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At least 145 records · Page 8Linked to original sources
PubMed2002

Phase specific strategies for the prevention, control, and elimination of sexually transmitted infections: case study in Lambeth, Southwark, and Lewisham, London, UK.

Lambeth, Southwark, and Lewisham are three London boroughs that probably have the worst set of indicators of sexual health in the United Kingdom. This area is used to illustrate an urban epidemic of bacterial sexually transmitted infections in an industrialised country with well developed public health infrastructure, and the generalisability of the phase specific model for prevention and control of sexually trasmitted infections. The results show that national strategies for preventing and controlling sexually transmitted infections comprise a limited repertoire of activities that fit with those suggested by the phase specific model. Specific strategies for men and for young black heterosexuals in the most heavily affected areas should be developed. There is, however, insufficient empirical evidence about whether particular interventions introduced at different epidemic stages are effective.

Adolescent↗
PubMed2002

Innovations in collaboration for the public's health through the Turning Point Initiative: the W.K. Kellogg Foundation perspective.

The need for a more integrated public health system led the W. K. Kellogg Foundation (WKKF) to establish Turning Point (TP): Collaborating for a New Century in Public Health, with a goal of transforming and strengthening the current public health infrastructure. WKKF partners with the Robert Wood Johnson Foundation (RWJF), the National Association of County and City Health Officials, the University of Washington, the Lewin Group, and the New York Academy of Medicine to support activities of 41 community and tribal jurisdiction grantee partnerships in 14 states. Preliminary evaluation of partnerships participation indicate: (1) most have accomplished breadth; (2) many did not achieve depth prior to the end of initial recruitment and (3) when the mission was internalized, penetration occurred. Strengthening public health systems requires redevelopment of human, organizational, financial, educational and information resources, and as in the past, WKKF will work to this end.

Community Health Planning↗
PubMed2002

Assessment of the infectious diseases surveillance system of the Republic of Armenia: an example of surveillance in the Republics of the former Soviet Union.

BACKGROUND: Before 1991, the infectious diseases surveillance systems (IDSS) of the former Soviet Union (FSU) were centrally planned in Moscow. The dissolution of the FSU resulted in economic stresses on public health infrastructure. At the request of seven FSU Ministries of Health, we performed assessments of the IDSS designed to guide reform. The assessment of the Armenian infectious diseases surveillance system (AIDSS) is presented here as a prototype. DISCUSSION: We performed qualitative assessments using the Centers for Disease Control and Prevention (CDC) guidelines for evaluating surveillance systems. Until 1996, the AIDSS collected aggregate and case-based data on 64 infectious diseases. It collected information on diseases of low pathogenicity (e.g., pediculosis) and those with no public health intervention (e.g., infectious mononucleosis). The specificity was poor because of the lack of case definitions. Most cases were investigated using a lengthy, non-disease-specific case-report form Armenian public health officials analyzed data descriptively and reported data upward from the local to national level, with little feedback. Information was not shared across vertical programs. Reform should focus on enhancing usefulness, efficiency, and effectiveness by reducing the quantity of data collected and revising reporting procedures and information types; improving the quality, analyses, and use of data at different levels; reducing system operations costs; and improving communications to reporting sources. These recommendations are generalizable to other FSU republics. SUMMARY: The AIDSS was complex and sensitive, yet costly and inefficient. The flexibility, representativeness, and timeliness were good because of a comprehensive health-care system and compulsory reporting. Some data were questionable and some had no utility.

Armenia↗
PubMedDate not supplied

The case for more active policy attention to health promotion.

Until recently, when anthrax triggered a concern about preparedness in the public health infrastructure, U.S. health policy and health spending had been dominated by a focus on payment for medical treatment. The fact that many of the conditions driving the need for treatment are preventable ought to draw attention to policy opportunities for promoting health. Following a brief review of the determinants of population health-genetic predispositions, social circumstances, environmental conditions, behavioral patterns, and medical care-this paper explores some of the factors inhibiting policy attention and resource commitment to the nonmedical determinants of population health and suggests approaches for sharpening the public policy focus to encourage disease prevention and health promotion.

