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PubMed1986

Health and illness of Moroccan immigrants in the city of Antwerp, Belgium.

This article reviews the literature on Moroccan migrants in Belgium dealing with health issues. The conclusion is that scientific research is too often (medical) professionally biased and therefore not a valid instrument to guide policy making. Complementary research based on the perceived needs of migrants is needed. Two studies are reported both based on samples of Moroccan migrants living in the city of Antwerp, Belgium. The first study is an ethnographic qualitative one (n = 85 households, 525 individuals); the second one is more quantitative-epidemiologic (n = 112 households, 563 individuals). The latter one is representative for the Moroccan migrant group living in the city district of Hoboken. Findings are reported on illness, knowledge and attitudes and on illness behaviour. These findings reveal points of continuity as well as of discontinuity with similar findings in Morocco. The health care system of the Moroccan migrant groups under study is described as pluralistic and complex. It consists of three distinct subsystems: the prophetic, the humoural and the Western one. An attempt is made to draw these subsystems to a structurally based typology.

Adult↗

PubMed1990

Health and social inequities in Belgium.

This paper presents two different yet complementary on-going studies related to the understanding of the mechanisms leading to social inequalities in health. The first part is devoted to a differential morbidity survey held in southern Belgium. It confirms that striking differences exist in the period around birth between social categories, and between the three districts under study. In a multivariate approach, differences remain between the social categories and between the district samples, which classically studied socio-demographical, behavioural and medical characteristics cannot fully explain. The role of cultural factors is analysed and discussed through the concept of 'health culture' and alternative hypotheses are reviewed in the light of the results. The second part reviews the studies conducted on the so-called avoidable mortality in the EEC and more specifically in Belgium. The concept of avoidable mortality is discussed, as well as its utility from the standpoint of the present concern on social inequalities. Differences between EEC countries are large, and even within Belgium there are important disparities between the districts. The role of health care supply has not been demonstrated yet in these two contexts. For Belgium, it appears that a major part of the unequally distributed mortality is constituted by causes of death considered as avoidable. Moreover, the most discriminating causes of death are overrepresented in socially deprived districts. The two perspectives are confronted in order to delineate perspectives for future research and operational outcomes for policy making and interventions.

Belgium↗

PubMed1994

Interests in health care technology assessment (HCTA) and HCTA training needs in eight European countries: COMETT-ASSESS.

Between mid-1991 and mid-1992, nearly 300 different organisations involved in European health care contributed their views to a survey covering a range of topics relevant to health care technology assessment (HCTA) and economic appraisal of health technologies. Organisations who participated included manufacturers, health care institutions, professional associations, health care reimbursement or funding agencies, academic institutions and policy making agencies in eight European countries. The study was carried out as part of a larger project, COMETT-ASSESS, funded partially by the EC COMETT programme, to design and deliver training in health care technology assessment and socioeconomic evaluation. The survey demonstrates a high level of interest in assessment of health care technologies among European organisations, regardless of the type of organisation. Eight out of ten organisations report high-medium levels of interest in using HCTA in their decision making. A similar proportion report high-medium interest in increasing their general understanding of HCTA, and 2 out of 3 in carrying out assessments. All organisations clearly identify a need to train their staff in HCTA. The two key groups of staff requiring training are managers and clinicians. Manufacturers also report a need to train their marketing staff. The principal reason for training is in order to improve the use staff make of HCTA in their decision-making. This finding indicates that it may not be sufficient for European countries to develop effective HCTA dissemination strategies which improve the flow of information on technology assessment results; decision-makers within the organisations targeted will also need training, if they are to use this information effectively. As well as a need to train decision-makers, organisations also report a need to train their researchers, and to a lesser extent their own trainers. When it comes to the types of technologies which need to be assessed, organisations consistently report that they are interested in assessment of accepted health technologies, as well as new or recently introduced ones. In contrast, to date the major emphasis in many HCTA programmes has been on technologies which are yet to enter the service setting. More thought now needs to be given to developing methodologies for assessing technologies once they have reached the service setting. For this the presence of a skilled and well-trained group of health personnel will also be necessary.(ABSTRACT TRUNCATED AT 400 WORDS)

Cost-Benefit Analysis↗

PubMed1993

The Oncology Nursing Society: commitment and activities promoting cancer pain relief.

