Community health and the midwife.
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Community Health Services↗
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Profile of public health nutrition personnel: challenges for population/system-focused roles and state-level monitoring.
OBJECTIVE: Our 3 objectives were to document the current public health nutrition workforce in the United States, identify top public health nutrition priorities for the next 5 years, and assess the capacity of public health nutrition personnel to address these priorities and the nutrition-related objectives of Healthy People 2000. DESIGN: A census survey was distributed to public health nutrition personnel in all state and local health agencies and nonprofit and for-profit agencies funded by official health agencies throughout the United States and US territories. Also, state and territorial nutrition directors were sent a different questionnaire. SUBJECTS: Data were collected from 49 states, the District of Columbia, and 2 territories; 7,550 public health nutrition personnel were represented. STATISTICAL ANALYSIS: Data were analyzed using EpiInfo software. Descriptive statistics are presented. RESULTS: Almost half of the respondents worked in local or county health agencies and about two thirds were involved in direct care services. Only about 40% were registered dietitians and about one fourth had a master's degree. Almost 90% of all full-time equivalent positions were funded through federal dollars; 78% of all funding was from the Special Supplemental Nutrition Program for Women, Infants, and Children. Top health concerns identified were diet/nutrition to prevent chronic disease, low breast-feeding rates, low birth weight, iron deficiency anemia, and obesity/overweight. Public health nutrition personnel will be challenged to assume population/system-focused roles and state-level monitoring of Healthy People 2000 objectives. Only 2 of the 17 nutrition objectives of Healthy People 2000 were monitored by more than 50% of the states. APPLICATIONS: If official health agencies are to shift to public health core functions, as recommended by an Institute of Medicine report, then a substantial proportion of the public health nutrition workforce must not only change how they practice but also obtain the knowledge and skills to do so. Strategies to improve workforce capacity are discussed, including continuing education interventions through professional organizations, distance and on-campus educational opportunities through approved public health nutrition programs, and advocacy for new funding streams focused on public health core functions.
Dietetics↗
[EURO-Medicines: a European program for bringing into agreement public health policies on drugs].
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Benchmarking↗
Devolution. How will the family planning program be affected when local governments get greater autonomy?
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Asia↗
Assistive devices: utilization by children.
The use of assistive devices by children has become widespread and has been supported financially by insurance carriers and governments. However, there has been little evaluation of the utilization of these devices. To determine utilization of, satisfaction with, and perceived value of the aid, an independent evaluator contacted 502 families who had used a provincial government funding program to obtain an assistive device. High levels of use, satisfaction, and perceived value were reported, indicating that a decentralized funding program can provide aids effectively.
Child↗
Sexually transmitted infections in female sex workers: reduced by condom use but not by a limited periodic examination program.
BACKGROUND AND OBJECTIVES: The sexually transmitted diseases (STD) control program for female sex workers (FSW) in Lima, Peru, provided periodic serological tests for syphilis and cervical smears for gonococci, but not medication for STD or condoms. GOAL OF THIS STUDY: To assess program effectiveness. STUDY DESIGN: We assessed prevalence of current STD and serum antibody to STD pathogens in FSW in relation to program participation and to condom use. RESULTS: Program participation was not associated with significantly reduced rates of current gonococcal or chlamydial infections or Venereal Disease Research Laboratory (VDRL) titers > or =4 with reactive fluorescent treponemal antibody absorption (FTA-ABS). However, regardless of control program participation, consistent condom use was associated with reduced prevalence of gonorrhea, and with significantly reduced seroreactivity for FTA-ABS, C. trachomatis, anti-hepatitis B core (HBc), and anti-human T-lymphotropic virus type I. Anti-HBc was associated with years of receiving penicillin injections for syphilis prophylaxis. CONCLUSION: The scope, quality, and efficacy of STD control programs must be technically appropriate, well managed, and adequately financed. The safety of marginal programs warrants scrutiny.
Adult↗
Initial findings from the evaluation of the Alzheimer's Disease Demonstration Grants to States Program.
This article describes the initial development and implementation of the Alzheimer's Disease Demonstration Grants to States (ADDGS) program in 15 states. In addition to describing the services delivered and the client populations served, key elements of program development are discussed. Development strategies common to the programs that most successfully used the demonstration as a catalyst for developing services that are likely to continue are identified. Successful community programs were characterized by community commitment fostered by forging new partnerships and expanding public awareness. Success was also linked to the creation of new resources an d flexibility in implementation of the federal program.
Aged↗
Ethics of the distribution of health care.
While the concept of a "right to health care" has been evolving in the United States, this should be distinguished from "the right to health," guaranteed in the constitutions of many socialist countries. In an effort to promote "quality of life" for their citizens, governments can, and do provide health care, but this does not always lead to health. In so doing, governments open access to care for those previously underserved--or unserved. For the United States at this time the goal becomes one of assuring equity, which will likely be achieved by locally based private and/or governmental entities, federated for greater efficiency and regulated by federal and state governments. Such programs will be staffed by a new breed of physician, the medical student of today.