Community Health Planning↗
PubMed1998

Accrediting local health departments: potentials and pitfalls.

A 1990 study was undertaken to determine if the public health infrastructure at the community level could be used to evaluate a health department. Characteristics of the infrastructure were defined and criteria were developed to see if these characteristics would enable one to differentiate between health departments. The appropriateness of a process of accreditation in carrying out the assessment was also examined. The infrastructure concept had a validity, utility, and composition that can be employed to make reasonable distinctions between health departments. Further, use of an accreditation protocol to assess the performance of local health agencies was found to be feasible.

Accreditation↗
PubMed2005

Disaster preparedness in health care.

Natural disasters frequently cause major problems which affect a population's health and hinder a nation's socioeconomic development by draining its scarce financial resources in an effort to repair damages. For example, the tsunami disaster in the Indian Ocean is one of the worst natural disasters in modern times. Well over 200,000 people died and more than 1.5 million people lost their homes and often their livelihoods. Losses are estimated to total more than US dollar 7 billion. Private assets, including housing and business equipment, account for the largest share of the losses. In the largest countries, the impact on GDP is likely to be minimal, but the damage in the affected areas is extreme. Poor people were disproportionately affected. A country's health systems and public health infrastructure must be organised and ready to act in disaster situations as well as under normal conditions and must be cognisant of the type of measures to be taken in event of a disaster. These will differ according to the severity of the disaster's impact on the national health system.

Delivery of Health Care↗
PubMedDate not supplied

The privatization of environmental health services: a national survey of practices and perspectives in local health departments.

OBJECTIVES: This article presents nationally representative data on environmental health (EH) services privatized by local public health departments, enforcement and assurance mechanisms for privatized services, and administrators' views about EH services that should not be privatized. METHODS: A national sample of 380 local public health departments, stratified by jurisdiction size, was drawn from a universe of 2,488 departments. Telephone interviews were conducted with 347 administrators of departments. Results were weighted to be nationally representative. RESULTS: Approximately one-quarter of departments had privatized at least one EH service, almost always to for-profit organizations. The two most common reasons given for privatizing EH services were cost savings or increased efficiency and lack of capacity or expertise to carry out the service. The most rigorous, although infrequent, technique of enforcement and assurance of EH standards when services were privatized was double-testing of samples. Departments more commonly relied on state licensing and certification of contractors. When asked what services should not be privatized, 27% of respondents cited EH services. Many respondents argued against privatizing environmental services that have inherent regulatory functions. They expressed concern that privatization would fragment the public health infrastructure by impairing communication, diminishing control over performance, or weakening health departments' capacity to respond to environmental and other health crises. CONCLUSION: These findings raise serious concerns about the privatization of EH.

Attitude of Health Personnel↗
PubMed2001

The potential impacts of climate variability and change on health impacts of extreme weather events in the United States.

Extreme weather events such as precipitation extremes and severe storms cause hundreds of deaths and injuries annually in the United States. Climate change may alter the frequency, timing, intensity, and duration of these events. Increases in heavy precipitation have occurred over the past century. Future climate scenarios show likely increases in the frequency of extreme precipitation events, including precipitation during hurricanes, raising the risk of floods. Frequencies of tornadoes and hurricanes cannot reliably be projected. Injury and death are the direct health impacts most often associated with natural disasters. Secondary effects, mediated by changes in ecologic systems and public health infrastructure, also occur. The health impacts of extreme weather events hinge on the vulnerabilities and recovery capacities of the natural environment and the local population. Relevant variables include building codes, warning systems, disaster policies, evacuation plans, and relief efforts. There are many federal, state, and local government agencies and nongovernmental organizations involved in planning for and responding to natural disasters in the United States. Future research on health impacts of extreme weather events should focus on improving climate models to project any trends in regional extreme events and as a result improve public health preparedness and mitigation. Epidemiologic studies of health effects beyond the direct impacts of disaster will provide a more accurate measure of the full health impacts and will assist in planning and resource allocation.

