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PubMed1998

Status of hepatitis B immunization programmes in 1998.

More than 90 countries have now included hepatitis B (HB) immunization into their National Immunization Programmes as a routine vaccine given to all infants and/or adolescents and many additional countries are planning for the introduction in the next two years. These countries include all industrial countries except the United Kingdom, Ireland, The Netherlands, the Scandinavian countries and Japan. Countries with routine HB immunization include about 45% of surviving new-borns, but almost 70% of hepatitis B virus carriers live in countries with routine HB programmes. Population based studies of HB immunization from around the world are now being reported with as long as 10 to 15 years of follow-up, showing a reduction of the chronic HB carrier prevalence from high (8% or greater) to low (less than 2%) endemicity in immunized cohorts of infants. Reductions in the price of HB vaccines, a significant increase in the number of producers and the advent of combination vaccines including an HB component will make the vaccine available to more children world wide, but economic constraints continue to hamper introduction of this vaccine to the children in the poorest countries.

Hepatitis B↗
PubMed2002

Study to increase the frequency of autopsies performed for cases of infant deaths--proposed revision of the law on postmortem examination and corpse preservation and other related regulations.

By definition, sudden infant death syndrome (SIDS) requires diagnosis through exclusion by conducting an autopsy. To obtain a reliable diagnosis of this disease, an autopsy is essential. However, the frequency with which autopsies are conducted in Japan is not sufficient to meet the need associated with the diagnosis of SIDS. To improve this frequency, various public policies, such as nationwide implementation of the administrative autopsy system (medical examiner system), the application of the practice of autopsy approved by families, and legally required autopsies, are being considered; but none has been put into practice. On the other hand, attention has been called to the fact that the Law on postmortem examination and corpse preservation, which was instituted at the end of the Second World War, requires updating. In the current report, it is proposed that the following be added to Article 8, item 3 of this Law: "the Metropolitan or Prefectural Governor must insist that an autopsy be conducted on all cases of a sudden and unexpected death of an infant to investigate the cause of this death." At present, the annual incidence of SIDS in Japan is reported to be 500. To put the above-recommended legal requirement into practice, the estimated annual addition to the budget, if conducted as approved or an administrative autopsy, will be in the order of 150,000-500,000 dollar, which is within the prescribed limits for an appropriation.

Autopsy↗
PubMed1991

The deteriorating administrative efficiency of the U.S. health care system.

BACKGROUND AND METHODS: In 1983 the proportion of health care expenditures consumed by administration in the United States was 60 percent higher than in Canada and 97 percent higher than in Britain. To assess the effects of recent health policy initiatives on the administrative efficiency of health care, we examined four components of administrative costs in the United States and Canada for 1987: insurance overhead, hospital administration, nursing home administration, and physicians' billing and overhead expenses. Most data were provided by the two nations' federal health and statistics agencies, supplemented by state and provincial data and published sources. Because data on physicians' billing costs were limited, we estimated a range for these costs by two methods that rely on different sources of data. All figures are reported in 1987 U.S. dollars. RESULTS: In 1987 health care administration cost between $96.8 billion and $120.4 billion in the United States, amounting to 19.3 to 24.1 percent of total spending on health care, or $400 to $497 per capita. In Canada, between 8.4 and 11.1 percent of health care spending ($117 to $156 per capita) was devoted to administration. Administrative costs in the United States increased 37 percent in real dollars between 1983 and 1987, whereas in Canada they declined. The proportion of health care spending consumed by administration is now at least 117 percent higher in the United States than in Canada and accounts for about half the total difference in health care spending between the two nations. If health care administration in the United States had been as efficient as in Canada, $69.0 billion to $83.2 billion would have been saved in 1987. CONCLUSIONS: The administrative structure of the U.S. health care system is increasingly inefficient as compared with that of Canada's national health program. Recent health policies with the avowed goal of improving the efficiency of care have imposed substantial new bureaucratic costs and burdens.

Canada↗
PubMedDate not supplied

Medical device evaluation in the United Kingdom: past, present and future.

The evaluation of medical devices in the UK has been through many changes since the early hospital equipment assessments in the 1960s. The range of medical devices evaluated has increased and the evaluation reports published have changed, but the evaluation programme continues to be a respected service for the NHS and social care. This review documents the history of the Device Evaluation Service, from its beginnings to the present day, and looks forward to its future. Following an independent strategic review and the Healthcare Industries Task Force (HITF) recommendations, the Device Evaluation Service is now entering a new and exciting developmental phase.

