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At least 217 records · Page 12Linked to original sources
PubMed1992

The role of the cancer registry in cancer control.

It has been accepted generally that the cancer registry has more of a 'back room' than a 'front line' role in cancer control, its particular responsibilities lying in description of cancer patterns, care, and outcome, in monitoring these variables in relation to control activities, and in providing a research database--often, for others to utilize. While readily justifiable, this prevailing concept of the cancer registry's role may not be sustainable in times of economic restraint. A survey of members of the International Association of Cancer Registries showed that most registries fit the accepted mold. Some, however, extend beyond it, particularly in the direct conduct of epidemiologic research and in the implementation of control programs, particularly screening. Sixteen percent appeared only to be collecting incidence statistics and may be at risk of economic rationalization. It would be consonant with their basic role and skills, and promote more rational cancer control, if cancer registries were to take on an expanded role, including direct participation in epidemiologic research, evaluation of interventions against cancer at the population level, situation analysis and cancer control planning, and implementation of aspects of cancer control--particularly coordination of screening--and monitoring the performance of cancer control programs. This expanded role could become the responsibility of specialized cancer control units of which cancer registration would be the central function.

Cancer Care Facilities↗
PubMed1989

[Implementation of an integrated program of prevention of chronic nonspecific diseases in the Kaĭshiador region of the Lithuanian SSR].

An integrated prevention programme of chronic noncommunicable diseases (CND) was started by the Lithuanian SSR in 1983. Improvement of population's health status due to primary preventive activities aimed at prevention of risk factors' development and correction was defined as the basic long-term goal of the programme. Organizational aspects of the integrated programme carried out in the Kaishyador Region of the Lithuanian SSR were described. Some results obtained during the implementation of the programme on prevalence and correction of major CND risk factors were presented.

Adolescent↗
PubMed1997

School-based smoking control: a research agenda.

Within the context of a framework for cancer control, this article reviews evidence and suggests research directions for 3 types of school-based smoking interventions: elementary school prevention, secondary school interventions and interventions linking community and school. Directions for smoking research in elementary schools include improving adoption through the provision of effectiveness criteria, tailoring interventions to schools and training. Monitoring at micro and macro levels may help planning and implementation, but clearer evidence is required of its feasibility. Fundamental research should explore new options to understand why youth do not start smoking. Smoking intervention research at the secondary school level is less well established, with only 1 effectiveness trial reported. We recommend testing models that involve youth in developing their own solutions and examining the interaction of various control measures. Sustainability issues have led researchers to embed school-based smoking interventions in community-wide activities. Intervention research of this sort still needs to determine how to apply approaches (e.g., comprehensive school health) and what the appropriate roles are (such as technical assistance) for community agencies. All research using these school-community approaches needs to include process measures to explain potential failures to obtain significant differences between components. In addition, we call for research on the training of educators and health personnel, to increase the priority given to smoking prevention and improve the implementation of existing programs. Research on policy initiatives that lead to effective training needs to be explored. Finally, we argue that application of the principles incorporated into the cancer control framework (e.g., through participatory research methods) strengthens the research process and results.

Adolescent↗
PubMed1995

Vector control for malaria and other mosquito-borne diseases. Report of a WHO study group.

Since the Ministerial Conference on Malaria in 1992, which acknowledged the urgent need for worldwide commitment to malaria control, efforts have been directed to implementation of a Global Malaria Control Strategy. Vector control, an essential component of malaria control, has become less effective in recent years, partly as a result of poor use of alternative control tools, inappropriate use of insecticides, lack of an epidemiological basis for interventions, inadequate resources and infrastructure, and weak management. Changing environmental conditions, the behavioural characteristics of certain vectors, and resistance to insecticides have added to the difficulties. This report of a WHO Study Group provides guidelines for the planning, implementation and evaluation of cost-effective and sustainable vector control in the context of the Global Malaria Control Strategy. It reviews the available methods - indoor residual spraying, personal protection, larval control and environmental management - stressing the need for selective and flexible use of interventions according to local conditions. Requirements for data collection and the appropriate use of entomological parameters and techniques are discussed and priorities identified for the development of local capacity for vector control and for operational research. Emphasis is placed both on the monitoring and evaluation of vector control to ensure cost-effectiveness and on the development of strong managerial structures, which can support community participation and intersectoral collaboration and accommodate the control of other vector-borne diseases. The report concludes with recommendations aimed at promoting the targeted and efficient use of vector control in preventing and controlling malaria, thereby reducing the threat to health and socioeconomic development in many tropical countries.

