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PubMed2005

Toward a procedure for integrating moral issues in health technology assessment.

OBJECTIVES: Although ethics has been on the agenda in health technology assessment (HTA) since its inception, the integration of moral issues is still not standard and is performed in a vast variety of ways. Therefore, there is a need for a procedure for integrating moral issues in HTA. METHODS: Literature review of existing approaches together with application of various theories in moral philosophy and axiology. RESULTS: The article develops a set of questions that addresses a wide range of moral issues related to the assessment and implementation of health technology. The issues include general moral issues and moral issues related to stakeholders, methodology, characteristics of technology, and to the HTA process itself. The questions form a kind of checklist for use in HTAs. CONCLUSIONS: The presented approach for integrating moral issues in HTA has a broad theoretical foundation and has shown to be useful in practice. Integrating ethical issues in HTAs can be of great importance with respect to the dissemination of HTA results and in efficient health policy making.

Bioethics↗

PubMed1999

Effective promotion of healthy nutrition and physical activity in Europe requires skilled and competent people; European Master's Programme in Public Health Nutrition.

Scientists in basic research and epidemiology deliver messages to policy makers. Effective population based strategies then require people trained and competent in the discipline of Public Health Nutrition (PHN). Since 1997, a European Master's Programme in PHN has been undergoing planning and implementation with the aid of funding from the European Commission (DGV). PHN is used as a broad term covering Nutrition and Physical Activity as well as Health Promotion and Disease Prevention. The partners in this project are academic departments from 17 countries. The students will undertake core modules and electives for a year and a half, followed by a research project for six months. In order to set up formalised procedures for the evaluation of the quality assurance of individual modules from across Europe, a quality assurance system has been set up. The academic year 1999-2000 will allow an opportunity for Universities and Institutes to start new modules, to develop other modules, assess the movement of students between modules, tackle funding issues and allow further marketing of the programme. Future activities include strengthening of the European Network for Public Health Nutrition (ENPHN), the establishment of a consortium with universities, the co-ordination of programme activities with other European Master's Programmes in Public Health, and the incorporation of new Member States from Eastern Europe. We can look forward to a new brand of professionals, who are truly European in their training, but who also have an integrated view of nutrition and physical activity, health promotion and disease prevention and who are prepared for policy making, action planning, implementation and evaluation.

Education, Graduate↗

PubMed1999

Diet and physical activity--interactions for health; public health nutrition in the European perspective.

For the majority of European adults, who neither smoke nor drink excessively, the most significant controllable risk factors affecting their long-term health are what they eat, and how physically active they are. Scientists are supposed to clarify to policy makers and health professionals the usefulness of their health messages. However, to be able to do that, a more detailed understanding is needed of the basic mechanisms behind the effects on health of diet and physical activity and, especially, the two in combination. Further, better methods for assessment of nutrition and physical activity in the population have to be developed, and more and better baseline data have to be collected. Increased and more efficient interventions are then needed. People trained and competent in the new discipline of Public Health Nutrition are required. Through the stimulating support that the European Commission, as well as other national and international partners, are presently giving to the development of Public Health Nutrition across Europe, we can hope for an increased mobility, networking and understanding between European nutrition and physical activity professionals. This will most likely result in greater and better policy making, strategy development, implementation and evaluation. We now have a great possibility to develop the integrated field of preventive nutrition and health enhancing physical activity.

Diet↗

PubMed2002

Emission inventories of NOx from commercial energy consumption in China, 1995-1998.

Emissions of nitrogen oxides (NOx) in China are of great concern because of their impact on local air pollution as well as on regional environmental risks such as acid rain, eutrophication, tropospheric ozone, fine particulate matter, and loss of biodiversity. In this paper, total anthropogenic emissions of NOx in China during the past two decades are estimated on the basis of commercial energy consumption and NOx emission factors of different sectors and fuel types. Specifically, emission inventories of NOx from 31 provinces, 7 economic sectors, and 11 fuel types from 1995 to 1998 are evaluated and analyzed in detail, and the distribution of provincial-based average NOx emission intensity in 1998 is presented. It can be seen that the calculated national total emissions of NOx have rapidly increased from 4.76 Mt in 1980 to a peak value of about 12.03 Mt in 1996, with an average annual growth rate of 6%. However, instead of increasing, NOx emissions in 1997 and 1998 decreased by 0.37 Mt and 0.85 Mt, respectively, as compared to the peak in 1996. In short, NOx emissions caused by energy use are mainly concentrated in the more populated and industrialized areas of China, i.e., the Eastern Central and Southeastern areas. These results imply that China's NOx emissions in the future may not become as high as previously expected which will be helpful for policy making to control local NOx pollution as well as to reduce acid rain and tropospheric ozone in East Asia.

