Measuring the authority of local public health directors in the context of organizational structure: an exploratory, multimodal approach.

Science.gov (United States)

Miner Gearin, Kimberly J; Thrash, Allison M Rick; Frauendienst, Renee; Myhre, Julie; Gyllstrom, M Elizabeth; Riley, William J; Schroeder, Janelle

2012-11-01

Studies have reported a relationship between the organization of public health services and variability in public health practice at the local and state levels. A national research agenda has prioritized practice-based research to understand pathways that lead to this variation and examine the impact of these differences on outcomes. To measure the extent to which Minnesota local health directors report having key authorities and examine the relationship between organizational structure and authority of local health directors. : Multimodal. Minnesota local health departments. Directors of Minnesota local health departments. Director authorities. Most Minnesota local health directors reported having 6 key authorities related to budget preparation and modification and interaction with local elected officials (n = 51, 71%). Twelve directors (16%) reported that they have 4 or fewer of the 6 authorities. The authority most commonly reported as lacking was the authority to initiate communication with locally elected officials (n = 15, 21%). The percentage of directors who reported having all 6 authorities was higher among those in stand-alone departments (82%) than those in combined organizations (50%). This descriptive study illustrates that emerging practice-based research networks can successfully collaborate on small-scale research projects with immediate application for systems development. Study findings are being used by local public health officials to help articulate their role, aid in succession planning, and inform elected officials, who need to consider the public health implications of potential changes to local public health governance and organization. More studies are needed to refine measurement of authority and structure.

Local wisdom and health promotion

DEFF Research Database (Denmark)

Demaio, Alessandro Rhyll

2011-01-01

The respectful, appropriate use of local wisdom (LW) in health promotion increases penetration and longevity of positive behavior change. Collaborations based on mutual respect, flexibility and trust between health program organizers, traditional and local practitioners, and the communities being...... served are the goal for public health physicians in our modern, globalized world. This meta-analysis reviewed literature from the past 18 years drawn from a wide range of sources. This investigations proposes a grassroots, material shift toward regarding health promotion interventions as partnerships...... when planning, executing, and evaluating health promotion projects. This holistic approach would be based on the premise that LW is equal to expert opinion. This article endorses the integration of LW at every stage of the health promotion process concluding that it is through empowerment...

Job Satisfaction and Expected Turnover Among Federal, State, and Local Public Health Practitioners.

Science.gov (United States)

Leider, Jonathon P; Harper, Elizabeth; Shon, Ji Won; Sellers, Katie; Castrucci, Brian C

2016-10-01

To use data on the governmental public health workforce to examine demographics and elucidate drivers of job satisfaction and intent to leave one's organization. Using microdata from the 2014 Federal Employee Viewpoint Survey and 2014 Public Health Workforce Interests and Needs Survey, we drew comparisons between federal, state, and local public health staff. We fitted logistic regressions to examine correlates of both job satisfaction and intent to leave one's organization within the coming year. Correlates of job satisfaction included pay satisfaction, organizational support, and employee involvement. Approximately 40% of federal, state, and local staff said they were either considering leaving their organization in the next year or were planning to retire by 2020. Public health practitioners largely like their jobs, but many are dissatisfied with their pay and are considering working elsewhere. More should be done to understand the determinants of job satisfaction and how to successfully retain high-quality staff. Public health is at a crossroads. Significant turnover is expected in the coming years. Retention efforts should engage staff across all levels of public health.

The structure and organization of local and state public health agencies in the U.S.: a systematic review.

Science.gov (United States)

Hyde, Justeen K; Shortell, Stephen M

2012-05-01

This systematic review provides a synthesis of the growing field of public health systems research related to the structure and organization of state and local governmental public health agencies. It includes an overview of research examining the influence of organizational characteristics on public health performance and health status and a summary of the strengths and gaps of the literature to date. Data were retrieved through an iterative process, beginning with key word searches in three publication databases (PubMed, JSTOR, Web of Science). Gray literature was searched through the use of Google Scholar™. Targeted searches on websites and key authors were also performed. Documents underwent an initial and secondary screening; they were retained if they contained information about local or state public health structure, organization, governance, and financing. 77 articles met the study criteria. Public health services are delivered by a mix of local, state, and tribal governmental and nongovernmental agencies and delivered through centralized (28%); decentralized (37%); or combined authority (35%). The majority of studies focused on organizational characteristics that are associated with public health performance based on the 10 Essential Public Health Services framework. Population size of jurisdiction served (>50,000); structure of authority (decentralized and mixed); per capita spending at the local level; some partnerships (academic, health services); and leadership of agency directors have been found to be related to public health performance. Fewer studies examined the relationship between organizational characteristics and health outcomes. Improvements in health outcomes are associated with an increase in local health department expenditures, FTEs per capita, and location of health department within local networks. Public health systems in the U.S. face a number of critical challenges, including limited organizational capacity and financial resources

The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru

Directory of Open Access Journals (Sweden)

Jeannie Samuel

2016-12-01

Full Text Available Background and objective: Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. Design: Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. Results: Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. Conclusions: Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women

The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru

Science.gov (United States)

Samuel, Jeannie

2016-01-01

Background and objective Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP) that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. Design Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. Results Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. Conclusions Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women themselves, can play an

Social media adoption in local health departments nationwide.

Science.gov (United States)

Harris, Jenine K; Mueller, Nancy L; Snider, Doneisha

2013-09-01

We examined whether characteristics of local health departments (LHD) and their geographic region were associated with using Facebook and Twitter. We also examined the number of tweets per month for Twitter accounts as an indicator of social media use by LHDs. In 2012, we searched for Facebook and Twitter accounts for 2565 LHDs nationwide, and collected adoption date and number of connections for each account. Number of tweets sent indicated LHD use of social media. LHDs were classified as innovators, early adopters, or nonadopters. Characteristics of LHDs were compared across adoption categories, and we examined geographic characteristics, connections, and use. Twenty-four percent of LHDs had Facebook, 8% had Twitter, and 7% had both. LHDs serving larger populations were more likely to be innovators, tweeted more often, and had more social media connections. Frequency of tweeting was not associated with adoption category. There were differences in adoption across geographic regions, with western states more likely to be innovators. Innovation was also higher in states where the state health department adopted social media. Social media has the potential to aid LHDs in disseminating information across the public health system. More evidence is needed to develop best practices for this emerging tool.

Urbanization and health in China, thinking at the national, local and individual levels.

Science.gov (United States)

Li, Xinhu; Song, Jinchao; Lin, Tao; Dixon, Jane; Zhang, Guoqin; Ye, Hong

2016-03-08

China has the biggest population in the world, and has been experiencing the largest migration in history, and its rapid urbanization has profound and lasting impacts on local and national public health. Under these conditions, a systems understanding on the correlation among urbanization, environmental change and public health and to devise solutions at national, local and individual levels are in urgent need. In this paper, we provide a comprehensive review of recent studies which have examined the relationship between urbanization, urban environmental changes and human health in China. Based on the review, coupled with a systems understanding, we summarize the challenges and opportunities for promoting the health and wellbeing of the whole nation at national, local, and individual levels. Urbanization and urban expansion result in urban environmental changes, as well as residents' lifestyle change, which can lead independently and synergistically to human health problems. China has undergone an epidemiological transition, shifting from infectious to chronic diseases in a much shorter time frame than many other countries. Environmental risk factors, particularly air and water pollution, are a major contributing source of morbidity and mortality in China. Furthermore, aging population, food support system, and disparity of public service between the migrant worker and local residents are important contributions to China's urban health. At the national level, the central government could improve current environmental policies, food safety laws, and make adjustments to the health care system and to demographic policy. At the local level, local government could incorporate healthy life considerations in urban planning procedures, make improvements to the local food supply, and enforce environmental monitoring and management. At the individual level, urban residents can be exposed to education regarding health behaviour choices while being encouraged to take

Local health departments and specific maternal and child health expenditures: relationships between spending and need.