Equipment Failure Analysis↗
PubMed1998

Pneumococcal vaccination in the United States and 20 other developed countries, 1981-1996.

This survey describes patterns of pneumococcal polysaccharide vaccine use, vaccine registration, vaccination recommendations, and reimbursement for vaccination in the United States and 20 other developed countries during the period 1981 through 1996. The United States was the only country to use appreciable amounts of the vaccine throughout the study period. Annual vaccine use was staple from 1982 through 1990 but then increased sharply. In the 20 other countries, very little pneumococcal vaccine was used until the 1990s, when new registrations and/or national recommendations were followed by dramatic increases in vaccine use in Iceland (1991), the United Kingdom (1994), Sweden (1995), and Norway, Belgium, and the province of Ontario in Canada (1996). In 1996, pneumococcal vaccine was still not licensed in three and not recommended in four of the 21 countries. Of the seven countries that used the most pneumococcal vaccine, public reimbursement for vaccination was provided in the United States, Canada, and the United Kingdom but not in Iceland, Sweden, Norway, or Belgium.

Bacterial Vaccines↗
PubMed2001

Adolescent hepatitis B immunisation--should it be the law?

Universal hepatitis B immunisation of young adolescents was included in the Australian Standard Vaccination Schedule in 1998. However, rates of immunisation among adolescents world-wide have often been inadequate. Australia's experience in this area is no exception, particularly in States where school-based delivery is not carried out. Legislation for pre-school immunisation certification currently exists in several States and this legislation is distinctly different from the compulsory or mandatory immunisation that exists in several other developed countries. There have been demonstrable gains in uptake as a result of mandatory immunisation requirements in the United States and there is evidence to suggest that immunisation certification in Australia has also been beneficial. However, it is important to recognise that both certification and mandatory immunisation legislation have inherent difficulties. In this paper, we argue that legislation for high school immunisation certification, as part of a multi-faceted vaccine delivery strategy tailored to adolescents, is required to achieve the uptake that will lead to interruption of transmission of the hepatitis B virus in Australia. Not only will it substantially reduce incident cases of hepatitis B for the next decade, it will also provide a framework for the successful introduction of future adolescent vaccine initiatives in Australia.

Adolescent↗
PubMed2006

Canada urgently needs a national network of libraries to access evidence.

Canadian health professionals and their patients are deprived of important evidence to guide health and healthcare decisions, ensure quality and avoid unnecessary deaths because, unlike other developed countries, Canada does not have a national medical library as can be found in the United States' National Library of Medicine and the United Kingdom's National Health Service.

Canada↗
PubMed1993

Local advocacy for the medically indigent: strategies and accomplishments in one county.

Because no national health program assures entitlement to basic services, advocates must cope with barriers to access on the local level. The authors report several strategies that a community-based coalition has used to improve indigent care in one county. Research strategies have involved short-term investigations of barriers to needed services. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor. Legal strategies have involved the participation of attorneys who represent clients unable to receive care. Although such advocacy efforts do not guarantee access, they can substantially improve the availability of local services.

California↗
PubMed1994

The strange career of managed competition: from military failure to medical success?

Managed competition remains untested as the basis of a national health program. However, key principles of managed competition first emerged in the military. For this study, published works on systems analysis and the planning-programming-budgeting system (PPBS), developed by Alain Enthoven and colleagues at the US Department of Defense during the 1960s, were compared with published presentations of managed competition. The influence of PPBS waned after it generated controversy and opposition. PPBS and managed competition represent similar managerial strategies of policy reform. Although the origin of managed competition in failed military policy does not ensure failure in the medical arena, this history also does not augur success.

Cost-Benefit Analysis↗
PubMed2001

Health issues and the Pala Indian Reservation, 1903-20.

Joel R. Hyer investigates health conditions on one Indian reservation in Southern California during the first two decades of the twentieth century. Hyer contends that unsanitary conditions on the Pala Reservation actually facilitated the spread of diseases among local Cupeño, Luiseño, and Kumeyaay Indians. He also describes how the United States federal government employed doctors, field matrons, and others to promote good health and combat disease among Indians at Pala. The author asserts that, despite their altruistic intentions, some of these government workers attempted to discourage local indigenous peoples from consulting their shamans for medical attention - Native healers whose extensive knowledge of roots and herbs had cured many forms of illness for years. In addition, the teacher at the reservation's day school sought to prevent the spread of disease among her Indian pupils by exposing them to American modes of health care. Furthermore, Hyer maintains that one national health program, the "Save the Babies" campaign, was successful on the Pala Reservation because Indian mothers believed in it and followed specific guidelines to lower mortality rates among their own children. Throughout his essay, the author addresses the pressures of assimilation and acculturation that were so accute at this time in the United States. Hyer concludes by suggesting that many of his findings reflect broader health trends on Indian reservations throughout the United States during this period.