Community Participation↗
PubMed2002

Moving from recommendation to implementation and audit: part 1. Current recommendations and programs: a critical commentary.

Growing concern over the spread of resistance to antibiotics and other antimicrobials has prompted a plethora of recommendations for its control. Strategic programs for resistance containment have been initiated in various countries, particularly in Western Europe and North America. The World Health Organization and the European Union have responded to the need for international action by publishing guidance and encouraging collaboration. These recommendations rightly focus on controlling resistance in the community. They agree on the importance of surveillance of resistance patterns and antibiotic usage and the need to encourage judicious antibiotic usage (especially through education of prescribers and the public). Yet there remains a pressing need for the implementation of effective actions to address these issues. Important considerations given less attention include infection prevention (e.g. through immunization), the use of rapid diagnostic tests to reduce antibiotic usage, audit of implemented actions, and the provision of feedback. Furthermore, research is necessary to fill the substantial gaps in our knowledge. Notably, the reversibility or containment of resistance with the optimization of antibiotic usage has yet to be definitely established. For now, antimicrobial management programs should focus on ensuring the most appropriate use of antimicrobials rather than simply on limiting choices. Finally, developed countries must recognize that a truly global approach to resistance containment will require greater support for developing countries.

Anti-Bacterial Agents↗
PubMedDate not supplied

States' implementation of the Section 510 abstinence education program, FY 1999.

CONTEXT: As part of its reworking of the nation's welfare system in 1996, Congress enacted a major new abstinence education initiative (Section 510 of Title V of the Social Security Act), projected to spend $87.5 million in federal, state and local funds per year for five years. The new program is designed to emphasize abstinence from sexual activity outside of marriage, at any age, rather than premarital abstinence for adolescents, which was typical of earlier efforts. The actual message and impact of the program, however, will depend on how it is implemented. METHODS: Program coordinators in all 50 states, the District of Columbia and Puerto Rico were surveyed concerning implementation of the Section 510 abstinence education program in FY 1999. The questionnaire asked about expenditures and activities performed, about policies established for a variety of specific situations and about how the term "sexual activity" is defined and what specific components of the federal definition of "abstinence education" are emphasized. RESULTS: Forty-five jurisdictions spent a total of $69 million through the Section 510 program in FY 1999. Of this total, $33 million was spent through public entities, $28 million was spent through private entities and $7million (in 22 jurisdictions) was spent through faith-based entities. Almost all jurisdictions reported funding school-related activities, with 38 reporting in-school instruction and presentations. Twenty-eight jurisdictions prohibited organizations from providing information about contraception (aside from failure rates), even at a client's request, while only six jurisdictions prohibited information about sexually transmitted diseases. Few reported having a policy or rendering guidance about providing services addressing sexual abuse, sexual orientation or existing pregnancy and parenthood. Only six respondents said they defined "sexual activity" for purposes of the program, and 16 reported focusing on specific portions of the federal definition of "abstinence education." CONCLUSIONS: More than one in 10 Section 510 dollars were spent through faith-based entities. Programs commonly conducted in-school activities, particularly instruction and presentations, not only through public entities, but also through private and faith-based entities. Most jurisdictions prohibited the provision of information about contraception, about providers of contraceptive services or about both topics, even in response to a direct question and when using other sources of funding. Most also left definitions of "abstinence" and "sexual activity" as local decisions, thus not clearly articulating what the program is designed to encourage clients to abstain from.

Adolescent↗
PubMed2006

The Massachusetts model: an artful balance.

The Massachusetts health reform law has attracted national attention for its bold vision and its unique combination of tested and innovative policy approaches. Despite the law's promise, implementation challenges lie ahead, including building and sustaining public and legislative support for the law; ensuring care for those who are left out; and containing health care costs. The provisions that are most certain of success should provide coverage to 70 percent of the state's 530,000 uninsured residents. The state's ultimate success in reaching its goal of near-universal coverage will depend on how well the state can respond and adjust as implementation proceeds.

Health Care Reform↗
PubMed2005

Breast and cervical cancer screening: clinicians' views on health plan guidelines and implementation efforts.

