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PubMed1998

[Health and environment. Between certainty and uncertainty, the emergence of environmental medicine].

The evaluation of environmental risks for the human health implies a complex process where a great number of parameters has to be considered. The complexity and the multiplicity of the problem brings on many uncertainties. However several leads exist to guide our reflection with more assurance. Toxicology, ecotoxicoly, occupational medicine, analyse of ecological disasters, epidemiological studies on environmental health issues are such elements the physician can refer to when confronted with a environmental health problem. In looking for solutions, it will be necessary to search and deal with other competences from social life and economics and to take technical feasibility as well as architectural reality and urban development policy into account.

Environmental Health↗
PubMed1998

Should condom use be promoted for contraception to prevent transmission of sexual transmitted diseases and AIDS? ACSF Group. French National Survey of Sexual behavior.

BACKGROUND: This study is an exploration of the relationship between the use of oral contraceptive or intrauterine device and condom use. The results should help us better understand how promoting condoms for contraception as compared to sexually transmitted disease prophylaxis might be an effective way of increasing their use in certain populations. METHODS: Women not involved in stable relationships were selected from the French National Survey on Sexual Behaviour using multi-stage probability sampling. We compared frequency of condom use at the last sexual intercourse by women who were using prescribed contraception with that by women who did not. Odds ratios (OR) were adjusted for age, duration of the relationship, education, type of partner and number of partners in the last 12 months. RESULTS: Overall, no difference was found in the frequency of condom use during the last sexual intercourse by women who were using prescribed contraception compared with women who were not. A more frequent use of condoms tended to be associated with the absence of contraception in relationships of less than three months' duration (adjusted OR: 4.5; 95% CI: 0.7-33.3) and for women of 25 to 34 years of age (adjusted OR: 2.4; 95% CI: 0.8-7.1). CONCLUSION: Many factors other than contraceptive practice influence the use of condoms. Nevertheless, our results suggest that reproductive issue should be taken into account in specific subgroups of the population when developing policies to prevent sexual transmission of HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Eradication of schistosomiasis in Guangxi, China. Part 2: Political economy, management strategy and costs, 1953-92.

Reported are the results of a study of the political economy, management, and costs of the successful Guangxi schistosomiasis eradication programme, spanning 40 years from 1953 to 1992. For this purpose we analysed all government data and memoranda on the policy, management, technical support, finance, and the control strategy of the programme. We also interviewed many local staff involved in the programme over the 40-year period and obtained cost data from annual county-level records on seven major categories of variable costs. Schistosomiasis control in Guangxi began with one of the first examples of community participation and rapid assessment in public health history--the use of pre-franked envelopes to return disease questionnaires and suspect snails from rural areas. This approach quickly and accurately delineated the endemic area. This was Mao Zedong's "mass line", incorporating ideas and knowledge from peasants directly into services run for and by them, here the schistosomiasis control programme. Recognition by China's leaders that schistosomiasis was a great economic burden, steadfast prioritizing of the programme over 40 years, local innovative scientific study, agricultural and environmental focus on eradicating the snail hosts and boosting rural production, and mass community education and support were all key factors in the final success. Local leaders motivated programme staff and everyone involved knew the objectives. The programme was always multisectoral, with policy developed centrally, and strategy and collaboration encouraged and rewarded at the grass-roots. These features explain how a very poor autonomous region such as Guangxi finally eradicated schistosomiasis, spending less than US$ 0.50 per protected citizen per year; it is remarkable that the disease and snails were initially found across a large area of complex environments and modern drugs such as praziquantel were not available for most of the 40-year period. The lessons from Guangxi can be adapted elsewhere and should encourage other areas to control endemic schistosomiasis using methods devised to suit the local culture and geography.

China↗
PubMed1998

Role of the SEAMEO TROPMED Network in health human resources development. Southeast Asian Ministers of Education Organization. Tropical Medicine and Public Health.

