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PubMed1997

Decentralisation from acute to home care settings in England.

The impact of technology and resource constraints on acute care, the concept of a 'primary-care led National Health Service' (NHS), and the emphasis on developing community-based alternatives to institutional care have contributed to a reshaping of the respective roles of acute and home care services over the past 10-15 years in the United Kingdom. In England, recent reforms are allowing GP Fundholders, District Health Authorities representing a specific geographic area, and local government social services departments to purchase both acute and community-based care. In addition, new constraints on further expansion of institutional long-term care are encouraging the substitution of home care for the elderly needing long term care services. The result has been a dramatic increase in use of home care services. However, resource and supply constraints impede further home care expansion. Other forces within the NHS continue to foster unnecessary post-acute institutionalization. The successful decentralization of acute services from hospitals to home care requires an integrated program across the continuum of health and social services. In practice, no such concerted program exists.

Ambulatory Care↗

PubMed1999

The influence of lung cancer mass screening on surgical results.

BACKGROUND: After the introduction of the mass screening program for lung cancer, the number of patients detected by mass screening increased as well as the number of early staged patients. Therefore, we examined the influence of lung cancer mass screening on surgical results. METHODS: A total of 1177 primary lung cancer cases, who underwent surgery from 1963 to 1992, were retrospectively reviewed. They were grouped according to the changes in the mass screening system: the first period (1963-1977) before lung cancer screening started, the second period (1978-1986) when mass screening was conducted by the local government, and the third period (1987-1992) after the launching of the national screening program. RESULTS: The rate of cases detected by mass screening increased over time and the 5-year survival rate improved significantly, from 33.7% in the first period, to 51.8% in the second period and finally, to 58.4% in the third period. The improvement is attributable to a relative increase of rate of stage I cases and better stage I survival rate. Specifically, in stage I cases, improvement resulted from a relative increase of stage IA in peripheral type and roentgenographically occult lung cancer cases and from better survival rate of these two groups. CONCLUSION: As lung cancer screening has come into widespread use, detection of peripheral small-sized lung cancer and roentgenographically occult lung cancer have increased and consequently, surgical results have improved.

Adenocarcinoma↗

PubMedDate not supplied

[Public health structures in Spain: a changing panorama].

In the last years the health care system in Spain has undergone very important transformations. However, the public health services have not followed a comparable process. Until 1979 public health structures were based in central services and their provincial units, on one side, and in the resources of local governments on the other. From then on began the process of transferring responsibilities and resources to the regional governments of Autonomous Communities (AC), which today manage most public health services, while the central government keeps as its responsibility the development of basic norms, the administration of public health services at borders and customs, and the general health coordination. The situation in 1995 resembles that of a Federal Country, although the Kingdom of Spain is not formally defined as such. The role of central government services is visibly reoriented towards coordination and the building of consensual and shared structures for health information, for need evaluation, and for policy formulation and evaluation. Although the General Health Law of 1986 considered public health as a main axis for all health agencies, its actual development has been more patchy. Several AC with an Autonomous Health Service have kept public health services separated from it. Besides, many public health functions and activities are developed today from other structures. The processes of change reveal two contradictory aspects. On one side, structures have been upgraded after decentralization, and teams reinforced, with trained and full-time staff. However, there is some dilution of public health responsibility in the periphery, and a lower visibility of the health authority.

Epidemiologic Methods↗

PubMed2001

Understanding the role of contextual influences on local health-care decision making: case study results from Ontario, Canada.

Approaches to involving the public in local health care decision making processes (and analyses of these approaches) have tended to treat participation and publics uniformly in search of the ideal method of involving the public or providing the same opportunities for public participation regardless of differing socio-economic, cultural, insitutional or political contexts within which decisions are made. Less attention has been given to the potential for various contextual factors to influence both the methods employed and the outcomes of such community decision-making processes. The paper explores the role that context (three sets of contextual influences more specifically) plays in shaping community decision-making processes. Results from case studies of public participation in local health-care decision making in four geographic communities in Ontario are presented. During the study period, two of these communities were actively involved in health services restructuring processes while one had recently completed its process and the fourth had not yet engaged in one. Several themes emerge from the case studies regarding the identification and role of contextual influences in differentially shaping participation in local health care decision-making. These include the propensity for communities with different social and structural attributes to engage in different "styles" of participation; the importance attached to "community values" in shaping both the qualitative and quantitative aspects of participation: the role of health councils, local government and inter-organizational collaboration as participation "enablers"; and the politicization of participation that occurs around contentious issues such as hospital closures.

