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PubMed1997

Prevalence of malnutrition and vitamin A deficiency in Nigerian preschool children subsisting on high intakes of carotenes.

The prevalence of malnutrition and vitamin A deficiency was determined in 204 preschool children of both sexes aged 3-57 months. The children were recruited from 2 rural communities of Atakumosa Local Government Area of Osun State in South West Nigeria. Dietary vitamin A intake was estimated from frequency of consumption of locally available vitamin A containing food items. Vitamin A status of the children was assessed from concentration of retinol in plasma. Nutritional status was assessed from height and weight compared with international reference standards. The results indicate widespread malnutrition among the children. The prevalence of stunting (low height for age) was 60.8% while prevalence of wasting (low weight for height) was 7.4% and of underweight (low weight for age) 27.5%. Dietary vitamin A intake appeared to be adequate in the children. Intake of vitamin A is predominantly from plant sources. At least 43% of the children consumed the carotene rich red palm oil 6 or more times per week in contrast to less than 1% who consumed eggs or milk for 6 or more times per week. Vitamin A deficiency was low in the children. Only 11.3% of the children had plasma retinol concentration < 0.70 mumol/L. The results indicate that childhood malnutrition of public health magnitude can coexist with adequate dietary vitamin A intakes or vitamin A status.

Anthropometry↗

PubMed1979

Health administration: the wealth and welfare wager.

Taking resources away from the NHS is not an easy thing to do, as the outraged cries of protest against the cuts over the past few months have testified. But hand in hand with this process has been the Government's determination to find new ways of putting money back into the service. Drew Clode examines some of the local approaches to fund raising so warmly espoused by the DHSS and examines how successful similar schemes have been when tried out in local government.

Financial Management↗

PubMed1977

Consumer participation in community health programs: a comparative analysis of two programs.

Two model inner city health-care delivery systems are examined in terms of their organizational structure, the role of the consumer within them, their strategies for change, and their ultimate impact and effectiveness. A group practice prepayment plan in Baltimore had consumers on its governing board and, in alliance with a powerful medical institution, successfully organized around political, economic, and social issues. An Office of Economic Opportunity (OEO) grant-supported, neighborhood health center in Washington, D.C. was less effective due to its lack of community representation in the decision-making process. The Baltimore model influenced the federal, state, and local governments, while the Washington, D.C. model had stronger local, than national, effects.

Community Health Services↗

PubMed1994

Will subsidiarity work for long-term care?

New financial and organization arrangements are changing the distribution of authority and power in the public service affecting managers, professionals and governing committees. The need for new roles like budget holding general practitioners, advocates, brokers and care managers are becoming recognized; traditional professional practice based on narrowly defined skills with the danger of a no-man's land between them is giving way to management arrangements that offer greater recognition of the needs of service users and their families. If the role of care manager and the new arrangements for assessment occur, much of the power now exercised by local authority members and by centrally based managers in local government will in the long-term be devolved locally to care managers. Various key issues are identified. Comprehensive multi-professional assessment is vital, with the results available to all groups of professionals so that a common voice can be presented to government circles in the future. Three broad areas need to be considered in the future implementation of long-term care. Firstly, some of the implications for assessment processes of the changes now taking place in community care will be described. Factors that inhibit good assessment will be discussed as well as key issues that also need to be addressed.

Community Health Services↗

PubMed1991

Hazard communication/right-to-know for health care facilities.

This manual is intended to provide useful information on the various new and pending health and safety regulations that affect hospitals. The governing bodies promulgating these regulations are the Occupational Safety and Health Administration (OSHA), the Environmental Protection Agency (EPA), and state and local governments. The majority of this document is dedicated to the OSHA Hazard Communication Standard (or federal Employee Right-to-Know Law) and the EPA Superfund Amendment Reauthorization Act (SARA) Title III Regulations (or federal Community Right-to-Know Law).

Communication↗

PubMed1998

Infant mortality: a multi-level analysis of individual and community risk factors.

