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PubMed2005

Complementary competencies: public health and health sciences librarianship.

OBJECTIVES: The authors sought to identify opportunities for partnership between the communities of public health workers and health sciences librarians. METHODS: The authors review competencies in public health and health sciences librarianship. They highlight previously identified public health informatics competencies and the Medical Library Association's essential areas of knowledge. Based on points of correspondence between the two domains, the authors identify specific opportunities for partnership. RESULTS: The points of correspondence between public health and health sciences librarianship are reflected in several past projects involving both communities. These previous collaborations and the services provided by health sciences librarians at many public health organizations suggest that some health sciences librarians may be considered full members of the public health workforce. Opportunities remain for productive collaboration between public health workers and health sciences librarians. CONCLUSIONS: Drawing on historical and contemporary experience, this paper presents an initial framework for forming collaborations between health sciences librarians and members of the public health workforce. This framework may stimulate thinking about how to form additional partnerships between members of these two communities.

Community-Institutional Relations↗
PubMedDate not supplied

Public health and the media in California: a survey of local health officers.

Increasingly, public health interventions are dependent on effective health communications. There are, however, few data examining the relationship and interactions between local public health officers and representatives of the media in the literature. This study sought to collect data on the quality and quantity of interactions between California's 62 local health officers and the media. A survey form was sent to the health officers representing all 58 county and four city health departments in the State of California to assess the extent of media interaction, the existence of institutional media policies, the professional and personal character of media relations, the perceived accuracy of media reporting, use of the media for health education and advocacy, the availability of training in media relations for staff members, and whether media interaction facilitated or impeded achievement of public health objectives. Differences in responses according to the population of the political jurisdiction also were assessed. With 87 percent of the health officers responding, 51 percent reported 10 years or more experience interacting with the media; 65 percent said they dealt with the print media mostly on a daily, twice weekly, or weekly basis. In only 19 jurisdictions were there written policies on media relations, but in 43, media releases undergo a pre-release review. Most health officers characterized media relations as reactive, and 80 percent said they were appropriate and had an educational impact. Media interactions were largely believed to be of benefit to the public and were not generally perceived as adversarial. Health officers were of the opinion that media representatives could become more technically and scientifically knowledgeable on public health issues but also indicated that they or their own public health staff would benefit from continuing education on managing media relations. Eighty-six percent stated that the media strongly or moderately facilitate the achievement of public health objectives. Further study of this important component of public health practice is warranted.

California↗
PubMed2003

New options for health care policy and health status insurance: citizens as customers.

Health education and health literacy programs have implications on health care policy and health care status insurance. There are many benefits of a transition from disease management to a health care system, which includes priorities in prediction, prevention, and health education. Health care and disease management could best be implemented by multiple-tier, market-oriented models of universal coverage allowing for competition among health status insurers and educational, pharmaceutical, nursing, and other health service providers. Promotion of health literacy will allow citizens to become educated customers and consumers of health care services. Internationally, health literacy might narrow the gap between economically richer and poorer countries.

Delivery of Health Care↗
PubMed1998

Managed care and school-based health centers. Use of health services.