Community Health Planning↗

PubMed2004

Prospects of safe motherhood in Botswana: midwifery training and nurses' ability to complete the Botswana obstetric record.

This paper examines several key factors that determine nurses' ability to complete the Botswana Obstetric Record (BOR), an instrument that should help with early diagnosis of problems during pregnancy, labour, delivery and the puerperium. Using a national sample of 309 nurses working in hospitals, clinics and health posts under the local government authority in Botswana, the study found that a nurse's ability to complete the BOR was significantly related to midwifery training, level of basic nursing training, age group, level of income, job satisfaction, adequacy of equipment, attendance of refresher courses, overall level of in-service training, reliance on workshops and seminars, peer reliance and self-reliance for information on new nursing practices. Multivariate analyses indicated that the most competent nurse in completing the BOR was one trained as a midwife, working in an adequately equipped health facility, and who often consulted with peers as well as attended workshops and seminars. The study concludes that it is more important to train all nurses to become midwives than to upgrade enrolled nurses to become registered nurses if the plan for safe motherhood is to be advanced. Further research is needed to establish the objective competence of nurses who claim to be comfortable completing the BOR.

Adult↗

PubMed1997

Essential obstetric care: assessment and determinants of quality.

This paper reports on a study to develop and to apply methods for measuring the quality of essential obstetric care (EOC) in health centers. Based on a Nigerian guideline and an international guideline, and in consultation with local experts in primary care obstetrics, norms were established for equipment, personnel, supplies and the process of EOC, focusing on critical tasks. A combination of assessment methods was used, including observation of tasks performed during intrapartum care; use of data from records of care kept by midwives during the period of observation; use of data from records kept by midwives in the calendar year preceding the period of observation; exit interviews with clients; and inventories of equipment and supplies. Twelve health centers in three Local Government Areas (LGAs) and 360 clients in labor were included in the study. Quality of care was measured quantitatively as a score, calculated for each task and for each delivery in the health center. The results show that the methods developed are useful for: identifying quality score differences among health centers, and the effects of methods of assessment on quality scores; identifying aspects of EOC requiring improvements within each health center; and identifying factors influencing the quality of care, as a basis for effective quality improvement efforts. Regression models show that the most consistent and important predictor of quality scores is the use of printed forms (i.e. routine records of labor) during intrapartum care. Printed forms served as job aids, providing prompts that reminded midwives to perform specific tasks.

Female↗

PubMed2000

Ecological and cultural barriers to treatment of childhood diarrhea in riverine areas of Ondo State, Nigeria.

In Nigeria diarrhea still poses the greatest health problem to the survival of the under-fives in spite of the fact that the majority of mothers are reportedly to have been reached by health education on oral rehydration therapy (ORT) regardless of their ecological and socioeconomic situations. This study assesses the effect of different ecological and sociocultural conditions on use of ORT in riverine areas of Ondo State for the identification of the most effective means of dissemination of information on ORT in similar geographically disadvantaged localities in Nigeria and elsewhere. It is a formative study, but its results are expected to lead to identification of potentially effective intervention modalities to improve diarrhea treatment in remote areas. Of great concern in this study are communities whose awareness and acceptance of ORT may be more dictated by environmental conditions. This study combines two different research methodologies; namely, semistructured questionnaires and in-depth interviews to gain 'focused' insight into the communities. The study was carried out in Ilaje-Ese-Odo local government area (LGA) in southwestern Nigeria. It covered 308 mothers from 2 subethnic groups (Ilaje and Apoi) from a set of randomly chosen villages situated in 3 ecological strata and the in-depth interviews with 42 key informants. The majority of the mothers described some dangerous signs of last diarrhea suffered by their children under the age of five. Preliminary results indicate that awareness of actual causation was lowest in the remotest saltwater areas compared with other mothers in the study communities. Sixty-eight percent of the mothers in Ilaje mainland, 57% in fresh water Apoi and 44% in saltwater Ilaje stated that they have ever heard of salt, sugar solution (SSS). Furthermore, only 43% of them said they could prepare SSS while 42% ever made it. None of those mothers in saltwater Ilaje who confirmed awareness of and how to administer and prepare SSS could in reality do it correctly. When shown a typical sachet of ORS, only 8% of mothers living in salt water swamps said they have seen one before. Thus, promotive health services to reduce high mortality rates of children under five have passed the study mothers whose area reported the highest incidence of diarrhea in the state.

