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PubMed2006

Kidney transplantation in Libya: a North African and Middle Eastern perspective.

OBJECTIVES: In August 2004, a national organ transplant program utilizing the latest policies, procedures, and protocols was begun in Libya. During the first year of the program, 50 kidney transplantations from living donors were performed. MATERIALS AND METHODS: Forty-nine patients (aged 7 to 65 years) received kidneys from living-related donors (aged 19 to 54 years), and 1 husband received a kidney from his wife. Donor selection was based on human leukocyte antigen compatibility. Renal failure was due to chronic glomerulonephritis in most patients, diabetes in 5 adults, systemic lupus erythematosus in 2 adults, and congenital anomalies in 2 children. Sixteen patients matched the human leukocyte antigens of their donors, 28 matched 1 haplotype, and 6 did not match any haplotype. Immunosuppression was accomplished with methylprednisolone and basiliximab. Maintenance therapy was with mycophenolate mofetil, cyclosporine, and prednisone. The latter was completely discontinued 1 month after transplantation. In patients with resistant hypertension, unilateral native nephrectomy was carried out during transplantation. Donor nephrectomy was performed through an open mini-incision using a Thompson retractor. RESULTS: At the time of this writing, 49 patients are alive and well, and 48 of them have had functioning kidneys for 10 to 22 months. Three patients had acute rejections that were successfully treated with methylprednisolone (n=1) or methylprednisolone and antithymocyte globulin (n=2). At the time of this writing, all 46 adults and 2 pediatric recipients have excellent renal function and are living normal lives. CONCLUSIONS: In terms of patient survival and quality of life, transplantation is superior to dialysis. Also, transplantation is less expensive than dialysis. In Libya, establishing an active and successful transplant program with early steroid withdrawal has brought many benefits to patients and their families and great financial savings to the government. Our program hopefully will provide a model for similar programs in Asia and Africa and encourage local governments to legalize organ procurement from cadaveric donors.

Adolescent↗

PubMed2004

HIV/AIDS in the Philippines.

HIV/AIDS has not yet caused a widespread epidemic in the Philippines. Rates in all the usual risk groups (sex workers, men who have sex with men, STD clients, returning overseas workers, etc.) have remained below 1%, except in a few areas, where they are still only 1-2% in some risk groups. The low level of HIV may be due in part to the low number of sex worker clients per night, the relatively low number of full-time sex workers, the low proportion of injectors among drug users, the early multisectoral response to the epidemic, and the presence of social hygiene clinics for sex workers. The incidence of STDs, multiple partners, and injection drug use with needle sharing, however, is increasing, suggesting that an explosive epidemic could occur if the virus is introduced into the appropriate risk groups. The Philippine government has confronted the problem of HIV/AIDS aggressively with an action plan that includes an emphasis on the response of the local government agencies, involvement and support of nongovernmental organizations (NGOs), incorporation of HIV/AIDS education into the school curriculum, and laws forbidding discrimination against persons with HIV/AIDS or belonging to risk groups. Local and international NGOs have been actively involved in prevention of HIV/AIDS and support of affected individuals. Although the Philippines is currently experiencing low rates of HIV/AIDS, the country needs to be prepared for the possibility of an explosive increase in the spread of HIV/AIDS. Vietnam and Indonesia provide examples of delayed epidemics of HIV/AIDS that could also occur in the Philippines.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Effective regulations with little effect? The antecedents of the perceptions of environmental officials on enforcement effectiveness in China.

