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PubMed2000

The context of HIV/AIDS surveillance.

HIV surveillance and diagnostic testing for HIV infection share elements in common, yet differ notably in context. Clinical testing provides vital information for individual medical and behavioral decisions, whereas surveillance, which focuses on populations, provides information to develop policy, direct resources, and plan services. HIV/AIDS surveillance has evolved over the course of the epidemic, reflecting changes in scientific knowledge, populations affected, and information needs. Likewise, the benefits of early diagnosis of HIV have become increasingly apparent with advances in HIV treatment. This article examines the changing context of HIV/AIDS surveillance and discusses the potential impact of HIV surveillance practices and policies on HIV testing behaviors. Special emphasis is placed on the importance of protecting the confidentiality of HIV/AIDS surveillance data and on the role of health department in monitoring the impact of surveillance policies on test-seeking patterns and behaviors.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Pediatric intensive care: the parents' experience.

A child's emergent admission to the pediatric intensive care unit (PICU) can strike fear and feelings of helplessness into the hearts of parents who only hours earlier had been in control of their lives. Acute critical illness seriously threatens the parents' ability to fulfill their familiar and important roles of protecting and providing for their child. The PICU setting can rapidly undermine the sense of competence, control, and stability of even the most dedicated parents. Parental stress is primarily caused by their displacement from familiar roles, the child's appearance and behavior, and difficulties in communicating with staff members. In planning interventions, these issues should be considered as well as the specific needs that parents have emphasized: accurate information, ready access to their children, and meaningful participation in their children's care. Advanced practice nurses are in an excellent position to improve delivery of psychosocial services to parents of critically ill children through direct care, acting as models of care practices and mentoring staff, staff education, policy development, and clinical research.

Adult↗

PubMed1997

Assessing public health performance in Iowa's counties.

Local health agencies in Iowa were surveyed to assess the performance of public health practices in their communities. Responses were received from 97 percent of counties. Less than 50 percent of counties were performing half of the indicators of the Assessment function. Policy Development functions also were frequently not performed. Performance was best in the Assurance function, with 86 percent of counties reporting that they inform and educate the public. However, the other three types of Assurance practices (Manage, Implement, and Evaluate) were performed less frequently. Comparison of the performance of Iowa's rural counties reveals a profile nearly identical to that reported elsewhere for a group of six other states.

Benchmarking↗

PubMed1997

Typology of local health departments based on maternal and child health core functions.

A survey of Missouri local health departments (LHDs) was conducted to measure core public health functions within maternal and child health (MCH). Measurement was based on a prior key informant study that defined each core function as a set of specific MCH activities, programs, and services. The 59 items in the survey operationalized these activities and enabled the creation of summary scores for assessment, policy development, and assurance. Participation included 93 of the 112 Missouri LHDs (83%) in 1995. Reliability coefficients for the summary scores ranged from .83 to .92. Cluster analysis produced six types of LHDs with differing core function patterns. By matching efforts to improve core function practice to LHD type, more efficient use of capacity building resources may result.

Female↗

PubMed1999

Who speaks for public health agencies: assessing the core functions in local health departments.

Several large-scale studies have attempted to measure public health agency performance of core functions by interviewing health directors. Because it is not self evident that a single respondent results in a valid performance assessment, the purpose of this study was to examine the relationship between two characteristics--position in the agency and racial/ethnic identity--and perceptions of the performance of core functions. Supervisors differed from nonsupervisors and Whites differed from African Americans in their perceptions of practices reflecting assessment and policy development. Efforts to develop surveillance measures of a complex institution such as a health department should incorporate methodologies to validate the responses.

Administrative Personnel↗

PubMedDate not supplied

The role of epidemiology in chronic disease prevention and health promotion programs.

Although the role for epidemiology is widely accepted in public health programs in general, its role in chronic disease programs is not as widely recognized. One possible barrier to improving epidemiologic capacity in chronic disease prevention and health promotion programs is that chronic disease program managers and public health decision makers may have a limited understanding of basic chronic disease epidemiology functions. We describe the assessment process of data collection, analysis, interpretation, and dissemination, and, using examples from two states, illustrate how this approach can be used to support program and policy development in three areas: by defining the problem, finding programs that work, and evaluating the effects of the program over time. Given the significant burden of chronic diseases in the United States, the scientific guidance provided by epidemiology is essential to help public health leaders identify priorities and intervene with evidence-based and effective prevention and control programs.

Chronic Disease↗

PubMedDate not supplied

The edge of America: struggling for health and justice.