Child↗

PubMed2002

Research for improving the autopsy rate for infant death--medical economic assessment of the forensic autopsy system in Japan.

The rate at which autopsies are performed in Japan for cases of infant death is not adequate for diagnosing sudden infant death syndrome (SIDS). In Japan, it will be necessary to increase the autopsy rate at the time of infant deaths in order to improve the certainty of diagnosing SIDS and improving the accuracy of determining the cause of death with respect to infant death. The objective of this research is to provide basic documentation required for administrative implementation of this objective. In Japan, the Medical Examiner System and its related Approved Autopsy System are not deployed nationwide. The estimated budget in the case of deploying the Medical Examiner System nationwide for the purpose of improving the infant death autopsy rate is in excess of 5 trillion yen, and that in the case of deploying the Approved Autopsy System nationwide is estimated at roughly 130 million US dollars. However, since the rate of autopsies performed for SIDS has not changed following the implementation of approved autopsies, the efficacy of the Approved Autopsy System has come to be viewed questionably. In addition, it is also necessary to enact legislation that mandates the conducting of autopsies for all cases of infant death as is done in Scandinavia. The required cost in the case of performing autopsies for all cases of abnormal infant death is estimated at 200,000-700,000 US dollars and is considered to be within a range that could be implemented through local government regulations. In addition, the cost per body of an autopsy performed at the State Crime Laboratory in the State of Arkansas in the US in 1999 was about 6000 US dollars. In contrast, the same cost at the Tokyo Medical Examiner Office is much less at only about 4000 US dollars.

Autopsy↗

PubMed2000

Emergency room outreach to chronically addicted individuals. A pilot study.

There is a dearth of literature describing the treatment needs of substance-abusing or chronically mentally ill homeless individuals who frequently utilize emergency medical services. This homeless subset represents a discrete population in the larger homeless community. We describe a pilot program, supported by local county public funds, and conducted by a local nonprofit social work agency, which was designed to provide intensive case management services to such a population. Outreach and case management activities resulted in linking clients to a broad range of entitlements and community services. Among those receiving outreach and case management services (n = 10), emergency services decreased by 58% in the year following referral compared to the year before (p <.03). Emergency services for the purpose of this study are defined as ambulance response and transport followed by emergency room admission and treatment. Those in a comparable control group (n = 8) showed no decrease in emergency service use. These results suggest that such community-based outreach programs can significantly improve patient outcome and provide substantial cost savings for local governments and hospitals.

Adult↗

PubMed1996

Considerations for regional health authorities in the provision of environmental health services.

As population health programs, environmental health services differ fundamentally from other forms of health service delivery. At a time when the health sector is striving for integration, the incorporation of these unique services into the delivery system presents a unique challenge to policy makers and administrators across the country. The University of Alberta recently completed a comprehensive review and redesign of locally governed and delivered environmental health protection services in Alberta. This paper outlines the key issues and unique features surrounding the delivery of environmental health services and presents the study team's suggested approach to addressing these issues.

Alberta↗

PubMed1999

Patient dosimetry activities in the United States: the nationwide evaluation of X-ray trends (NEXT) and tissue dose handbooks.