Acid Rain↗

PubMed2004

Variability assessment of groundwater exposure to pesticides and its consideration in life-cycle assessment.

Pesticide leaching from agricultural fields to groundwater is an environmentally relevant and highly variable process. In the present paper, leaching scenarios typical in European agriculture are defined. These scenarios consider important sources of pesticide leaching variability, namely site factors, farming practice, and substance properties. The logic-tree method was used to structure these scenarios. For each scenario, leached fractions of pesticide applied in agriculture were calculated with data and models used in the registration process of the European Union (EU). Contributions of all parameters to variability were calculated for 11 pesticides. Substance properties (Koc and DT50,soil) contributed the mostto variability, followed by site, weather, season of application, crop, and macropore flow. The results of the variability assessment may be directly applied in policy making or they may be used in the environmental assessment of pesticides, e.g. with the life-cycle assessment (LCA) method. Several approaches are suggested for howthe variability assessment presented in this paper may be incorporated in LCA. The application of these approaches is illustrated by a case study on atrazine.

Europe↗

PubMed1998

Hepatitis C in France: a national survey in the Departments of Internal Medicine and Infectious Diseases. The GERMIVIC (Joint Study Group on Hepatitis C virus of the French National Society of Internal Medicine and the French Society of Infectious Diseases).

Infection with Hepatitis C virus is a significant public health problem that has important clinical and financial consequences. Understanding of the epidemiology of HCV is needed to help define future therapeutic and preventive strategies. So far, the importance and characteristics of the epidemics have been best appreciated in specialist units dealing with liver disease. The purpose of our study was to survey the number and characteristics of hepatitis C antibody positive patients in Departments of Internal Medicine and Infectious Diseases. We conducted a multicentre national prospective analysis of all positive HCV-antibody patients, either inpatient or outpatient, reported over a period of one month across France. Two thousand and two cases were identified. Epidemiological, clinical and therapeutic characteristics are described. Risk factors were identified in 86%. For 10% of the patients, hepatitis C seropositivity was discovered during the period of survey. At the time of first diagnosis, 47% of patients presented with no clinical or biological abnormality. Coinfection with HIV was frequent (59%). Only 20.3% of the patients had received or were receiving a treatment with interferon. Within the limits of the methodology used, this study shows that Hepatitis C infection is a substantial clinical problem in French Departments of Internal Medicine and Infectious Diseases. Our findings may help the public health authorities in better appreciating the impact of hepatitis C and making policy decisions.

Adolescent↗

PubMed2000

Job matching in pharmacy labor markets: a study in four states.

PURPOSE: Reports from various pharmacy labor market sectors suggest that the United States may be experiencing a shortage of pharmacists. To guide policy making and planning with respect to this shortage, it is necessary to develop a better understanding of the process by which pharmacists choose jobs. Using the economic theory of job matching, this study sought to understand how (a) attributes of the practice setting, (b) characteristics of pharmacists, and (c) regional and urbanization variables are associated with pharmacy practice setting choices. METHODS: A secondary database containing information about employment characteristics and work histories of 541 pharmacists in four states was used. The data were augmented with information on the relative number of employment opportunities in each of three practice settings (large chain, institutional, and independent) in the year the respondent's most recent employment change occurred. Practice setting choices were modeled using multinomial conditional logit regression. RESULTS: A total of 477 pharmacists represented in the database met the inclusion criteria for the study. Multivariate analyses showed that the impact of search costs and wage differentials varied with the practice setting chosen. Pharmacists choosing independent settings over large chain settings were more likely to be white and to have worked in an independent setting in their prior job. Pharmacists living in Oregon were less likely to choose institutional settings compared to those living in Massachusetts, whereas those living in areas with populations greater than 50,000 were more likely to choose institutional settings. CONCLUSIONS: Pharmacist job matching appears to be a complex process in which diverse factors interact to produce a final match. Our results suggest that the pharmacy labor market may actually be composed of two distinct labor markets: an ambulatory market and an institutional market.

