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PubMedDate not supplied

Health care reform in Kenya: a review of the process.

The paper looks at the process of health care reform in Kenya during the past 30 years, with a focus on implementation strategies. The data are from official documents of the government. The main finding is that development plans served as the medium through which the government announced its intentions as well as its decisions to implement reforms. A decision to implement a reform was normally accompanied by an implementation budget, whereas an announcement of an intention typically lacked such support. Some of the reforms were implemented speedily and firmly, whereas others suffered delays and reversals. Reforms were implemented with speed and firmness when research provided clear guidance on key policy issues or when political will and skill existed. Donor influence on the timing of reforms might have been excessive. Policy lessons from the process are indicated.

Delivery of Health Care↗
PubMed1992

Malaria vector analysis and control.

Antivector measures in malaria control should aim for a cost-effective reduction of the transmission potential ideally to below the critical level for sustained transmission. The available measures include those that decrease vector abundance, vector-human contact and vector survival rate or that increase the length of the sporogonic cycle. These have widely different impact on malaria transmission, as shown by epidemiological modelling. Direct modification of vector receptivity to Plasmodium is also hypothetically attainable by the use of transmission-blocking vaccines or by genetic manipulation and replacement of the vector population. Vector analysis constitutes the essential prerequisite for basic malaria epidemiology as well as for the development, planning and evaluation of antivector measures. The rationale, the problems and the perspectives of vector analysis are reviewed here by Mario Coluzzi, on the basis of his experience with Afrotropical and Mediterranean malaria vectors.

Journal Article↗
PubMed1994

Novel sensor technology for monitoring and control of critical plant nutrient parameters.

A novel dielectric sensor technology has been developed for monitoring and control of plant nutrient delivery systems as part of NASA's Controlled Ecological Life Support System (CELSS) program. A unique measurement phenomenon was discovered in which the electrostatic field is shunted to a third terminal of the sensor, resulting in a much greater sensitivity to changes in the complex dielectric properties of the nutrient solution. Based on this phenomenon, a small, flexible, thin-film shunting dielectric sensor (SDS) was designed to provide low-frequency, non-invasive measurement of both the thickness and nutrient concentration of the layer of solution on a plant growth surface. Test results indicate a sensitivity of +/- 0.05mm in layer thickness while characterization of the ability to measure nutrient concentration continues. The development plan for this sensor is presented and other applications are discussed.

Algorithms↗
PubMed1982

Policy and practice. The case of medical facilities in Nigeria.

Elaborate health programmes have always been an important feature of national development plans in Nigeria, especially since independence in 1960. The aspect of the programmes that is examined in this paper is the geographical distribution of medical facilities. The policy objectives in this regard have been to improve access to facilities and personnel by distributing them equally according to population, and to correct the rural urban imbalance in the system. But how far have these objectives been realized? In an attempt to answer this question, the situation in Bendel State is examined in some detail and the results show that the rural urban imbalance is still evident. Correlation analyses showed that areas that have a comparatively large urban population have more facilities and personnel than areas that are predominantly rural. Also, three step-wise multiple regression analyses revealed that Urban population is a far more important factor than total population in explaining the distribution of hospitals, hospital beds and doctors. The doctor/population ratios are exceedingly high for the predominantly rural areas, over 1:70,000 in some cases. These ratios are far in excess of 1:14,000 which was the national target for 1980. All these show that some important policy objectives of the health programmes have not been realized.

Health Policy↗
PubMed1986

Malnutrition and basic needs surveys in Thailand.

Data on various socio-economic characteristics and the nutritional status of the population of the Province of Nakhon Rachasima had been collected in a basic human needs survey for the purpose of integrated rural development planning. The collected data represent the conditions of an entire province. An assessment of the correlations between various agricultural, socio-economic and sanitation parameters is made. Malnutrition of children under 5 years of age is correlated with some of the assessed parameters. But, the usefulness of general basic needs surveys for designing nutrition intervention projects is limited due to a lack of specific information on the points of leverage to bring about change in the nutritional status.

Child, Preschool↗
PubMed2003

Opisthorchiasis control in Thailand.