In the United States the Food and Drug Administration (FDA) in collaboration with the Conference of Radiation Control Program Directors (CRCPD) and state and local government agencies surveys clinical facilities about X-ray system air kerma and ancillary data related to patient dosimetry for a variety of diagnostic X-ray examinations. The survey program is known as the Nationwide Evaluation of X-ray Trends (NEXT). The survey utilizes reference patient-equivalent phantoms in the collection of comprehensive technical information. With knowledge of the skin-entrance air kerma, specific tissue doses can be calculated. An overview of NEXT and previously published FDA tissue dose handbooks for diagnostic X-ray examinations is presented.

Child↗

PubMed2003

Sociocultural contexts of adolescent sexual behavior in rural Hanover, Jamaica.

PURPOSE: To investigate sexual behavior of adolescents in rural Hanover, Jamaica, and to elucidate the cultural contexts of this behavior. METHODS: Focus group discussion (FGD) sessions with 73 out-of-school young adolescents aged 15 to 18 years, recruited from health centers, as well as community-based organizations through the Social Development Commission (SDC) in Hanover, a local youth and community development organization, within the Ministry of Local Government, Youth and Community Development. The discussions focused on the adolescents' knowledge of sex and sexual risks, perceived vulnerability to sexual risks, use of protection, self-efficacy, and societal expectations. Data were analyzed, using the content analysis technique. RESULTS: Analyses of transcripts revealed the existence of different sexual scripts for males and females. Whereas females are culturally restrained, abstinence is less desirable for males. Both male and female adolescents expressed the view that the family was an important part of an adolescent's life, and has a strong influence on adolescent sexual behavior. Perception of vulnerability to HIV/AIDS and other sexually transmitted infections, and knowledge of sexual risks among the adolescents was low, and often erroneous. CONCLUSIONS: The results show that sexual attitudes and behavior of adolescents in the study setting are shaped by cultural and gender norms that impose different standards on males and females.

Adolescent↗

PubMed2003

[A national campaign for the prevention of hand accidents].

The objective of this article is to propose the launch of a prevention campaign against hand-related accidents. This effort is motivated by: epidemiological studies which, despite their disparate and inhomogeneous character, show that hand and wrist accidents are the primary cause of traumatic lesions. They occur two-third of the time during daily activities. For the work-related accidents, they are also the primary cause of work stoppages as well as permanent invalidities. current legal and regulatory prevention measures have reached their efficacy limits. These can not be applied to errors of individuals by inattention, negligence or a lack of information. Sensibilization efforts in public education, professional training programs or direct to the public are still much too limited in scope and are never included in a global strategy. The objective of the prevention campaign will be to increase public awarenesses as a function of one's milieu (school, workplace, leisure, household) to identify the risks of hand injuries and to provide advice on how to avoid them. In this context, the operationalization of the campaign will pass, at the level of each region, by the coordination of each traditional agencies (public health, local government, corporations), of new partners (insurers, renters or sellers of handiwork and gardening equipment, etc.), as well as FESUM centres.

Accident Prevention↗

PubMed2002

Environmental health challenges in South Africa: policy lessons from case studies.

In South Africa, the challenges of economic growth, job creation and effective service delivery are regarded as key to the long-term development of the country. The provision of basic environmental health services is acknowledged as an important factor impacting on the quality of living environments and the health of communities. This paper outlines the environmental health challenges faced by local authorities in the context of national policy, the wider local government development framework and the backlog in the provision of basic services. Using South African examples, the paper concludes with a synopsis of the gaps in policy and delivery drawing on the policy framework of the World Health Organisation, Health for All in the 21st Century. Many of the insights highlighted are likely to parallel the experiences in other developing countries.

Air Pollution↗

PubMed2003

Historical view of schistosomiasis japonica in Japan: implementation and evaluation of disease-control strategies in Yamanashi Prefecture.