Science.gov (United States)

Bekemeier, Betty; Dunbar, Matthew; Bryan, Matthew; Morris, Michael E

2012-11-01

As a part of the Public Health Activities and Service Tracking study and in collaboration with partners in 2 Public Health Practice-Based Research Network states, we examined relationships between local health department (LHD) maternal and child health (MCH) expenditures and local needs. We used a multivariate pooled time-series design to estimate ecologic associations between expenditures in 3 MCH-specific service areas and related measures of need from 2005 to 2010 while controlling for other factors. Retrospective expenditure data from LHDs and for 3 MCH services represented annual investments in (1) Special Supplemental Nutrition for Women, Infants, and Children (WIC), (2) family planning, and (3) a composite of Maternal, Infant, Child, and Adolescent (MICA) service. Expenditure data from all LHDs in Florida and Washington were then combined with "need" and control variables. Our sample consisted of the 102 LHDs in Florida and Washington and the county (or multicounty) jurisdictions they serve. Expenditures for WIC and for our composite of MICA services were strongly associated with need among LHDs in the sample states. For WIC, this association was positive, and for MICA services, this association was negative. Family planning expenditures were weakly associated, in a positive direction. Findings demonstrate wide variations across programs and LHDs in relation to need and may underscore differences in how programs are funded. Programs with financial disbursements based on guidelines that factor in local needs may be better able to provide service as local needs grow than programs with less needs-based funding allocations.

Joint Community Health Needs Assessments as a Path for Coordinating Community-Wide Health Improvement Efforts Between Hospitals and Local Health Departments.

Science.gov (United States)

Carlton, Erik L; Singh, Simone Rauscher

2018-05-01

To examine the association between hospital-local health department (LHD) collaboration around community health needs assessments (CHNAs) and hospital investment in community health. We combined 2015 National Association of County and City Health Officials (NACCHO) Forces of Change, 2013 NACCHO Profile, and 2014-2015 Area Health Resource File data to identify a sample of LHDs (n = 439) across the United States. We included data on hospitals' community benefit from their 2014 tax filings (Internal Revenue Service Form 990, Schedule H). We used bivariate and multivariate regression analyses to examine LHDs' involvement in hospitals' CHNAs and implementation strategies and the relationship with hospital investment in community health. The LHDs that collaborated with hospitals around CHNAs were significantly more likely to be involved in joint implementation planning activities than were those that did not. Importantly, LHD involvement in hospitals' implementation strategies was associated with greater hospital investment in community health improvement initiatives. Joint CHNAs may improve coordination of community-wide health improvement efforts between hospitals and LHDs and encourage hospital investment in community health improvement activities. Public Health Implications. Policies that strengthen LHD-hospital collaboration around the CHNA may enhance hospital investments in community health.

STRUCTURAL AND HIDDEN BARRIERS TO A LOCAL PRIMARY HEALTH CARE INFRASTRUCTURE: AUTONOMY, DECISIONS ABOUT PRIMARY HEALTH CARE, AND THE CENTRALITY AND SIGNIFICANCE OF POWER.

Science.gov (United States)

Freed, Christopher R; Hansberry, Shantisha T; Arrieta, Martha I

2013-09-01

To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States. Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach. Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers. Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power. This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

Where Is Obesity Prevention on the Map? Distribution and Predictors of Local Health Department Prevention Activities in Relation to County-Level Obesity Prevalence in the US

Science.gov (United States)

Stamatakis, Katherine A.; Leatherdale, Scott T.; Marx, Christine; Yan, Yan; Colditz, Graham A.; Brownson, Ross C.

2013-01-01

Context The system of local health departments (LHD) in the US has potential to advance a locally-oriented public health response in obesity control and reduce geographic disparities. However, the extent to which obesity prevention programs correspond to local obesity levels is unknown. Objective This study examines the extent to which LHDs across the US have responded to local levels of obesity by examining the association between jurisdiction level obesity prevalence and the existence of obesity prevention programs. Design Data on LHD organizational characteristics from the Profile Study of Local Health Departments and county-level estimates of obesity from the Behavioral Risk Factor Surveillance System were analyzed (n=2,300). Since local public health systems are nested within state infrastructure, multilevel models were used to examine the relationship between county-level obesity prevalence and LHD obesity prevention programming and to assess the impact of state-level clustering. Setting 2,300 local health department jurisdictions defined with respect to county boundaries Participants Practitioners in local health departments who responded to the 2005 Profile Study of Local Health Departments. Main Outcome Measures Likelihood of having obesity prevention activities and association with area-level obesity prevalence Results The existence of obesity prevention activities was not associated with prevalence of obesity in the jurisdiction. A substantial portion of the variance in LHD activities was explained by state-level clustering. Conclusions This paper identified a gap in the local public health response to the obesity epidemic and underscores the importance of multilevel modeling in examining predictors of LHD performance. PMID:22836530

Reforming Local Government in England: An Examination of the Blairite Agenda

Directory of Open Access Journals (Sweden)

Andy ASQUITH

2006-06-01

Full Text Available This article examines the impact of the reformist agenda implemented in English local government since the election in 1997 of the first Blair government. Under 18 years of Conservative administrations (1979-1997, English local government had survived what some described as a legislative onslaught which had been designed to direct, control and remove functions from local authorities. Against this background, the first Blair administration inherited a system of local government upon which it would depend for key policy implementation. However, many within the Blair inner circles were deeply suspicious as to the motivations and capacity of local government to deliver on these key policies. The result therefore was a widespread overall of how local authorities were to be managed and importantly how they were to connect with their respective communities. As the article will examine, one of the key strategies for achieving Blair’s objectives was to be, in terms of the UK, both a radical and controversial innovation. Central to the Blairite agenda was the introduction to the UK of the concept of a directly elected mayor.

Local enactments of national health promotion policies

DEFF Research Database (Denmark)

Wimmelmann, Camilla Lawaetz

2017-01-01

organisational levels. Visiting, observing and interviewing 15 policy workers from 10 municipalities during a two-year period, this study investigated what happened to a Danish national health promotion policy as it was put into practice and managed in the Danish municipalities. The analysis reveals...... the concrete enactments and their locally experienced effects, our understanding of national public health policies risks becoming detached from praxis and unproductive. Public health policy-makers must pay methodological and analytical attention to the policies' multimodality and their concrete locally......Governments of welfare states are firmly committed to public health, resulting in a substantial number of public health policies. Given the multi-level structure of most welfare systems, the influence of a public health policy is related to its ability to spread geographically and move across...

Local health rules and building regulations: a survey on local hygiene and building regulations in Italian municipalities.

Science.gov (United States)

Gola, Marco; Signorelli, Carlo; Buffoli, Maddalena; Rebecchi, Andrea; Capolongo, Stefano

2017-01-01

WHO has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Local Health Rules (LHRs) and Building Regulations (BRs) are tools which provide safety and building hygiene in construction practices. Currently the Italian Government is considering to establish a National Building Regulation and, related to the following purpose, this paper presents a survey on the status of adoption and updating of LHRs and BRs in Italian municipalities. The current Italian state of LHRs, BRs and Municipal Development Plans (MDPs) have been examined by a survey considering a sample of about 550 cities, with different demo graphic and geographic features, starting from the previous research work by Signorelli et al. (1999). The analysis underlines a serious shortage of updated LHRs, especially in small and medium-sized municipalities whereas BRs and MDPs are widespread. Only 30% of them are previously approved and validated by Local Health Authorities. Starting from a survey, the present scenario of Building Regulations requires the introduction of further performance guidelines instead of normative ones and, therefore, the current actions to give rise to a National Building Regulation could be integrated by building hygiene contents of LHRs.

Social capital and health: measuring and understanding social capital at a local level could help to tackle health inequalities more effectively.

Science.gov (United States)

Pilkington, Paul

2002-09-01

This paper examines whether an understanding of the concept of social capital and its local measurement can help to tackle inequalities in health within and across communities. The paper concludes that the concept of social capital offers a valuable opportunity to help public health professionals understand how to approach inequalities in health with a greater awareness of the social processes affecting the health of communities. The measurement of social capital has been problematic. However, new guidance from the Health Development Agency (HDA) provides a useful tool for developing social capital research. A greater understanding of whether, and how social capital relates to health will help to improve strategies to reduce health inequalities at the community level. Public health professionals contributing to community development strategies such as Neighbourhood Renewal Projects, Community Safety Partnerships, Health Action Zones and Health Improvement Programmes (HImPs) should encourage thought to be given about the role that an understanding of social capital could play in making these strategies more effective. Using the HDA measurement tool locally could be one way of doing this.