The National Association of County and City Health Officials (NACCHO) is the national organization representing local public health agencies. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.

Community Health Planning↗

PubMedDate not supplied

Local health department and academic partnerships: education beyond the ivy walls.

The National Association of County and City Health Officials (NACCHO) is the national organization representing local health departments. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.

Cooperative Behavior↗

PubMedDate not supplied

Influenza, local public health practice, and the necessary paradigm shift.

Humans↗

PubMedDate not supplied

2005 National profile of local health departments.

Catchment Area, Health↗

PubMedDate not supplied

Searching for lessons from the New Orleans Health Department: implications for public health practice.

The National Association footline of County and City Health Officials (NACCHO) is the national organization representing local health departments. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.

Disaster Planning↗

PubMedDate not supplied

Managing intravenous medications in the non-hospital setting: an ethnographic investigation.

Little published information exists about the issues involved in conducting complex intravenous medication therapy in patients' homes. An ethnographic study of a local hospital-in-the-home program in the Australian Capital Territory explored this phenomenon to identify those factors that had an impact on the use of medicine in the home environment. This article focuses on one of the three themes identified in the study-Clinical Practice. Within this theme, topics related to the organization and management of intravenous medications, geography and diversity of patient caseload, and communication in the practice setting are discussed. These findings have important implications for policy development and establishment of a research agenda for hospital-in-the-home services.

Adaptation, Psychological↗

PubMed2025

Causal relationships between modifiable risk factors and heart failure: A comprehensive Mendelian randomization study.

Heart failure threatens human health across the globe. Comprehensively identifying its risk factors has public health importance. This work utilized the Mendelian randomization (MR) method to evaluate the effects of over 200 modifiable factors on heart failure. The data from genome-wide association studies (GWAS) was used, with the sample size ranging from 711 to 1232,091. Two distinct GWAS datasets for heart failure were employed for results validation. The inverse variance weighted (IVW) method was used and other supplementary models were employed for comparison. Sensitivity analysis was conducted to verify the results. After integrating the MR estimates derived from heart failure GWAS datasets from integrative epidemiology unit (IEU) and Finngen, we found that body measurement indices like body mass index, whole body fat mass, trunk fat mass, basal metabolic rate, body fat percentage, waist circumference, and waist-hip ratio, were associated with a higher risk of heart failure. Similarly, smoking behavior, sedentary behavior, overall health rating, and type 2 diabetes were determined to increase the risk of heart failure. In contrast, college or university degree showed a protective effect on heart failure. Among these significant findings, body mass index, whole body fat mass, trunk fat mass, basal metabolic rate, body fat percentage, overall health rating, smoking initiation, waist circumference, lifetime smoking index, college or university degree, sedentary behavior, waist-hip ratio, and type 2 diabetes were replicated validated. This MR work figured out that obesity, socioeconomic factors, lifestyle factors, and metabolic features showed broad relations with heart failure. The findings would provide evidence for future policy development for the management of heart failure.

Humans↗

PubMed1998

The changing nature of conflict and famine vulnerability: the case of livestock raiding in Turkana District, Kenya.

The context of famine in Turkana has changed in recent years as the role played by livestock raiding in contributing to famine has increased. External responses to famine in Turkana have largely been drought driven, for example, food assistance and livestock restocking programmers, which have failed to meet the real needs of herders. The role of armed conflict in the form of raiding has been overlooked as a common feature of societies facing famine and food insecurity. The traditional livelihood-enhancing functions of livestock raiding are contrasted with the more predatory forms common today. The direct impact of raiding on livelihood security can be devastating, while the threat of raids and measures taken to cope with this uncertainty undermine herders' livelihood strategies. Self-imposed restrictions on mobility negatively affect the vegetation of both grazed and ungrazed pastures and restrict the available survival strategies. Predatory raiding leads to a collapse in the moral economy. Some implications of this for relief and development policy are considered, including approaches to conflict resolution.

Animal Husbandry↗

PubMed2000

The political economy of complex emergency and recovery in northern Ethiopia.