Adult↗

PubMed1997

Scenario analysis of the future of clinical pharmacy.

The role of clinical pharmacy in the health care system is changing rapidly. This change is almost universal among different countries and is related to developments in medical technology, health economics, informatics, socio-economic status, and professional relations. Transitions to new systems of clinical pharmacy are difficult to anticipate. Even with well defined targets, it remains uncertain what the future of clinical pharmacy will bring us. The construction of plausible scenarios may help us better in preparing for the 'new world' ahead. At the annual congresses of ESCP in Prague 1995 (24th) and Lisbon 1996 (25th), a number of scenario analysis workshops with respect to the future of clinical pharmacy were organized. This paper gives a report of the results of these scenario sessions and reflects on the implications for future policy making. After we identified the driving forces behind the future of clinical pharmacy, various sets of assumptions were made and from them scenarios were constructed which are plausible: they 'could' happen. This analysis provided a logical framework in which we ultimately depicted three alternating stories of the future of clinical pharmacy, named 'CLERK', 'CONTROLLER' and 'CARE MANAGER'. These scenarios are intended to help clinical pharmacists to break free of familiar mental maps and to stimulate creative thinking on the future.

Education, Pharmacy↗

PubMed2001

Trade-offs in the conduct of economic evaluations of child mental health services.

Childhood psychological morbidity places both short-term and long-term costs on families, health services, social services, voluntary organizations, and society as a whole. Internationally, there have been few economic evaluations alongside clinical trials of population-based interventions to improve child mental well-being. This paper sets out a number of trade-offs relevant to the evaluation of the costs and benefits of multisectoral interventions to improve child mental well-being. These trade-offs have relevance for those who fund research, those who conduct research, and those who make policy decisions. The paper sets out a conceptual model for the economic evaluation of population-based interventions to improve child mental health. Finally, the paper argues that with the advent of "joined up" public policy and the breakdown of traditional ring-fenced budgets for health and social care, there is now, more than ever before, an opportunity for the research community to generate guidance for multisectoral collaborative interventions to promote the mental well-being of children and their families.

Child↗

PubMed2002

Family-centered preventive intervention science: toward benefits to larger populations of children, youth, and families.

The field of family-centered preventive intervention science is well poised to seize an opportunity for larger-scale intervention implementation and greater public health impact. This opportunity has been created by earlier research in the areas of epidemiology, developmental etiology, and intervention outcome research. Both earlier and current research define a number of key tasks required to meet the many challenges involved in scaling-up for greater impact. Illustrations of how these tasks can be addressed are provided in articles on programs of family-centered research with infants, children, and adolescents. Each article in this special issue treats one or more tasks that concern (a) expansion of the set of rigorously evaluated, theory-driven interventions that have potential to reach large numbers of children, youth, and families; (b) effective strategies for family recruitment and retention; (c) cultural sensitivity of interventions; (d) application of a developmental life course perspective; (e) strategies for linking higher-risk population subgroups with potentially beneficial services; (f) improved diffusion mechanisms for sustained, quality delivery; and (g) policy making informed by research, including economic analysis. A summary of how articles address these tasks concludes with a discussion of the importance of futher strengthening a public service orientation in prevention science.

Adolescent↗

PubMedDate not supplied

Exposing the myths surrounding preventive outpatient commitment for individuals with chronic mental illness.

Using New York's "Kendra's Law" as an illustrative vehicle, this article addresses the principal criticisms lodged by opponents of preventive outpatient commitment. The authors argue that preventive outpatient commitment is a useful adjunct to conditional release or placement in the least restrictive alternative that has neither produced revolutionary change in psychiatric commitment standards nor will be used inappropriately to assert governmental control over mentally ill citizens. The authors contend additionally that preventive outpatient commitment does not violate federal constitutional norms or represent bad policy making. The authors acknowledge, however, that the coercion inherent in outpatient commitment schemes may produce certain undesirable side effects. Thus, they explore an alternative approach currently in development in Australia that promotes community-based treatment for chronically mentally ill persons without judicial intervention.

Australia↗

PubMed2001

Predicting work outcomes and service use in supported employment services for persons with psychiatric disabilities.

