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PubMed1980

[Poliomyelitis vaccination in infants in the canton of St. Gall].

Since 1977 all vaccinations against Poliomyelitis in pre-school age in the county of St-Gall have been paid for and evaluated by the local government. The comparison of the vaccinated children with the regionally registered births of 1978 showed that an average of 81% of children born in that year received at least two oral Polio vaccinations. The analysis on a regional basis shows, however, substantial local differences in the vaccination rates (25-100%). There is evidence for a positive correlation between vaccination rates and population density as well as between vaccination rates and the number of pediatritians.

Child, Preschool↗

PubMed2001

Disaster mitigation and preparedness: the case of NGOs in the Philippines.

The Philippines is very vulnerable to natural disasters because of its natural setting, as well as its socio-economic, political and environmental context--especially its widespread poverty. The Philippines has a well-established institutional and legal framework for disaster management, including built-in mechanisms for participation of the people and NGOs in decision-making and programme implementation. The nature and extent of collaboration with government in disaster preparedness and mitigation issues varies greatly according to their roots, either in past confrontation and political struggles or traditional charity activities. The growing NGO involvement in disaster management has been influenced by this history. Some agencies work well with local government and there is an increasing trend for collaborative work in disaster mitigation and preparedness. Some NGOs, however, retain critical positions. These organisations tend to engage more in advocacy and legal support for communities facing increased risk because of development projects and environmental destruction. Entry points into disaster mitigation and preparedness vary as well. Development-oriented agencies are drawn into these issues when the community members with whom they work face disaster. Relief organisations, too, realise the need for community mobilisation, and are thus drawn towards development roles.

Community Participation↗

PubMed1988

Management of associated soft-tissue injury.

Initially, soft-tissue injuries associated with vascular trauma require management according to the general surgical principles of wound care. Antimicrobial prophylaxis should be instituted. The mechanism and extent of injury must be determined, and debridement and irrigation should be completed in the operating room with the intent to preserve vital structures, decrease bacterial contamination, and render the wound free of devitalized tissue. Prompt coverage of exposed vascular repairs is vital in order to minimize the chance for infection and to protect the repair from desiccation and subsequent trauma. Early primary closure of heavily contaminated wounds can have disastrous results. Therefore, questionable wounds should be managed by delayed primary closure after repeated irrigation and debridements, with the definitive decision as to the timing of wound closure being based on quantitative cultures. The plastic and reconstructive surgeon can aid the vascular surgeon in the primary or secondary closure of such wounds by bringing healthy, vascularized muscle to cover the vascular repair. Vascularized muscle has proved superior in the coverage and healing of contaminated wounds. If conditions permit, this can be most readily accomplished by transfer of local muscle. Musculocutaneous flaps are of special value in cases that require increased durability or where extended coverage is necessary. With either of these flap techniques, the surgeon must be thoroughly familiar with the anatomy, blood supply, and function of the local muscles. Free-tissue transfer is to be utilized when local tissue is severely damaged in a way that precludes the use of adjacent muscle or myocutaneous flaps. Strict adherence to the principles and techniques of microsurgery, thorough evaluation of the zone of injury and recipient blood vessels, and understanding of the principles governing local muscle transfer are essential for a successful outcome.

Bacterial Infections↗

PubMed2004

The roles of government in improving health care quality and safety.

BACKGROUND: Discussions surrounding the role of government have been and continue to be a favorite American pastime. A framework is provided for understanding the 10 roles that government plays in improving health care quality and safety in the United States. Examples of proposed federal actions to reduce medical errors and enhance patient safety are provided to illustrate the 10 roles: (1) purchase health care, (2) provide health care, (3) ensure access to quality care for vulnerable populations, (4) regulate health care markets, (5) support acquisition of new knowledge, (6) develop and evaluate health technologies and practices, (7) monitor health care quality, (8) inform health care decision makers, (9) develop the health care workforce, and (10) convene stakeholders from across the health care system. CONCLUSION: Government's responsibility to protect and advance the interests of society includes the delivery of high-quality health care. Because the market alone cannot ensure all Americans access to quality health care, the government must preserve the interests of its citizens by supplementing the market where there are gaps and regulating the market where there is inefficiency or unfairness. The ultimate goal of achieving high quality of care will require strong partnerships among federal, state, and local governments and the private sector. Translating general principles regarding the appropriate role of government into specific actions within a rapidly changing, decentralized delivery system will require the combined efforts of the public and private sectors.

Federal Government↗

PubMedDate not supplied

Opportunities and challenges for clinical and cardiovascular research in Latin America.

