Female surgical sterilization: issues and recommendations.
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Risk assessment, as defined by the National Academy of Sciences in 1983, is comprised by the following components: hazard identification, dose-response assessment, exposure assessment, and risk characterization. The U.S. Environmental Protection Agency (EPA) has developed risk assessment guidelines which follow the NAS format for Program Offices to follow in evaluating the potential adverse effects of environmental agents on humans. Guidelines have been published in the Federal Register on cancer, mutagenicity, developmental toxicity, chemical mixtures, and exposure. Proposed guidelines are expected to be published shortly on female and male reproductive toxicity.
Preventive measures for many chronic diseases depend upon identification of asymptomatic individuals who have the disease or who may be at risk for developing it. A screening biochemical test can identify such individuals. Mass screening for biochemical markers or risk factors for chronic conditions, especially for elevated serum cholesterol and blood glucose, has been advocated in recent years and has become increasingly common in various nonmedical community settings. Although generally well intentioned, such programs may fall short of their goals and may even be counterproductive. In recognition of the use of biochemical screening in nonmedical community settings, and in an attempt to make such efforts as productive as possible, the California Department of Health Services (CDHS) has developed state guidelines for these screening programs. These guidelines make recommendations regarding: (1) the criteria for judging the effectiveness of biochemical screening tests; (2) the qualifications and training of screening program staff; (3) the proper use and maintenance of equipment used in screening programs and other quality control measures; (4) referral procedures for persons with abnormal test results; and (5) the lawful implementation of screening programs. Optimally, as pointed out by these guidelines, all community-based screening programs should complement a larger health education or risk-reduction program that guarantees appropriate medical follow-up and management. Preventive medicine practitioners and organizations embarking on such activities should be familiar with the issues addressed by these guidelines and may find adherence to them useful in developing effective community screening programs.
Increases in the prevalence of disability due to the ageing of the population have given rise to the need for simple indicators which may be used to estimate service needs and to assess whether resources have been fairly distributed. The present study involved the validation of an indicator based on confinement level by reference to epidemiological studies of disability, social support, and living conditions in three regions of France. Using factorial correspondence analysis and regression methods it was found that such an indicator could adequately summarize more complex empirical observations and thus provide a means of classifying elderly populations into four dependency groups. While comparisons of the percentage of persons classified at each level with national data suggest that the observations from the three studies may be reasonably representative of France as a whole, the application of this indicator to other European countries should be preceded by a preliminary validation involving regional or national health survey data for each country. The use of this indicator should also be complemented by individual need assessment procedures.
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Planning and implementing a successful immunization program at the worksite requires a committed, interdepartmental effort and a dedicated occupational health staff. Planning should start well in advance of influenza season with adherence to strict timelines. Key strategies for campaign success include generating a sense of enthusiasm about the campaign; creating an employee- and family-friendly atmosphere to diffuse possible uneasiness about receiving vaccinations; assuring easy access to vaccines; and providing employees with evidence-based information related to influenza and immunization using a variety of media. Using the proven best practices of its on-site employee health vendor and adapting other strategies, the vaccine manufacturer succeeded in raising employee influenza immunization rates from 34% in 2002 to 66% by the end of November 2003, well beyond the program's goal of 50%. By the end of December, after extra clinics were added in response to intense media coverage, the employee immunization rate increased to 76%.
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OBJECTIVES: To examine the health status of Californians using a set of 18 health status indicators (HSIs) corresponding to goals set forth in Healthy People 2000 and to develop a health status profile for use in research and surveillance, policy development program planning, and program evaluation. METHODS: Federal, state, and county data were used to evaluate California's performance on 18 indicators of health status related to mortality, disease incidence, and health risks. RESULTS: By 1994, California had achieved Year 2000 objectives associated with seven HSIs and significant declines in mortality associated with two other HSIs. Nationally, California was ranked among the states with the lowest rates for infant mortality, lung cancer, female breast cancer, and syphilis but among states with the highest rates for homicide, AIDS, measles, tuberculosis, late prenatal care, childhood poverty, and poor air quality. CONCLUSIONS: California's experience may provide a useful model for other state and local health agencies monitoring the health status of populations using HSIs associated with Year 2000 objectives.
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