We summarized historical aspects of disease control activities targeting schistosomiasis japonica in Kofu basin, Yamanashi Prefecture, Japan. Kofu Basin was one of the biggest endemic foci of schistosomiasis japonica in Japan, and the last place where transmission of Schistosoma japonicum was confirmed in Japan. Because of the most severe endemic situations in Yamanashi, intensive control measures had been implemented by the central as well as the local government. The last human case in Japan was in 1977, which is just before praziquantel being available. Therefore, the main efforts were focused on snail control. Mass examination and mass chemotherapy were implemented, however, the compliance was not so good because of the severe side effects due to the available therapeutics, Stibnal. Along with socioeconomic development after World War II, big changes in land use, life style, and farming led drastic reduction in the disease prevalence in Kofu Basin in the 1960s. A large amount of budget was also used for disease control. Cementing water canals covered more than 95% of paddy fields in Kofu Basin, and this resulted in ecological changes. After elimination of schistosomiasis, environmental repair is the urgent subject in Kofu Basin. Our experiences in Yamanashi contain both good influences and also a lot of reflection. It is important to evaluate each activity in our history before we give intensive cooperation with countries where endemic foci is still present.

Animals↗

PubMed1994

Results of a large scale onchocercosis survey in Enugu State, Nigeria.

The prevalence of onchocercosis was determined in three Local Government Areas (Ezeagu, Oji-River and Uzo-Uwani) in Enugu State, Eastern Nigeria between March 1989 and June 1990. Enugu State was shown to be mesoendemic for onchocercosis. A total of 7472 (26.9%) persons out of 27,831 examined were positive for skin microfilariae. There was no significant difference in infection rates between males (27.6%) and females (26.2%). Of the 118 villages surveyed only five had no inhabitant with skin microfilariae. There was a progressive increase of prevalence to the second decade of life, although 96.6% of cases with skin microfilariae had only a light infection. Onchocercomata prevalence was recorded as 27.3% which tallies with the prevalence of skin microfilariae at 26.9% hence onchocercomata prevalence may be used as a yardstick for predicting skin microfilariae prevalence.

Adolescent↗

PubMed1998

Assessment of the maximum waiting time guarantee for cataract surgery. The case of a Swedish policy.

Cataract is the most common reason for visual problems in old age. The introduction of intraocular lens (IOL) implantation revolutionized cataract surgery. Since the IOL technique was established in Sweden in the early 1980s, the demand for surgery has been increasing, leading to lengthy waiting lists. To shorten some of the most troublesome waiting lists, national and local governments (county councils) in Sweden introduced a maximum waiting time guarantee in 1992. The assessment of the guarantee made in this article shows that ophthalmic surgery units vary in their adoption of the guarantee, leading to different levels of goal achievement in waiting times for their patients. The less successful units could be divided into two groups: one where the units have a low operation rate, and one where the units chose not to follow the recommendations in priority setting made in the guarantee.

Aged↗

PubMed2001

Methodologies for estimating emissions for the U.S. EPA's NOx SIP call, CER rule, and other complexities.

Emissions inventories play an important role in many air quality decisions, and the importance of obtaining correct emissions data challenges the emissions inventory community to continuously improve its estimation techniques. The Clean Air Act Amendments of 1990 requires states with ozone nonattainment areas (NAAs) to submit periodically a comprehensive, accurate, and actual inventory of ozone precursor emissions until the areas are redesignated to attainment. They require the states with NAAs to report peak ozone season daily and annual estimates of the inventories for the counties that are in nonattainment. The recently proposed U.S. Environmental Protection Agency's (EPA) NO(x) SIP call and the Consolidating Emissions Reporting (CER) rule are more demanding still. The CER rule requires the states to report statewide point source inventories, 3-yr cycle inventories, and NO(x) SIP call inventories by county for all source types, regardless of the attainment status; the estimating periods are peak ozone season daily, 5-month ozone season, and annual estimates. Furthermore, complexities in emissions inventories such as estimating the emissions with different seasonal and multiple controls exist. These complexities and methodologies for estimating emissions for different time periods are not addressed sufficiently either by the EPA's procedure manuals or by the Emissions Inventory Improvement Program guidance documents. This paper presents methodologies for estimating emissions for different time periods and multiple controls. These methodologies will help the EPA, state, and local government agencies to meet the evolving demands of emissions inventories and the reporting requirements of the NO(x) SIP call and the CER rules.

Air Pollutants↗