Acculturation↗
PubMed2005

Q fever vaccine uptake in South Australian meat processors prior to the introduction of the National Q Fever Management Program.

Despite the availability of a vaccine, the incidence of Q fever disease among populations at risk continues to be high. Q fever is an important cause of morbidity for workers, particularly in the meat and agricultural industries. Following an increase in 1998 in the number of Q fever notifications among meat processors to the Communicable Disease Control Branch, South Australia, a survey was conducted in the same year to assess the uptake of Q fever immunisation programs in meat processors and to identify barriers to offering these programs. This survey was conducted prior to the introduction of the National Q Fever Management Program in 2001 that provided a targeted vaccination program to specific at-risk occupations. The results of the survey highlighted that very few meat processors in South Australia offered a Q fever immunisation program to their workers. More importantly, this article highlights that there was a wide variety of attitudes and beliefs about Q fever disease and its prevention. These attitudes and beliefs have the potential to impact on whether workers at risk are offered or seek Q fever vaccination. Previous attitudes may return and levels of protection in at-risk occupations will decrease without a concerted effort at a state level. A replication of this study should benchmark the prevailing attitudes about Q fever programs. In response to the 1998 survey a number of strategies and initiatives were developed to address the barriers to Q fever vaccination in South Australian meat processors. The National Q Fever Management Program (2001-2005) further enhanced the ability to address barriers such as vaccine cost.

Abattoirs↗
PubMed2000

Pharmacotherapy of nicotine dependence.

Withdrawal treatment of cigarette smokers is a task of the utmost urgency in view of the consequences for national health programs and legislative policies of the high morbidity and mortality rates caused by smoking. Smokers need medical consultation in addition to drug-based treatment, but this results in self-willed quitting of the smoking habit in a limited number of smokers only. From the point of view of the criteria of "evidence-based medicine", non-drug methods such as hypnosis therapy and acupuncture are not effective (odds ratio = 1.22). Among the drug-based methods, treatment with nicotine substitution preparations has shown confirmed efficacy in numerous studies (odds ratio 1.63 to 2.67, depending on the application form used) and results in successful withdrawal from the smoking habit in 30-40% of cases. A decisive problem in the initial therapeutic phase appears to be the amount of the applied nicotine dose, but beyond that can be mastered above all by combining 2 or 3 application forms (patchs, chewing gum, nasal spray). Treatment is then continued for 4-12 weeks, depending on the degree of dependence, with successively reduced nicotine dosage. Two controlled studies with disparate designs have been done on bupropion (odds ratio 2.3/3.0). However, further studies are desirable due to concern about undesirable effects of bupropion described recently. Other substances subjected to trials in years past, such as clonidine, lobeline, mecamylamine and antidepressants including buspirone cannot be recommended on the basis of current data for treatment of smokers seeking a withdrawal cure.

Bupropion↗
PubMed1993

Managed competition. An analysis of consumer concerns. Single-Payer Coalition for Health Security.

This analysis of managed competition was written by the Single-Payer Coalition for Health Security, a broad-based coalition of groups representing for the most part consumers of health care, including American Public Health Association; Church Women United; Citizen Action; Consumers Union; National Association of Social Workers; National Council of Senior Citizens; Neighbor to Neighbor; NETWORK: A National Catholic Social Justice Lobby; Oil, Chemical & Atomic Workers International Union; Older Women's League; Physicians for a National Health Program; Public Citizen; United Cerebral Palsy Associations; and United Church of Christ. What follows is a substantial excerpt from their working paper, issued in January 1993.

Competitive Medical Plans↗
PubMed1976

Sudan: national health programme and primary health care, 1977/78-1983/84.

As a follow-up to the national health programming process developed in 1975 in Sudan, a primary health care programme for the whole country was formulated with assistance from WHO. In this article the methods used in the programming and formulation are described and discussed. These methods ensured an intersectoral approach on which technical, cultural, socioeconomic, financial, and political considerations were based. Areas in the field of health and rural development requiring government and community action during the period 1977/78-1983/84 are identified. Details on the strategies for population coverage of rural and nomadic communities with primary health care are given. Fundamental to these strategies is community participation in the development of primary health care within community development as a whole.The guiding principles of these strategies are their technical, political, social and financial feasibility. The social relevance of the primary health care programme for the community and the developmental sectors is emphasized.

Health Planning↗