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PubMed1999

Tuberculosis prevention and control activities in the United States: an overview of the organization of tuberculosis services.

After a 20% increase in tuberculosis (TB) cases between 1986 and 1992, TB cases in the United States have declined from 1993 through 1997, an average of 5 to 7 per cent per year. In this paper, we review trends and the current epidemiology of TB in the US, present a brief history of TB control efforts in the country, and present the key strategies for TB control in the US. We describe the current organizational structure of TB services in the US, the role of the private sector in TB control, and how TB control is funded. Finally we discuss the mechanisms by which TB policy is developed. The US model represents a categorical disease program that combines a centralized role of the national government in development of policy, funding, and in the maintenance of national surveillance, and a decentralized role of state and local jurisdictions, which adapt and implement national guidelines and which are responsible for day-to-day program activities. Given the relative success of this combined approach, other countries facing the challenge of maintaining an effective TB control program in the face of increased decentralization of health services may find this description useful.

Adolescent↗
PubMed1999

Commentary: ethical issues in the use of computerized databases for epidemiologic and other health research.

Computerization of databases has increased apprehension about loss of privacy. The intent of this paper is to facilitate health research that gives proper respect to ethical principles, thereby increasing public comfort and reducing demands for restrictive legislation concerning access to databases. We review how computerization has increased the saliency of concerns and discuss examples of the application of ethical analysis in published database research. Extreme positions notwithstanding, there is general agreement among researchers that research curiosity and the convenience of database research cannot justify the suspension of moral concerns about privacy and confidentiality. Public and professional concerns may affect policy development; therefore, the methods of ensuring privacy and protecting confidentiality must be routinely described in research proposals and published reports along with the benefits of the research. An important issue requiring further attention is that the moral responsibility to respect privacy increases with the sensitivity of information.

Confidentiality↗
PubMed1999

Review of national tuberculosis programmes: the experience in Bangladesh.

Tuberculosis control efforts should be evaluated periodically to assess progress made by national programmes and to plan for the future. Simple and reliable tools are required for such assessments. This paper summarises the methodology and results of the review of the national tuberculosis programme in Bangladesh conducted in 1997. The authors conclude that similar reviews would not only help to verify the reports from the routine recording system, but would also assist policy development and future planning.

Bangladesh↗
PubMed2000

Hamilton county physicians' experience with managed care.

BACKGROUND: Widespread physician participation in managed care over the last several years prompted this survey of the members of the Medical Society of Chattanooga and Hamilton County. METHODS: A 36-item questionnaire was mailed to all members of the Medical Society. RESULTS: Ninety-six responses from solo practitioners and groups representing 325 physicians were analyzed. More than 80% of respondents believed that managed care has affected the quality of patient care negatively and 71.8% believed managed care policies have compromised their patient care. More importantly, 90% said insurers have not secured their input in policy development. Referral processes were regarded as cumbersome or impossible by 78.2%. Regression analysis showed a significant relation between issues of too much managed care control, cumbersome referral processes, and physicians' opinion on impact of managed care on quality of patient care. CONCLUSIONS: Physician dissatisfaction with managed care in Hamilton County appears widespread and is mainly related to issues of too much managed care control over daily patient care, which physicians feel results in compromised quality of patient care.

Adult↗
PubMed1999

Screening workers for genetic hypersusceptibility: potential ethical, legal, and social implications from the Human Genome Project.

One of the potential outcomes of the Human Genome Project will be the ability to identify individuals who are at increased risk of adverse health effects following exposure to hazardous substances in the workplace because of genetic hypersusceptibility. The ability to identify such individuals is likely to lead to the inclusion of genetic screening in worker protection programs. This technology and its applications will have a number of potential ethical, legal, and social implications. In this commentary, the authors examine five broad topics relating to the use of screening for genetic hypersusceptibility in the workplace: (1) issues of risk; (2) the rationale and legal basis for screening; (3) the privacy concerns of workers; (4) the confidentiality of test results; and (5) potential discrimination. The authors close by suggesting some guidelines for developing policies regarding genetic screening.

Bioethics↗
PubMedDate not supplied

[The goals and tasks of the Roll Back Malaria WHO Cabinet Project].