The Southeast Asian Ministers of Education Organization (SEAMEO) is a chartered international organization for the promotion of regional cooperation in education, science, technology and culture. The Regional Tropical Medicine and Public Health Network (TROPMED) operates through four specialized Centers in Indonesia, Malaysia, the Philippines and Thailand, with a coordinating unit, the TROPMED Central Office in Bangkok, Thailand. In line with the overall mission of SEAMEO, the role of TROPMED is to promote health and to prevent or control disease, thus improving the quality of life of people in the Asia-Pacific Region. Toward this end, SEAMEO TROPMED serves to facilitate the strengthening of national and institutional capabilities in research and training through postgraduate academic programs; short-term training courses; scientific fora; publications and information dissemination and as such, has been in the mainstream of health human resources development since its inception in 1967. To date, a total of 3,353 TROPMED alumni have benefited from training in 26 regular course offerings; of these, 1,596 were females and 1,757, males. From 1991 to 1995, a total of 434 key health personnel have attended short-term training courses, with increasing attendance from Cambodia, Lao PDR and Vietnam. TROPMED's effectiveness comes from the collective strength of and the spirit of cooperation among its host institutions and partners. Faced with a health scenario of both developing and developed economies, SEAMEO TROPMED aims to further its role as an international forum for health development thus, addressing the need for effective strategies for health sector reform and advocacy of relevant health, environmental and development policies through its various programs and activities.

Asia, Southeastern↗
PubMed2006

Development of a risk-priority score for category A bioterrorism agents as an aid for public health policy.

In developing public health policy and planning for a bioterrorist attack or vaccination of military personnel, the most common method for assigning priority is using the probability of attack with a particular agent as the single criterion. Using this approach, smallpox is often dismissed as an unlikely threat. We aimed to develop an evidence-based, systematic, multifactorial method for prioritizing the level of risk of each category A bioterrorism agent. Using 10 criterion, anthrax scored the highest, followed by smallpox. Tularemia was the lowest scoring agent. We suggest that such a system would be useful for developing public policy, stockpiling of vaccines and therapeutics, vaccination of military personnel, and planning for public health responses to a bioterrorist attack.

Anthrax↗
PubMed2006

Regulating biorisks: Developing a coherent policy logic (part I).

This is the first of two articles empirically detailing the working practices of regulators who are charged with overseeing biological research. Specifically, it considers how regulators from the Biological Agents Unit of the UK Health and Safety Executive review notifications and applications, carry out inspections of research centres, and enforce the law once breaches are uncovered. This first article focuses on the Unit's working practices before 9/11, and the second, forthcoming article focuses on the Unit's working practices after 9/11. I argue that an understanding of the implementation processes--that is, the strategies adopted by regulatory agencies and the styles employed by agency regulators in their interactions with those regulated--is critical to developing a coherent policy logic for the developing regulatory regime around biorisks.

Academies and Institutes↗
PubMed2005

[Implementation of State Policy in healthy nutrition of the population of the Russian Federation on the regional level: building-up regional policy and programs. Methodical aspects of development and implementation. Part 2. Recommendations were made development and realization of regional policy and programs in the healthy nutrition of the population].

Recommendations were made development and realization of regional policy and programs in the healthy nutrition of the population.

Food Supply↗
PubMed1999

An approach to policy analysis and development of medical informatics.

There are three grand challenges for medical informatics policy: (1) What is it? (2) What should it be? (3) How can we influence its development? To address these challenges requires: (1) an historical analysis of medical informatics policies in a representative sample of countries. This should include an account of major events, the roles of technology, individuals, culture and social settings. Pioneers have been led by visions of what medical informatics should achieve. The role of these visions and the reactions to unmet expectations thus also need to be analysed; (2) a generally applicable medical informatics policy that places the needs of its stakeholders and clients first. Top priorities are to support quality health care delivery and quality management of health care facilities; (3) an explanation of how policies in medical informatics are created and implemented together with a strategy to guide medical informatics professionals in their lobbying efforts.