BACKGROUND: Optimizing breast and cervical cancer screening rates within health plans requires clinician support for screening guidelines, an awareness of whether there are tools available and functioning to aid screening implementation, and a perception of collegial and leadership support for quality screening services. This study investigated clinicians' perceptions of guidelines, reminders for screening, and plan and practice commitment in order to assess where opportunities exist to improve the screening process. METHODS: A stratified sample of 761 primary care clinicians from three comprehensive health plans were surveyed to assess awareness of and agreement with guideline elements, perception of guidelines' usefulness, awareness of plan strategies to promote guideline adherence, perception of support for high-quality screening services, and ratings of plan efforts to maximize members' access. RESULTS: Clinician awareness of and agreement with guideline elements was high (98% breast, 94% cervical). Across guideline elements, agreement was lower for mammography than cervical screening, notably for upper age limit recommendations (58% breast, 79% cervical). Knowledge of systems that cue patients and clinicians that screening is due varied by cancer test, and clinician report and plan report data about the existence of systems were, at times, not congruent. Views about consistent operation of systems differed by test (mammograms, 74%-92%; Pap, 66%-84%). Clinicians rated local colleagues and local and plan medical leadership as very committed to high-quality screening, albeit with somewhat lower ratings for cervical testing. Although the majority rated overall plan efforts to maximize screening as very good or excellent, perceived consistency of systems to cue a woman that she is due for testing and perception of collegial support were independently and significantly related to ratings of plan efforts. CONCLUSIONS: Improvements in knowledge of systems that support guideline implementation varied, and action to ensure accurate perception of reminders, as well as consistent implementation of systems, may be important for improving screening rates and outcomes. Plan efforts and clinician efforts at the practice level are closely linked and need to be aligned to maximize screening rates. This requires plan and practice-level analyses of structures and processes that could be improved.

Adult↗
PubMed2006

Differential effect of early or late implementation of prior authorization policies on the use of Cox II inhibitors.

BACKGROUND: State Medicaid programs introduce many types of prescribing restrictions to manage pharmaceutical use and expenditure. Little is known about the differential effect of implementing prior authorization (PA) policies at market entry versus waiting until several years later when prescribing behavior may already be established. OBJECTIVES: We sought to examine the impact on overall use of Cox II inhibitors of PA policies implemented at market entry versus at least 2 years after market entry. RESEARCH DESIGN: We quantified Cox II inhibitor and nonselective nonsteroidal anti-inflammatory drug (NSAID) utilization for state Medicaid programs from January 1996 to September 2003. We used generalized estimating equations, Tukey's studentized range test and segmented linear regression on state Medicaid programs to determine the significance of changes in medication use. MEASURES: The primary end point was the number of defined daily doses (DDD) per 1000 population per day. RESULTS: Six states implementing prescribing restrictions for Cox II inhibitors at market entry had the lowest rates of uptake, averaging 10.9 DDD/1000/d. Twelve states adopting restrictions more than 2 years after market entry experienced declines in use from 23.0 DDD/1000/d before to 13.9 DDD/1000/d after the restrictions (P < 0.01). The 17 states that had never restricted access had the highest utilization, averaging 29.0 DDD/1000/d. CONCLUSION: Implementing prescribing restrictions at market entry of Cox II inhibitors was effective in restricting uptake. Despite the difficulty in changing well-established prescribing patterns, utilization in states implementing policies 2 years after market entry approached that of the early adopting states within 1 year. Clinical outcomes of such policies remain unknown.

Anti-Ulcer Agents↗
PubMed1984

Planning for rural community health nursing needs: the experience of Ecuador.

One of the most prevalent and enduring health care delivery problems in the Third World and less developed countries is the lack of skilled medical personnel. This is particularly true in Ecuador where there are serious deficiencies at the community health level. This paper describes the health problems which have resulted from this situation. A planning model is then presented which Ecuador is beginning to follow for improving its rural community health nursing capabilities. Other countries or developing regions with similar problems might consider the model and its implementation in resolving their own community health problems.

Community Health Nursing↗
PubMed2004

Formulating a health quality improvement strategy for a developing country.

The purpose of this paper is to present the idea of a national health quality plan as a way of mobilising and organising effort towards quality improvement, and stimulate debate and interes in the West in the subject, showing how quality improvement can be developed and invigorated by engaging in issues arising from quality strategies in developing countries. Considers why developing countries are concerned to improve the quality of health care and the different methods which can be used. Stresses the importance of recognising the starting-point and what can help and hinder this work. Concentrates on improving the quality of health care, rather than the wider and important question of improving health. Concludes that developing countries do have the exerptise and that extra resources are needed, mostly for training and supervision. Opines that if implementation is not managed then the investment will be wasted.

Credentialing↗