The Korean social life, health and aging project-health examination cohort

Directory of Open Access Journals (Sweden)

Ju-Mi Lee

2014-05-01

Full Text Available The Korean Social Life, Health, and Aging Project (KSHAP is a population-based longitudinal study of health determinants among elderly Koreans. The target population of the KSHAP are people aged 60 years or older and their spouses living in a rural community of Korea. A complete enumeration survey was conducted in the first wave of the KSHAP on 94.7% (814 of 860 of the target population between December 2011 and July 2012. The KSHAP-Health Examination (KSHAP-HE cohort consists of 698 people who completed additional health examinations at a public health center (n=533 or at their home (n=165. Face-to-face questionnaires were used to interview participants on their demographics, social network characteristics, medical history, health behaviors, cognitive function, and depression symptoms. Health center examinations included anthropometric measures, body impedance analysis, resting blood pressure measurement, radial artery tonometry, bone densitometry, the timed up-and-go test, and fasting blood analysis. However, only anthropometric measures, blood pressure measurement, and non-fasting blood analysis were available for home health examinations. Collaboration is encouraged and access to the KSHAP baseline data will be available via the website of the Korean Social Science Data Archive (http://www.kossda.or.kr.

Does eating local food reduce the environmental impact of food production and enhance consumer health?

Science.gov (United States)

Edwards-Jones, Gareth

2010-11-01

The concept of local food has gained traction in the media, engaged consumers and offered farmers a new marketing tool. Positive claims about the benefits of local food are probably not harmful when made by small-scale producers at the local level; however, greater concern would arise should such claims be echoed in policy circles. This review examines the evidence base supporting claims about the environmental and health benefits of local food. The results do not offer any support for claims that local food is universally superior to non-local food in terms of its impact on the climate or the health of consumers. Indeed several examples are presented that demonstrate that local food can on occasions be inferior to non-local food. The analysis also considers the impact on greenhouse gas emissions of moving the UK towards self-sufficiency. Quantitative evidence is absent on the changes in overall emissions that would occur if the UK switched to self-sufficiency. A qualitative assessment suggests the emissions per item of food would probably be greater under a scenario of self-sufficiency than under the current food system. The review does not identify any generalisable or systematic benefits to the environment or human health that arise from the consumption of local food in preference to non-local food.

A cross-sectional study examining predictors of visit frequency to local green space and the impact this has on physical activity levels

Directory of Open Access Journals (Sweden)

Elliott P. Flowers

2016-05-01

Full Text Available Abstract Background Lack of physical activity (PA is a growing public health concern. There is a growing body of literature that suggests a positive relationship may exist between the amount of local green space near one’s home and PA levels. For instance, park proximity has been shown to predict PA levels amongst certain populations. However, there is little evidence for the role of relatedness towards nature and perceptions of local green space on this relationship. The aim of this study was to examine, in a National UK sample, whether subjective indices associated with local green space were better predictors of visit frequency to local green space and PA levels compared to objectively measured quantity of local green space. Methods A cross-sectional survey was designed. From a random sample, 2079 working age adults responded to an online survey in September 2011. Demographics, self-reported PA, objective measures of the local environment (including local green space, road coverage, and environmental deprivation, were assessed in conjunction with perceptions of local green space and nature relatedness. Quantity of local green space was assessed by cross-referencing respondents’ home postcodes with general land use databases. Regression models were conducted to assess which of our independent variables best predicted visit frequency to local green space and/or meeting PA guidelines. In addition, an ordinal regression was run to examine the relationship between visit frequency to local green space and the likelihood of meeting national PA guidelines. Results Nature relatedness was the strongest predictor for both visit frequency to local green space and meeting PA guidelines. Results show that perceived quality is a better predictor of visit frequency to local green space than objective quantity of local green space. The odds of achieving the recommended amount of PA was over four times greater for people who visited local green space once

State funding for local public health: observations from six case studies.

Science.gov (United States)

Potter, Margaret A; Fitzpatrick, Tiffany

2007-01-01

The purpose of this study is to describe state funding of local public health within the context of state public health system types. These types are based on administrative relationships, legal structures, and relative proportion of state funding in local public health budgets. We selected six states representing various types and geographic regions. A case study for each state summarized available information and was validated by state public health officials. An analysis of the case studies reveals that the variability of state public health systems--even within a given type--is matched by variability in approaches to funding local public health. Nevertheless, some meaningful associations appear. For example, higher proportions of state funding occur along with higher levels of state oversight and the existence of local service mandates in state law. These associations suggest topics for future research on public health financing in relation to local accountability, local input to state priority-setting, mandated local services, and the absence of state funds for public health services in some local jurisdictions.

Monitoring and evaluation of disaster response efforts undertaken by local health departments: a rapid realist review.

Science.gov (United States)

Gossip, Kate; Gouda, Hebe; Lee, Yong Yi; Firth, Sonja; Bermejo, Raoul; Zeck, Willibald; Jimenez Soto, Eliana

2017-06-29

Local health departments are often at the forefront of a disaster response, attending to the immediate trauma inflicted by the disaster and also the long term health consequences. As the frequency and severity of disasters are projected to rise, monitoring and evaluation (M&E) efforts are critical to help local health departments consolidate past experiences and improve future response efforts. Local health departments often conduct M&E work post disaster, however, many of these efforts fail to improve response procedures. We undertook a rapid realist review (RRR) to examine why M&E efforts undertaken by local health departments do not always result in improved disaster response efforts. We aimed to complement existing frameworks by focusing on the most basic and pragmatic steps of a M&E cycle targeted towards continuous system improvements. For these purposes, we developed a theoretical framework that draws on the quality improvement literature to 'frame' the steps in the M&E cycle. This framework encompassed a M&E cycle involving three stages (i.e., document and assess, disseminate and implement) that must be sequentially completed to learn from past experiences and improve future disaster response efforts. We used this framework to guide our examination of the literature and to identify any context-mechanism-outcome (CMO) configurations which describe how M&E may be constrained or enabled at each stage of the M&E cycle. This RRR found a number of explanatory CMO configurations that provide valuable insights into some of the considerations that should be made when using M&E to improve future disaster response efforts. Firstly, to support the accurate documentation and assessment of a disaster response, local health departments should consider how they can: establish a culture of learning within health departments; use embedded training methods; or facilitate external partnerships. Secondly, to enhance the widespread dissemination of lessons learned and facilitate

A Scoping Review of Observational Studies Examining Relationships between Environmental Behaviors and Health Behaviors

Directory of Open Access Journals (Sweden)

Jayne Hutchinson

2015-05-01

Full Text Available Individual lifestyles are key drivers of both environmental change and chronic disease. We undertook a scoping review of peer-reviewed studies which examined associations between environmental and health behaviors of individuals in high-income countries. We searched EconLit, Medline, BIOSIS and the Social Science Citation Index. A total of 136 studies were included. The majority were USA-based cross-sectional studies using self-reported measures. Most of the evidence related to travel behavior, particularly active travel (walking and cycling and physical activity (92 studies or sedentary behaviors (19 studies. Associations of public transport use with physical activity were examined in 18 studies, and with sedentary behavior in one study. Four studies examined associations between car use and physical activity. A small number included other environmental behaviors (food-related behaviors (n = 14, including organic food, locally-sourced food and plate waste and other health behaviors ((n = 20 smoking, dietary intake, alcohol. These results suggest that research on individual environmental and health behaviors consists largely of studies examining associations between travel mode and levels of physical activity. There appears to be less research on associations between other behaviors with environmental and health impacts, and very few longitudinal studies in any domain.

Local health department food safety and sanitation expenditures and reductions in enteric disease, 2000-2010.

Science.gov (United States)

Bekemeier, Betty; Yip, Michelle Pui-Yan; Dunbar, Matthew D; Whitman, Greg; Kwan-Gett, Tao

2015-04-01

In collaboration with Public Health Practice-Based Research Networks, we investigated relationships between local health department (LHD) food safety and sanitation expenditures and reported enteric disease rates. We combined annual infection rates for the common notifiable enteric diseases with uniquely detailed, LHD-level food safety and sanitation annual expenditure data obtained from Washington and New York state health departments. We used a multivariate panel time-series design to examine ecologic relationships between 2000-2010 local food safety and sanitation expenditures and enteric diseases. Our study population consisted of 72 LHDs (mostly serving county-level jurisdictions) in Washington and New York. While controlling for other factors, we found significant associations between higher LHD food and sanitation spending and a lower incidence of salmonellosis in Washington and a lower incidence of cryptosporidiosis in New York. Local public health expenditures on food and sanitation services are important because of their association with certain health indicators. Our study supports the need for program-specific LHD service-related data to measure the cost, performance, and outcomes of prevention efforts to inform practice and policymaking.