OBJECTIVE: To explore the use of physical and mental health services for adolescents who are enrolled in managed care and have access to a school-based health center (SBHC), compared with adolescents enrolled in managed care without access to an SBHC. DESIGN: Retrospective cohort designed with age, sex, and socioeconomic status matching to compare the use of health services for adolescent members of Kaiser Permanente of Colorado (who had access to SBHCs) with those with no access. PARTICIPANTS: The study included 342 adolescents, resulting in 3394 visits that occurred during 3 academic years. During the study, 240 adolescents with access to an SBHC were compared with 116 adolescents without access to an SBHC. MAIN OUTCOME MEASURES: The use of primary and subspecialty medical, mental health, and substance abuse treatment services; the use of after-hours (emergent or urgent) care; and comprehensive preventive health supervision visits and documentation of screening for high-risk health behaviors. RESULTS: Adolescents with access to SBHCs were more than 10 times more likely to make a mental health or substance abuse visit (98% of these visits were made at the SBHC) (P < .001). Adolescents with SBHC access had an after-hours (emergent or urgent) care visit rate of 0.33 to 0.52 visits per year less (38%-55% fewer visits) than adolescents without SBHC access, and, overall, made almost 1 additional medical visit per year. A greater percentage, 80.2%, of adolescents with access to SBHCs had at least 1 comprehensive health supervision visit compared with 68.8% of adolescents without access (P = .04). In addition, the adolescents with access were screened for high-risk behaviors at a higher rate. CONCLUSIONS: School-based health centers seem to have a synergistic effect for adolescents enrolled in managed care in providing comprehensive health supervision and primary health and mental health care and in reducing after-hours (emergent or urgent) visits. School-based health centers are particularly successful in improving access to and treatment for mental health problems and substance abuse.

Adolescent↗
PubMed2001

National health information privacy: regulations under the Health Insurance Portability and Accountability Act.

Health information privacy is important in US society, but existing federal and state law does not offer adequate protection. The Department of Health and Human Services, under powers granted by the Health Insurance Portability and Accountability Act of 1996, recently issued a final rule providing systematic, nationwide health information privacy protection. The rule is extensive in its scope, applying to health plans, health care clearinghouses, and health care providers (hospitals, clinics, and health departments) who conduct financial transactions electronically ("covered entities"). The rule applies to personally identifiable information in any form, whether communicated electronically, on paper, or orally. The rule does not preempt state law that affords more stringent privacy protection; thus, the health care industry will have to comply with multiple layers of federal and state law. The rule affords patients rights to education about privacy safeguards, access to their medical records, and a process for correction of records. It also requires the patient's permission for disclosures of personal information. While privacy is an important value, it may conflict with public responsibilities to use data for social goods. The rule has special provisions for disclosure of health information for research, public health, law enforcement, and commercial marketing. The privacy debate will continue in Congress and within the president's administration. The primary focus will be on the costs and burdens on health care providers, the ability of health care professionals to use and share full medical information when treating patients, the provision of patient care in a timely and efficient manner, and parents' access to information about the health of their children.

Confidentiality↗
PubMedDate not supplied

Maori health and the health care reforms.

Maori participation in the 1991 health care reforms is considered against the background of their involvement in health reforms since the turn of the century. Throughout this period Maori have consistently sought autonomous health care. Traditional indigenous healers have provided healing for Maori as they have for other indigenous people, such as Aborigines, Pacific Islands people and Canadian Indians. Maori, including western health care professionals, submitted that healers should be included among the health care services personnel providing core health services. They argued this on the basis of their health status and of their rights with respect to the Treaty of Waitangi. The influence of the 1977 WHO resolution, concerning the role of traditional healers in attaining 'Health for All by the Year 2000', is considered in relationship to Maori health initiatives and how the 1991 health care reforms may impact upon them, and the bicultural policy that has guided Maori health developments over the last decade. Evaluating Maori health and the health care reforms in terms of Maori participation, the status of traditional indigenous healers and the future of Maori health initiatives leaves Maori in no doubt that they have some hard work ahead to maintain the position they held prior to the reforms.

Health Care Reform↗
PubMed2005

Community environmental health assessment strengthens environmental public health services in the Peruvian Amazon.