The primary mission of the ONS is promoting excellence in oncology nursing. In its efforts to accomplish this mission, the undertreatment of cancer pain has emerged as a significant issue for clinicians, educators, researchers, and administrators involved in the care of people with cancer. In an effort to promote cancer pain relief, the ONS contributes human, administrative, and financial resources from its existing organizational structure, personnel, and volunteers in the variety of ways described above. The structure of the ONS enables it to support the goal of cancer pain relief from the broadest of policy-making activities nationally to the provision of care by a nurse to a patient and family. The ONS Position Paper on Cancer Pain, other position papers and statements, adopted resolutions, and the strategic planning process will continue to guide the ONS's commitment and contributions to promoting cancer pain relief.

Health Promotion↗

PubMed1995

Trial of Nonpharmacologic Intervention in the Elderly (TONE). Design and rationale of a blood pressure control trial.

National and international policy-making organizations advocate nonpharmacologic therapies to reduce blood pressure (BP). However, data to support such recommendations in older persons are virtually nonexistent. The Trials of Nonpharmacologic Intervention in the Elderly (TONE) is a randomized, controlled trial that will test whether weight loss or a reduced sodium (Na) intake or both can maintain satisfactory BP control, without unacceptable side effects, after withdrawal of antihypertensive drug therapy. Medication-treated hypertensives (aged 60 to 80 years) with a systolic BP less than 145 mm Hg and a diastolic BP less than 85 mm Hg who are taking one antihypertensive medication are randomly assigned to one of four groups: (1) weight loss alone, (2) reduced Na intake alone, (3) combined weight loss and reduced Na intake, or (4) usual life-style (control group). Overweight participants are randomized to one of these four groups, while nonoverweight individuals are assigned to either the reduced Na intake or the usual life-style group. The interventions, tailored to the needs of older persons, use behavioral approaches to accomplish intervention-specific goals (weight loss > or = 10 lb, daily Na intake < or = 80 mEqa). Three months after the start of intervention, antihypertensive drug therapy is withdrawn. The primary trial end point is a BP of 150/90 mm Hg or higher, resumption of antihypertensive drug therapy, or the occurrence of a BP-related clinical complication during 2 to 3 years of follow-up. It is anticipated that TONE findings may identify an effective and acceptable nonpharmacologic approach to control hypertension in the increasingly large number of older persons treated with antihypertensive drug therapy.

Aged↗

PubMed2006

Confidence in controlling a SARS outbreak: experiences of public health nurses in managing home quarantine measures in Taiwan.

BACKGROUND: Taiwan experienced one of the most serious outbreaks of severe acute respiratory syndrome (SARS) during the 2003 epidemic. Public health nurses faced unprecedented challenges in implementing an extensive quarantine policy to prevent disease spread. Their professional confidence, however, was shattered during the SARS crisis. This paper assesses factors related to public health nurses' confidence in managing community SARS control programs. METHODS: In May 2003, we sent structured questionnaires to all 361 health centers in Taiwan and asked the public health nurses responsible for epidemic control to complete. A total of 312 completed surveys were returned for a response rate of 86.4%. Descriptive methods and logistic regression were used to analyze the data. RESULTS: Most public health nurses (71.9%) expressed a general lack of confidence in handling the SARS epidemic. Confidence was significantly associated with perceived epidemic severity (OR, 0.58; 95% CI: 0.35-0.99), daily epidemic updates (OR, 2.26; 95% CI: 1.28-3.98), and number of cases in the community (OR, 2.21; 95% CI: 1.13-4.31). CONCLUSION: Nurses' individual risk perception and prompt update of epidemic information significantly affect levels of professional confidence, a key factor influencing quarantine implementation success. Strategies to promote productive interagency collaboration and advocate participatory policy making involving health workers at all levels are needed to control effectively infectious disease outbreaks.