This paper reports the results of an analysis of infant mortality based on a conceptual model that combines micro-level and macro-level variables taken from demographic, sociological and epidemiological research traditions. Using generalized hierarchical linear modeling techniques, we analyze 1988 and 1989 linked birth and death records for Upstate New York matched with county-level data from government and private sources. Net of health and sociodemographic risk factors. our results show that the number of per capita primary care physicians and local government expenditures on health care services and hospitals are positively linked to an increase in the probability of infant death and that our indicator of hospital facilities is negatively related to risk of death. We also find that some negative health behaviors and health resources of mothers are mediated by the local health care environment. Our results demonstrate the utility of combining perspectives from several disciplines when evaluating infant death, especially the impact of policy-related issues concerning health care service in

Humans↗

PubMed1997

Devolving authority for health care in Canada's provinces: 3. Motivations, attitudes and approaches of board members.

OBJECTIVE: To obtain information from the members of the boards of devolved health care authorities on their motivations, attitudes and approaches, to evaluate their relative orientations to the expectations of provincial governments, local providers and community members, and to evaluate the influence of members' being employees in health care or social services and being willing to stand for election. DESIGN: Mail survey conducted in cooperation with the devolved authorities during the summer of 1995. SETTING: Three provinces (Alberta, Saskatchewan and Prince Edward Island) with established boards and 2 provinces (British Columbia and Nova Scotia) with immature boards. PARTICIPANTS: All 791 members of the boards of devolved authorities in the 5 provinces, of whom 514 (65%) responded. OUTCOME MEASURES: Respondents' declared motivations, levels of confidence in board performance and attitudes toward accountability; differences between members who were willing to run for election to boards and others and differences between members who were employees in health care or social services and others. RESULTS: The main motivations of board members were an interest in health care and a desire to be part of decision-making and their main concern was inadequacy of data for decision-making. Almost all (93%) felt that they made good decisions, and 69% thought that they made better decisions than those previously made by the provincial government. Most (72%) felt that they were accountable to all of the local citizens, although nearly 30% stated that they represented the interests of a specific geographic area or group. Attitudes toward their provincial governments were polarized, with half agreeing and half disagreeing that provincial rules restrict the board members. The board members who were employed in health care and social services and those who were willing to stand for election did not differ substantially from their counterparts, although potential electoral candidates were less likely than others to feel accountable to provincial-level constituencies (such as taxpayers and the minister of health) and more likely to represent the interests of a specific geographic area or group. Only a modest number of differences were found among members from different provinces. CONCLUSIONS: Board members' strong feelings of accountability to and representation of local citizens could counteract the structural influences leading board members to favour the interests of provincial governments and providers.

Canada↗

PubMed1989

Demographic and budgetary influence on the geography of the poll tax: alarm or false alarm?

"The paper examines the influence of demographic change and the adaptation of local authority budgets on the level of poll tax between local authorities. The changes introduced by the Local Government Finance Act [in the United Kingdom] are argued to make almost all the possible variation between areas depend upon demography and local decisions on expenditure. Means of assessing local expenditure need are outlined and a consistent measure is developed which is used to estimate the relative contributions of changing need, tax base, new expenditures and grants over the period 1974-85 and up to 1991. 'New realism' in local authority spending is argued to combine with demographic change to allow radically reduced potential poll tax levies to be estimated than have been forecast by other sources. The reductions are particularly significant in inner London and many metropolitan districts."

Demography↗

PubMed1982

Occupational screenings: recruitment of government employees.

Occupational screening involving government employees represents a recruitment source with relatively high volumes of initial contacts and entries, a low ratio of entries to initial contacts, and a relatively high effort level requirement for the recruitment team. In the CPPT, nine centers made significant use of this strategy, to provide 11% of total initial contacts, 8% of first protocol visits and 7% of entries. Screening of government employees is costly and involves careful planning and implementation of complex arrangements. Shorter than expected lag-times were associated with local government sources. The tendency toward requiring screening of age- and sex-ineligible persons also characterized this strategy.

Adult↗

PubMed1989

The district concept for primary health care planning: attempts at implementation in The Netherlands.

Strengthening district-level primary health care systems has high priority in the WHO's 'Health for All' strategy. This article reviews governmental efforts to implement district health care systems in the Netherlands. Up to 1987, these activities corresponded to the WHO objectives, but their impact was limited. In 1987, government policy drifted away from these goals; the regulation of market forces and the increased influence of financing institutions have replaced planning by local government. Attempts to implement the district concept have, in fact, set primary health care planning back without offering the prospect of a leap forward.