Delivery of Health Care↗
[The federal targetted programs Children of the North and Children of Refugee Families and of Forced Migrants. Their structure and tasks].
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Child↗
Using principles of community-based participatory research to enhance health data skills among local public health community partners.
In a prior statewide health disparities assessment, local community public health and social service professionals indicated a need for technical capacity growth in order to understand and effectively utilize health data. Using a community-based participatory research approach in addressing this need, health data training was provided to 26 individuals with the primary goals being to provide capacity to identify health disparities that result in higher morbidity and mortality, and to provide the skills needed to access, interpret, and utilize health data. Satisfaction surveys showed that an overwhelming majority of participants were extremely pleased with the training. Follow-up telephone interviews (100% response rate) conducted 2 months after the training indicated positive results, with participants discussing how they felt empowered to find, interpret, and use data as a result of the training. Results of a 6-month follow-up questionnaire (54% response rate) further supported the program's desired outcome to expand participants' knowledge and use of health data. This pilot project illustrated how utilizing a community-level partnership approach to program development not only enhances the utilization of such programs but also helps sustain participants' knowledge and skills.
Community Participation↗
Aging and the environment: a research framework.
The rapid growth in the number of older Americans has many implications for public health, including the need to better understand the risks posed to older adults by environmental exposures. Biologic capacity declines with normal aging; this may be exacerbated in individuals with pre-existing health conditions. This decline can result in compromised pharmacokinetic and pharmacodynamic responses to environmental exposures encountered in daily activities. In recognition of this issue, the U.S. Environmental Protection Agency (EPA) is developing a research agenda on the environment and older adults. The U.S. EPA proposes to apply an environmental public health paradigm to better understand the relationships between external pollution sources --> human exposures --> internal dose --> early biologic effect --> adverse health effects for older adults. The initial challenge will be using information about aging-related changes in exposure, pharmacokinetic, and pharmacodynamic factors to identify susceptible subgroups within the diverse population of older adults. These changes may interact with specific diseases of aging or medications used to treat these conditions. Constructs such as "frailty" may help to capture some of the diversity in the older adult population. Data are needed regarding a) behavior/activity patterns and exposure to the pollutants in the microenvironments of older adults; b) changes in absorption, distribution, metabolism, and excretion with aging; c) alterations in reserve capacity that alter the body's ability to compensate for the effects of environmental exposures; and d) strategies for effective communication of risk and risk reduction methods to older individuals and communities. This article summarizes the U.S. EPA's development of a framework to address and prioritize the exposure, health effects, and risk communications concerns for the U.S. EPA's evolving research program on older adults as a susceptible subpopulation.
Aged↗
University of Wyoming, College of Engineering, undergraduate design projects to aid Wyoming persons with disabilities.
In Spring 2002 the University of Wyoming received NSF funding from the Division of Bioengineering and Environmental Systems to provide a meaningful design experience for University of Wyoming, College of Engineering students that will directly aid individuals with disabilities within the state of Wyoming. Other universities have participated in this very worthwhile program [1, 2, 3]. To achieve the program purpose, the following objectives were established: Provide engineering students multi-disciplinary, meaningful, community service design projects, Provide persons with disabilities assistive devices to empower them to achieve the maximum individual growth and development and afford them the opportunity to participate in all aspects of life as they choose, Provide engineering students education and awareness on the special needs and challenges of persons with disabilities, and Provide undergraduate engineering students exposure to the biomedical field of engineering. To accomplish these objectives the College of Engineering partnered with three organizations that provide education and service related to disability. Specifically, the college has joined with the Wyoming Institute for Disabilities (WIND) assistive technology program, Wyoming New Options in Technology (WYNOT) and their Sports and Outdoor Assistive Recreation (SOAR) project along with the university's Special Education program. In this paper we will describe how the program was created, developed, and its current status.
Biomedical Engineering↗
Surveillance for stroke in Canada.
The goal of surveillance is to identify patterns of disease occurrence, detect disease outbreaks, develop clues about possible risk factors, find persons that need further investigation, and anticipate health service needs. Two sources of data are available for the purposes of surveillance: primary data, such as those arising from health surveys or local population-based registries; and secondary data, arising from large administrative databases. The effectiveness of any program to monitor the health of a community can be judged by the application of three "r's": right (accuracy), reasonable (cost) and rapid (speed). Programs using primary sources of data satisfy only one of the three "r's," that of accuracy. Programs using secondary sources sacrifice accuracy for speed and cost. The challenge for Canada in setting up surveillance for stroke is that there is a relatively small population unevenly distributed over a very large geographical area. To date, surveillance in Canada has consisted of a combination of individually initiated research projects and government sponsored programs. The main focus has been to tackle the issue of the accuracy of the large databases by validating the discharge codes listed in the provincial hospital discharge databases. Three provinces have carried out independent validation studies yielding remarkably similar results, and this lends confidence that hospital discharge databases will provide a means of carrying out surveillance for at least this one aspect of stroke. It is likely that any program for stroke surveillance in Canada will be multifaceted, involving the use of large computerized databases supplemented by hospital-based registries set up in a few highly motivated local centres. Stroke surveillance will best be accomplished by a joint effort between government and researchers to ensure that the end product is of high quality and will meet the needs of improving the health of Canadians.