Enforcement gaps are an especially vexing problem in China due to pervasive "pro-growth" local government priorities, the weak administrative capacity of environmental agencies themselves, and relatively weak levels of societal support for a cleaner environment. This study seeks to examine this problem from the perspective of the local enforcement officials by empirically examining the relationships between these and other influences on their perceptions of enforcement effectiveness. Using samples of enforcement officials from the fast-growing cities of Chengdu, Dalian, and Guangzhou, this study finds that many of the more commonly cited problems related to regulatory enforcement were not as influential in accounting for variations in perceptions of enforcement effectiveness than the current literature might suggest. Moreover, this study also finds that the pattern of influences varies greatly across jurisdictions, with only the officials' belief in the legitimacy of the governments' policies being significant in all three samples. Strong influences on perceptions of enforcement effectiveness in two of the three samples include the environmental values of enforcement officials, their perceptions of organizational capacity for enforcement, and their assessment of government support for environmental protection. Although government support was found to be a strong predictor of enforcement effectiveness in two of the three samples, the influence of societal support had a somewhat mixed and more complicated effect. In addition, this study suggests that further improvements in enforcement effectiveness may be possible by cultivating or selecting enforcement officials with strong environmental values and beliefs in the legitimacy of the government's environmental policy to take charge of enforcement. Because it is generally accepted that local environmental protection bureaus are generally upgrading their organizational capacity for improvement as the result of increasing central government support for environmental protection and institutional restructuring, and because environmental awareness in China is growing, this study suggests that some incremental progress is likely in China's efforts to close the enforcement gap. Unfortunately, such improvements are likely to be masked by the steep trajectory of economic growth, the narrow scope of regulatory control (i.e., with scant attention paid to nonindustrial sources), and the migration of industrial pollution to rural areas.

China↗

PubMed1998

Appointment of medical officers of health (food safety) is essential for achieving food safety objectives in the UK. Response to food borne illness section (4.44-4.49) of the White Paper, the Food Standard Agency--a force for change, MAFF January 1998.

National surveys reveal that the public has lost confidence in the safety of food. There is lack of co-ordination and failure to overcome institutional barriers at many levels throughout the food chain. The abolition of the post of medical officer of health and the public health departments of local government over which it presided, in view of many, including members of parliament, has been the most damaging of all changes to the public health and many have asked for the restoration of this post. Health departments have no overall statutory responsibility for food safety. The medical expertise of medical officers of health provided the executive authority with the necessary support in managing and controlling outbreaks of food poisoning, a point emphasised in the recommendations made by an inquiry set up by the government following the worst ever outbreak of food poisoning in Lanarkshire, Scotland, UK. Only such an appointment at local level will restore public confidence in food safety.

Attitude to Health↗

PubMed1991

Expenditures and sources of funds for mental health organizations: United States and each state, 1988.

Expenditures. Expenditures by the 8 types of mental health organizations covered in this report totaled $23.1 billion in 1988 in the United States and territories. Three States (California, New York, and Pennsylvania) accounted for 30 percent of this total. Nationally, State and county mental hospitals (hereafter called State mental hospitals) accounted for the largest proportion of all expenditures (30 percent, down from 34 percent in 1986). Private psychiatric hospitals and multiservice mental health organizations had the next largest expenditures, each accounting for 20 percent of the total, followed by the separate psychiatric services of non-Federal general hospitals at 16 percent. Department of Veterans Affairs (VA) mental health services, residential treatment centers (RTCs) for emotionally disturbed children, freestanding psychiatric outpatient clinics, and freestanding psychiatric partial care organizations accounted for 6 percent, 6 percent, 3 percent, and less than one-half percent of total expenditures, respectively. State mental hospitals represented the largest expenditures of any single type of mental health organization in 23 States; expenditures of private psychiatric hospitals were largest in 12 States; and expenditures of multiservice mental health organizations were the largest in 10 States. The $23.1 billion total for 1988 represented a 25 percent increase over the 1986 figure but, when adjusted for inflation, the estimated increase (expressed in constant dollars) was only 10 percent overall and 8 percent on a per capita basis. Constant dollar expenditures of most types of mental health organizations increased between 1986 and 1988, with the largest increase occurring among private psychiatric hospitals (54 percent). In contrast, constant dollar expenditures decreased for State mental hospitals and VA mental health services. Sources of Funds In 1988, the funds received by mental health organizations totaled $23.4 billion. Of this total, $8.8 billion (38 percent) was provided directly by State governments, predominantly by State mental health agencies. Direct Federal funds, plus Medicare and Medicaid (including the State and local share of Medicaid), provided $6.5 billion (28 percent) of total funding. Fees from clients (including private insurance) provided $5.2 billion (22 percent); direct local government funds provided 7 percent; and all other sources, 5 percent. State governments provided 77 percent of the funds received by State mental hospitals and were also the largest single source of funds for multiservice mental health organizations (51 percent) and freestanding psychiatric partial care organizations (44 percent). VA mental health services were funded by the Federal government, while 62 percent of funding for private psychiatric hospitals came from client fees (including private insurance).(ABSTRACT TRUNCATED AT 400 WORDS)

Community Mental Health Services↗

PubMed2004

Development of the rural health insurance system in China.