Climate↗
PubMed1995

Family physicians and human rights: a case example from former Yugoslavia.

BACKGROUND: The role of family physicians in the protection of human rights is unclear. The purpose of this article is to explore this role through examination of the specific case of former Yugoslavia. METHODS: In January/February 1993, we investigated medical aspects of human rights abuses as part of a fact-finding mission for the Physicians for Human Rights organization. We used primarily qualitative methods, including direct observation, key informant interviews, focus groups, and key document review. RESULTS: We observed pervasive violations of medical neutrality, as indicated by the shelling of Kosevo Hospital, the major tertiary care hospital in Sarajevo. Forty-one percent of former prison camp detainees from north Bosnia housed at the Karlovac, Croatia, refugee camp had scars consistent with physical abuse. Civilians in north central Bosnia and Sarajevo were targeted through physical violence, artillery shelling, and strangulation of the public health infrastructure--food, water, electricity, heat, and medical supplies. CONCLUSIONS: Physicians can be uniquely useful in the investigation of human rights. The flexibility of family physicians and their attention to the biopsycosocial aspects of health can be especially useful. Family physicians should become actively involved in the protection of human rights.

Adult↗
PubMed2003

Preventing lead poisoning in children: can the US experience inform other countries? The case of Poland.

Exposure to excess lead during childhood is preventable, but nowhere has that goal been achieved. In the US, recommendations for prevention of childhood lead poisoning are issued by the Centres for Disease Control and Prevention, based on periodically updated population-based data on the prevalence of lead poisoning by age and blood lead level. A well developed public health infrastructure is to provide case management to the lead exposed children. In Poland, the social and economic transitions of the last decade changed the potential for childhood lead exposure, and there has been a profound restructuring of the health care system. Blood lead testing in children is performed outside the primary care. Data on blood lead levels are not collected and analysed centrally. The range of follow-up services may differ among the regions, depending on the local expertise. An updated approach to prevention of childhood lead poisoning, making better use of the existing expertise and involving primary care providers, needs consideration. Complex public health programs like this of lead poisoning prevention cannot be transplanted whole to other countries. However, experiences gained by the US might provide valuable suggestions for others, even though the US policy has flaws and is not fully implemented. Discussing proposal for Poland in light of the current US practice highlights the necessity of reliable estimates of the exposed population for rational policy. It also helps to define research questions relevant to public health practice in Poland, and confirms that prevention of lead poisoning in children requires the coordinated work of different professionals.

Child↗
PubMed2004

Veterinary medicine protecting and promoting the public's health and well-being.

Dr. Calvin Schwabe's vision of "One Medicine" has long inspired many in the public health community to strive toward bringing human and veterinary medicine together to improve the public's health and well-being around the world. In an increasingly human-dominated world, as Dr. Schwabe suggested many years ago, human health provides the most-logical unifying or apical cause in veterinary medicine's hierarchy of values. Veterinarians in all aspects of the profession-have opportunity and responsibility to protect the health and well-being of people in all that they do, including protecting food security and safety; addressing threats to antibiotic sensitivity; preventing and controlling zoonotic emerging infectious diseases; protecting environments and ecosystems; participating in bio- and agro-terrorism preparedness and response; using their skills to confront non-zoonotic diseases (such as malaria, HIV/AIDS, vaccine preventable diseases, chronic diseases and injuries); strengthening the public-health infrastructure; and advancing medical science through research. This article provides an overview of contributions made by veterinarians in each of these areas, and discusses the challenges to be overcome and the need for strategic thinking and action to achieve the vision of "one medicine".

Animals↗
PubMed2003

Food and waterborne infections associated with package holidays.