New funding policies make it timely to identify correlates of effectiveness and effciency in supported employment (SE) programs for persons with psychiatric disabilities. In a statewide sample of SE participants with serious mental illness, individual clinical characteristics were unrelated to competitive work or hours of services consumed. However, amounts of SE provider time devoted to travel, training, and nonemployment advocacy were independently related to the likelihood of obtaining competitive work. These results suggest that SE providers should pursue an individualized, participant-driven model of services that includes active efforts to remove logistical barriers to community employment.

Adolescent↗

PubMed1999

The potential use of maternal size in priority setting when combating childhood malnutrition.

OBJECTIVE: To devise a strategy for assessing the nutritional status of a household and specifying the major needs in combating childhood wasting, distinguishing between inadequate food availability, poor parental care and/or the need for improved public health measures. DESIGN: An evaluation of the relationship between children's wasting, stunting, or underweight and mothers' or adult women's body mass indexes (BMIs) in the same household. A household was designated as 'malnourished' on the basis of a single child's weight/height of < -2.0 s.d. or at risk of being malnourished if the Z-score was below--1.5. Adult women's BMI was taken to signify adequate household food availability. Sibling concordance of anthropometric measures was investigated. RESULTS: A wide variety of prevalence of severe (BMI < 16.0), moderate (BMI 16.0-16.9) and marginal (17.0-18.4) malnutrition existed in the various study areas. The worst condition was recorded in India, while 18% of the women in Zimbabwe were classified as obese. Similarly wide variation in the prevalence of child wasting and stunting was observed, with the Indian children again faring worst and those in Zimbabwe the best. The within-household analysis of concordance gave higher concordance for height than for weight between siblings. Mothers' BMI was highly correlated with the BMI of all other adult women in the same household and the BMI of all the women was found to be as useful as that of the mother for relating to children's anthropometry. Households with mothers of normal body weight but wasted children were designated as in need of public health measures and improved parental care rather than of enhanced food security. The distribution of households on this combined basis of maternal BMI and child nutritional status highlighted very diverse situations in the various study areas, with higher proportions of combined maternal and child malnutrition in India and in some areas of Ethiopia, while in Zimbabwe only 1-2% presented this condition. On this basis, the principal problem in India was food security; in Zimbabwe household security was rarely apparent, so public health measures and maternal care were designated as problems. In three Ethiopian communities there was a mixture of needs. CONCLUSIONS: A relatively simple household-based approach is proposed to discriminate the most pressing needs in combating childhood malnutrition, and a policy-making tool is suggested for setting priorities in community action.

Adolescent↗

PubMed2001

Clumsiness, dyspraxia and developmental co-ordination disorder: how do health and educational professionals in the UK define the terms?

At the turn of the century, the idea that there might be a discrete childhood syndrome, which had 'clumsiness' of movement as its defining symptom, began to emerge. Since then numerous labels have been applied to the syndrome. In spite of recent attempts to standardise the terminology used, variation continues to compromise inter-professional communication and interpretation of research. The aim of this study was to determine how the three terms 'Clumsy', 'Dyspraxia' and 'Developmental Co-ordination Disorder (DCD)' are viewed by health and educational professionals in the UK. Two hundred and thirty-four adults (57% from the health professions and 43% from education) provided a written definition of each term. Content analysis of the 702 definitions was used to determine: (1) the extent to which the terms were familiar/acceptable to the respondents; and (2) to capture differences in the meaning of the term being defined. The results indicated that the terms 'DCD' and 'Dyspraxia' were less familiar than the term 'clumsy' which was, however, least acceptable. Amongst those professionals who were familiar with all three terms, there was general agreement that all were used to describe some sort of overall movement difficulty. Beyond that point, divergence of understanding and inter-professional differences in emphasis emerged. The implications of these differences for clinical and educational practice, research and policy making are discussed.

Adult↗

PubMed1999

Primary care in the United States and its precarious future.

Primary care has not secured a firm place within the US health services system. Since primary care lacks a strong research base, is not institutionalized in medical education or in policy-making and is marginalized in both proposed and actual reforms, it has not developed into a central component of the health care infrastructure. We discuss recent efforts that promised modest improvements, including the Clinton health care reform proposals and subsequent federal and state actions, in the role of primary care within the health services system. We also assess the likely fate of primary care given the accelerated growth of managed care and market competition, the dissatisfaction of large segments of the population with managed care and misperceptions of managed care as synonymous with primary care. We highlight how managed care fails to achieve the cardinal functions of primary care and summarize initiatives that, at a minimum, would be required to secure a stronger position for primary care in the future.

