oral health.

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened, with the Children's Dental Health Project (CDHP), a select group of grantmakers and national experts who have made a major commitment to improving oral health. This Issue Dialogue - held on May 16,2001, in Washington, DC - explored current challenges related to oral health in the United States, and highlighted public and private sector initiatives to overcome these challenges. The roundtable also illustrated current activities and future opportunities for foundations in the area of oral health. This Issue Brief synthesizes key points from the day's discussion with a background paper previously prepared for Issue Dialogue participants. It includes quantitative and qualitative information on oral health as well as profiles of public sector, private sector, and grantmaker strategies for promoting improvements.

Adult↗
PubMedDate not supplied

[Occupational chemical risk: elements for a diagnostic in Spain].

BACKGROUND: Lack of information and accurate knowledge about the properties of chemicals and the exposure derived from its use; hinder health and safety measures to protect exposed workers. The aim of this study is to identify the elements that will help us draw a balance of chemical hazards in Spain and register the most dangerous chemicals at the workplace (by sector or field of activity). METHODS: Study of secondary sources, identification of risk perception by workers' representatives and study of the approach on chemical risk in risk assessments. The last step is to set up a Chemical Exposure Database arranged by industrial sectors. RESULTS: Great volumes of production and consumption of chemicals, generalization of exposure, but insufficient data on specific use; little information is provided on specific dangerous factors of commonly used chemicals; chemicals are barely identified in risk assessments. High levels of exposure in industrial sectors; damage is not adequately registered; there are difficulties in risk perception. Set-up of a preliminary database on exposure by sector of activity. CONCLUSIONS: Data is collected; information sources and procedures, which allow a forecast of chemical risk, are identified. A database on exposure by sector of activity is developed (to be checked and enhanced as new evidence is found).

Hazardous Substances↗
PubMed2003

What is public health legal preparedness?

Legal preparedness has gained recognition as a critical component of comprehensive public health preparedness for public health emergencies triggered by infectious disease outbreaks, natural disasters, chemical and radiologic disasters, terrorism and other causes. Public health practitioners and their colleagues in other disciplines can prepare for and respond to such an event effectively only if law is used along with other tools. The same is true for more conventional health threats. At first glance, public health legal preparedness may appear to be only a matter of having the right laws on the books. On closer examination, however, it is as complex as the field of public health practice itself. Public health legal preparedness has at least four core elements: laws (statutes, ordinances, regulations, and implementing measures); the competencies of those who make, implement, and interpret the laws; information critical to those multidisciplinary practitioners; and coordination across sectors and jurisdictions. The process of improving public health legal preparedness has begun in earnest with respect to potentially massive public health emergencies. Elected officials, public health, legal, and law enforcement practitioners, and national security organizations have contributed to initial benchmarks for the core elements. A few gaps in legal preparedness have been identified in the context of exercises, actual public health emergencies, and through more general assessments of public health preparedness conducted by CDC and the Department of Justice. While a strong beginning has been made, this work is incomplete. Redoubled effort is needed to define practical, measurable benchmarks or standards of legal preparedness, to identify and correct shortcomings, and to review findings from regular exercises and actual public health emergencies. There is great value in having this work move forward on two converging tracks, one defined by states and localities acting on their own initiative and the other shaped by the federal government as informed by state and local experience. The TOPOFF and Dark Winter exercises exemplify the grounded, case-based approach that teaches practical lessons about benchmarks, gaps, and steps to improve public health's legal preparedness. It goes without saying that action on both tracks should be taken by collaboratives whose membership includes representatives of the many different communities integral to the design and application of laws that affect the health of the public and the effectiveness of the public health system itself. Consistent with the concept of a public health or population health system with which we began this paper, participants in both tracks should include representatives of non-governmental bodies--community-based organizations, non-profit organizations active in disaster preparedness and response, and others. This paper presents a conceptual and analytic framework those groups may apply, one that is sufficiently broad to serve as an integrating schema across sectors and jurisdictions but also sufficiently flexible to accommodate the unique features of the many community and state public health systems which, together with federal partners, comprise the U.S. public health system, in sum, a framework responsive to the exigencies of our times, faithful to the guiding principles of American federalism, and conductive to a new standard of health protection for all our citizens.

Benchmarking↗
PubMed1995

Rehabilitation services in the health sector: the perspectives of providers and consumers: Part 2.