Adult↗

PubMed2006

The importance of estimating selection bias on prevalence estimates shortly after a disaster.

PURPOSE: The aim was to study selective participation and its effect on prevalence estimates in a health survey of affected residents 3 weeks after a man-made disaster in The Netherlands (May 13, 2000). METHODS: All affected adult residents were invited to participate. Survey (questionnaire) data were combined with electronic medical records of residents' general practitioners (GPs). Data for demographics, relocation, utilization, and morbidity 1 year predisaster and 1 year postdisaster were used. RESULTS: The survey participation rate was 26% (N = 1171). Women (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.28-1.67), those living with a partner (OR, 2.00; 95% CI, 1.72-2.33), those aged 45 to 64 years (OR, 2.00; 95% CI, 1.59-2.52), and immigrants (OR, 1.50; 95% CI, 1.30-1.74) were more likely to participate. Participation rate was not affected by relocation because of the disaster. Participants in the survey consulted their GPs for health problems in the year before and after the disaster more often than nonparticipants. Although there was selective participation, multiple imputation barely affected prevalence estimates of health problems in the survey 3 weeks postdisaster. CONCLUSIONS: Estimating actual selection bias in disaster studies gives better information about the study representativeness. This is important for policy making and providing effective health care.

Adolescent↗

PubMed2004

Ethical aspects of cryobiology: responsible applications in biomedicine and in clinical practice.

This paper focuses on ethical issues in applications of cryobiology to humans, more particularly in the field of human reproduction and cryosurgery. The paper also provides essential ingredients for the interface of bioethics and cryobiology. For instance, since the 1970s bioethicists have developed four principles to guide the moral evaluation of the 'new medicine.' These are: respect for persons, non-maleficence, beneficence, and justice. In the field of human reproduction major progress was made by the cryopreservation of reproductive material. Still, ethical issues arise whenever partnerships cease to exist (death) or deteriorate (divorce), and decisions have to be made about the disposition of frozen gametes and embryos. Policy-making becomes, then, a prime concern. Examples of regulation in the United States of America, in the United Kingdom, and across Europe are being offered. Cryosurgery remains a field where cryobiologists struggle in their quest for an optimal technique, thus illustrating the need for assessment of safety, efficacy, and benefit to patients. Increasingly, cryobiologists have been joining in the ethical reflection on the use of cryo-technologies. They may further do so by perfecting their ability to identify ethical aspects, by analysing the norms and values at stake, by learning the skill of making the appropriate choices, and by showing their willingness to justify the choices made be it in the inner circle of pairs or publicly.

Bioethical Issues↗

PubMed2005

Patients seeking care from acupuncture practitioners in the UK: a national survey.

OBJECTIVE: The primary aim was to describe the characteristics of acupuncture patients and in particular the main problem or symptom for which they were seeking treatment. Our secondary aim was to compare the profiles of acupuncture patients with those of a patient survey undertaken in 1988. METHODS: We used the data from a recent prospective adverse event survey of a representative sample of 9408 acupuncture patients who were consulting members of the British Acupuncture Council. We analysed patient reports of demographic details, pathways to care, whether the National Health Service paid for their treatment, whether they had previously consulted a GP or hospital specialist for their main problem and whether they were consulting an acupuncturist for the first time. We separately analysed equivalent data from a survey funded by the Nuffield Provincial Hospital Trust undertaken in 1988. RESULTS: Seventy-four percent of patients were female, and with an average age of 51 years. Most commonly, patients had self-referred (39%), had previously consulted their doctor about their problem or symptom (78%), were paying for their own treatment (95%), and had received acupuncture before (87%). The most common main problem or symptom reported by patients was musculo-skeletal (38%), followed by psychological (11%), general (9%), neurological (8%) and gynaecological/obstetric (8%), while 5% of patients were seeking treatment for their general well-being. In comparing our data with that of the 1988 survey, we found a number of changes over time, in particular the proportion of musculo-skeletal conditions had dropped significantly (chi(2) = 17.36, d.f. = 1, p < 0.001), indicating a wider case mix amongst patients compared with those seeking care in 1988. CONCLUSION: This evidence from acupuncture patients' reports shows that musculo-skeletal problems provide the main reason for seeking treatment. The large dataset from this study provides a wealth of information and a fresh raft of questions which will inform future research and policy-making.