In December 1999, the Centers for Disease Control and Prevention (CDC) and the Cooperative for Assistance and Relief Everywhere, Peru Country Office (CARE Peru), initiated the Urban Environmental Health Project (SAU, in Spanish) to strengthen environmental public health services in urban and periurban settlements in Peru. The project received funding from the Woodruff Foundation as part of the CARE-CDC Health Initiative (CCHI). The "Protocol for Assessing Community Excellence in Environmental Health" (PACE EH) guided the development of a community environmental public health assessment (CEHA) process in Cardozo, a settlement in Iquitos, Peru. The project developed a three-phase process that merged scientific understanding and community perception about local environmental health problems. In phase 1, local environmental health technicians assisted the community in understanding environmental health conditions in Cardozo and selecting priorities. During phase 2, local technicians assessed the community-selected priorities: water and sanitation. Results from recent water quality assessments revealed that 82% (9 of 11) of samples from shallow dug wells, 18% (2 of 11) from deeper drilled wells, and 61% (11/18) from household drinking containers were positive for thermotolerant coliforms. Phase 3 activities produced an action plan and an intervention to mitigate health problems associated with inadequate water and sanitation services in the Cardozo community. As a result of the CEHA process, CARE Peru obtained funding from the United States Agency for International Development (USAID) to develop and implement an environmental health risk monitoring system and the proposed water and sewage intervention in the settlement. CDC continues to provide technical assistance to the local environmental health services groups in Iquitos through an agreement with CARE Peru as part of the USAID-funded Urban Environmental Health Models Project (MUSA). Technical assistance activities and the development of the environmental health risk monitoring system have helped to strengthen the local environmental public health services delivery system.

Community-Institutional Relations↗
PubMed1995

Survey of health promotion organisational arrangements and levels of service for health promotion.

This study was promoted by the Executive Committee of the Association of Directors of Public Health when faced with the need to examine the organisation of and quantify health promotion arrangements in the Health Districts of England and Wales, resulting from the concerns of many of the members of the Association. These concerns were based on the views that health promotion is a key purchasing function of the District Health Authorities and must be appropriately and effectively structured and adequately resourced if the requirements of The Health of The Nation are to be fulfilled. There are many aspects to health promotion work and the delivery of health promotion services which will need addressing in the new commissioning environment of the NHS. A need was recognised for up-to-date data about health promotion services to inform a necessary debate about future arrangements, since it appeared that organisational change was being driven by influences unconnected with the possibly most appropriate structure of health promotion departments and which relate to a contemporary view of health promotion. Reducing the size and cutting the cost of commissioning authorities was perceived as one of the most important influences. A postal questionnaire survey to all Health District and Regional Health Authorities in England and Wales was conducted covering questions about the present organisational arrangements and levels of service, and soliciting the opinions of those canvassed. A total of 185 District and Regional Health Authorities, effectively reduced to 171 because of mergers, was sent questionnaires, of which 141 were completed and returned, giving a response rate of 82.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Contract Services↗
PubMed1999

Social support, social selection and self-assessed health status: results from the veterans health study in the United States.

This study provided a comprehensive assessment of the association between social support and health using longitudinal data from the Veterans Health Study. Unlike previous studies which examined the relationship between one single domain of social support with either mental or physical health, the present study assessed the effects of three different domains of social support on multiple measures of health. The findings of the study indicated that social support tended to mediate the deleterious effects of non-military traumatic events; whereas the adverse consequences of traumatic events experienced in the military were not affected by social support, suggesting that stressors associated with combat had a long lasting effect on the health status of veterans. The study results revealed that compared with those with better health, respondents with poor health were more likely to have lower levels of social support, suggesting that poor health might be a barrier to a person's ability to participate and/or maintain social relationships. The study also showed that different types of social support had varying beneficial effects on different measures of health. While perceived support had a strong effect on all the measures of health (except alcoholism) included in the study, living arrangement had a significant effect on post-traumatic stress disorder or physical health and participation in group activities had a strong effect only on physical functioning. The results of the study highlight the need for future research to determine whether particular types of social support affect various aspects of health differently. This simultaneous focus on multiple support functions and health outcomes is important because it provides insight into the mechanisms linking social support to health.

Adult↗
PubMed1998

Relationship of domain-specific measures of health to perceived overall health among older subjects.