History of opisthorchiasis control started in 1950 as a small scale helminthiasis control program in some high risk areas. Following a number of studies and trial projects of the Faculty of Tropical Medicine, Mahidol University, the national liver fluke control program has been developed and operated under several National Public Health Development Plans. Presently, the program is being operated in some provinces of the Central, and all provinces of the Northeast and North of Thailand. The main strategies for liver fluke control comprise of three interrelated approaches, namely stool examinations and treatment of positive cases with praziquantel for eliminating human host reservoir; health education for a promotion of cooked fish consumption to prevent infection, and the improvement of hygienic defecation for the interruption of disease transmission. Between 1984 and 1987, the positive rate of liver fluke infection was 63.6%. In 1988, the positive rate went down to 35.6%. Following the region wide control program started in 1989, the annual positive rates had subsequently decreased to 9.4% in the year 2001. The prevalence rate was remarkably high in the North and moderately high in the Northeast, while the prevalence in the Central region was considerably low and there was no evidence of disease transmission in the South.

Animals↗
PubMed2006

Effects of a statewide physician-led quality-improvement program on the quality of cardiac care.

BACKGROUND: Several states have implemented mandatory public reporting of outcomes of cardiac revascularization procedures. Washington is the first to develop a nonmandatory, physician-led reporting program with public accountability and universal hospital participation. The purpose of this study was to determine whether quality improvement interventions resulted in the correction of data deficiencies and performance outliers for cardiac revascularization procedures. METHODS: From 1999 through 2003, there were 18 hospitals with coronary bypass surgery and interventional cardiology programs and 12 with only the latter. All patients > or =18 years undergoing 24372 isolated coronary bypass surgeries and 59,656 percutaneous coronary interventions were included. After 1999 to 2001 data were analyzed in early 2002, the Clinical Outcomes Assessment Program implemented a 6-step quality-improvement intervention to measure and remeasure data quality, process compliance, and performance. RESULTS: In 2003, 4 of the 18 surgery programs had 1 statistical outlier with respect to 4 performance measures, whereas 2 of 30 coronary intervention programs were mortality outliers. For bypass surgery, all programs maintained full compliance with program standards by adhering to timely and reliable submission of data, developing plans to address performance outliers, and demonstrating that outlier status did not persist from baseline to remeasurement. For coronary interventions, 1 program was a persistent outlier for mortality in 2002 and 2003. CONCLUSIONS: The Clinical Outcomes Assessment Program has successfully monitored cardiac care patterns in Washington State over a 5-year period. Most hospitals that perform coronary revascularization procedures meet acceptable performance standards.

Aged↗
PubMed2006

Methodology for reorganization of the cervical cancer program in Chile.

BACKGROUND: Early cancer detection methods need to be accompanied by effective public health implementation strategies in order to successfully reduce national mortality. A cervical cancer screening program was run in Chile from 1965 to 1985 which had almost no impact on cervical cancer mortality. The problem faced was how to change the entrenched practices of physicians and other professionals who had been running a multi-component program for 2 decades, with no increase in financial resources. METHODS: Expanding intervention cycles were defined for different population groups, focusing initially on females health workers and finally on the general at-risk population. The expanding cycles move from the simplest intervention, involving health service staff, to the more complex intervention, involving changing the behavior of the general public. At each cycle level the overall problem was assessed and a preliminary plan developed by a team of local experts. This was followed by involvement of the responsible public health care system managers using a workshop, problem solving in the field, a workshop presenting results and learning, and the start of a new cycle. RESULTS: In the Santiago Metropolitan Region this methodology resulted in cycles of 3-8 months duration. Clear improvements in technical and managerial skills of the staff and overall program management were observed. Pap smear screening in the Santiago Metropolitan Region rose from 43% to 66% in 2 years and the national age-adjusted cervical cancer mortality rate fell by about half over 20 years. CONCLUSIONS: Problem solving in expanding cycles produced an effective National Cervical Cancer Screening Program. This methodology can also be applied to other public health problems.

Adult↗
PubMed2004

Fronto-orbital and cranial osteotomies with resorbable fixation using an endoscopic approach.

Over the past 3 years the authors have used modified minimally invasive endoscopic techniques in the surgical correction of craniosynostosis. For selected patients, these techniques offer an alternative to traditional techniques, minimizing postoperative morbidity and the need for cranial banding. Long-term follow-up will be needed to assess the ultimate efficacy of these techniques. Traditional techniques for repair of craniosynostosis have historically had a record of excellent aesthetic results with acceptable morbidity. Ultimately, each patient is best served by a customized plan, developed and implemented by a multidisciplinary team capable of the full range of techniques.