Acupuncture Therapy↗

PubMed2005

Neighborhood design and active aging.

This qualitative analysis of focus groups describes how neighborhood design encourages active aging. Nine focus groups were conducted in 2002 and 2003 with residents (N=60) aged 55 and over living in Portland, OR, USA. Content analysis revealed that local shopping and services, traffic and pedestrian infrastructure, neighborhood attractiveness, and public transportation influence activity among older adults. This information will be useful for making policy recommendations relating to land use planning and transportation, to assist in senior-friendly developments and neighborhood improvements, and to design effective senior health interventions with an emphasis on neighborhood design influences.

Aged↗

PubMed2004

Spatial pattern of private health care provision in Ujjain, India: a provider survey processed and analysed with a Geographical Information System.

In developing countries like India, official information on private health care providers is scanty. This is an obstacle for effective health care planning and policy development. In this paper, we present a project aimed to enumerate, characterise and digitally map all private providers (PPs) using Geographical Information System (GIS) in a rural district in India. A team of surveyors carried out a census of private providers in the district. This data was combined with official data on geophysical characteristics and infrastructure, demographic situation and location of settlements and public health care providers. This study highlights the need to consider PPs in health policy making in India. The survey identified about 2000 additional PPs over and above those listed with the health authorities. About half practised modern medicine (Allopathy) while the rest practised other types of formal medical systems (Ayurveda or Homeopathy) or informal therapeutic systems. Individuals with no formal health care training constituted the majority of PPs. Formally trained doctors were highly concentrated in urban areas while trained non-doctors and untrained PPs dominated in the rural areas. The study shows how GIS can be used to create an improved basis for health services research. In the future, the digitised map will be used as a sampling frame and point of reference for studies on quality and utilisation of PPs in Ujjain district. However, the utility for health care planning is less clear. GIS has limitations in countries like India due to lack of valid routine data to enter into GIS as well as to competing demand for health care resources.

Data Collection↗

PubMed2005

The politics of childbirth in the context of conflict: policies or de facto practices?

The impact of warlike conditions on the lives of Palestinian women and children is far reaching. Beginning in September 2000, curfews, closures, siege and the parceling up of the country into small isolated entities have all led to a lack of access to basic maternity services, rendering pregnant women and their newborns a highly vulnerable group. Because any discussion of childbirth in the Occupied Palestinian Territories (OPT) cannot be separated from the larger historical context of international health politics, we begin with a brief review of international historical trends in childbirth policies, focusing on the relationship between discourse in the developed and developing world contexts to show how these models have intersected and diverged. We point to the similarities between the OPT and other developing countries, but also highlight the specificities that characterize the Palestinian experience today that include local political systems, medical dominance, professional group interests and the politics of gender, as well as the legacy of colonialism intertwined with an ongoing national conflict. We then provide a review of the history of childbirth in the OPT and analyze the various forces that led to the emergence of today's chaotic and contradictory de facto policies and practices. By assessing the health policy environment, we demonstrate the seeming impossibility of developing national level childbirth policies, given the current political conditions and a mix of other determinants that are not all within Palestinian control. Finally, we emphasize the importance of establishing a process as opposed to a blueprint of health policy-making based on people's immediate and long-term needs in all areas of the country. We also propose interim measures that rest on the notion of developing decentralized sub-strategies relevant to different zones of political reality and stages of system and human resource development, aiming at combining survival imperatives with those of improving women's birth experiences and women's health.

Arabs↗

PubMed2004

Heuristic evaluation of infusion pumps: implications for patient safety in Intensive Care Units.