How much do workers' health examinations add to health and safety at the workplace? Occupational preventive usefulness of routine health examinations.

Science.gov (United States)

Rodríguez-Jareño, Maria Cruz; Molinero, Emilia; de Montserrat, Jaume; Vallès, Antoni; Aymerich, Marta

2015-01-01

Despite no evidence in favour, routine workers' health examinations, mostly pre-employment and periodic, are extensively performed worldwide with important allocation of resources. In Spain they are performed within a theoretical job-specific health surveillance system. Our objective was to ascertain their occupational preventive usefulness from the perspective of occupational health professionals. Cross sectional study. Online survey addressed to all physicians and nurses members of the Catalan Society of Safety and Occupational Medicine (n=539) in 2011. Univariate and bivariate analyses of prevalence and prevalence differences of answers. Response rate 53% (n=285). According to more than 70% of respondents the health surveillance system isn't cost-effective, doesn't meet the goal of early detection of health damage related to work, and doesn't contribute to improve the occupational risk prevention system. Further deficiencies were identified regarding specificity and scientific basis for health examinations, quality of collective health surveillance and referral of suspected cases to mutual insurance companies for diagnosis and treatment. Bivariate analysis showed a significantly more negative opinion for several items amongst physicians (versus nurses) and amongst professionals working in external prevention services (versus internal services). This study raises serious concerns about how health examinations are performed within our workers' health surveillance system, which should be reviewed to ensure the fulfilment of its occupational preventive objective. Our results might encourage other countries with similar practices to assess them in order to assure their fitness for purpose. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Examining Citizen Participation: Local Participatory Policy Making and Democracy

NARCIS (Netherlands)

Michels, A.M.B.|info:eu-repo/dai/nl/11124501X; de Graaf, L.J.

2010-01-01

Citizen participation is usually seen as a vital aspect of democracy. Many theorists claim that citizen participation has positive effects on the quality of democracy. This article examines the probability of these claims for local participatory policymaking projects in two municipalities in the

Global agenda, local health: including concepts of health security in preparedness programs at the jurisdictional level.

Science.gov (United States)

Eby, Chas

2014-01-01

The Global Health Security Agenda's objectives contain components that could help health departments address emerging public health challenges that threaten the population. As part of the agenda, partner countries with advanced public health systems will support the development of infrastructure in stakeholder health departments. To facilitate this process and augment local programs, state and local health departments may want to include concepts of health security in their public health preparedness offices in order to simultaneously build capacity. Health security programs developed by public health departments should complete projects that are closely aligned with the objectives outlined in the global agenda and that facilitate the completion of current preparedness grant requirements. This article identifies objectives and proposes tactical local projects that run parallel to the 9 primary objectives of the Global Health Security Agenda. Executing concurrent projects at the international and local levels in preparedness offices will accelerate the completion of these objectives and help prevent disease epidemics, detect health threats, and respond to public health emergencies. Additionally, future funding tied or related to health security may become more accessible to state and local health departments that have achieved these objectives.

National Health and Nutrition Examination Survey (NHANES)

Data.gov (United States)

U.S. Department of Health & Human Services — 1999-2000 forward. The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of...

Health Impact Assessment (HIA) in Ireland and the role of local government

Energy Technology Data Exchange (ETDEWEB)

O' Mullane, Monica, E-mail: Monica.omullane@truni.sk [Department of Public Health, Faculty of Health Care and Social Work/Fakulta Zdravotnictva a Socialnej Prace, Trnavska univerzita, Univerzitne namestie 1, 917 01 Trnava (Slovakia); Quinlivan, Aodh, E-mail: A.quinlivan@ucc.ie [Department of Government, College of Business and Law, 2nd Floor O' Rahilly Building, University College Cork (Ireland)

2012-01-15

Background: Health Impact Assessment (HIA) in Ireland has developed significantly since its endorsement in the health strategies of the Republic of Ireland (2001) and Northern Ireland (2002). Throughout 2007 and 2008, research was conducted to examine HIA as a policy-informing tool throughout both jurisdictions. One aspect of this research investigated the role of local government and its relationship in advancing HIA practise and use in Ireland. Methods: A case study research design was used which employed qualitative research methods, including semistructured interviewing and participant observation. In total 48 interviews were conducted with members of the HIA steering committees and individuals closely involved in the HIAs. Results: The relationship between local government and HIA in Northern Ireland is a positive one given the strong tradition of local government in the jurisdiction. The Review of Public Administration (RPA) negatively influenced the integration of HIA into local authority procedures. In the Republic of Ireland, the influence of social values and political will was found to be negatively present with the HIA on Traveller accommodation. Evidence from the HIA conducted on traffic and transport in Dublin was used to plan further health promotion and community planning activities in the area. Conclusion: Local government plays a vital role in HIA practise and development in both jurisdictions. The willingness to work with external partners (such as the health care services) was an important enabler or barrier to HIA operation. This will remain the case in the foreseeable future. - Highlights: Black-Right-Pointing-Pointer We investigated influences on the use of HIA knowledge of four cases from Northern Ireland and the Republic of Ireland. Black-Right-Pointing-Pointer The engagement of the public authorities assists implementation of the findings of the HIA. Black-Right-Pointing-Pointer Tension continues between positivist and incrementalist

Health Impact Assessment (HIA) in Ireland and the role of local government

International Nuclear Information System (INIS)

O'Mullane, Monica; Quinlivan, Aodh

2012-01-01

Background: Health Impact Assessment (HIA) in Ireland has developed significantly since its endorsement in the health strategies of the Republic of Ireland (2001) and Northern Ireland (2002). Throughout 2007 and 2008, research was conducted to examine HIA as a policy-informing tool throughout both jurisdictions. One aspect of this research investigated the role of local government and its relationship in advancing HIA practise and use in Ireland. Methods: A case study research design was used which employed qualitative research methods, including semistructured interviewing and participant observation. In total 48 interviews were conducted with members of the HIA steering committees and individuals closely involved in the HIAs. Results: The relationship between local government and HIA in Northern Ireland is a positive one given the strong tradition of local government in the jurisdiction. The Review of Public Administration (RPA) negatively influenced the integration of HIA into local authority procedures. In the Republic of Ireland, the influence of social values and political will was found to be negatively present with the HIA on Traveller accommodation. Evidence from the HIA conducted on traffic and transport in Dublin was used to plan further health promotion and community planning activities in the area. Conclusion: Local government plays a vital role in HIA practise and development in both jurisdictions. The willingness to work with external partners (such as the health care services) was an important enabler or barrier to HIA operation. This will remain the case in the foreseeable future. - Highlights: ► We investigated influences on the use of HIA knowledge of four cases from Northern Ireland and the Republic of Ireland. ► The engagement of the public authorities assists implementation of the findings of the HIA. ► Tension continues between positivist and incrementalist approaches towards HIA.

[The contributions of local authorities to regional public health policy].

Science.gov (United States)

de Maria, Florence; Grémy, Isabelle

2009-01-01

Local authorities in France are key players in shaping public health policy by their action on the determinants of health and through their actions aimed at specific population groups. Since the public health act of 9 August 2004 establishing the first regional public health plans, their level of involvement and role continues to grow as coordinators, funders and project managers within the greater Paris metropolitan region. Their active participation in regional policy to improve population health and reduce inequalities in health has led to a better organization of the public health programs implemented (in terms of visibility, dialogue, coordination, transparency, and better awareness of context and integration of local issues). Their participation is also a source of innovation resulting in the proposal and use of new approaches (such as the development of health surveillance and observation for advising the local decision-making process). Within the current context of the "Hospitals, patients, health and territories" bill, which entrusts the governance of regional health policy to a specific agency, the role given to local authorities in this new organizational structure must be clearly defined to take into account all of their existing and potential contributions to public health policy.

Health promotion activities in annual reports of local governments: 'Health for All' targets as a tool for content analysis.