Latin America in the past two decades has increasingly become a significant contributor of clinical research. The future capacity of clinical and specifically cardiovascular research has the potential to positively affect human health in the region and foster economic growth. However, the challenges of conducting clinical research in Latin America include a need for logistical support from local governments, continued commitment to education of physicians and ethics committees, and creation of oversight bodies to guarantee the highest quality of research. Bibliometric analyses were conducted to assess trends in clinical research. Latin American investigators demonstrated a tendency to publish clinical results in local and regional journals. The region offers many opportunities for clinical research including large treatment-naive patient populations and most importantly motivated investigators capable of producing high-quality results. Strategies to foster clinical research in Latin America must be based on development of a positive regulatory environment, leveraged protection of intellectual property, creation of alliances between private and public sectors with incentives for investment in science and technology, and finally focus on areas of clinical expertise such as cardiovascular disease, epidemiology, gastroenterology, and infectious diseases. Fostering the creation of research alliances across and between continents will help in establishing the supportive environment for dissemination of important ethical clinical research in the region.

Cardiovascular Diseases↗

PubMed1991

[Economic development, social policies, and population].

Using data for Latin America, "this paper analyses the [potential] of using social policies in connection with policies to affect demographic behaviour.... It shows that there is a coincidence between the interests of the countries, as expressed by the national governments, and the demographic wishes of couples.... It shows that to a certain extent, it is possible to...[implement] social and population policies that are relatively independent from the economic situation. The document also discusses the role of social scientists...[and central and local governments] in the elaboration and execution of policies in general, and socio-demographic polices in particular...." (SUMMARY IN ENG)

Behavior↗

PubMed1997

Health sector reform: lessons from China.

As a result of China's transition to a socialist market economy, its rural health services have undergone many of the changes commonly associated with health sector reform. These have included a decreased reliance on state funding, decentralisation of public health services, increased autonomy of health facilities, increased freedom of movement of health workers, and decreased political control. These changes have been associated with growing inequality in access to health services, increases in the cost of medical care, and the deterioration of preventive programmes in some poor areas. This paper argues that the government's strategy for addressing these problems has overemphasised the identification of new sources of revenue and has paid inadequate attention to factors that influence provider behaviour. The strategy also does not address contextual issues such as public sector employment practices and systems of local government finance. Other countries can learn from China's experience by taking a systematic approach to the formulation and implementation of strategies for health sector reform.

China↗

PubMed1995

Telemedicine and health care policy: the new federalism taking hold.

The new federalism is now taking hold in Washington, with far-reaching implications for the role of the federal government in health, education, and welfare programs; financial support for such programs; and the shift of control to the states. For telemedicine, the implications of these changes include having to make do with less external financial support and a need to establish partnerships between state and local governments, public sector developers and vendors, third-party payers, and community-based telemedicine programs. The long-term challenge for telemedicine programs, particularly in rural, medically underserved areas, is likely to be their sustainability in an adverse financial environment. The problem is further compounded by the lack of reimbursement for teleconsultations.

Budgets↗

PubMed1992

Coping by nonprofit organizations during the Reagan years.

Contrary to expectations that a divested federal role would lead to the demise of nonprofit agencies, the relationship between nonprofit and government sectors in New York at the end of the 1980s was stronger than ever. This article presents longitudinal data for six nonprofit agencies in Rochester, New York, to demonstrate "management by groping along" during the Reagan years, behavior that resulted in increased reliance on state and local governments for funds and programs and in different ways of doing business.

Charities↗

PubMed1993

Politics and scientific expertise: scientists, risk perception, and nuclear waste policy.

To study the homogeneity and influences on scientists' perspectives of environmental risks, we have examined similarities and differences in risk perceptions, particularly regarding nuclear wastes, and policy preferences among 1011 scientists and engineers. We found significant differences (p < 0.05) in the patterns of beliefs among scientists from different fields of research. In contrast to physicists, chemists, and engineers, life scientists tend to: (a) perceive the greatest risks from nuclear energy and nuclear waste management; (b) perceive higher levels of overall environmental risk; (c) strongly oppose imposing risks on unconsenting individuals; and (d) prefer stronger requirements for environmental management. On some issues related to priorities among public problems and calls for government action, there are significant variations among life scientists or physical scientists. We also found that--independently of field of research--perceptions of risk and its correlates are significantly associated with the type of institution in which the scientist is employed. Scientists in universities or state and local governments tend to see the risks of nuclear energy and wastes as greater than scientists who work as business consultants, for federal organizations, or for private research laboratories. Significant differences also are found in priority given to environmental risks, the perceived proximity of environmental disaster, willingness to impose risks on an unconsenting population, and the necessity of accepting risks and sacrifices.