Humans↗
PubMed1981

Orphan drugs: creating a policy.

Ensuring the development and availability of drugs that are medically important but commercially unprofitable poses a significant problem in our free market economy. Recent attempts by the federal government to develop a policy regarding these "orphan" drugs provides an important first step. The federal Interagency Task Force on Drugs of Limited Commercial Value recommendations propose initiation of a wide spectrum of administrative and legislative changes; these are designed to create incentives for industry to cooperate with government in developing and making orphan drugs available to those who need them. But before the proposed recommendations are accepted or rejected, a clearer understanding is needed of the nature of interrelated problems of orphan drugs. Thereafter, the wide spectrum of "stakeholders" involved in and affected by orphan drug policies or programs should seek means for interactive planning to determine desired ends and to devise means for achieving them.

Drug Industry↗
PubMedDate not supplied

Computerized screening devices and performance assessment: development of a policy towards automation. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: The extension of automation to the diagnostic assessment of clinical materials raises issues of professional responsibility, on the part of both the medical professional and designer of the device. The International Academy of Cytology (IAC) and other professional cytology societies should develop a policy towards automation in the diagnostic assessment of clinical cytologic materials. CONSENSUS POSITION: The following summarizes the discussion of the initial position statement at the International Expert Conference on Diagnostic Cytology Towards the 21st Century, Hawaii, June 1997. 1. The professional in charge of a clinical cytopathology laboratory continues to bear the ultimate medical responsibility for diagnostic decisions made at the facility, whether automated devices are involved or not. 2. The introduction of automated procedures into clinical cytology should under no circumstances lead to a lowering of standards of performance. A prime objective of any guidelines should be to ensure that an automated procedure, in principle, does not expose any patient to new risks, nor should it increase already-existing, inherent risks. 3. Automated devices should provide capabilities for the medical professional to conduct periodic tests of the appropriate performance of the device. 4. Supervisory personnel should continue visual quality control screening of a certain percentage of slides dismissed at primary screening as within normal limits (WNL), even when automated procedures are employed in the laboratory. 5. Specifications for the design of primary screening devices for the detection of cervical cancer issued by the IAC in 1984 were reaffirmed. 6. The setting of numeric performance criteria is the proper charge of regulatory agencies, which also have the power of enforcement. 7. Human expert verification of results represents the "gold standard" at this time. Performance characteristics of computerized cytology devices should be determined by adherence to defined and well-considered protocols. Manufacturers should not claim a new standard of care; this is the responsibility of the medical community and professional groups. 8. Cytology professionals should support the development of procedures that bring about an improvement in diagnostic decision making. Advances in technology should be adopted if they can help solve problems in clinical cytology. The introduction of automated procedures into diagnostic decision making should take place strictly under the supervision and with the active participation and critical evaluation by the professional cytology community. ONGOING ISSUES: Guidelines should be developed for the communication of technical information about the performance of automated screening devices by the IAC to governmental agencies and national societies. Also, guidelines are necessary for the official communication of IAC concerns to industry, medicolegal entities and the media. Procedures and guidelines for the evaluation of studies pertaining to the performance of automated devices, performance metrics and definitions for evaluation criteria should be established.

Automation↗
PubMed1990

Developing a formal policy for the management of blood and body fluids in an outpatient setting.

"Is it necessary for the average outpatient facility to develop a formal policy for handling blood and body fluids?" is a question medical group administrators have come face-to-face with over the past several years. It became clear to the author of this case study that something had to be done to ensure the safety of both his organization's employees and the patients they cared for.

Accident Prevention↗
PubMed2003

Developing an effective policy for home hygiene: a risk-based approach.