Science.gov (United States)

Andersson, Camilla M; Bjärås, Gunilla E M; Tillgren, Per; Ostenson, Claes-Göran

2003-09-01

This article presents an instrument to study the annual reporting of health promotion activities in local governments within the three intervention municipalities of the Stockholm Diabetes Prevention Program (SDPP). The content of health promotion activities are described and the strengths, weaknesses and relevance of the method to health promotion discussed. A content analysis of local governmental reports from 1995-2000 in three Swedish municipalities. A matrix with WHO's 38 'Health for All' (HFA) targets from 1991 was used when coding the local health promotion activities. There are many public health initiatives within the local governmental structure even if they are not always addressed as health promotion. The main focuses in the local governmental reports were environmental issues, unemployment, social care and welfare. Local governmental reports were found to be a useful source of information that could provide knowledge about the priorities and organizational capacities for health promotion within local authorities. Additionally the HFA targets were an effective tool to identify and categorize systematically local health promotion activities in the annual reports of local governments. Identifying local health promotion initiatives by local authorities may ease the development of a health perspective and joint actions within the existing political and administrative structure. This paper provides a complementary method of attaining and structuring information about the local community for developments in health promotion.

Working for the public health: politics, localism and epistemologies of practice.

Science.gov (United States)

Phillips, Gemma; Green, Judith

2015-05-01

The recent move of public health back to English local government has reignited debates about the role of a medicalised public health profession. The explicit policy rationale for the move was that local government is the arena in which the social determinants of health can be addressed, and that public health specialists could provide neutral evidence to support action on these. However, if a discourse of 'evidence-based' policy is in principle (if not practice) relatively unproblematic within the health arena, within the more overtly politicised local government space, rather different policy imperatives come to the fore. Responding to calls for research on evidence in practice, this article draws on ethnographic data of local authorities in the first year of the reorganised public health function. Focusing on alcohol policy, we explore how decisions that affect public health are rationalised and enacted through discourses of localism, empiricism and holism. These frame policy outcomes as inevitably plural and contingent: a framing which sits uneasily with normative discourses of evidence-based policy. We argue that locating public health in local government necessitates a refocusing of how evidence for public health is conceptualised, to incorporate multiple, and political, understandings of health and wellbeing. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Examining the relationship between local extinction risk and position in range.

Science.gov (United States)

Boakes, Elizabeth H; Isaac, Nicholas J B; Fuller, Richard A; Mace, Georgina M; McGowan, Philip J K

2018-02-01

Over half of globally threatened animal species have experienced rapid geographic range loss. Identifying the parts of species' distributions most vulnerable to local extinction would benefit conservation planning. However, previous studies give little consensus on whether ranges decline to the core or edge. We built on previous work by using empirical data to examine the position of recent local extinctions within species' geographic ranges, address range position as a continuum, and explore the influence of environmental factors. We aggregated point-locality data for 125 Galliform species from across the Palearctic and Indo-Malaya into equal-area half-degree grid cells and used a multispecies dynamic Bayesian occupancy model to estimate rates of local extinctions. Our model provides a novel approach to identify loss of populations from within species ranges. We investigated the relationship between extinction rates and distance from range edge by examining whether patterns were consistent across biogeographic realm and different categories of land use. In the Palearctic, local extinctions occurred closer to the range edge than range core in both unconverted and human-dominated landscapes. In Indo-Malaya, no pattern was found for unconverted landscapes, but in human-dominated landscapes extinctions tended to occur closer to the core than the edge. Our results suggest that local and regional factors override general spatial patterns of recent local extinction within species' ranges and highlight the difficulty of predicting the parts of a species' distribution most vulnerable to threat. © 2017 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity.

Science.gov (United States)

McPherson, Charmaine; Ndumbe-Eyoh, Sume; Betker, Claire; Oickle, Dianne; Peroff-Johnston, Nancy

2016-08-19

Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada. A descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. Three themes related to the SDH-PHN role implementation were identified: (1) 'Swimming against the tide' to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations. This study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is

Tests to evaluate public health disease reporting systems in local public health agencies

National Research Council Canada - National Science Library

Dausey, David J

2005-01-01

... to evaluate the ability to receive and respond to case reports 24 hours a day, 7 days a week. We refined these tests by beta-testing them at 20 metropolitan area local public health agencies across the country over the course of 10 months. The contents of this manual will be of interest to public health professionals at the state and local l...

Delivering on a gendered definition of health needs in local ...

African Journals Online (AJOL)

Delivering on a gendered definition of health needs in local government budgeting: ... of financial grants channelled annually from central to local governments. ... does not reflect the broad community-wide understanding of health needs.

Health Medical Examination and the Prevalence of Metabolic Syndrome

Directory of Open Access Journals (Sweden)

Yong Hwan Kim

2018-06-01

Full Text Available Metabolic syndrome (MetS is a highly prevalent condition that cannot be cured but can be controlled by health management. Health management not only includes regulation of drinking, smoking, and physical activity but also health medical examinations. However, health medical examinations at private medical facilities involve high cost, limiting continuous and regular examination. The aim of this study was to analyze the prevalence of MetS and health management behavior according to the number of health medical examinations conducted in 14 years. According to the number of health medical examinations undertaken each year from 1999 to 2012, in 2012, 21,803 visitors (14,511 men and 7,292 women from a health medical examination center at a private medical facility were assigned to low- (3–5 health examinations in 14 years, middle- (6–10 health examinations in 14 years, and high-frequency groups (11–14 health examinations during 14 years. MetS was evaluated according to the criteria of the National Cholesterol Education Program and Adult Treatment Panel III and waist circumference was measured according to the standard for Asians by the World Health Organization. Odds ratio (OR was calculated by logistic regression analysis. Blood pressure tended to decrease to 124.5 vs. 123.9 vs. 123.5 in the low-, middle-, and high-frequency groups in men, respectively. In addition, middle- and high-frequency groups demonstrated better total cholesterol, high-density lipoprotein, low-density lipoprotein, and systolic blood pressure compared with the low-frequency group. The prevalence of MetS demonstrated no significance before adjusting for variables in men, and high-frequency examinees demonstrated 18% low OR values (0.823, p<0.001 after adjusting for age. OR was 0.868 (p=0.015 when adjusted for age, other socioeconomic factors, and health behavior. In women, the prevalence of MetS demonstrated significantly high OR of 1.205 (p=0.007 and 1.300 (p=0.008 in

Patient, hospital, and local health system characteristics associated with the use of observation stays in veterans health administration hospitals, 2005 to 2012

OpenAIRE

Wright, Brad; O'Shea, Amy M.J.; Glasgow, Justin M.; Ayyagari, Padmaja; Vaughan-Sarrazin, Mary

2016-01-01

Abstract Recent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals. The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system characteristics explain variation in observation stay rates across Veterans Health Administration (VHA) hospitals. Our data came from years 2005 to 2012 of the nationwide VHA Medical SAS inpatient...

[What determines the market shares of the health funds in Israeli localities?].

Science.gov (United States)

Shmueli, Amir; Engelcin-Nissan, Esti

2011-08-01

Four health funds operate nationally in Israel, but their local market shares vary dramatically across localities. To identify the main localities' characteristics which affect the size of the market shares of the various health funds. A total of 60 Localities with more than 20,000 inhabitants were chosen. The following Localities' characteristics were retrieved for the year 2004: the market shares of the four health funds, average income, standardized mortality ratio (SMR), periphery index, the age structure, the distance from the nearest general hospital, the share of Arab population, and size. Four market share equations were estimated using SURE (seemingly unrelated regressions estimation), allowing for inter-equation correlations. The results show that the market shares of the different health funds are affected by different factors. Clalit Health Services' (CHS) share increases with the distance from Tel Aviv and SMR, and decreases with the level of mean income and the distance from the nearest CHS hospital. Leumit's market share increases only with the distance from a CHS's hospital. The market share of Maccabi Healthcare Services is higher in central localities, Jewish localities, small cities and further away from a non-CHS hospital. Meuhedet's market share is higher in big cities, rich and healthy localities, and in Localities which are further away from CHS's hospitals. These findings indicate that the presence of the health funds in different Localities varies according to the Localities' characteristics. There appears to be a market segmentation and "specialization" of certain health funds in specific populations, and of the other health funds in the rest of the population.