The surveillance and prevention of food and waterborne infections in package holiday tourists relies more on common sense and experience rather than evidence based scientific facts. In spite of the major economic value to both sending and receiving countries it is a problem that is largely ignored by health departments at both local and national levels. Package holiday tourism is a growing industry with over 20 million holidays sold every year in the UK. Destinations are in every continent including countries with poorly developed, as well as those with an advanced, public health infrastructure. The incidence of gastrointestinal infection is not reflected in official surveillance programmes as they largely fail to capture information on travel associated infections. Outbreaks of food and waterborne infections in these resorts are largely not investigated. Major British tour operators have responded by developing a crude but effective continuous surveillance system for subjective travellers' diarrhoea. The importance of food and water hygiene is, however, not ignored and proactive preventative programmes are being developed and implemented in some resort as well as by the tourist industry and international agencies. There is a need for further cooperation and partnership between workers in different countries, different disciplines and between the public and private sectors.

Commerce↗
PubMed2005

Traveller's diarrhoea.

Traveller's diarrhoea affects over 50% of travellers to some destinations and can disrupt holidays and business trips. This review examines the main causes and epidemiology of the syndrome, which is associated with poor public health infrastructure and hygiene practices, particularly in warmer climates. Although travellers may be given common sense advice on avoidance of high-risk foods and other measures to prevent traveller's diarrhoea, adherence to such advice is sometimes difficult and the evidence for its effectiveness is contradictory. However, non-antimicrobial means for prevention of traveller's diarrhoea are favoured in most settings. A simple stepwise approach to the management of traveller's diarrhoea includes single doses or 3-day courses of antimicrobials, often self administered. The antibiotics of choice are currently fluoroquinolones or azithromycin, with an emerging role for rifaximin. In the long term, there will be greater benefit and effect on the health of local inhabitants and travellers from improving public health and hygiene standards at tourist destinations.

Anti-Bacterial Agents↗
PubMed1998

Causes of locomotor disability and need for orthopaedic devices in a heavily mined Taliban-controlled province of Afghanistan: issues and challenges for public health managers.

We conducted a locomotor disability survey on a heavily mined Taliban-controlled province of Afghanistan to document the problem of locomotor disability and to assess the need for orthopaedic rehabilitation devices in a study population of 12065. Global prevalence of locomotor disability was 23/1000 (95% CI: 20-26). )War-related injuries were the leading cause of disability, affecting almost exclusively adult males. Leading causes of disability among women and children were medical and poliomyelitis. Devices most needed were lower limb ortheses (8.2 devices/1000 people; 95% CI: 5.9-10.4) and orthopaedic shoes (6.0/1000; 95% CI:4.1-8.0). The need for lower limb prostheses was less frequent (2.0/1000; 95% CI: 1.1-2.8). Most lower limb amputees (mainly victims of landmine injuries) were fitted with an artificial leg, while rehabilitation needs for other types of disability remained largely unmet. We estimated that it would take at least 3 years to provide enough orthopaedic shoes and 10 years for ortheses, whereas the need for lower limb prostheses could be met in less than 4 months. None of the 27 women with lower limb disability were equipped with an orthopaedic device, although this was the case for 31 of 89 men (35%). The problem of landmines should not divert attention from other causes of disability such as poliomyelitis or from other rehabilitation requirements. Immunization programmes and restoration of the public health infrastructure should be given high priority; rehabilitation services are largely insufficient and should be developed. Extreme gender difference in needs coverage is a matter of concern. Researching culturally sensitive strategies to tackle this problem should be a priority for donors and implementing agencies.

Adolescent↗
PubMed2000

West Nile virus in the United States: guidelines for detection, prevention, and control.

The epidemic/epizootic of West Nile (WN) encephalitis in the northeastern United States in the summer and fall of 1999 was an unprecedented event, underscoring the ease with which emerging infectious pathogens can be introduced into new geographic areas in today's era of rapid transportation and increased movement of people, animals, and commodities. This epidemic/epizootic and the increased frequency of other exotic pathogens being imported into the United States raises the issue of whether local, state, and national public health agencies are prepared to deal with epidemics/epizootics of vector-borne infectious diseases. The overwintering of WN virus and the epizootic transmission in the summer of 2000 reinforces the need to rebuild the public health infrastructure to deal with vector-borne diseases in this country. This article summarizes guidelines for surveillance, prevention, and control of WN virus that were drafted in December 1999 to help prepare state and local health departments for monitoring WN virus activity in the spring and summer of 2000 and also summarizes the data collected from those surveillance systems through September 2000.