The associations between nine domain-specific measures of health (e.g., depressive symptoms, psychological distress, mental health, physical functioning, role functioning, social functioning, bodily pain, somatic symptoms, and chronic medical morbidity) and a single-item measure for perceived overall health were studied in an extensive community-based sample of elderly persons (n = 5279). The results showed that: (1) the discriminative power of perceived overall health compared to domain-specific measures of health was moderate to large only at the fair/poor end of the perceived overall health spectrum; (2) a single-item measure of perceived overall health did not cover domain-specific measurements of health since only 41.8% of the variance in perceived overall health was explained by all domain-specific measures; and (3) the affective domains of functioning (psychological distress, mental health) were weakly related to perceived overall health. Bodily pain, chronic medical morbidity and, to a lesser extent, physical functioning were more strongly related to perceived overall health. These results were fairly consistent for men and women and for three age groups. We conclude that a global, single-item measure of perceived health and domain-specific health measures are not exchangeable in evaluation, survey, or epidemiological research.

Activities of Daily Living↗
PubMed2004

Association between perceived health status and satisfaction with quality of care: evidence from users of primary health care in Oman.

OBJECTIVE: Our aim was to assess the influence of perceived health status, as measured by SF-12, on the client's views of service quality. METHODS: A structured interview of patients was carried out in six primary health care centres in Adh Dhahira region health authority in the Sultanate of Oman. A total of 1226 patients aged 15 and over attending the different health care services within the health centres took part in the study. The main outcome measures were patients' satisfaction with the different aspects of health care and their perceived physical and mental health status. RESULTS: When adjusted for the relevant background factors such as age and gender, poor perceived health status has been found to predict less positive judgements of various aspects of health care quality. Poor mental health status, for example, predicts less positive judgements of aspects that are linked to the accessibility of the service and interpersonal aspects of care such as the working hours of the centre, GP's attitude and time spent with the GP (P < 0.05, <0.05 and <0.01, respectively). Poor physical health status, on the other hand, predicts less positive judgements of aspects such as cleanliness of the building, confidentiality of consultation with the GP, explanation about the visit to the antenatal clinic and standard of antenatal clinic in general (P < 0.05, <0.05, <0.05 and <0.05, respectively). CONCLUSION: Users' perceived health status has to be evaluated concurrently with assessing satisfaction with the quality of health care services. This would provide more valid results with regard to the patients' views on their level of satisfaction with health care quality.

Ambulatory Care Facilities↗
PubMed1997

The impact of social inequalities in child health on health visitors' work.

BACKGROUND: Preventive and health promotion work by health visitors ought to reduce social inequalities in child health. However, the increased health and developmental problems among disadvantaged children may constrain health visitors' ability to carry out effective preventive work. This paper measures the impact of socioeconomic inequalities in children's health on the work of health visitors and the amount of preventive work they can provide, with emphasis on 'parenting' programmes. METHODS: Data collected for health visitors' profiles were analysed in an ecological cross-sectional study. Individual caseloads were classified according to the proportions of families in social class IV or V and families headed by an unemployed person. A range of measures of young children's health and development indicated the demands on health visitors' time. Preventive work was divided into post-natal support, parenting programmes, special clinics and other preventive work. RESULTS: All the outcome measures were poorer in the most disadvantaged caseloads. Odds ratios between the most and least disadvantaged 20 per cent of caseloads were 0.6 for breast feeding at birth, and at seven months, 1.9 for post-natal depression, 3.2 for mothers under 18, 10 for lone parent families, 2.6 for families needing high intervention, 4.5 for families with a smoker, 11 for domestic violence, 4.4 for parents with a chronic health problem, 2.7 for children on the child protection register and 2.8 for children with developmental problems. There was 30 per cent greater health visitor time provided in the most disadvantaged caseloads than in the most advantaged. There was no consistent difference in the amount of preventive work carried out; in particular, parenting programmes were delivered at a similar rate in all caseloads. CONCLUSIONS: Large differences in demands on health visitors' time exist between affluent and disadvantaged caseloads which are barely reflected in the provision of extra time to poorer caseloads. There is no consistent pattern to the delivery of preventive programmes designed to ameliorate the effects of disadvantage on children's health and development.