Journal Article↗

PubMed1999

Transition of care: an evaluation of the role of the discharge liaison nurse in The Netherlands.

Problems in the transition of care from hospital to the home situation have led to the introduction of the discharge liaison nurse role in the Netherlands. A nation-wide hospital survey was carried out to gain insight into the role and function of discharge professionals. It was found that 56 of the 117 hospitals in the Netherlands (48%) have a special discharge professional. The discharge professional is a relatively new concept. On average it covers a full-time position. The function differs greatly between hospitals. Three working profiles can be distinguished: the organizational type, the advisory type and the policy-making type. In most cases the discharge professional is a nurse from a community agency based in the hospital and therefore best fits the description of a discharge liaison nurse. Of the 56 hospital-based initiatives involving discharge professionals, 11 (20%) have been systematically evaluated. A critical review of these evaluation studies showed a positive outcome on some aspects of quality of care, but no results were given on efficiency aspects. There was general appreciation of the discharge liaison nurse and continuation of the function was widely recommended. The quality of the evaluation studies was rather poor, and it is suggested that more substantial research should be carried out on this relatively new function.

Adult↗

PubMed2004

Teamworking in nursing homes.

BACKGROUND: Nursing homes have an important role in the care of frail older people, but concerns have been raised about the quality of care. High standards of care appear to be facilitated when nurses work in effective teams. Greater understanding of teamworking in nursing homes could have implications for training and policy-making. AIM: The aim of the study was to explore the experiences and perceptions of teamworking with qualified nurses working in nursing homes. METHOD: This was a small, exploratory focus group study. The sample was 12 qualified nurses working in nursing homes in the south of England. Transcriptions of the focus groups were coded by the research team and agreement was achieved by discussion. FINDINGS: Teams described were constructed in 'vertical', hierarchical terms rather than as 'flat', collaborative structures. The achievement of good teamworking was hindered by inadequate communication, particularly as many staff worked part-time and on shifts. Management was perceived as remote, and lines of authority were ambiguous and unfocused. CONCLUSIONS: This group of nurses were aware of the difficulties of working in a hierarchical, profit-making culture. Individually, they tried to provide good quality care for patients and aspired to teamworking, but seldom succeeded to their satisfaction. There may be considerable potential to improve the working lives of staff and quality of patient care by effective teamworking. However, significant barriers, particularly concerning organizational culture, need to be overcome.

Adult↗

PubMed2003

Nurse Directors' jobs - a European perspective.

UNLABELLED: BACKGROUND OF STUDY: The European Nurse Directors Association (ENDA) was founded in 1996. Members agree on an annual action plan based on the three main aims of the Association to strengthen the nursing contribution to policy making within Europe, further nursing leadership and to establish a communication network of experts Nurse Directors across Europe. This study supports the above aims by examining issues relating to the job of Nurse Directors across Europe. AIM: The aim of the study was to identify shared aspects of the job from which further work could emerge to support the three aims of the Association and, in particular, to further nursing leadership across Europe. METHOD: An action centred research method (strengths, weaknesses, opportunities and threats [SWOT] analysis) was chosen which gave the opportunity for respondents to expand on key points. The texts were submitted in French, German and English with opportunities built in to individually discuss statements in order to minimize inaccuracies which could have emerged during translation. RESULTS: Nurse Directors of today give a clear indication of 'can-do' mentality and the strengths and weaknesses which are demonstrated indicate that there are areas which need to be further explored and supported. The findings were presented at the 5th Congress of ENDA in Rotterdam in 2001 and were well received. Funding has been obtained from the National Nursing Leadership Centre to expand the research. LIMITATIONS: This study is a snapshot only of those working at the leading edge in nursing. The responses also reflect feedback from nurses working in mainly acute hospitals and further work needs to be undertaken to include additional European countries. CONCLUSION: It has been demonstrated how Nurse Directors in Europe are taking and making opportunities to lead influence nursing and healthcare. Areas of further work that need to be addressed have emerged.

Europe↗