Local Health Department Food Safety and Sanitation Expenditures and Reductions in Enteric Disease, 2000–2010

Science.gov (United States)

Yip, Michelle Pui-Yan; Dunbar, Matthew D.; Whitman, Greg; Kwan-Gett, Tao

2015-01-01

Objectives. In collaboration with Public Health Practice–Based Research Networks, we investigated relationships between local health department (LHD) food safety and sanitation expenditures and reported enteric disease rates. Methods. We combined annual infection rates for the common notifiable enteric diseases with uniquely detailed, LHD-level food safety and sanitation annual expenditure data obtained from Washington and New York state health departments. We used a multivariate panel time-series design to examine ecologic relationships between 2000–2010 local food safety and sanitation expenditures and enteric diseases. Our study population consisted of 72 LHDs (mostly serving county-level jurisdictions) in Washington and New York. Results. While controlling for other factors, we found significant associations between higher LHD food and sanitation spending and a lower incidence of salmonellosis in Washington and a lower incidence of cryptosporidiosis in New York. Conclusions. Local public health expenditures on food and sanitation services are important because of their association with certain health indicators. Our study supports the need for program-specific LHD service-related data to measure the cost, performance, and outcomes of prevention efforts to inform practice and policymaking. PMID:25689186

Tax-Exempt Hospitals' Investments in Community Health and Local Public Health Spending: Patterns and Relationships.

Science.gov (United States)

Singh, Simone R; Young, Gary J

2017-12-01

To investigate whether tax-exempt hospitals' investments in community health are associated with patterns of governmental public health spending focusing specifically on the relationship between hospitals' community benefit expenditures and the spending patterns of local health departments (LHDs). We combined data on tax-exempt hospitals' community benefit spending with data on spending by the corresponding LHD that served the county in which a hospital was located. Data were available for 2 years, 2009 and 2013. Generalized linear regressions were estimated with indicators of hospital community benefit spending as the dependent variable and LHD spending as the key independent variable. Hospital community benefit spending was unrelated to how much local public health agencies spent, per capita, on public health in their communities. Patterns of local public health spending do not appear to impact the investments of tax-exempt hospitals in community health activities. Opportunities may, however, exist for a more active engagement between the public and private sector to ensure that the expenditures of all stakeholders involved in community health improvement efforts complement one another. © Health Research and Educational Trust.

An Interim Examination of the US Public Health Response to Ebola.

Science.gov (United States)

Schemm Dwyer, Katherine; Misner, Heather; Chang, Sara; Fajardo, Neyling

From the summer of 2014 to the spring of 2016, the United States was involved in the Ebola response on both the national and international levels. The United States received 2 imported cases from West Africa and had 2 locally hospital-acquired cases, which spurred a massive and unprecedented public health response. As the domestic response stabilized and the epidemic in West Africa slowed, the Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO), through a cooperative agreement with the Centers for Disease Control and Prevention (CDC), led an in-progress review to assess the national public health response to Ebola. The goal was to identify opportunities to improve the Ebola response and best practices to inform future responses. To inform the review, NACCHO and ASTHO relied on feedback collected from several sources, including a stakeholder meeting held in August 2015, a series of key informant interviews, ASTHO's and NACCHO's internal response assessments, and perspectives shared by state and local health department members and workgroups and national partner organizations. ASTHO and NACCHO engaged experts and practitioners in public health, health care, emergency management, laboratory sciences, environmental health, occupational health, homeland security, communications, and public works from US federal, state, and local governments, the nonprofit community, and private industry. This article summarizes feedback and lessons learned as shared by these sources. Additionally, this article presents recommendations for federal, state, local, and nongovernment partners to improve current and future preparedness and response efforts to infectious disease threats.

Content analysis of physical examination templates in electronic health records using SNOMED CT.

Science.gov (United States)

Gøeg, Kirstine Rosenbeck; Chen, Rong; Højen, Anne Randorff; Elberg, Pia

2014-10-01

Most electronic health record (EHR) systems are built on proprietary information models and terminology, which makes achieving semantic interoperability a challenge. Solving interoperability problems requires well-defined standards. In contrast, the need to support clinical work practice requires a local customization of EHR systems. Consequently, contrasting goals may be evident in EHR template design because customization means that local EHR organizations can define their own templates, whereas standardization implies consensus at some level. To explore the complexity of balancing these two goals, this study analyzes the differences and similarities between templates in use today. A similarity analysis was developed on the basis of SNOMED CT. The analysis was performed on four physical examination templates from Denmark and Sweden. The semantic relationships in SNOMED CT were used to quantify similarities and differences. Moreover, the analysis used these identified similarities to investigate the common content of a physical examination template. The analysis showed that there were both similarities and differences in physical examination templates, and the size of the templates varied from 18 to 49 fields. In the SNOMED CT analysis, exact matches and terminology similarities were represented in all template pairs. The number of exact matches ranged from 7 to 24. Moreover, the number of unrelated fields differed a lot from 1/18 to 22/35. Cross-country comparisons tended to have more unrelated content than within-country comparisons. On the basis of identified similarities, it was possible to define the common content of a physical examination. Nevertheless, a complete view on the physical examination required the inclusion of both exact matches and terminology similarities. This study revealed that a core set of items representing the physical examination templates can be generated when the analysis takes into account not only exact matches but also terminology

Globalisation and local power: influences on health matters in South Africa.

Science.gov (United States)

Gilbert, Tal; Gilbert, Leah

2004-03-01

This paper reviews some of the multiple influences on health issues in South Africa, placing them in the context of globalisation. By examining the complexity of factors, both domestic and global, which impact on these issues, it questions the extent to which global patterns in areas such as health policy, HIV/AIDS, health care pluralism, and neo-liberal macroeconomic policy have played out in South Africa. The identification of some of the multiple and complex forces in each case reveals a relatively consistent story of global pressures interacting with domestic realities, with some recognizably local results. There is no doubt that a full and nuanced understanding of health in South Africa requires an appreciation of developments in the global political economy, international organizations such as the WHO and World Bank, and forces which operate outside of institutions. In each case, however, the specific opportunities available to actors within the country, as well as the relative power of those actors, should be given their due consideration in analysing their potential impact on health matters.

Preparing Master of Public Health Graduates to Work in Local Health Departments.

Science.gov (United States)

Hemans-Henry, Calaine; Blake, Janice; Parton, Hilary; Koppaka, Ram; Greene, Carolyn M

2016-01-01

To identify key competencies and skills that all master of public health (MPH) graduates should have to be prepared to work in a local health department. In 2011-2012, the New York City Department of Health and Mental Hygiene administered electronic surveys to 2 categories of staff: current staff with an MPH as their highest degree, and current hiring managers. In all, 312 (77%) staff members with an MPH as their highest degree and 170 (57%) hiring managers responded to the survey. Of the respondents with an MPH as their highest degree, 85% stated that their MPH program prepared them for work at the New York City Health Department. Skills for which MPH graduates most often stated they were underprepared included facility in using SAS® statistical software, quantitative data analysis/statistics, personnel management/leadership, and data collection/database management/data cleaning. Among the skills hiring managers identified as required of MPH graduates, the following were most often cited as those for which newly hired MPH graduates were inadequately prepared: quantitative data analysis, researching/conducting literature reviews, scientific writing and publication, management skills, and working with contracts/requests for proposals. These findings suggest that MPH graduates could be better prepared to work in a local health department upon graduation. To be successful, new MPH graduate hires should possess fundamental skills and knowledge related to analysis, communication, management, and leadership. Local health departments and schools of public health must each contribute to the development of the current and future public health workforce through both formal learning opportunities and supplementary employment-based training to reinforce prior coursework and facilitate practical skill development.

Managing costs, managing benefits: employer decisions in local health care markets.

Science.gov (United States)

Christianson, Jon B; Trude, Sally

2003-02-01

To better understand employer health benefit decision making, how employer health benefits strategies evolve over time, and the impact of employer decisions on local health care systems. Data were collected as part of the Community Tracking Study (CTS), a longitudinal analysis of health system change in 12 randomly selected communities. This is an observational study with data collection over a six-year period. The study used semistructured interviews with local respondents, combined with monitoring of local media, to track changes in health care systems over time and their impact on community residents. Interviewing began in 1996 and was carried out at two-year intervals, with a total of approximately 2,200 interviews. The interviews provided a variety of perspectives on employer decision making concerning health benefits; these perspectives were triangulated to reach conclusions. The tight labor market during the study period was the dominant consideration in employer decision making regarding health benefits. Employers, in managing employee compensation, made independent decisions in pursuit of individual goals, but these decisions were shaped by similar labor market conditions. As a result, within and across our study sites, employer decisions in aggregate had an important impact on local health care systems, although employers' more highly visible public efforts to bring about health system change often met with disappointing results. General economic conditions in the 1990s had an important impact on the configuration of local health systems through their effect on employer decision making regarding health benefits offered to employees, and the responses of health plans and providers to those decisions.