Ever since the collapse of the once successful Rural Cooperative Medical System (RCMS) in the early 1980s, when China transformed its system of collective agricultural production to private production, many rural communities, especially the poorer residents, have faced several major problems. In 1993, insurance coverage for rural residents was already low, at 12.8%. By 1998, only 9.5% of the rural population was insured. User charges have effectively blocked access for many rural residents who lack adequate income to purchase basic health care when needed. Impoverishment due to medical expenses is also a serious problem, which begs the question: why has there been no vigorous development of the rural health insurance system in China despite the country's rapid economic growth? This paper analyzes the major underlying reasons for the lack of rural health insurance in China. We found that lack of demand for the voluntary community financing schemes and inadequate government policies are the two major hindrances. Recently, the Chinese government announced a new rural health financing policy that relies on 'matching-funds' by the central and local governments as well as household contributions. The potential for success of this new model might be inferred from China's past experiences, as well as from the pilot projects that are underway.

China↗

PubMed2005

Eliminating disparities in cardiovascular health: six strategic imperatives and a framework for action.

Disparities in cardiovascular health are among the most serious public health problems in the United States today. Despite the remarkable declines in cardiovascular mortality observed nationally over the last 3 decades, many population subgroups defined by race, ethnicity, gender, socioeconomic status, educational level, or geography show striking, and often widening, disparities in cardiovascular health. The pervasive nature of these disparities and compelling evidence of the adverse impact they have on clinical outcomes and quality of life have been well documented. The elimination of these disparities is 1 of the 2 overarching goals of the Healthy People 2010 national public health agenda; however, few publications provide guidance on what actions to take. In this review, 6 strategic imperatives within a framework for action are presented. Other key elements of the framework include 10 focal areas and 6 major settings within which the framework calls for accelerated interventions to eliminate disparities in cardiovascular health. Success in this endeavor will require innovative and comprehensive interventions built on a foundation of sound clinical and public health science. Strategic partnerships with communities, community-based organizations, state and local governments, and public and private partners from both health and nonhealth sectors are essential. Additionally, investment in local-level disparities surveillance, community-based participatory research, and development of a diverse clinical and public health workforce will be invaluable.

Attitude of Health Personnel↗

PubMed2006

Community participation and appropriate technologies for dengue vector control at transmission foci in Thailand.

A community-based dengue vector control trial was conducted at transmission foci in Plaeng Yao District, Chachoengsao Province, eastern Thailand. Implementation was done by the local community in collaboration with local administration, public health, and school authorities. Our cost-effective approaches combined a source reduction campaign with appropriate vector control technologies applied within the foci (within 100 m around the foci) and also within schools attended by children from the treated areas. Vector management measures by local government included cleanup campaigns before the rainy season followed by a routine garbage pickup during the rainy season. Locally made screen covers for water jars, a combination of local Bacillus thuringiensis subsp. israelensis and Mesocyclops thermocyclopoides (copepod), and locally made lethal ovitraps were appropriate technologies used by the community in this campaign. The success of our intervention was evidenced by the significant reduction of dengue vectors and dengue hemorrhagic fever cases in treated areas compared with untreated areas.

Aedes↗

PubMed1988

Immigration measures, 1988.

In 1988, the Government of Norway undertook the following immigration measures: 1) it merged the Office of Immigration, which deals with asylum matters, and the Government Refugee Agency, which handles reception and settlement, into a new Directorate for Immigration under the Ministry of Local Government and Labour; 2) it instituted visa requirements for Chileans; and 3) it established a new reception program, under which five regional reception centers are to be created accommodating 200 to 300 people each, where asylum seekers will be placed until they have completed their police interview and a municipality has agreed to accept them.

Americas↗

PubMedDate not supplied

[The physician and primary health cares (author's transl)].