WHO's Roll Back Malaria Cabinet Project (RBM) has been initiated by WHO Director-General Dr. G. Brundtland in 1998. The World Health Organization, The United Nation's Children's Fund, the United Nation's Development Programme and World Bank have joined forces to fight malaria, which kills more than one million people a year. RBM is being launched at time of growing and investment in malaria, which still remains grossly underfunded. RBM is different from previous efforts to fight malaria. The project is working not only through new tools for controlling the disease but also by involving and strengthening the health services to affected population. This pattern of activities is close to Russian version of malaria eradication programme that had been carried out with the success in the former Soviet Union in the 1950s. RBM seeks to reduce substantially the human suffering and economic losses due one of the most costly diseases. Malaria causes an estimated 300 to 500 million acute cases per year. Malaria is a disease of young and the poor, many of them children who live with no easy access to health service. RBM goal is a significant reduction--ideally halving within ten years--in the global burden of disease associated with malaria. RBM purpose is to create an environment that helps countries develop policies and implement relevant elements of RBM strategy. There are six elements to roll back malaria. They are: early detection of malaria illness; rapid treatment of those who are ill; multiple means for preventing infection; strengthening of health sector and intersectoral activities; a powerful sustained social involvement and movement; focused research for new tools and better implementation. New tools are available to combat malaria. They include among others: rapid diagnostics; new drugs (artesunates) and new means for delivery; impregnated bednets; new means for predicting epidemics (satellite mapping). WHO will be coordinating the RBM project. Endemic countries and affected populations have identified malaria as a priority health issue. Activities will cut across WHO programmes and regions to support government, to improve technical efficiency and capacity, to optimize resource allocation, utilization and mobilization.

Disease Outbreaks↗
PubMed2000

Problems of an aging population in an era of technology.

With the substantially growing number of elderly persons in Canada and the rest of the developed world, the need for adequate health and social care will increase. Health and social service providers must develop policies and programs allowing the elderly to lead rich and independent lives for as long as possible. As advances in age-related diseases are made, the elderly will potentially live longer and lead more active and fulfilling lives. Society, governments and those involved in the care of the elderly must meet the new challenges of this aging population in a humane and respectful way.

Age Factors↗
PubMed2000

Partnering for better lung health: improving tobacco and tuberculosis control.

Tuberculosis and tobacco together constitute a considerable threat to global health. Several recent initiatives by non-governmental organisations and the World Health Organization have highlighted the need for concerted approaches to lung health that require addressing both of these major threats. However, the emphasis has been on independent effects on health and on independent strategies to control. There is a clear case for closer partnering between researchers, service providers and policy makers in addressing tuberculosis and tobacco. This is based upon growing epidemiological and laboratory evidence that indicate that tobacco is a risk factor for tuberculosis and for death from tuberculosis. Despite the fact that a very high percentage of tuberculosis patients smoke in all settings for which data are available, opportunities to treat tobacco dependence in such patients are under-utilised. This paper will recommend areas that require research, policy development and immediate action.

Humans↗
PubMed1999

Commercialization of genetic research and its impact on the communication of results.

Canada has recently seen significant commercial growth in biotechnology; at the same time we have witnessed a considerable reduction in public funding for research. One result is the development of partnerships between academic institutions and industry, which has had important effects on the relationships between researchers, companies, research subjects and society, particularly in the field of genetics. Commercialization of research creates obstacles to the diffusion of research results which is fundamental to the advancement of science. Several recent studies and cases, which are briefly reviewed here, have highlighted these problems. In this paper, the author examines clauses in research contracts in order to analyze and categorize the types of provisions these contracts may contain regarding publication and disclosure of research results. She then discusses the relationships between various actors in genetic research and the issues and conflicts that may arise. Finally, an examination of some recently developed policies in this area reveals the complex network of norms to which a researcher must adhere. The normative framework must take into account the interests of all the various actors, should apply to the broadest possible population, and its various parts must be consistent. Researchers must then be vigilant that they do not enter into contracts which conflict with their rights and obligations regarding publication and dissemination of results.