Catchment Area, Health↗

PubMed1987

On the federal level.

Last month, the federal government's role in emergency medical services from the late '60s to the present was discussed in "Decades of Change," the first of this two-part article on coordinating EMS agencies. State and local governments generally monitor emergency services within their region. Recently, the federal government has shown increasing concern over lack of coordination between EMS agencies. Senate Bill S-10 and the ASTM Committee F-30 on EMS are examples of recent governmental efforts to bring the various services in line. This month, Emergency brings you a more detailed summation of the federal government's involvement in the nation's emergency medical services. More than 10 federal agencies have been set up to assist EMS on state and local levels. This intriguing list of agencies, from the Department of Agriculture to the Veterans Administration, will offer insight into the growing trend toward development of national standards, as well as provide information on alternative funding and training resources.

Emergency Medical Services↗

PubMed2002

Legal, social, cultural and political developments in mental health care in the UK: the Liverpool black mental health service users' perspective.

Documentary evidence suggests that attitudes among local health and social services professionals towards the concept of user involvement in health and social care remain deeply polarized, a position characterized by commentators simultaneously as praise and damnation. Perhaps user involvement in health and social care will enhance, and it appears to resonate with the logic of, participatory democracy, in localities where the centralization of power has posed questions as to the nature and purpose of local governance in public services provision. The problems experienced by Britain's black and ethnic minorities within the mental health system have been the subject of exhaustive social inquiry. This essay attempts to explore the way in which legal, social, cultural, and political developments interface with mental health care practice in the UK, in order to assist those responsible for mental health services provision to deliver services that are in line with the Government's expectation of a modernized mental health service that is safe, sound, and supportive. An exploration of these developments within the European, national (UK), and local (Liverpool) contexts is undertaken. An appropriate local response to national priorities will ostensibly cut a swathe through the barriers confronted by the ethnic minority mental health service user in the cross-cultural context, an important prerequisite for the implementation of genuine user involvement.

Humans↗

PubMed2002

Chorea and community in a nineteenth-century town.

The dominant historical narrative of Huntington's disease (Huntington's chorea) has portrayed the early American sufferers from this disorder as marginalized and vilified. This article argues, however, that afflicted families in East Hampton, New York--the site of George Huntington's mid-nineteenth-century observations--were mostly accepted and integrated within the community, some of them as members of the gentry and active participants in local governance. As descendants of early English settlers in this multiracial town, these white Presbyterian families, some of whose members were afflicted with what was locally called "St. Vitus's dance" or "that disorder," were always defined as "one of ours." While this fatal inherited neurological illness became more secret and hidden toward the end of the nineteenth century, this article suggests that it was larger cultural and social changes, rather than factors intrinsic to the disease, that led to the shift. The East Hampton story suggests the ways in which specific historical circumstances in a community may shape the-social meanings of even so severe a disease as Huntington's, and that social integration of the afflicted families may have helped mitigate the suffering of the disease.

Attitude to Health↗

PubMed1993

Promoting water fluoridation.

The Department of Health published two reports in 1962 and 1969 confirming the effectiveness of water fluoridation in demonstration studies in Watford, Anglesey and Kilmarnock. By 1988, approximately 6 million consumers (12 per cent of the population of England and Wales) were receiving artificially fluoridated water, although much of that progress was the result of decisions taken by local authorities prior to the reorganisation of local government and the health service in 1973-74. The Water Fluoridation Act (1985) established a clear process for decision making which incorporated requirements for local consultation. National opinion surveys indicate that public support for fluoridation has increased from 66 per cent in 1980 to 79 per cent in 1992. Regional Fluoridation Publicity Action Groups will need to convince local decision makers of the extent of this public support.

Fluoridation↗

PubMedDate not supplied

The economics of prescription drug prices, government intervention, and the importation of drugs from Canada.

Popular attention has focused on the skyrocketing health care costs in the United States and specifically on increasing insurance and prescription drug prices. Individuals and some local governments have advocated importing price-controlled prescription drugs from Canada to help ease the financial burden. What effects would this have on consumer prices, drug companies' incentives, and the development of new medications?

Canada↗

PubMed1996

[Questionnaire survey of AIDS examination recipients at government-run public health center regarding AIDS awareness promotion and HIV examinations].

