The multiple risk factor intervention trial (MRFIT). III. The model for intervention.
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OBJECTIVE: In all western countries the demand for ICU-services is increasing and complaints about a lack of ICU-beds arise--independent of the actual density of ICU-services. The demand for more ICU-beds triggered a debate on whether it is possible to define an "objective" need. It was the aim of the assessment to analyze conventional as well as innovative approaches to plan and to evaluate ICU-services. METHOD: Systematic review, multistep searches in Medline, EmBase, Cochrane, HTA-Database, websearches, informal searches through planning and HTA-networks. INTRODUCTION: The differences between the density of intensive care in Europe and other parts of the western world is enormous. At a first superficial glance, Austria and Germany--in absolute figures--have many more ICU-beds than any other European country. In relative figures, taken into consideration that Austria and Germany have also many more acute care beds, the number of ICU-beds is among European average. It is therefore, impossible to analyze the need for ICU-beds without taking into account the national context of delivered acute hospital services. Although ICU-services take about 15-20% of the hospital budgets, there are still more questions than answers. RESULTS: Recent planning-documents: a review of trends in recent planning shows that all planners calculate on the basis of existing style of practice within their countries; the figures change only marginally. But while planners in countries with a relatively low ICU-bed density (Great Britan, Australia, Canada) certify a certain need for an increase, planners in countries with high density (USA, Germany, Austria) state a "satisfied need" and an over-provision of ICU-services. Innovative planners apply an "appropriateness of ICU-use" approach with analysing the actual utilisation by interpreting scores (especially TISS) and by identifying "low-risk" groups and propose a more flexible organisation of ICUs and a higher proportion of (intermediate care unit) IMCU-beds. Clinical and ICU-management tools, such as admission and discharge guidelines, strategies to reduce treatment-variations, certain organisational changes (leadership, horizontal hierarchy) and costing methods gain importance for better, more efficient and co-ordinated use of ICU-resources. CONCLUSION: In countries with a high density of ICU-services--such as Austria and Germany--not an expanding of the capacities, but a better use of the existing resources is recommended. For a fair comparison, participation in national databases, in registers as well as benchmarking and quality-assurance programs should be enforced.
Flu pandemics (worldwide epidemics) have occurred at irregular and unpredictable intervals, and have been associated with substantial morbidity, mortality and economic cost. In response to the emerging potential for a new pandemic to occur, national and international preparedness plans are being drawn up specifying the use of antivirals and vaccines. A number of challenges to pandemic vaccine development, large-scale production and the timing of distribution have also been highlighted. This article reviews the rationale and consequential policy for aligned public- and private sector planning in the present inter-pandemic period despite the prevalent risks and uncertainties. We propose a model for product development of pandemic flu vaccine based on public-private partnership, including push and pull incentive mechanisms for stimulating work in this therapeutic area. In addition, we argue that innovative vaccination strategies, together with special vaccine formulations which may offer cross-protection against multiple flu pandemic strains might avert the worse effects of an influenza infection.
Influenza vaccinations and antiviral drugs are the foundation of epidemic and pandemic preparedness, but only close collaboration between public health authorities and industry can achieve the necessary production levels and ensure the smooth distribution necessary to protect European citizens from this public health scourge. To focus the minds of all public health stakeholders, ESWI has translated these simple facts into clear achievable goals: it recommends that EU governments vaccinate one-third of their populations by 2010 and stockpile antiviral drugs for 20% of their citizens while promoting public-private partnerships. The scientific justification behind this objective is easily understood namely that while the annual flu shot protects against three viral strains,the pandemic vaccine will focus on only the one highly lethal virus. As a result if countries succeed in meeting the target to vaccine one-third of the EU-25 population with a trivalent vaccine, sufficient monovalent pandemic vaccine could be produced to vaccinate almost the entire EU-25 population at least once. Achieving these objectives would go far to containing the pandemic and ensuring necessary treatment to avoid needless deaths and social and economic disruption. It would also signal that influenza preparedness had become part of the European mindset. Relying on the technique of force-field analysis organised by professional facilitators the session asked government representatives and policy makers to identify existing factors that either provide support for the objectives or hinder progress.
Influenza pandemic planning is a complex, multifactorial process, which involves public health authorities, regulatory authorities, academia and industry. It is further complicated by the unpredictability of the time of emergence and severity of the next pandemic and the effectiveness of influenza epidemic interventions. The complexity and uncertainties surrounding pandemic preparedness have so far kept the various stakeholders from joining forces and tackling the problem from its roots. We developed a mathematical model, which shows the tangible consequences of conceptual plans by linking possible pandemic scenarios to health economic outcomes of possible intervention strategies. This model helps to structure the discussion on pandemic preparedness and facilitates the translation of pandemic planning concepts to concrete plans. The case study for which the model has been used shows the current level of global pandemic preparedness in an assumed pandemic scenario, the health economic implications of enhanced pandemic vaccine supply and the importance of cell culture-based influenza vaccine manufacturing technologies as a tool for pandemic control.
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In Malawi, community health nurses and environmental health officers are helping communities to solve their own health problems. Below, the lessons learned in one district.
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Industrial hygiene can have a powerful effect on family, community, and environmental health in addition to its effect on occupational health. Contemporary industrial hygiene begins in the workplace, but its impact can spread and improve the health status of the nation in several ways. Thirteen objectives for industrial hygiene are presented in this report. Industrial hygienists should know what the objectives are, how the objectives are useful to their practice, and how they can help to achieve them to improve the health of Americans.
Atlantic Storm was a tabletop exercise simulating a series of bioterrorism attacks on the transatlantic community. The exercise occurred on January 14, 2005, in Washington, DC, and was organized and convened by the Center for Biosecurity of UPMC, the Center for Transatlantic Relations of Johns Hopkins University, and the Transatlantic Biosecurity Network. Atlantic Storm portrayed a summit meeting of presidents, prime ministers, and other international leaders from both sides of the Atlantic Ocean in which they responded to a campaign of bioterrorist attacks in several countries. The summit principals, who were all current or former senior government leaders, were challenged to address issues such as attaining situational awareness in the wake of a bioattack, coping with scarcity of critical medical resources such as vaccine, deciding how to manage the movement of people across borders, and communicating with their publics. Atlantic Storm illustrated that much might be done in advance to minimize the illness and death, as well as the social, economic, and political disruption, that could be caused by an international epidemic, be it natural or the result of a bioterrorist attack. These lessons are especially timely given the growing concerns over the possibility of an avian influenza pandemic that would require an international response. However, international leaders cannot create the necessary response systems in the midst of a crisis. Medical, public health, and diplomatic response systems and critical medical resources (e.g., medicines and vaccines) must be in place before a bioattack occurs or a pandemic emerges.
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The evolution of state injury control programs, like the evolution of public health itself, involves many jurisdictions and disciplines outside the health domain and requires the cooperation and coordination of many sectors. Perhaps most important is that it requires involvement by the states to assure success. In California, the federal investment of less than $2 million in capacity building spread over five years has produced more than $8 million in injury control programming in the subsequent four years.