Evaluation of the infection potential in the home suggests that improved hygiene practice could significantly reduce the impact of infectious diseases. Fundamental to developing infection prevention policy for the home is the need to recognise that people live in an environment where all human activities occur, including food and water hygiene, hand hygiene, and hygiene related to care of vulnerable groups. In all these situations, reducing infection risks is based on the same underlying microbiological principles. In developing countries, disposal of human and animal excreta and other waste is often also the responsibility of the family and community. Adopting a holistic approach provides the opportunity for a rational approach to home hygiene based on risk assessment. The International Scientific Forum on Home Hygiene (IFH) believes that to deliver hygiene policy with real health benefits, a risk-based approach must be developed and promoted for the home. A risk-based approach starts from the principle that pathogens are introduced continually into homes on people, food and water, pets, insects and air. Inadequate disposal of human and animal excreta serves to increase this risk. Additionally, sites where stagnant water accumulates, such as sinks, toilets and cleaning cloths can support microbial growth and become a source of infection. By assessing the frequency occurrence of pathogens and potential pathogens on hands, hand and food contact surfaces, laundry, reservoir and reservoir/disseminator sites, together with the potential for transfer in the home, the exposure risk can be assessed.

Animals↗
PubMed1993

The interaction between policy and research in the implementation of server training.

This paper describes the relationship between research and policy in the development of server training policy in Ontario. With the emergence of civil liability for the conduct of intoxicated patrons, there has been a growing movement toward the training of managers and servers in licensed establishment in the responsible service of alcohol. As part of a major government reform of alcohol regulations which has led to a new Liquor Licence Act, all persons who serve alcohol in licensed establishments in Ontario will be required to attend a server training course. The process leading to new alcohol regulations in Ontario is summarized with particular attention to the implementation of mandatory server training. The paper concludes with a discussion of the role of research in policy development. It is argued that the role of research in policy making is limited by an inherent conflict between the nature of scientific enquiry and the exigencies of policy development.

Accidents, Traffic↗
PubMedDate not supplied

Serious mental health problems: policy changes.

Recent developments in services and strategies for helping people with serious mental health problems represent a watershed in mental health provision. This has implications not only for specialist mental health nursing, but also-- as increasing numbers of people with serious mental health problems live in the community-- for nurses working in all areas of health care, who will have to play a role in meeting their needs. This article describes current developments in policy and practice, and seeks to explain the basic principles of working with people in this client group.

Delivery of Health Care↗
PubMed2000

Welfare reform, family support, and child development: perspectives from policy analysis and developmental psychopathology.

This article explores the implications of recent welfare-related policy change for the well-being of children in low-income families, and for research investigating child development processes and outcomes. It provides an overview of current welfare-related policies and explores the implications for developmental researchers. The article also synthesizes early findings from research, highlighting both overall impacts and the more nuanced evidence that while families are transitioning off welfare, only a small number are transitioning out of poverty, and a subgroup of families at risk are not faring well. It then examines, from a theoretical and methodological framework, what developmental psychopathology might bring to the study of welfare-related impacts on children in the context of this complex and changing policy landscape, and what welfare researchers might bring to the field of developmental psychopathology. The article concludes with broad recommendations for both research and policy.

Adaptation, Psychological↗
PubMed1997

[Participatory action-research in the development of health policies for Izumo City, Japan].

The method of participatory action-research has been introduced in planning and implementing health and welfare projects for the elderly in Izumo City since 1993. Public health researchers have participated in the projects with other related administrative sectors, citizen and non-profit organizations. This study analyzes the establishment and implementation of health policies of Izumo from the following five aspects: policy-making, priority, education, intersectoral cooperation and community development. The participatory action-research method was useful for developing the ability of health-staff to work with citizens; for integrating community care and community development; for using community resources effectively for primary health care; and for developing community-based education of citizens, medical students and health staff. This method can be and should be adopted for strengthening the policy-making ability of public health researchers who learn through cooperation with citizens and non-profit organizations.

Community Participation↗