An anonymous questionnaire survey was conducted among persons who had undergone screening for AIDS at public health centers under the auspices of 7 local government bodies (Hokkaido, Metropolitan Tokyo, Aichi Prefecture, Osaka Prefecture, Kobe City, Saga Prefecture, Okinawa Prefecture). There were 1,230 replies, for a response rate of 46.8%. Questions in the survey pertained to general knowledge of AIDS, information desired by the recipients, desired ways to foster awareness, and a desirable examination system. A comparison was made in terms of gender, marriage status (married, single) and age (less than 40 years of age, more than 40 years of age), respectively. The survey results were as follows. 1. Concerning the infection route, accurate response rate was low with regard to the mother-child infection, mosquito transmission, and use of contaminated needles. 2. Desired methods to promote AIDS awareness expressed among replies were given in the following order or frequency: "information via radio and TV," "spread of knowledge through telephone consultation," and "holding an AIDS Week or similar kinds of campaigns." 3. Information sought by respondents frequently included AIDS treatment, pathology, and spread. This trend was most obvious among those under 40 years of age. 4. As for the AIDS examination system, replies most often reflected the hope that the examination site would be the Public Health Center, the charge would be gratis, and that one could be examined at night during the week, and on days off. 5. For those undergoing examination where there was no actual concern of possibility of HIV infection, single persons, accounted for around 80% of the overall. 6. More than half of those who had been examined mentioned having experienced concerns about maintaining confidentiality at the time they were examined.

Acquired Immunodeficiency Syndrome↗

PubMed1997

A history of the people of Bikini following nuclear weapons testing in the Marshall Islands: with recollections and views of elders of Bikini Atoll.

The people of Bikini Atoll were moved from their homeland in 1946 to make way for the testing of 23 nuclear weapons by the United States government, beginning with the world's fourth atomic detonation. The subsequent half-century exodus of the Bikini people included a 2-y stay on Rongerik Atoll, where near starvation resulted, and a 6-mo sojourn on Kwajalein Atoll, where they lived in tents beside a runway used by the U.S. military. In 1948, they were finally relocated to Kili, a small, isolated, 200-acre island owned by the U.S. Trust Territory government. Numerous hardships have been faced there, not the least of which was the loss of skills required for self-sustenance. Located 425 miles south of Bikini, Kili Island is without a sheltered lagoon. Thus for six months of the year, fishing and sailing become futile endeavors. Because of the residual radioactive contamination from the nuclear testing, the majority of the Bikinian population still resides on Kili today. One attempt was made to resettle Bikini in the late 1960's when President Lyndon B. Johnson, on recommendations from the Atomic Energy Commission, declared Bikini Atoll safe for habitation. In 1978, however, it was discovered by the U.S. Department of Energy that in the span of only one year, some of the returned islanders were showing a 75% increase in their body burdens of 137Cs. In 1978, the people residing on Bikini were moved again, this time to a small island in Majuro Atoll. In the early 1980's, the Bikinians filed a class action lawsuit against the U.S. government for damages arising out of the nuclear testing program. Although the claim was dismissed, eventually a $90 million trust fund was established for their local government. Since then the leaders of the people of Bikini residing on Kili Island and Majuro Atoll have been confronted with the immense responsibility of determining how to clean their atoll while at the same time maintaining the health and welfare of their displaced population. For the community and their leaders, grappling with these technical decisions has created a life of strife, debate and conflict-and an uncertain future. Now, a radiological cleanup of Bikini is expected to begin sometime within 1997. The objective of this paper, with the support of the views and the recollections of elder Bikinians, is to recount the history and discuss issues facing the first displaced people of the nuclear age.

History, 20th Century↗

PubMed2001

More reliable minority ethnic population estimates and proportions for local areas: which areas to select and other choices to be made--an exploratory analysis.

Central and Local Government and other organisations are interested, for a variety of purposes, in obtaining better--more reliable--estimates of the proportions of the total populations in local authority districts which belong to the minority ethnic population. In inter-censal periods, this aim could be met, for example, by an increase in the size of the Labour Force Survey sample in selected areas. This article considers the optimal sample size for each area under different criteria to improve the reliability of its estimated minority ethnic proportion.

Censuses↗