Absorbable Implants↗
PubMed2006

Regulating biopharmaceuticals under CDER versus CBER: an insider's perspective.

The FDA has recently transferred jurisdiction for the regulation of certain biopharmaceuticals from the Center for Biologics, Evaluation and Research to the Center for Drugs, Evaluation and Research, where they will be reviewed in the same FDA divisions as are traditional pharmaceutical agents. With this transfer, sponsors of investigational biopharmaceuticals should expect changes in the regulatory requirements the FDA imposes on the clinical development plans, including an increase in the size and number of pivotal studies; more consistent requirements for conducting preclinical tests in two animal species; increased emphasis on organ structure and function as components of primary endpoints; more emphasis on characterizing dose-ranging and pharmacology; more intense scrutinizing of product advertising; and decreased direct communication with the review team.

Biological Products↗
PubMed2006

Proof of Principle studies.

Proof of Principle studies are an early stage of clinical drug development when a compound has shown potential in animal models and early safety testing. This step of proof-of-principle (PoP) or proof-of-concept (PoC) often links between Phase-I and dose ranging Phase-II studies. These small-scale studies are designed to detect a signal that the drug is active on a pathophysiologically relevant mechanism, as well as preliminary evidence of efficacy in a clinically relevant endpoint. Sponsors use these studies to estimate whether their compound might have clinically significant efficacy in other diseases states as well as epilepsy (e.g., migraine, neuropathic pain, anxiety, depression). Endpoints other than seizure frequency often reveal special characteristics of the drug. A structured dose escalation design can reveal dose-dependent effects and adverse effects, crossover studies can demonstrate change, presurgical studies can define efficacy, interictal discharges and photosensitivity models can explain changes in seizure features, transcranial magnetic stimulation evaluates hyperexcitability. PoP studies allow exploration of a wide range of potential therapeutic areas beyond epilepsy as part of an integrated CNS development plan.

Anticonvulsants↗
PubMed2004

Selecting agri-environmental indicators to facilitate monitoring and assessment of EU agri-environmental measures effectiveness.

Since its introduction in the early 1960s, the EU Common Agricultural Policy (CAP) has demonstrated a capacity to adapt and change in the face of new challenges. The reformed CAP, under AGENDA 2000, encourages more environmentally friendly farming practices. In the context of their rural development plans, Member States are required to link policies on agriculture with protection of the environment and to ensure that farmers meet environmental standards. Additionally, Member States should maintain and restore the quality of both their aquatic and adjacent terrestrial ecosystems according to the Directive 2000/60/EU, 'Establishing a framework for Community Action in the field of Water Policy'. Within this framework, agri-environmental indicators play an important role in planning and implementing CAP guidelines. However, selection and use of the proper indicators remains unresolved, considering that ecosystem processes are complex and interactions in most cases not obvious. This paper proposes a methodology for assessing the environmental state and impacts of current land use and management when implementing agri-environmental measures of CAP. The proposed methodology includes a modified Driving forces-Pressures-Impacts-Responses (DPSIR) framework, identification of Zones of Specific Functional Interest (ZSFI), and criteria for selecting agri-environmental indicators, which assess the functional performance of each zone and meet existing legislation. The Mygdonia Watershed (Greece) is an example where through use of both the appropriate Minimum Data Set of agri-environmental indicators at the identified zones and the proposed modified DPSIR, the functioning performance of each ZSFI can be assessed to evaluate the applied agri-environmental measures.

Agriculture↗
PubMed2006

Institutionalizing effective pain management practices: practice change programs to improve the quality of pain management in small health care organizations.

The Resource Center of the American Alliance of Cancer Pain Initiatives provided templates, faculty, and ongoing consultation to assist seven state pain initiatives to implement programs to improve pain management practices. A total of 113 health care organizations participated. Each organization committed to support a team of two to three staff through a 10-month pain quality improvement process, which included a site visit, two educational conferences, pre- and postprogram analyses of the organizational structures in place to support pain assessment and management, quality improvement work plan development, and patient survey data collection. Postprogram results showed statistically significant increases in the presence of structural elements that are critical to effective pain management, as well as statistically significant, though modest, decreases in the percentage of patients who reported pain of any severity, and specifically moderate to severe pain, in the previous 24 hours. The largest changes occurred in long-term care facilities. Nevertheless, the percentage of patients in moderate to severe pain remained unacceptably high.

Delivery of Health Care↗
PubMed2004

Developing the young academic surgeon.