Aged↗
Are lower legal blood alcohol limits and a combination of sanctions desirable in reducing drunken driver-involved traffic fatalities and traffic accidents?
In 1970 and 1978, a set of strict new countermeasures against drunk driving went in to effect in Japan. Analysis of official statistics of motor vehicle fatality data have indicated that alcohol involvement in fatal crashes has declined substantially in Japan since 1970. From the beginning of 1970 to the late 1980s and 1990s, public awareness of and tolerance for the problem of alcohol-impaired driving changed dramatically, as shown in this study. Further it seems that attitudes in Japan on drink driving have improved over the last 20 years or so, instep with a major program of government action. As well as being part of a long running campaign to reduce alcohol related road deaths and injuries, these accident savings are an important part of a national strategy which began in 1970, comprising a well structured legislative program introducing a lower legal limit, progressive penalties for those above the legal limit, over and above Police enforcement strategies underpinning the law and reinforcing the publicity massage. Enactment of the lower legal blood alcohol level with a combination of other severe sanctions is desirable for prevention of alcohol-related traffic casualties, DWI, and accidents, which is shown in this study. Finally, much of the current reduction in alcohol-related fatalities and morbidity reflects that Japanese society has largely endorsed alcohol impaired driving as a socially undesirable behavior. However, this study suggests that it is necessary for policy makers to understand that the DUI problem in Japan must be handled with diverse approaches, rather than relying exclusively on the deterrence based laws.
Accidents, Traffic↗
Poverty, food programs, and childhood obesity.
Sixteen percent of children 6-11 years of age were classified as overweight in 1999-2002, four times the percentage in 1965. Although poverty has traditionally been associated with underweight as a result of poor diet, researchers have recently pointed to a paradox in the U.S., which is that low income and obesity can coexist in the same population. This paper first examines whether income is linked to overweight in school-age children. Second, it explores whether food programs such as the Food Stamp Program, the National School Lunch Program, and the School Breakfast Program are associated with overweight among children in different income groups. The data come from the nationally representative 1997 Panel Study of Income Dynamics Child Development Supplement. No evidence either that poor children are more likely to be overweight or that food programs contribute to overweight among poor children was found.
Body Mass Index↗
Federal employees health benefits program; revision of contract cost principles and procedures, and miscellaneous changes. Final rule.
The U.S. Office of Personnel Management (OPM) is issuing a final regulation amending the Federal Employees Health Benefits (FEHB) Acquisition Regulation (FEHBAR). This regulation provides additional contract cost principles and procedures for FEHB Program experience-rated contracts and is intended to clarify our requirements and enhance our oversight of FEHB carriers.
Contract Services↗
A model for primary care delivery to a widely dispersed medically indigent population.
Access to Care is a unique program uniting private and public resources to provide primary care to the uninsured poor. The model was designed to serve a medically indigent population that is dispersed over a large geographic area, where clinics are not a practical option. Care for illness is provided in the offices of private physicians throughout the area and supported by laboratory, radiology, and pharmacy services. The program is designed for the estimated 88,000 persons in suburban Cook County, Illinois, with family incomes of less than twice the federal poverty level, who are uninsured and ineligible for Medicaid and Medicare. Supported by grants from foundations and local governments, the program, which has been in operation for 2 years in two demonstration areas, is administered by a private not-for-profit confederation of four health and social service organizations.
Delivery of Health Care↗
The US national isotope program: current status and strategy for future success.
Since their introduction in the 1940s, peaceful use of stable isotopes and radioisotopes in the United States has expanded continuously. Today, new isotopes for diagnostic and therapeutic uses are not being developed, critical isotopes for national security are in short supply, and demand for isotopes critical to homeland security exceeds supply. While commercial suppliers, both domestic and foreign, can only meet specific needs, the nation needs a consistent, reliable supply of radioactive and stable isotopes for research, medical, security, and space power applications. The national isotope infrastructure, defined as both facilities and trained staff at national laboratories and universities, is in danger of being lost due to chronic underfunding. With the specific recommendations given herein, the US Department of Energy may realign and refocus its Isotope Program to provide a framework for a successful National Isotope Program.
Government Agencies↗