AIMS: To gain information from consumers of rehabilitation services about service use and availability, and priorities for future development. To compare this with area health board (AHB) priorities for future services. METHOD: A postal survey of 740 consumers of rehabilitation services used the membership list of the Disabled Persons' Assembly (DPA) of New Zealand. There was a 311 (42%) response rate of whom 84% were people with disabilities and 16% were care givers. RESULTS: Causes of disability included illness (45%), congenital (26%), accidents (22%), and multiple causes (7%). Most people had physical (66%) or multiple disabilities (22%), while few had sensory (7%), intellectual (3%), psychiatric (3%), or learning disabilities (0.4%). The main factors affecting service delivery were lack of information, restricted service, needs not assessed, difficult access to services, lack of coordination, and transport difficulties. Most respondents were aware of statutory services such as district nursing, home help, occupational therapy, physiotherapy, social work and wheelchair assessment and maintenance. One third were aware of regular review, attendant care, and similar programmes. The services that were least known were advocacy and supported accommodation. Consumer priorities were regular review and disability information services, while AHB priorities were attendant care and supported accommodation. CONCLUSIONS: Lack of information, lack of regular assessment, and lack of coordination were major barriers to consumers obtaining adequate rehabilitation services. A single agency purchaser, clear entry points, case management and assessment would provide potent mechanisms for overcoming these difficulties. Priorities for consumers reflected their need for information and support, while provider priorities showed their commitment to the policy of de-institutionalisation. We conclude that it is important that consumers are involved in the planning process so that informed decisions are made about appropriate resource allocation.

Consumer Behavior↗
PubMed1999

[Little communication between company doctors and private physicians with respect to hindrances to return to work after prolonged absence from work because of low back pain].

OBJECTIVE: To determine occurrence and reasons of contact between company doctors and treating physicians with respect to patients absent with low back pain for three months. DESIGN: Prospective cohort study. METHOD: A cohort of employees who were absent for 3 months with back pain were selected according to defined criteria. A questionnaire about medical status and communication with treating physicians was sent to their company doctors. RESULTS: The company doctors of 300 of 467 employees participated. In 19% of the employees the company doctor contacted the curative sector (56 contacts had taken place, 14 were planned). The contact consisted almost always of exchange of information and less frequently of co-operation towards a mutual policy. In almost 50% of the cases the company doctors regarded the clinical waiting period, length of treatment and opinion of the curative sector as disincentives to return to work. Psychosocial factors such as psychological problems, work-related motivation, private problems and a conflict between employer and employee all were mentioned less frequently. Although contacts were slightly more frequent when psychosocial factors, treatment or opinion of the curative sector inhibited return to work, only disincentives such as work-related motivation, motivation to return to work and the waiting period were significantly associated with the contact frequency. CONCLUSION: The communication rate between company doctors and the curative sector in employees long absent with back pain is low. Communication consists of exchange of information rather than co-operation towards a mutual policy. Although according to many company doctors the curative sector plays an inhibitive role in return to work, they do not communicate accordingly.

Absenteeism↗
PubMed2003

Evaluating health care interventions in the European Union.

This paper examines the current state of evaluations of health care interventions in the European Union, from the identification and commissioning of research through to its impact on policy and practice. Material is drawn from a survey conducted for the ASTEC project as well as a review of literature. Although the use of evaluative research has increased substantially in the last decade, both the pace of change and preferred research methodologies employed differ markedly. Much research still concentrates on issues of safety, efficacy and effectiveness, although there is evidence of an increasing emphasis on cost-effectiveness. Many countries are beginning to introduce systems linking economic evaluation to the decision-making process, while networks for the exchange of information continue to evolve. Research capacity in the public sector, although improving, is uneven, in part due to the uncertainty over long term career prospects and competition from industry. Capacity building measures should in particular ensure that dissemination expertise is strengthened, and that more emphasis is placed on developing receptor capacity within different stakeholder groups. Linking knowledge production to changes in practice remains a key challenge. Further research on implementation and impact assessment is required, to help demonstrate the value of evaluations on both policy and practice.

Delivery of Health Care↗
PubMed1991

The health services utilisation of a general practice population.

OBJECTIVE: to establish a viable methodology for the linkage of patients information between general practice and the secondary health care sector. To demonstrate this by examining the activities and cost of health care to a general practice community. METHODS: the linkage of computerised records was achieved using a unique alpha numeric identifier (the National Master Patient Index number). Using this link all patient activities for one general practice were analysed. Consultations and their outcomes in terms of pathology and radiology requests, prescriptions, and referrals to other health care providers were recorded. Secondary care activities analysed were outpatient, inpatient, day care, and accident and emergency attendances. RESULTS: the study population of 3611 patients produced 15,453 contacts in general practice (4.3 contacts per person per annum) and 2804 contacts with the secondary care system (0.8 contacts per person per annum). The total government expenditure was $824,567 for general practice care and $1,410,198 for secondary care, ie, $2,234,765 in total or $619 per person. CONCLUSION: this methodology for information linkage provides the potential for comprehensive examination of publicly funded health care in both general practice and hospital settings, thereby promoting better coordinated and more rational planning of services.

Costs and Cost Analysis↗