Attitude↗

PubMed1997

Political realities of statewide smoking legislation: the passage of California's Assembly Bill 13.

OBJECTIVE: To prepare a history of the enactment of California Assembly Bill 13 (AB 13), a state law prohibiting smoking in most workplaces passed in 1994, and to discuss its initial impacts. METHODS: Data were gathered from open ended interviews with representatives of voluntary health organisations, local government organisations, and principal legislators involved in the process, as well as observers around the state who could provide insight into the legislative process. Information was also obtained from legislative hearings and debates, public documents, letters and personal communications, internal memoranda, and news reports. RESULTS: The success of local tobacco control legislation in California led to a situation in which some health groups were willing to accept state preemption in order to attract the support of the state restaurant association for a bill. The decision to accept this preemption compromise was made by the state level offices of the voluntary health agencies without consulting the broader tobacco control community within California. In contrast, local tobacco control advocates did not accept this compromise, in part because of their belief that local legislation was a better device to educate the public, generate media coverage, and build community support for enforcement and implementation of clean indoor air and other tobacco control laws. Enactment of AB 13 was associated with a slowing of all local tobacco control legislation, including youth oriented laws. CONCLUSIONS: Because its supporters initially doubted that AB 13 would pass, there was never an effort to reconcile the policy differences between state oriented and locally oriented tobacco control policies. This lack of consensus, combined with the political realities inherent in passing any state legislation, led to a bill with ambiguous preemption language which replaced the "patchwork of local laws" with a "patchwork of local enforcement."

California↗

PubMed1994

Sweeping changes for Welsh Health Authorities.

Despite the fact that Welsh Secretary John Redwood has stated he would like to see Welsh health authorities (HAs) administration cut by around 50% he has provided no indication as to whether or not his local government reforms will alter the HA's geographical or structural basis. This may mean that not only is there the possibility of moves towards 'commissioning authorities' and increases in the number of HAs and FHSAs merging, in addition Wales will have to contend with the unknown effect of local authority boundary changes. This is a concept which England and Scotland will also have to deal with. Russell Deacon and Tracey Deacon explore.

Catchment Area, Health↗

PubMed2005

Challenges for control of taeniasis/cysticercosis in Indonesia.

Taeniasis/cysticercosis has been reported from several provinces of Indonesia: Papua (=former Irian Jaya), Bali, North Sumatra, East Nusa Tenggara, South East Sulawesi, Lampung, North Sulawesi, Jakarta, West Kalimantan, and East Java. The highest level of endemicity of taeniasis/cysticercosis has been found in Papua. Recent surveys in Jayawijaya District of Papua in 2000 and 2001 showed that 5 of 58 local people (8.6%) harbored the adult tapeworm, Taenia solium, whereas 44 of 96 people (45.8%), 50 of 71 pigs (70.4%), and 7 of 64 local dogs (10.9%) were seropositive for T. solium cysticercosis. Current surveys in Bali and Samosir District, North Sumatra during 2002-2005 revealed that Taenia saginata taeniasis has increased in incidence whereas T. solium cysticercosis is now rather rare compared to one-two decades ago in Bali. Taenia asiatica taeniasis is still common in Samosir District. Data from other provinces of Indonesia are very limited or unavailable. Control of these diseases is not a priority in the health or veterinary services, neither at central or local government levels. However, limited efforts toward control of the diseases have been implemented such as training of health personnel, community education on disease prevention, and provision of anthelminthics. A working group for control of the disease in Indonesia and an international collaboration have been established among Ministry of Health, Indonesia; University of Indonesia; and Asahikawa Medical College, Asahikawa, Japan since 1996. Future goals include implementation of active case finding (active surveillance) and treatment of tapeworm carriers, sustainable public health education, establishment of a system to check the quality of beef/pork and determine the distribution of infected animals and strengthening of laboratory capacity. Efforts to motivate provinces and districts should be implemented in developing the strategic plan to control of the disease. Given the considerable differences in cultures, religions, levels of education, socio-economic levels, daily habits and behaviour etc., control programmes must be adapted to the local situations.

Animals↗

PubMed1998

Is new immigrant screening for tuberculosis still worthwhile?