In the past, the process of developing the young academic surgeon was arguably less strategic, one that was often not deliberately managed and monitored, leading in some cases to academic drift and disillusionment. Once upon a time it was assumed that greatness was genetic and that the next triple threat would emerge when a pre-programmed set of genes was turned on. Today, as the complexities and vicissitudes of our work increase, it is practically impossible for even the most gifted young person to be successful without careful attention to career development. Faculty development must be deliberate and strategic--every junior faculty member is unique and will require a customized career development plan that is well thought out, linked to measurable goals, monitored routinely and buttressed by effective mentoring. This approach will require time and commitment--precious commodities that are in short supply as the demands on our time are only escalating. By recruiting the right people (those who fit with the organization's values and goals) and providing the right environment, we can optimize the growth and satisfaction of our young faculty and, in so doing, create departments that are leaders in carrying out our missions of research, education and patient care. We cannot afford to have our young people fail--it is simply too costly, both from a financial and a human perspective.

Academic Medical Centers↗
PubMed2005

Developing the young academic surgeon.

In the past, the process of developing the young academic surgeon was arguably less strategic, one that was often not deliberately managed and monitored, leading in some cases to academic drift and disillusionment. Once upon a time it was assumed that greatness was genetic and that the next triple threat would emerge when a pre-programmed set of genes was turned on. Today, as the complexities and vicissitudes of our work increase, it is practically impossible for even the most gifted young person to be successful without careful attention to career development. Faculty development must be deliberate and strategic--every junior faculty member is unique and will require a customized career development plan that is well thought out, linked to measurable goals, monitored routinely and buttressed by effective mentoring. This approach will require time and commitment--precious commodities that are in short supply as the demands on our time are only escalating. By recruiting the right people (those who fit with the organization's values and goals) and providing the right environment, we can optimize the growth and satisfaction of our young faculty and, in so doing, create departments that are leaders in carrying out our missions of research, education and patient care. We cannot afford to have our young people fail--it is simply too costly, both from a financial and a human perspective.

Academic Medical Centers↗
PubMed2005

Multidisciplinary post-registered education in child and adolescent mental health services.

This article describes a study conducted in England as part of the preparation work for the Children's Taskforce, looking at the training needs of specialist Child and Adolescent Mental Health Service (CAMHS) staff, and of primary care staff who work with children and young people. A survey of existing service provision and of training opportunities was conducted, and as a result a series of recommendations for future training needs within CAMHS are made. It includes the needs of the developing role of Primary Mental Health Workers (PMHWs) within this area in their crucial link position between primary and secondary services. The study is multi-disciplinary in nature, given that all CAMHS teams are provided by multi-professional workers. Since this work was undertaken the workforce development plans for future CAMHS have progressed under the Children's Taskforce, with the National Service Framework for Children being published in October 2004.

Adolescent↗
PubMedDate not supplied

Lessons learned from a pilot study on the health status of children from itinerant populations.

The pilot study is used to guide development of a research design or to test an already developed plan; however, results of pilot work often are not reported. Pilot work can yield many valuable lessons and provide investigative training to the principal investigator and as well as evidence to funding agencies that the research is feasible and worthwhile. The pilot study described here is preliminary work on health disparities in two itinerant populations: carnival and migrant farmworker children. This pilot study had three aims: (a) identify the most productive methods to recruit subjects from these two "invisible" populations; (b) test feasibility of the research protocol; and (c) collect preliminary data on the children's health status for future research proposals.

Agriculture↗
PubMed2004

The Horizontal Gene Pool: an ESF workshop summary.

The European Science Foundation (ESF) funds a limited number of exploratory workshops each year that enable scientists to meet and develop plans for a program of integrated research which would benefit from a coordinated European effort. In summer 2003, the Standing Committee for Life and Environmental Sciences (LESC) sponsored such a workshop called The Horizontal Gene Pool: The Functional Role of Mobile Genetic Information--How Bacteria Perceive, Sample, and Utilize Genetic Elements in evolution and Local Adaptation. The workshop took place at St. Catherine's College, Oxford, UK. Its purpose was to identify how recent advances in the application of genomics and microbial ecology can be harnessed to determine the genetic mechanisms that underpin the biological role of the horizontal gene pool. Scientific excellence at the workshop was contributed by senior scientists and young investigators from research institutes located in nine European countries.

Bacteria↗