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PubMed2000

Development of notification policy in Namibia.

On 21 April, 1999, the Namibian press reported that the government was going to declare AIDS a notifiable disease. This announcement sparked much debate about the role of confidentiality in a sound public health approach to the prevention and control of HIV/AIDS. It also became apparent that in Namibia people's understanding of the principle of confidentiality varies widely. Many seem to confuse the concepts of secrecy and confidentiality. They see preserving confidentiality about HIV/AIDS information as strengthening the "veil of secrecy" that surrounds HIV, reinforcing stigma and undermining efforts to control the spread of HIV. A consultative process, initiated by Joint UN Program on HIV/AIDS, led to the formulation of a much needed policy framework for reporting and notification of HIV/AIDS. A task force was established to identify, discuss and report on national issues, policies and experiences that could inform the discussion on HIV reporting and confidentiality.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Development of public policy and physical activity initiatives internationally.

Epidemiological, pathological, clinical, and experimental studies over the past 40 years convincingly show that physical inactivity and low physical fitness contribute substantially to the major chronic diseases prevalent in industrialised societies. Several industrialised countries around the world report increases in physical activity participation among adults in recent years, but the prevalence of inactivity remains high. These increases in voluntary exercise are at least partially offset by decreasing daily energy demands due to increased mechanisation at home, at work and during leisure-time. In developing countries, physical inactivity is becoming a prevalent lifestyle due to rapid social and economic changes. Clinical interventions and mass appeals to be more physically active are limited in effectiveness against the background of increasingly sedentary lifestyles. Exercise scientists and public health officials need to turn attention to public policy and legislative initiatives to restructure physical and social environments to encourage more physical activity and discourage sedentary habits.

Adult↗
PubMed1997

Recent developments in population policy in Australia: the demographic setting.

"The major parties [in Australia] are moving away from an exclusive pre-occupation with immigration to a broader focus on population policy and the Minister for Immigration has expressed an implicit preference for a population of 23 million. The contributions in this section of People and Place document his concerns together with those of the shadow Minister. They also provide demographic analyses which show that the Minister's goal will be hard to achieve. This is largely because of the exceptionally high migration of the Hawke years."

Australia↗
PubMed1997

Recent policy and technical developments in biological monitoring in the United Kingdom.

In 1996 the United Kingdom's Health and Safety Executive introduced biological monitoring guidance values for six substances, butoxyethanol, N,N-dimethylacetamide, lindane, methylene-bis(2-chloroaniline), mercury and methylenedianiline. These guidance values were set as either health-based values or hygiene-based values calculate according to the 90th percentile (benchmark concept). Recent technical developments from the Health and Safety Laboratory are described in this paper and include: (i) the use of breath analysis as a useful non-invasive routine monitoring technique; (ii) flow cytometry as a means for measuring different patterns of immune cell activation from workers exposed to respiratory sensitisers when compared with those exposed to chemical irritants; (iii) the use of molecular techniques to explore the possible role of individual susceptibility in the development and severity of glomerulonephritis; (iv) the development of expert systems for predicting the skin permeability of chemicals, and respiratory and skin sensitisation.

Breath Tests↗
PubMed1989

Ethical analyses in the development of congressional public policy.

A wide range of conflicting established moral viewpoints makes development of public policy related to infertility difficult. Where there are pluralities of viewpoints and no single established moral approach, uniform solutions are questionable. The Office of Technology Assessment (OTA), is a nonpartisan analytic support agency that serves the United States Congress by providing objective analyses of major public policy issues related to scientific and technological change. Because analysis of ethical issues is an important part of technology assessment, OTA included a thematic analysis of ethical issues in the report, Infertility: Medical and Social Choices. A consideration of whether infertility is a disease was an important conceptual starting point, and religious perspectives were reviewed as possible sources of moral and ethical insight.

Biomedical Research↗
PubMed1991

Politics, public policy, and the development of community mental retardation services in the United States.

Data emanating from the community services component of the Third National Study of Public Spending for Mental Retardation and Developmental Disabilities was analyzed. An empirical model of community services spending in the states was tested in a hierarchical regression analysis using cumulative community services fiscal effort in the states across 1977-1988 as the dependent variable. Strength of consumer advocacy organizations in the states coupled with states' historical orientations toward the adoption of policies promoting racial equality were highly significant predictors of state-by-state variance in community spending patterns. The implications of this and other findings emerging from the national study were discussed.

Community Mental Health Services↗
PubMed1999

The development of funding policies for hospices: is casemix-based funding an option?

The 1993 health reforms, with their emphasis on the purchasing of defined amounts or units of service, have led to the implementation of casemix-based funding for the acute medical and surgical services of the public hospitals. Despite growing interest in New Zealand in casemix-based funding for non-acute services such as palliative care, the nature of this service and the characteristics of its patient population pose particular difficulties for the development and implementation of casemix. This paper examines the feasibility of implementing casemix-based funding for hospice/palliative care services and discusses the development of casemix classification systems for palliative care. Problems associated with implementing casemix-based funding are considered including: the dual funding of hospices, the multi-agency nature of palliative care service provision and the need for the Health Funding Authority to identify and specify the hospice services it is willing to fund. While it is concluded that these problems will impede the introduction of casemix-based funding of hospice care, they highlight important issues that the hospice movement must address if it is to ensure its future within the new health environment.