For many years in developing countries, rural or sub-urban populations are trying to set up some structures, through community effort, capable to provide to them elementary but indispensable health cares. Because of its fundamental commitment, medical and Public Health staff must participate to the improvement of such structures which are out of the local government health facilities, but have to be integrated in the National Health Plan. Therefore, simple but effective and locally adapted technology has to be set up. The physician must go beyond his conventional technical responsibility, and must supervise and stimulate the village health teams composed essentially of first-aid and sanitation workers and rural matrons, all of them selected by the concerned communities themselves.

Community Health Services↗

PubMed1997

Beef exports: looking for an opening.

BSE, food safety and the veterinarian's role in certification were among matters discussed by the BVA's President, Mr Ted Chandler, at a speech in Ballymena on October 29. Speaking at the BVA's Northern Ireland dinner, at which representatives of Government, local veterinary associations, the farming community and other organisations were present, Mr Chandler emphasised the need for the Government to recognise the veterinary profession's vital contribution to food hygiene and its pivotal role in ensuring that standards are maintained. The main text of his speech is given here.

Animals↗

PubMed2004

Social and political amplification of technological hazards. The case of the PEPCON explosion.

Using an industrial explosion in Henderson, Nevada, as a case study, this paper examines three main issues: the efficacy of a technological hazard event in amplifying otherwise latent issues, the extent to which the hazard event can serve as a focusing event for substantive local and state policy initiatives, and the effect of fragmentation of political authority in managing technological hazards. The findings indicate that the explosion amplified several public safety issues and galvanized the public into pressing for major policy initiatives. However, notwithstanding the amplification of several otherwise latent issues, and the flurry of activities by the state and local governments, the hazard event did not seem to be an effective focusing event or trigger mechanism for substantive state and local policy initiatives. In addition, the study provides evidence of the need for a stronger nexus between political authority, land-use planning and technological hazard management.

Accidents, Occupational↗

PubMed1988

Document on illegal marriages, 1987.

In December 1987, the State Family Planning Commission of China issued a document calling for government at all levels to take resolute measures to educate people about the Marriage Law and stop violations. The Document also provides that local governments should insist on legal registration and, after education with the help of associations of women, workers, and youths, punish Marriage Law violators. It stresses that local officials should abide by the law and stipulates that they will be severely punished for dereliction of duty or taking bribes.

Asia↗

PubMed1992

Long-term salvageability for patients with locally recurrent soft-tissue sarcomas.

Between 1971 and 1988, 39 patients were referred because of local recurrence of soft-tissue sarcomas and data from their patient records were analyzed to determine the parameters governing local recurrence. Mean follow-up was 11.1 years, with a mean time to local recurrence of 22 months. Twenty-one patients had local recurrence only, without metastatic disease. Salvage was provided for 14 (67%) of these patients after reexcision of local recurrence, and all 14 patients remained free of disease (mean follow-up, 112 months). We conclude that (1) excisional biopsy of tumors larger than 3 cm leads to potential contamination of clean tissue planes, limits ability to achieve an adequate margin of resection, and may compromise the definitive excision, and (2) in patients with local recurrence only, there is a high rate of long-term salvage (67% for follow-up of 9.3 years) after radical compartmental excision with or without postoperative radiation therapy.

Adolescent↗

PubMed1990

Expenditures and sources of funds for mental health organizations: United States and each state, 1986.