Social determinants of health and local government: understanding and uptake of ideas in two Australian states.

Science.gov (United States)

Lawless, Angela; Lane, Anna; Lewis, Felicity-Ann; Baum, Fran; Harris, Patrick

2016-10-23

To examine the awareness and perceptions of local government staff about the social determinants of health (SDoH) and health inequity and use of these ideas to shape policy and practice. 96 staff at 17 councils in South Australia or New South Wales responded to questions in a pilot online survey concerning: sources of knowledge about, familiarity with the evidence on, attitudes towards, and uses of ideas about the social determinants of health. Eight of 68 SA councils and 16 of 152 NSW councils were randomly selected stratified by state and metropolitan status. Differences between states and metropolitan/non-metropolitan status were explored. The majority of respondents (88.4%) reported some familiarity with ideas about the broad determinants of health and 90% agreed that the impact of policy action on health determinants should be considered in all major government policy and planning initiatives. Research articles, government/professional reports, and professional contacts were rated as important sources of knowledge about the social determinants of health. Resources need to be dedicated to systematic research on practical implementation of interventions on social determinants of health inequities and towards providing staff with more practical information about interventions and tools to evaluate those interventions. The findings suggest there is support for action addressing the social determinants of health in local government. The findings extend similar research regarding SDoH and government in NZ and Canada to Australian local government. © 2016 Public Health Association of Australia.

Public health promotion of "local food": Constituting the self-governing citizen-consumer.

Science.gov (United States)

Derkatch, Colleen; Spoel, Philippa

2017-03-01

This article explores how the recent and growing promotion of local foods by public health units in Ontario, Canada, rhetorically interpellates the "good" health citizen as someone who not only takes responsibility for personal health but, through the consumption and support of "local food," also accepts and fulfills her responsibilities to care for the local economy, the community's well-being, and the natural environment. Drawing on Charland's concept of constitutive rhetoric, we analyze a selection of public health unit documents about local food to develop a textured account of the complex, multifaceted forms of health citizenship they constitute. Our analysis reveals that, despite their appeals to environmental sustainability and community well-being, these materials primarily characterize the ideal health citizen as an informed consumer who supports the interests of the neoliberal state through individualized lifestyle behaviors, consuming goods produced and distributed through private enterprise. By exhorting individuals to "buy local," public health discourse therefore frames responsible health citizenship principally in consumerist terms that constrain the range of available options for citizens to engage in meaningful action vis-à-vis their food systems.

Reducing health care costs - potential and limitations of local ...

African Journals Online (AJOL)

Reducing health care costs - potential and limitations of local authority health services. ... both the quality and the cost-effectiveness of health care would be improved. ... LAs offer an appropriate structure for effective community control over the ...

Tax levy financing for local public health: fiscal allocation, effort, and capacity.

Science.gov (United States)

Riley, William J; Gearin, Kimberly J; Parrotta, Carmen D; Briggs, Jill; Gyllstrom, M Elizabeth

2013-12-01

Local health departments (LHDs) rely on a wide variety of funding sources, and the level of financing is associated with both LHD performance in essential public health services and population health outcomes. Although it has been shown that funding sources vary across LHDs, there is no evidence regarding the relationship between fiscal allocation (local tax levy); fiscal effort (tax capacity); and fiscal capacity (community wealth). The purpose of this study is to analyze local tax levy support for LHD funding. Three research questions are addressed: (1) What are tax levy trends in LHD fiscal allocation? (2) What is the role of tax levy in overall LHD financing? and (3) How do local community fiscal capacity and fiscal effort relate to LHD tax levy fiscal allocation? This study focuses on 74 LHDs eligible for local tax levy funding in Minnesota. Funding and expenditure data for 5 years (2006 to 2010) were compiled from four governmental databases, including the Minnesota Department of Health, the State Auditor, the State Demographer, and the Metropolitan Council. Trends in various funding sources and expenditures are described for the time frame of interest. Data were analyzed in 2012. During the 2006-2010 time period, total average LHD per capita expenditures increased 13%, from $50.98 to $57.63. Although the overall tax levy increase in Minnesota was 25%, the local tax levy for public health increased 5.6% during the same period. There is a direct relationship between fiscal effort and LHD expenditures. Local funding reflects LHD community priorities and the relative importance in comparison to funding other local programs with tax dollars. In Minnesota, local tax levy support for local public health services is not keeping pace with local tax support for other local government services. These results raise important questions about the relationship between tax levy resource effort, resource allocation, and fiscal capacity as they relate to public health

Patient, hospital, and local health system characteristics associated with the use of observation stays in veterans health administration hospitals, 2005 to 2012.

Science.gov (United States)

Wright, Brad; OʼShea, Amy M J; Glasgow, Justin M; Ayyagari, Padmaja; Vaughan-Sarrazin, Mary

2016-09-01

Recent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals.The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system characteristics explain variation in observation stay rates across Veterans Health Administration (VHA) hospitals.Our data came from years 2005 to 2012 of the nationwide VHA Medical SAS inpatient and enrollment files, American Hospital Association Survey, and Area Health Resource File. We used these data to estimate linear regression models of hospitals' observation stay rates as a function of hospital, patient, and local health system characteristics, while controlling for time trends and Veterans Integrated Service Network level fixed effects.We found that observation stay rates are inversely related to hospital bed size and that hospitals with a greater proportion of younger or rural patients have higher observation stay rates. Observation stay rates were nearly 15 percentage points higher in 2012 than 2005.Although we identify several characteristics associated with variation in VHA hospital observation stay rates, many factors remain unmeasured.

Undressing "health fashion": an examination of health-cause clothing and accessories.

Science.gov (United States)

Walker, Kandi L; Hart, Joy L; Gregg, Jennifer L; LaJoie, A Scott

2010-09-01

Today, fashion items such as rubber wristbands in various colors, pink ribbons, and red dresses represent different health-related causes and can be seen frequently across demographic groups. Complete with pithy slogans (e.g., "Go Red for Women"), these items are part of a larger "health fashion" trend--one that involves wearing, using, and displaying health-cause clothing and accessories. In this article, the authors explore recent interest in "health fashion," examining in particular its origins, effectiveness, and implications.

The current status of the Korean student health examination

Directory of Open Access Journals (Sweden)

Hye-Jung Shin

2013-08-01

Full Text Available Recent trends place an emphasis on school health care, the ultimate goal of which is to protect,maintain, and promote students’ health. School health care is a program that integrates health careservices, health education, health counseling, and local social health services. The student healthexamination (SHE system is a part of school health care and schools and communities must beavailable to provide professional health services. Pediatricians also have important roles as experts inboth school health care and the SHE system. In this article, the history of school health care, its legalbasis, and the current status of the SHE system in Korea are reviewed. Furthermore, sample surveysfrom the past few years are reviewed. Through this holistic approach, future directions are proposed forthe improvement of SHE and school health care.

Can We Improve Training for Health Professionals to Sustain Local Health Development?

Science.gov (United States)

King, Stephen

2016-01-01

Can we improve training for health professionals? We explore specific variables that need to be accounted for to achieve sustainable local health development through training. A problem-based approach with appreciation of the need for making changes is suggested as the only authentic basis for training. PMID:28090174

Stigmatized biologies: Examining the cumulative effects of oral health disparities for Mexican American farmworker children.

Science.gov (United States)

Horton, Sarah; Barker, Judith C

2010-06-01

Severe early childhood caries (ECC) can leave lasting effects on children's physical development, including malformed oral arches and crooked permanent dentition. This article examines the way that the ECC of Mexican American farmworker children in the United States sets them up for lasting dental problems and social stigma as young adults. We examine the role of dietary and environmental factors in contributing to what we call "stigmatized biologies," and that of market-based dental public health insurance systems in cementing their enduring effects. We adapt Margaret Lock's term, local biology, to illustrate the way that biology differs not only because of culture, diet, and environment but also because of disparities in insurance coverage. By showing the long-term effects of ECC and disparate dental treatment on farmworker adults, we show how the interaction of immigrant caregiving practices and underinsurance can having lasting social effects. An examination of the long-term effects of farmworker children's ECC illustrates the ways that market-based health care systems can create embodied differences that in turn reproduce a system of social inequality.