Diagnosis-Related Groups↗
PubMed2002

The impact of regulatory policy on the development of somatic cell therapies in the United States.

Cellular therapies offer new promise for the treatment of a variety of diseases. In order to protect patients and donors, the Food and Drug Administration in the USA has been developing specific regulations. These have undergone several iterations, however, a broad-based strategy has recently emerged. These proposals are reviewed and their impact on academic institutions is assessed.

Accreditation↗
PubMed2001

How a teaching hospital implemented its termination policies for disruptive residents.

The development of Policy Standards for Termination that both protect and support residents while safeguarding sponsoring institutions has become increasingly necessary. To date, however, there has been little in the literature that discusses policies that have undergone thorough testing to the highest levels of the U.S. judicial system. Berkshire Medical Center (BMC), an acute-care community teaching hospital affiliated with the University of Massachusetts Medical School, developed a set of specific policies to cope fairly with the resident dismissal process. The authors describe a nine-year legal test of these policies in the case of a resident whose disruptive behavior required their implementation. Also presented is a summary of due process as it applies in such cases. The dismissed resident tested the policies through the Courts of the Commonwealth of Massachusetts all the way to the United States Supreme Court, the Equal Employment Opportunity Commission, and the Massachusetts Department of Industrial Accidents. At every level the termination action was upheld. The resident had previously been in two graduate medical education programs at other institutions, and neither of them had communicated issues of concern that would have forewarned BMC's program about potential problems. A plea for honest and open communication between programs is made. This may help to avoid the lengthy, expensive, and potentially serious consequences of such situations. However, the authors emphasize that when such situations arise, strong policies serve as an ultimate legal protection.

Adult↗
PubMed1995

Current and future risk assessment guidelines, policy, and methods development for chemical mixtures.

Humans are typically exposed to low doses of combinations of chemicals rather than to one or two chemicals at a time, yet most of the available toxicity data provide information on single chemicals or binary pairs, rather than on whole mixtures. The use of existing interactions study data for the quantitative risk assessment of chemical mixtures is problematic. These studies generally lack the necessary statistical characterizations to be useful in quantitative risk assessment procedures. The U.S. EPA developed guidelines for risk assessment for chemical mixtures in 1986 and is currently in the process of making revisions. Significant advances have been made in both the theoretical development and application of procedures such as dose addition, response addition, toxicity equivalence factors, comparative potency and interactions data characterizations. Details on the current revisions to the guidelines are given, along with information on the research efforts that have influenced these revisions or that represent future directions in chemical mixtures risk assessment.

Drug Interactions↗
PubMed2005

Understanding the policy context for supporting students with psychiatric disabilities in higher education.

Interest in postsecondary education for persons with psychiatric disabilities is high among consumers and advocates. However, the existence of program supports for higher educational goals is very uneven across U.S. states. This study was designed to examine the policy context in which states and educational institutions address needs of individuals with psychiatric disabilities to attend and succeed in postsecondary education. In 10 selected states, telephone interviews were conducted with key informants in state agencies of mental health, vocational rehabilitation, and higher education, as well as representatives of state-level advocacy organizations. Additionally, a search of websites relevant to state policy was conducted. The findings identify factors that facilitate and inhibit the development of policy and programs supportive of students with psychiatric disabilities. Facilitating factors include a strong community college system, progressive philosophy of the state mental health agency, and interest of consumers and the advocacy community. Inhibiting factors include political and budgetary uncertainty, competing priorities in the mental health system, emphasis on a medical rather than rehabilitative model, regulations of the VR system, and lukewarm enthusiasm of the advocacy community. Implications for community mental health services are included, particularly related to further policy development in support of students with psychiatric disabilities.

Adolescent↗
PubMed2005

Advanced nursing practice: policy, education and role development.

AIMS AND OBJECTIVES: This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. BACKGROUND: The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. CONCLUSION: The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. RELEVANCE TO CLINICAL PRACTICE: In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.

Accreditation↗
PubMed1995

The tribal tobacco policy project: working with Northwest Indian tribes on smoking policies.

BACKGROUND: This article reports on the objectives, study design, intervention methods, baseline results, and process data from a trial involving 39 Northwest Indian tribes. METHODS: Tribes were stratified and then randomized to either early or late intervention conditions. Intervention consisted of a consultation process to assist tribes to review and modify existing tobacco policies or to develop new policies relevant for their tribe and that protect tribal members from environmental tobacco smoke. Outcome measures consist of: (a) phone interviews to assess the comprehensiveness of tribal tobacco policy, (b) surveys of tribal leaders to assess norms and attitudes regarding tobacco use, and (c) observations of tribal settings to assess policy implementation and indicants of tobacco use. RESULTS: Early and later intervention tribes were well matched on baseline measures and tribal characteristics potentially related to policy outcomes. There was considerable variability across tribes on all measures though, in general, tribal leaders expressed support for more stringent tobacco use policies. Process data indicated that early intervention tribes strengthened their tobacco policies, but generally did not do so through tobacco policy committees as originally envisioned. CONCLUSIONS: There is good potential for tobacco policy interventions with Indian tribes. Consultation processes and products, such as policy guidebooks, that are sensitive to traditional uses of tobacco and to differences among tribes can help to modify policies to reduce exposure of tribal members to environmental tobacco smoke.

Attitude↗