EXPENDITURES: Expenditures by the 8 types of mental health organizations covered in this report totaled $18.5 billion in 1986, for the United States and the Territories. Three States (California, New York, and Pennsylvania) accounted for one-third of this total. Nationally, the largest proportion of total expenditures were the expenses of State and county mental hospitals (34 percent, down from 38 percent in 1983) and those of multiservice mental health organizations (20 percent). In all but 19 States, State and county mental hospitals (hereafter called State mental hospitals) had the largest expenditures of any type of mental health organization; in 10 of the remaining 19 states, expenditures of multiservice mental health organizations were largest. Nationally, separate psychiatric services of non-Federal general hospitals, private psychiatric hospitals, and VA psychiatric organizations ranked next, with 16, 14, and 7 percent of total mental health expenditures, respectively. At the other extreme, residential treatment centers (RTCs) for emotionally disturbed children, freestanding psychiatric outpatient clinics, and freestanding psychiatric partial care organizations accounted for 5 percent, 3 percent, and less than 1 percent of national total expenditures, respectively. The $18.5 billion expenditure in 1986 was a 28 percent increase over the 1983 figure, but when adjusted for inflation, the estimated increase was only 5 percent overall and 3 percent on a per capita basis. Constant dollar expenditures (1983 = 100) of most types of mental health organizations increased between 1983 and 1986, but those of freestanding psychiatric outpatient clinics were virtually unchanged, and those of State mental hospitals and VA psychiatric organizations actually decreased. SOURCES OF FUNDS: In 1986, the funds received by mental health organizations totaled $19.0 billion. Of this total, $7.9 billion (41 percent) was provided directly by State governments, predominantly by the State mental health agencies. Direct Federal funds plus Medicare and Medicaid (including the State and local share of Medicaid) provided $4.8 billion, or one-fourth, of total funding. Fees from clients (including private insurance) provided $4 billion, or 21 percent, of total funding; direct local government funds provided 8 percent and all other sources 5 percent. State governments provided 78 percent of the funds received by State mental hospitals and were also the largest single source of funds, although not so dominant, for multiservice mental health organizations, freestanding psychiatric partial care organizations, and freestanding psychiatric outpatient clinics. VA medical centers were funded by the Federal Government, while two-thirds of funding for private psychiatric hospitals came from client fees...

Costs and Cost Analysis↗

PubMedDate not supplied

Health care facility preparation for weapons of mass destruction.

Weapons of mass destruction (WMD) are a threat that all health care facilities must be prepared for. Every health care facility is a vital part of the community response system and must be ready to respond. A terrorist attack using WMD can occur in any location, urban or rural. Private vehicles or buses may transport the majority of patients, with only a small percentage arriving by emergency medical services. Most will go to the hospitals closest to the incident, even if this results in overcrowding. Others will go directly to their private physicians' offices or primary hospitals, even if these facilities are not part of the local disaster plan. Most of these victims will not be decontaminated before arrival. If a hospital allows any of these patients in, the staff may become ill from the toxic exposure and the facility may require closure for decontamination. Since the risk is universal, all health care facilities must plan for the care of victims of a WMD incident. They must plan for communications that allow local government to transmit alerts regarding the emergency. Health care facilities must also communicate their status and emergency needs to local officials during the emergency. They must be prepared to establish a single entry control point and attempt to secure all other entrances. They must be able to establish a patient decontamination team from on-duty staff with only a few minutes' notice at any time of the day or night.

Biological Warfare↗

PubMed1992

One approach to tracking state and local health spending.

National health system reform proposals continue to emphasize states' shared responsibility for their citizens' health care. In view of this increased interest, this Data Watch examines how much state and local governments spend for health care, using primarily data from the U.S. Bureau of the Census. Significant discrepancies exist between these data and other sources of state and local health spending data. Nevertheless, census data are the most comprehensive source of information on state and local spending. In the 1980s the gross rate of state spending on health was exceeded only by spending on corrections; later reports indicate that health has now overtaken corrections. Health and hospital spending varies widely among states, ranging from $1.79 per $100 of personal income in New York (after federal funding and charges are subtracted) to $0.36 per $100 in Nebraska. Continued work is needed to unravel the differences between data sources and to improve the collection and use of data at the state and local levels.

Budgets↗

PubMed2001

Negotiating and managing partnership in primary care.

In the UK public service organisations are increasingly working together in new partnerships, networks and alliances, largely stimulated by government legislation, which aims to encourage 'joined-up' policy-making. This is particularly prevalent in health-care where local government, health authorities and trusts, voluntary and community groups are extending existing, and developing new, forms of partnership, particularly around Health Improvement Programmes and new primary care organisations. This paper explores two main aspects of how these new interorganizational relationships are being developed and managed and is based on research conducted in one case study locality. First, the new structures of partnership in primary care are mapped out, together with discussion on why these particular patterns of relationship between statutory and voluntary sector organisations have emerged, exploring both centrally and locally determined influences. Secondly, the paper explores the tensions associated with working within new policy-making and management structures, and how the additional demands of audit, performance measurement and the sheer pace of change, pose a potential threat to the partnership process.

England↗