Animals↗
PubMed1996

The state of the nation's oral health: mid-decade assessment of Healthy People 2000.

OBJECTIVES: This communication reviews the history and process of establishing and assessing national health objectives, presents the status of oral health objectives in Healthy People 2000, and summarizes major issues related to the outlook for the nation's oral health from the perspectives of participants in a July 1995 briefing session with the US Assistant Secretary for Health. METHODS: Data obtained from sources such as the third National Health and Nutrition Examination Survey-Phase 1, the 1991 Indian Health Service Survey, and 1989-92 National Health Interview Surveys were examined in relation to specific indicators and populations defined at baseline using mid-1980s data. RESULTS: Examination of baseline measures and progress data shows that the indicators for objectives are, for the most part, stable or improving slightly. Deaths due to oral cancer have decreased. Edentulousness is declining. Placement of dental sealants on children's teeth is increasing. Adult dental visits are on the expected course. Little change has been observed in water fluoridation. Apparent declines in dental visits and increases in untreated dental decay for young children are potential concerns. Four objectives have no data for progress evaluation. CONCLUSIONS: The persistent and often dramatic race-ethnicity and socioeconomic differences on many objectives, in combination with possible alterations in the public health infrastructure, indicate that concentrated and collaborative efforts are needed to achieve Healthy People 2000 targets.

Adolescent↗
PubMed2001

Revisiting emerging infectious diseases: the unfinished agenda.

Infectious diseases present a formidable threat to the world today. Not only are new infectious diseases emerging, but those presumed to be contained or eradicated are re-emerging. Developing nations, with the least resources to respond, bear the greatest burden of this threat. However, with the potential to spread rapidly and ubiquitously, infectious diseases present a significant risk to the health and development of all nations. No country or population is immune, and geographic and political barriers offer little protection. Many factors facilitate the spread of infectious diseases, including globalization of travel and trade, weakening of national and international public health infrastructure, deterioration of socioeconomic conditions, and heightened political and civil strife in some developing nations. These conditions render populations more vulnerable to infections and provide an environment conducive to the transmission of infectious diseases. Compounding these risk factors is the emergence of another threat: antimicrobial resistance. Antimicrobial drugs are rapidly losing their effectiveness because of their misuse. As a result, the global health community is confronted with the daunting task of combating more offenders with fewer defenses.

Communicable Disease Control↗
PubMed2001

Climate variability and change in the United States: potential impacts on water- and foodborne diseases caused by microbiologic agents.

Exposure to waterborne and foodborne pathogens can occur via drinking water (associated with fecal contamination), seafood (due to natural microbial hazards, toxins, or wastewater disposal) or fresh produce (irrigated or processed with contaminated water). Weather influences the transport and dissemination of these microbial agents via rainfall and runoff and the survival and/or growth through such factors as temperature. Federal and state laws and regulatory programs protect much of the U.S. population from waterborne disease; however, if climate variability increases, current and future deficiencies in areas such as watershed protection, infrastructure, and storm drainage systems will probably increase the risk of contamination events. Knowledge about transport processes and the fate of microbial pollutants associated with rainfall and snowmelt is key to predicting risks from a change in weather variability. Although recent studies identified links between climate variability and occurrence of microbial agents in water, the relationships need further quantification in the context of other stresses. In the marine environment as well, there are few studies that adequately address the potential health effects of climate variability in combination with other stresses such as overfishing, introduced species, and rise in sea level. Advances in monitoring are necessary to enhance early-warning and prevention capabilities. Application of existing technologies, such as molecular fingerprinting to track contaminant sources or satellite remote sensing to detect coastal algal blooms, could be expanded. This assessment recommends incorporating a range of future scenarios of improvement plans for current deficiencies in the public health infrastructure to achieve more realistic risk assessments.

Bacterial Infections↗