Biotechnology↗
PubMedDate not supplied

Social planning in Canada for families with HIV infection.

Parents living with HIV and their children face complex medical and social problems. Whether the children are infected or not, they are all affected by the presence of HIV in a parent. The purpose of this article is to describe the problems of families with HIV and to propose social planning measures to respond to their psychosocial needs. It is based on a multicentre study that included in-depth interviews with 110 parents representing 91 Canadian families living with HIV. The study's findings and recommendations were reviewed by parents with HIV, social workers specializing in helping affected families, and a multidisciplinary consensus conference. This process identified six areas needing attention: stigma and disclosure; promoting and supporting family health; planning and transitions for the care of children; economic issues; cultural and immigrant issues; and education, advocacy, policy development, and research. Recommendations for action were made in each area.

Canada↗
PubMedDate not supplied

Genomic instability, bystander effects and radiation risks: implications for development of protection strategies for man and the environment.

The last few years has seen what people are now referring to as a "shifting Paradigm" in our way of thinking about radiation effects on biological systems. The concept of the central role of DNA damage due to double strand breaks induced by a radiation "hit" has been itself hit by many studies showing persistent effects in the distant progeny of radiation exposed cells. This phenomenon is known as radiation induced genomic instability. More recently evidence has been accumulating that not even the parent cell need be exposed to radiation (the bystander effect). The new paradigm suggests that cellular stress responses or damage signalling through a range of signal transduction pathways are involved and that cell-cell contact or secretion of damage signalling molecules can induce responses in undamaged and unirradiated cells. Are these new effects relevant to risk assessment, or does it matter HOW radiation affects cells if we have good epidemiological evidence of which to base our risk estimates? The aim of this paper is to introduce the new concepts and to consider reasons why they might alter our methods of risk estimation. The paper also considers the impact of the new concepts on environmental protection and discusses the need for research in the field of comparative radiobiology if we are to develop policies which can adequately protect biodiversity.

Animals↗
PubMedDate not supplied

Intimate partner violence: a health system's response--Part 2.

Part 1 of this two-part article (January-February 2001 issue) on a health care system's response to domestic violence (DV) described the process St. Joseph Mercy Health System (Ann Arbor, MI) followed to develop policies and procedures for identifying and intervening in DV cases among its patients. In Part 2, Continuum reports on the 2000 SSWLHC Conference presentation by the co-author of that article--Susan Kheder, MSW, ACSW, Program Director, Women's Health Services. Kheder explains how effectively implementing the new DV policy has depended on a long-term effort to foster cultural change among the professional staff and all system employees.

Attitude of Health Personnel↗
PubMed1995

KEYNOTE ADDRESS OF THE SEVENTH INTERNATIONAL CONFERENCE ON THE HEALTH OF CHINESE IN NORTH AMERICA: Health Status of Chinese Americans: Challenges and Opportunities.

PURPOSE. This paper is based on the author's keynote address given at the Seventh International Conference on the Health Problems of Chinese in North America. METHODS. The author/speaker reviewed the literature related to Chinese American health problems within the context of the broader demographic and aggregated health data reported on Asian Americans and Pacific Islanders. FINDINGS. In addition to background demographic statistics provided on Chinese Americans, the author/speaker focused on two categories of diseases: (1) communicable diseases; and (2) chronic diseases because of the greater availability of data on these categories. Communicable diseases from which Chinese Americans appear to suffer disproportionally are tuberculosis and hepatitis B. Infection with the hepatitis B virus also makes Chinese Americans much more susceptible to chronic liver diseases including cancer. Chinese also suffer disproportionally more from nasopharyngeal cancer; because of higher than average adult male smoking rates, these men can be expected to suffer disproportionally from a future epidemic of lung cancer cases. Unhealthy acculturation patterns in food consumption point towards changing profiles of cardiovascular morbidity and mortality as well as higher rates of dietary related cancers. OBSERVATIONS. Rather than conclusions, observations of the current health status of Chinese Americans were offered. Four measures that organizations such as the Chinese medical societies and Chinese American health professionals can pursue to advance the health status of Chinese Americans, particularly in the area of heaslth policy, are: (1) voting; (2) collecting data on health status; (3) writing for professional journals; and (4) being active in policy development. KEY WORDS. Chinese Americans; health status; tuberculosis; hepatits B; cancer; diet; acculturation; smoking

Journal Article↗
PubMed2001

A new health system and its quality agenda.