OBJECTIVE: The goal of this research was to use a heuristic evaluation methodology to uncover design and interface deficiencies of infusion pumps that are currently in use in Intensive Care Units (ICUs). Because these infusion systems cannot be readily replaced due to lease agreements and large-scale institutional purchasing procedures, we argue that it is essential to systematically identify the existing usability problems so that the possible causes of errors can be better understood, passed on to the end-users (e.g., critical care nurses), and used to make policy recommendations. DESIGN: Four raters conducted the heuristic evaluation of the three-channel infusion pump interface. Three raters had a cognitive science background as well as experience with the heuristic evaluation methodology. The fourth rater was a veteran critical care nurse who had extensive experience operating the pumps. The usability experts and the domain expert independently evaluated the user interface and physical design of the infusion pump and generated a list of heuristic violations based upon a set of 14 heuristics developed in previous research. The lists were compiled and then rated on the severity of the violation. RESULTS: From 14 usability heuristics considered in this evaluation of the Infusion Pump, there were 231 violations. Two heuristics, "Consistency" and "Language", were found to have the most violations. The one with fewest violations was "Document". While some heuristic evaluation categories had more violations than others, the most severe ones were not confined to one type. The Primary interface location (e.g., where loading the pump, changing doses, and confirming drug settings takes place) had the most occurrences of heuristic violations. CONCLUSION: We believe that the Heuristic Evaluation methodology provides a simple and cost-effective approach to discovering medical device deficiencies that affect a patient's general well being. While this methodology provides information for the infusion pump designs of the future, it also identifies important insights concerning equipment that is currently in use in critical care environments.

Humans↗

PubMed2006

Context, automated decision support, and clinical practice guidelines: does the literature apply to the United States practice environment?

BACKGROUND: Context - the combined effect of factors such as physician type, clinical setting, and guideline characteristics - influences the ability of automated decision support (ADS) to improve physician compliance with clinical practice guidelines (CPGs). Our goal was to determine whether research about the utility of ADS for promoting CPG compliance is contextually applicable to United States physicians. METHODS: We extracted information about physicians, settings, and guidelines from all articles published in the last 10 years that describe original research about the use of ADS to promote CPG compliance. The extracted information was compared to the range of practice contexts seen in the United States. RESULTS: Nearly two-thirds (65.3%) of papers described studies conducted in an academic setting, but only 11% of physicians report academic affiliations (p<0.0001). Physician reimbursement structure is often not reported. Salaried physicians were explicitly included as subjects in 14% of articles, but make up 45% of US physicians (p<0.0001). There are little data about the generalizability of ADS research to emergency care settings (6% of articles), and nursing home or skilled nursing facilities (10% of articles). Finally, ADS has not been studied at all in several epidemiologically important disease categories. CONCLUSION: The literature does not adequately address some physician, setting, and guideline contexts. Before making policy or spending decisions based on the effectiveness of ADS, additional research is needed to determine whether ADS research can be generalized to under-represented contexts.

Decision Support Systems, Clinical↗

PubMed2005

Results of the 2003 Association of Residents in Radiation Oncology (ARRO) surveys of residents and chief residents in the United States.

PURPOSE: To document demographic characteristics of current residents, career motivations and aspirations, and training program policies and resources. METHODS: In 2003, the Association of Residents in Radiation Oncology (ARRO) conducted two nationwide surveys: one of all U.S. radiation oncology residents and one of chief residents. RESULTS: The Chief Residents' Survey was completed by representatives from all 77 programs (response rate, 100%). The Residents' Survey was returned by 229 respondents (response rate, 44%). In each, 32% of respondents were female. The most popular career after residency was private practice (46%), followed by permanent academic practice (28%). Changes that would entice those choosing private practice to consider an academic career included more research experience as a resident (76%), higher likelihood of tenure (69%), lesser time commitment (66%), and higher salary (54%). Although the majority of respondents were satisfied with educational experience overall, a number of programs were reported to provide fewer resources than required. CONCLUSIONS: Median program resources and numbers of outliers are documented to allow residents and program directors to assess the relative adequacy of experience in their own programs. Policy-making bodies and individual programs should consider these results when developing interventions to improve educational experiences of residents and to increase retention of radiation oncologists in academic practice.