Child↗
PubMed1998

Improving health outcomes--a review of case studies from English health authorities.

We review a series of case studies from English health authorities that have tackled the assessment and improvement of health outcomes. We reflect their concerns and difficulties and the lessons they learnt. We identified case studies from a telephone survey of 91 representatives of the 100 English health authorities (61 were directors of public health). We edited 26 structured case studies which described how they had used population health outcome assessments or indicators. The health outcome assessments included service reviews, needs assessment projects, case-control studies, small area variations analyses, action research, and the use of focus groups. Many case studies highlighted inequalities in health service delivery. Health authorities chose some topics because they were outliers on national indicators, others had found unacceptable inequalities within their district, and others had been concerned that clinicians were not using the most effective interventions. Public health departments played a major role in these population-based health outcome assessments. The case studies highlighted the strengths and weakness of national population-based health outcome indicators, the difficulties of using information on effectiveness, the role of evidence-based process proxies for outcome, the need to extend information sources, the involvement of patients and carers, and the difficulty of changing clinical behaviour. We make recommendations as to how the Department of Health and NHS Executive could help health authorities improve the health outcomes of the populations they serve.

England↗
PubMed2006

Commentary: Health systems and health policy: a curriculum for all medical students.

A companion article in this issue of Academic Medicine provides an example of a method for electively integrating health systems and health policy issues into medical education. However, a curriculum in health systems and health policy is crucial to the education of all future physicians and other health professionals. The Clinical Prevention and Population Health Curriculum Framework of the Healthy People Curriculum Task Force has recently recommended a health systems and health policy curriculum that includes the domains of organization of clinical and public health systems; health services financing; health workforce; and health policy process. The curriculum should commence prior to year three and continue in years three and four so that students have a framework for integrating and subsequently sharing their experiences. Current Liaison Committee on Medical Education data indicate that on average less than 70% of medical schools require any curriculum in these four domains and only 40% of medical schools include all four of these domains in their required curriculum. Incorporation all of these domains into well-defined, required curricula that are broad in scope has the potential to change the attitudes of future clinicians toward efforts to control costs, collaborate with other health professions, and influence health policies.

Curriculum↗
PubMedDate not supplied

Critical thinking, perceived health status, and participation in health behaviors.

BACKGROUND: Critical thinking has been proposed as crucial for processing conflicting information when people make decisions about participation in health behaviors. The critical thinking of individuals about participation in health behaviors may depend on their perceived health status. OBJECTIVES: To examine the relations between critical thinking and participation in three categories of health behaviors, and to determine whether these relations are moderated by perceived health status. METHODS: A cross-sectional, correlational design was used to study a sample of 112 community-dwelling adults who resided in a large, urban Midwest community. The participants were women and men 18 to 90 years of age (mean, 55 +/- 20.47 years) who completed self-report, written questionnaires including the Test of Everyday Reasoning and the Health Practices Instrument. RESULTS: According to hierarchical multiple regression analyses, the relation between critical thinking and health promotion behaviors and the relation between critical thinking and secondary prevention behaviors were moderated by perceived health status, whereas the relation between critical thinking and health protection behaviors was not. CONCLUSIONS: The relation between critical thinking and participation in health behaviors depends on perceived health status and category of health behaviors. Researchers can explore the role of other variables (e.g., functional status and perceived susceptibility to disease) to explain why perceived health status moderates the relations between critical thinking and participation in various types of health behaviors differently.

Activities of Daily Living↗
PubMed1995

Health care utilization for low back pain in Belgium. Influence of sociocultural factors and health beliefs.