During the 1980s Ethiopia experienced the effects of conflict, drought and famine on a scale far greater than many CPEs elsewhere. In May 1991, after the decisive defeat of the military dictatorship of Mengistu Haile Mariam by the Ethiopian Peoples' Revolutionary Democratic Front (EPRDF) and after decades of civil war, drought and famine, Ethiopia faced the prospects of peace and of much needed development. This paper explores both Ethiopia's experience of conflict and humanitarian intervention in areas of Tigray held by the Tigray Peoples' Liberation Front (TPLF) during the 1980s, and its experience of post-conflict rehabilitation and reconstruction in the 1990s. It first deals with the roots of the conflicts within Ethiopia: political marginalisation, heavy state intervention and highly extractive relations between state and peasants, inappropriate and failed development policies, ethnic identity and the politicisation of ethnicity. The Mengistu regime's counter-insurgency measures are then contrasted with the policies and programmes of the TPLF, Ethiopia's most effective opposition movement and the leading element in the EPRDF, and its achievements in mobilising popular support: its establishment of democratically elected structures of local governance and its famine relief distribution programme.

Disasters↗

PubMed2004

The sociocultural context of condom use within marriage in rural Lebanon.

Prevalence rates for condom use are low across the Middle East despite limited alternate contraceptive options and growing awareness of sexually transmitted diseases (STDs) and HIV/AIDS. Virtually no research exists to explain this situation and to guide policy development or effective interventions. An analysis of 25 focus-group discussions with married women and men, interviews with service providers, and a survey of 589 women of childbearing age in a rural district of southern Lebanon reveal that a broad and complex set of sociocultural factors influence condom use. In the study area, 7 percent of married women currently use condoms, 24 percent reported ever use, and inconsistent use is common. Condoms are preferred primarily for their lack of physiological side effects. Five factors were found to impede method adoption and sustained use. These include various encumbering beliefs, reduced sexual pleasure, adverse experiences, gender-related fears and tensions, and a residual social stigma attached to condoms. Several strategies are suggested to increase and improve condom use. These issues will assume greater importance as fertility declines further in the region, demand for contraception continues to increase, and STDs and HIV/AIDS become more deeply rooted, as has occurred in other parts of the world.

Adolescent↗

PubMed2004

Dilemmas and challenges for the shelter sector: lessons learned from the Sphere revision process.

Key dilemmas and challenges for those involved in the shelter sector are described, based on issues that emerged from the extensive global consultative process undertaken to inform the revision of the Sphere handbook. The range of perspectives on the major themes is presented, with suggestions as to how these issues could be progressed. Themes include the poor definition of the sector and the lack of a consistent approach among the leading shelter actors; the absence of a common terminology; the conflict between "temporary" versus "durable" solutions; the disconnect between technical advisers and the field; the need for greater recognition of local coping strategies and the local context; the involvement of recipients and host governments in policy development; the need for better "how-to" guidance; and the limited incorporation of the emerging themes of livelihoods etc. to date.

Housing↗

PubMed2004

Psycho-educational interventions for children with chronic disease, parents and siblings: an overview of the research evidence base.

BACKGROUND: The role of psycho-educational interventions in facilitating adaptation to chronic disease has received growing recognition and is in keeping with policy developments advocating greater involvement of patients in their own care. The purpose of this paper is to provide an overview of the current literature regarding the effectiveness of psycho-educational interventions for children and adolescents with chronic disease, their parents and siblings. METHODS: Electronic searches were conducted using AMED, CINAHL, Cochrane Database, DARE, HTA, MEDLINE, NHS EED, PsycLIT, PsycINFO, and PubMED. Inclusion criteria were systematic reviews, meta-analyses and overviews based on traditional reviews of published literature. The titles of papers were reviewed, abstracts were obtained and reviewed, and full copies of selected papers were obtained. RESULTS: No reviews of psycho-educational interventions were found for either parents or siblings. Twelve reviews of interventions for children and adolescents were identified: chronic disease in general (three); chronic pain (one); asthma (three); chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) (one); diabetes (two); juvenile idiopathic arthritis (JIA) (one) and one informational intervention for paediatric cancer patients. The main focus was on disease management (particularly in asthma and diabetes) with less attention being paid to psychosocial aspects of life with a chronic condition. Overall, there is evidence of effectiveness for interventions incorporating cognitive-behavioural techniques on variables such as self-efficacy, self-management of disease, family functioning, psychosocial well-being, reduced isolation, social competence, knowledge, hope, pain (for chronic headache), lung function (asthma), days absent from school (asthma), visits to A & E (asthma), fatigue (CFS), and metabolic control (diabetes). A number of gaps and limitations were identified across all disease categories, such as inadequate description of interventions, small sample sizes, and lack of evidence regarding cost-effectiveness. CONCLUSION: This overview has highlighted the need to extend the evidence base for psycho-educational interventions, particularly in a UK context. It is essential that effective interventions are implemented and embedded in service provision in order to maximize empowerment through self-care for children, adolescents and their parents.

Adaptation, Psychological↗