Adult↗

PubMed2007

Prognostic value of p53 for high risk superficial bladder cancer with long-term followup.

PURPOSE: The risk of muscle invasive disease in a high risk patient with superficial bladder cancer is up to 50%. Identifying patients at risk for progression remains an unsolved problem. A suggested prognosticator is mutations in the p53 tumor suppressor gene. We determined the value of p53 mutation, as demonstrated by mutation analysis, in a clinically selected group of high risk patients with superficial bladder cancer. MATERIALS AND METHODS: p53 Mutation analysis was performed by automated sequencing of bladder wash samples of 105 patients with high risk superficial bladder cancer. The mutation and WT groups were subsequently compared with regard to mortality, progression, disease worsening and the recurrence-free period. RESULTS: A total of 29 patients had a mutation and 76 had WT. Median followup was 58.3 months (range 3 to 161). A total of 13 patients died of bladder cancer, including 6 of 29 with a mutation and 7 of 76 patients in the WT group. p53 Mutation had no significant prognostic value for decreased survival, progression or disease worsening. Recurrence-free survival was significantly lower in the WT group. CONCLUSIONS: We observed a trend toward a worse clinical outcome in high risk patients with a p53 mutation in the bladder wash. However, no significant differences were seen in clinical outcome parameters. Based on these data we conclude that the prognostic value of a p53 mutation is insufficient for individual policy making.

DNA Mutational Analysis↗

PubMed2026

Project ODIN: advancing environmental genomic surveillance for public health across sub-Saharan Africa.

Persistent SARS-CoV-2 transmission, ongoing mpox outbreaks, and the continued spread of endemic diseases such as typhoid fever and cholera underscore the urgent need for global, multiomics surveillance. In this Personal View, we present Project ODIN, a consortium of European and African partners launched in 2023 that aims to meet this challenge by deploying innovative systems for near real-time pathogen detection and actionable public health insights. The project is a collaboration between high-income and low-income countries in northern Europe and sub-Saharan Africa. Focusing on low-income and middle-income countries, ODIN integrates metagenomics with mobile laboratory systems for comprehensive pathogen monitoring across diverse environments. ODIN emphasises standardised sampling, bioinformatics pipelines, and data-sharing protocols to ensure reliable, interoperable results while addressing infrastructure and resource limitations. By bridging gaps in genomic surveillance, these initiatives seek to strengthen outbreak preparedness, improve pathogen detection, monitor antimicrobial resistance, and provide a holistic approach to One Health challenges. Together, these innovations could advance global surveillance capacity-particularly in under-resourced regions-paving the way for effective disease control and evidence-based policy making.

Humans↗

PubMed2005

Neurodevelopmental toxicology.

The fields of neurotoxicology and developmental toxicology are exploding in research and interest. Much of the data currently known are from epidemiologic human studies or studies of animal models. Each of these modes is difficult to translate to individual clinical encounters. It is often difficult to state with certainty which of the numerous chemical or physical agents in our environment are neurotoxic. Basic scientists will help with advances in molecular biology and toxicology. Improved clinical understanding of these issues may help patients to understand the medical issues; allay feelings of anxiety, guilt, or fear; and avoid unnecessary testing. For exposures that manifest as threshold phenomena, such as lead, the risk to society is even greater than to an individual. Individual risk may be less of a concern than the population's risk because small elevations in the average BLL can cause profound shifts in the normative curve of intelligence, increasing the burden on our institutions and bankrupting the brain trust. Good scholarship and interpersonal judgement are vital when counseling patients on the potential consequences of chemical exposures and are no less important when making policy. The challenge for the clinician reading the research is to remain aware of the limitations and biases of our science.

Adult↗