BACKGROUND: new immigrant screening in the 1980s showed that the official Port of Arrival (POA) system performed poorly, that there was a significant yield in terms of clinical tuberculosis, and that preventive measures (chemoprophylaxis and BCG) were appropriate in a substantial minority Data for the 1990s was sought for comparison. METHODS: prospective data on new immigrant screening for 1990-1994 inclusive in the Blackburn, Hyndburn and Ribble Valley local government areas were analysed, and compared with previous 1983-1988 data. RESULTS: of the 2242 new immigrants screened, 1333 were from Pakistan, 604 from India and 305 from the rest of the world. A total of 898 (40%) were found via the POA system, but 1344 (60%) were only identified by local links with the Family Health Services Authority (FHSA). Ten cases of active tuberculosis were found (0.45%), chemoprophylaxis was given to 19/465 (4.1%) of children aged 0-15 years, and BCG vaccination to 530/1705 (31%) of those aged under 30 years. CONCLUSIONS: between 1990-1994 the official POA system continued to perform poorly. The yield of new tuberculosis cases detected was lower than in the 1980s. Chemoprophylaxis at 4% and BCG vaccination at 31% showed that preventive health measures were appropriate for over one-third of new immigrants aged under 30.

Adolescent↗

PubMedDate not supplied

Comparing employee health benefits in the public and private sectors, 1997.

Data from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey provide new information comparing public- and private-sector employee health benefits. The federal government is ahead of other employers in adopting managed competition principles using financial incentives and consumer information to promote choosing efficient plans. Federal employees experience a $200 annual compensation gap relative to those in the private sector, but it is partly explained by advantage in purchasing power. In contrast, state and local governments make higher payments toward health insurance than private-sector employers do. Their premiums are equivalent, but they pay a greater share of the total cost.

Efficiency, Organizational↗

PubMed2006

Evidence for environmental contamination in residential neighborhoods surrounding the defense depot of Memphis, Tennessee.

An interdisciplinary environmental assessment team from the Howard University Environmental Justice Partnership (HUEJP) conducted a site visit and assessment of the Defense Depot of Memphis, Tennessee in February of 2000. This depot was built in the late 1940's for storage of numerous chemicals and munitions. As the years progressed, many Memphis citizens have grown to believe that the activities and chemical stockpile located at this site have negatively affected the health environment of their residents. There is anecdotal evidence and documentation of numerous cancers and other illnesses in those local territories, and specifically, at the Memphis Depot site. Currently, this depot is closed and in remediation by the local government. Particularly, citizens of the Rozelle community have started a campaign to investigate any signs of exposure pathways to noted health risks. The HUEJP was contacted and asked to investigate the community concerns. Obliging to the request, we aimed to sample at three drainage sites and a residential site, talk to local citizens, and gain any additional information that would be helpful in relieving anxiety in the Rozelle community. Soil, sediment, and water samples were collected and analyzed for total organic carbon, inorganic anions, and heavy metals. These data show that for the four sites sampled, the highest concentrations of organic compounds and heavy metals were located either within a residential area or in an area with a direct transport pathway to the community. Atomic absorption analysis revealed detectable amounts of cadmium, lead and chromium metals at all sites with direct transport pathways into the residential community, with chromium concentrations being far in excess of the EPA standard limits.

Environmental Pollutants↗

PubMed2005

Normal and pathological oscillatory communication in the brain.

The huge number of neurons in the human brain are connected to form functionally specialized assemblies. The brain's amazing processing capabilities rest on local communication within and long-range communication between these assemblies. Even simple sensory, motor and cognitive tasks depend on the precise coordination of many brain areas. Recent improvements in the methods of studying long-range communication have allowed us to address several important questions. What are the common mechanisms that govern local and long-range communication and how do they relate to the structure of the brain? How does oscillatory synchronization subserve neural communication? And what are the consequences of abnormal synchronization?

Animals↗

PubMed2004

Financing immunizations in the United States.

Children in the United States receive immunizations through both private and public sectors. The federal government has supported childhood immunization since 1963 through the Vaccination Assistance Act (Section 317 of the Public Health Service Act). Since 1994, the Vaccines for Children (VFC) program has provided additional support for childhood vaccines. In 2002, 41% of childhood vaccines were purchased through VFC, 11% through Section 317, 5% through state and/or local governments, and 43% through the private sector. The recent introduction of more-expensive vaccines, such as pneumococcal conjugate vaccine, has highlighted weaknesses in the current system. Adult immunization is primarily performed in the private sector. Until 1981, there was no federal support for adult immunization. Since 1981, Medicare has reimbursed the cost of pneumococcal vaccine for its beneficiaries; influenza vaccine was added in 1993. This paper summarizes the history of financing immunizations in the United States and discusses some current problems and proposed solutions.

Adult↗