This article reviews recent work on healthcare quality, highlights findings and recommendations of the Institute of Medicine (IOM) reports on medical errors and quality, and describes response to the reports to date. In it, Detmer, chair of the IOM's Board of Health Care Services and a member of its Committee on Quality of Health Care in America, identifies implications of the reports for healthcare delivery organizations and professionals and outlines ways organizations and professionals can improve the six dimensions of patient quality defined by the IOM. Sustained efforts at the point of care and in policy development are needed to overcome cultural inertia, realign incentives, support innovation, and address technical and human resource issues. Success requires that healthcare executives embrace the goal of transforming the healthcare sector into a true system and provide leadership for their organizations and communities in this most fundamental of challenges for twenty-first century healthcare.

Delivery of Health Care↗
PubMed2002

The Institute of Medicine's independent scientific assessment of Gulf War health issues.

The Institute of Medicine has frequently been the source of expert advice to the government and others on questions related to health and medicine. Such has been the case as Congress, federal agencies, and veterans attempt to resolve conflicts and develop policies to address the health concerns of Persian Gulf War veterans. Twelve reports issued by Institute of Medicine committees address what is known about exposures and illnesses in Gulf War veterans and what additional information is needed, how clinical programs for Gulf War veterans could be improved, and what strategies could help prevent or better address similar health problems in the future. The Institute of Medicine reports recommend guidelines and interventions to treat sufferers of medically unexplained symptoms, longitudinal studies to measure changes in health status, and improved risk communication. They emphasize the need for the maintenance of retrievable electronic records of baseline health status, of exposures, and of health events that occur during a service member's career.

Humans↗
PubMed2002

HIV disease management: new technologies improve outcomes and contain costs.

HIV disease presents a continuous learning curve as we move from managing a fatal illness to treating a chronic disease. Even though the HIV epidemic is more than 20 years old, our understanding of the disease and its management are constantly evolving. New technologies are an important part of this learning curve. As they are introduced, providers and managed care organizations need to develop policies and procedures that reflect the state of the art in HIV care to continue to build on the good outcomes seen since the advent of HAART. While this model of care is "expensive," it is less expensive long-term than the poorer outcomes and costs associated with increased hospitalization, drug resistance, and preventable morbidity in HIV disease.

Anti-HIV Agents↗
PubMed2002

Improve care of kids with pediatric coordinator.

New guidelines from the American Academy of Pediatrics and the American College of Emergency Physicians recommend having physician and nurse pediatric coordinators to improve the care of children in the ED. The role of pediatric coordinator doesn't need to be a full-time or newly added position. Physician and nurse coordinators should work together to develop policies for improved care. Coordinators should routinely audit patient charts as part of a quality improvement program.

Child↗
PubMedDate not supplied

Racial/ethnic diversity management and cultural competency: the case of Pennsylvania hospitals.

Major demographic trends are changing the face of America's labor pool, and healthcare managers increasingly face a scarcer and more diverse workforce. As a result, healthcare organizations (HCOs) must develop policies and practices aimed at recruiting, retaining, and managing a diverse workforce and must meet the demands of a more diverse patient population by providing culturally appropriate care and improving access to care for racial/ethnic minorities. Ultimately, the goal of managing diversity is to enhance workforce and customer satisfaction, to improve communication among members of the workforce, and to further improve organizational performance. Research on diversity management practices in HCOs is scarce, providing few guidelines for practitioners. This study attempted to close that gap. Results show that hospitals in Pennsylvania have been relatively inactive with employing diversity management practices, and equal employment requirements are the main driver of diversity management policy. The number and scope of diversity management practices used were not influenced by organizational or market characteristics. The results suggest that hospitals need to adopt diversity management practices for their workforces and need to pay particular attention to marketing and service planning activities that meet the needs of a diverse patient population.

Cultural Diversity↗