STUDY DESIGN: A population-based survey was undertaken. OBJECTIVES: To describe health care utilization for low back pain (LBP) in a culturally diverse society with universal access to health care; to describe how LBP chronicity influences health care utilization; and to describe how sociocultural and demographic factors and health beliefs influence health care utilization. METHODS: A probability sample of approximately 5,000 Belgian adults stratified by gender, age, social class, and habitat was surveyed by trained interviewers. Information on demographics, health beliefs, frequency of LBP, and health care utilization was elicited. Statistical analysis was conducted by means of univariate and multivariate logistic regression. Analysis was restricted to 2,660 respondents with history of LBP. RESULTS: Of subjects with LBP, 38% reported daily LBP. Sixty-three percent had seen a health professional for the most recent episode; 11% had been on bed rest. Forty-four percent had at sometime undergone radiography; three and a half percent had ever undergone spinal surgery. Eighty-six percent considered themselves in good health. Controlling for LBP frequency, all forms of health care utilization examined were associated with health beliefs. CONCLUSIONS: LBP frequency, health beliefs, and sociocultural factors influence health care behaviors and utilization among adults with a history of LBP in a society with universal access to health care. The association of history of spinal surgery with reports of daily LBP suggests that spinal surgery has failed, at least partly, to relieve LBP.

Adolescent↗
PubMed1997

Aren't health services already promoting health?

Smoke-free health care environments are now the norm in Australia and exemplify the way in which environments for health care can become more health promoting. Community health services that assist people with chronic illnesses and disabilities to increase control over their lives, hospitals that provide nutritious food choices for staff and patients, and general practices that encourage routine preventive care throughout the life span are other examples of health-promoting environments. In their roles as providers of services, employers, community corporations and citizens, health care organisations have a wide range of opportunities for developing their capacity for health promotion. These include transforming the principles and values on which service delivery models are based, developing an organisational capacity for health promotion through staff training and designing programs, services and facilities to promote health. While some industry accreditation programs are evolving to embody specific elements that are health promoting, significant barriers to this area of organisational development continue to exist. These include disincentives linked with health care financing and the values, priorities and skills of health care workers who must turn rhetoric into practice. Just as the introduction of smoke-free environments success on research findings and a supportive political and social milieu to be successful, the further development of environments for health care which are health promoting in other ways will need to be driven by evidence and advocacy.

Australia↗
PubMed1994

Comprehensive periodic health examination: impact on health care utilisation and costs in a working population in Japan.

STUDY OBJECTIVE: To examine the impact of a comprehensive periodic health examination programme on health care utilisation and costs in a working population. DESIGN: A cohort method was used to observe the trends in health care utilisation and costs for a group of local government employees from 1 February 1986 until 31 January 1992, during which time (in 1988) a comprehensive periodic health examination programme had been introduced. Health care utilisation was measured by a claim rate per employee (number of claims in a year divided by number of employees) and a utilisation rate per 100 employees (number of employees who submitted at least one claim in a year divided by number of employees x 100). Health care costs were measured by claim costs per employee (total cost of claims divided by number of employees). National and prefectural changes in per capita health care costs were used for the adjustment of claim costs. Internal comparisons were made in relation to the intensiveness of the periodic health examinations administered before the introduction of the comprehensive programme. SETTING: Fukuoka Prefecture, Japan. PARTICIPANTS: A total of 19,146 local government employees (12,455 men, 6691 women) who worked in small cities, towns, and villages in Fukuoka Prefecture throughout the study period participated. MAIN RESULTS: Both the claim and utilisation rates showed an increase in 1988 when the comprehensive programme was introduced. After adjustment for the national changes in per capita health care costs and the aging effect of the study participants, substantial increases in claim costs were noted after introduction of the comprehensive programme. The programme had a greater but short term effect of increasing the health care utilisation of those who had received less intensive periodic health examinations before 1988, but no similar effect on claim costs was noted. CONCLUSIONS: The comprehensive programme had some role in increasing health care utilisation and costs. Its effect on costs was confirmed when the general population or another population was used as a reference. When comparisons were made internally, the comprehensive programme was seen to have had a greater but short term effect of increasing the utilisation of those who had previously received less intensive health examinations to equalise the health care utilisation and costs within the study population.

Adult↗