CDC's National Environmental Public Health Tracking Program in Action: Case Studies From State and Local Health Departments.

Science.gov (United States)

Eatman, Shana; Strosnider, Heather M

The Centers for Disease Control and Prevention's (CDC's) National Environmental Public Health Tracking Program (Tracking Program) is a multidisciplinary collaboration that involves the ongoing collection, integration, analysis, interpretation, and dissemination of data from environmental hazard monitoring, human exposure surveillance, and health effects surveillance. With a renewed focus on data-driven decision-making, the CDC's Tracking Program emphasizes dissemination of actionable data to public health practitioners, policy makers, and communities. The CDC's National Environmental Public Health Tracking Network (Tracking Network), a Web-based system with components at the national, state, and local levels, houses environmental public health data used to inform public health actions (PHAs) to improve community health. This article serves as a detailed landscape on the Tracking Program and Tracking Network and the Tracking Program's leading performance measure, "public health actions." Tracking PHAs are qualitative statements addressing a local problem or situation, the role of the state or local Tracking Program, how the problem or situation was addressed, and the action taken. More than 400 PHAs have been reported by funded state and local health departments since the Tracking Program began collecting PHAs in 2005. Three case studies are provided to illustrate the use of the Tracking Program resources and data on the Tracking Network, and the diversity of actions taken. Through a collaborative network of experts, data, and tools, the Tracking Program and its Tracking Network are actively informing state and local PHAs. In a time of competing priorities and limited funding, PHAs can serve as a powerful tool to advance environmental public health practice.

Public Health Agency Accreditation Among Rural Local Health Departments: Influencers and Barriers.

Science.gov (United States)

Beatty, Kate E; Erwin, Paul Campbell; Brownson, Ross C; Meit, Michael; Fey, James

Health department accreditation is a crucial strategy for strengthening public health infrastructure. The purpose of this study was to investigate local health department (LHD) characteristics that are associated with accreditation-seeking behavior. This study sought to ascertain the effects of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB). Cross-sectional study using secondary data from the 2013 National Association of County & City Health Officials (NACCHO) National Profile of Local Health Departments Study (Profile Study). United States. LHDs (n = 490) that responded to the 2013 NACCHO Profile Survey. LHDs decision to seek PHAB accreditation. Significantly more accreditation-seeking LHDs were located in urban areas (87.0%) than in micropolition (8.9%) or rural areas (4.1%) (P < .001). LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs (RLHDs). LHDs that had completed an agency-wide strategic plan were 8.5 times (95% CI, 4.0-17.9), LHDs with a local board of health were 3.3 times (95% CI, 1.5-7.0), and LHDs governed by their state health department were 12.9 times (95% CI, 3.3-50.0) more likely to seek accreditation. The most commonly cited barrier was time and effort required for accreditation application exceeded benefits (73.5%). The strongest predictor for seeking PHAB accreditation was serving an urban jurisdiction. Micropolitan LHDs were more likely to seek accreditation than smaller RLHDs, which are typically understaffed and underfunded. Major barriers identified by the RLHDs included fees being too high and the time and effort needed for accreditation exceeded their perceived benefits. RLHDs will need additional financial and technical support to achieve accreditation. Even with additional funds, clear messaging of the benefits of accreditation

Tests to evaluate public health disease reporting systems in local public health agencies (electronic resource)

National Research Council Canada - National Science Library

Ricci, Karen; Lurie, Nicole; Stoto, Michael A; Wasserman, Jeffrey; Dausey, David J; Meade, Barbara; Diamond, Alexis; Molander, Roger C

2005-01-01

... to evaluate the ability to receive and respond to case reports 24 hours a day, 7 days a week. We refined these tests by beta-testing them at 20 metropolitan area local public health agencies across the country over the course of 10 months. The contents of this manual will be of interest to public health professionals at the state and local l...

Quantified, localized health benefits of accelerated carbon dioxide emissions reductions

Science.gov (United States)

Shindell, Drew; Faluvegi, Greg; Seltzer, Karl; Shindell, Cary

2018-04-01

Societal risks increase as Earth warms, and increase further for emissions trajectories accepting relatively high levels of near-term emissions while assuming future negative emissions will compensate, even if they lead to identical warming as trajectories with reduced near-term emissions1. Accelerating carbon dioxide (CO2) emissions reductions, including as a substitute for negative emissions, hence reduces long-term risks but requires dramatic near-term societal transformations2. A major barrier to emissions reductions is the difficulty of reconciling immediate, localized costs with global, long-term benefits3,4. However, 2 °C trajectories not relying on negative emissions or 1.5 °C trajectories require elimination of most fossil-fuel-related emissions. This generally reduces co-emissions that cause ambient air pollution, resulting in near-term, localized health benefits. We therefore examine the human health benefits of increasing 21st-century CO2 reductions by 180 GtC, an amount that would shift a `standard' 2 °C scenario to 1.5 °C or could achieve 2 °C without negative emissions. The decreased air pollution leads to 153 ± 43 million fewer premature deaths worldwide, with 40% occurring during the next 40 years, and minimal climate disbenefits. More than a million premature deaths would be prevented in many metropolitan areas in Asia and Africa, and >200,000 in individual urban areas on every inhabited continent except Australia.

Quantified, Localized Health Benefits of Accelerated Carbon Dioxide Emissions Reductions.

Science.gov (United States)

Shindell, Drew; Faluvegi, Greg; Seltzer, Karl; Shindell, Cary

2018-01-01

Societal risks increase as Earth warms, but also for emissions trajectories accepting relatively high levels of near-term emissions while assuming future negative emissions will compensate even if they lead to identical warming [1]. Accelerating carbon dioxide (CO 2 ) emissions reductions, including as a substitute for negative emissions, hence reduces long-term risks but requires dramatic near-term societal transformations [2]. A major barrier to emissions reductions is the difficulty of reconciling immediate, localized costs with global, long-term benefits [3, 4]. However, 2°C trajectories not relying on negative emissions or 1.5°C trajectories require elimination of most fossil fuel related emissions. This generally reduces co-emissions that cause ambient air pollution, resulting in near-term, localized health benefits. We therefore examine the human health benefits of increasing ambition of 21 st century CO 2 reductions by 180 GtC; an amount that would shift a 'standard' 2°C scenario to 1.5°C or could achieve 2°C without negative emissions. The decreased air pollution leads to 153±43 million fewer premature deaths worldwide, with ~40% occurring during the next 40 years, and minimal climate disbenefits. More than a million premature deaths would be prevented in many metropolitan areas in Asia and Africa, and >200,000 in individual urban areas on every inhabited continent except Australia.

Building Sustainable Local Capacity for Global Health Research in West Africa.

Science.gov (United States)

Sam-Agudu, Nadia A; Paintsil, Elijah; Aliyu, Muktar H; Kwara, Awewura; Ogunsola, Folasade; Afrane, Yaw A; Onoka, Chima; Awandare, Gordon A; Amponsah, Gladys; Cornelius, Llewellyn J; Mendy, Gabou; Sturke, Rachel; Ghansah, Anita; Siberry, George K; Ezeanolue, Echezona E

Global health research in resource-limited countries has been largely sponsored and led by foreign institutions. Thus, these countries' training capacity and productivity in global health research is limited. Local participation at all levels of global health knowledge generation promotes equitable access to evidence-based solutions. Additionally, leadership inclusive of competent local professionals promotes best outcomes for local contextualization and implementation of successful global health solutions. Among the sub-Saharan African regions, West Africa in particular lags in research infrastructure, productivity, and impact in global health research. In this paper, experts discuss strategies for scaling up West Africa's participation in global health evidence generation using examples from Ghana and Nigeria. We conducted an online and professional network search to identify grants awarded for global health research and research education in Ghana and Nigeria. Principal investigators, global health educators, and representatives of funding institutions were invited to add their knowledge and expertise with regard to strengthening research capacity in West Africa. While there has been some progress in obtaining foreign funding, foreign institutions still dominate local research. Local research funding opportunities in the 2 countries were found to be insufficient, disjointed, poorly sustained, and inadequately publicized, indicating weak infrastructure. As a result, research training programs produce graduates who ultimately fail to launch independent investigator careers because of lack of mentoring and poor infrastructural support. Research funding and training opportunities in Ghana and Nigeria remain inadequate. We recommend systems-level changes in mentoring, collaboration, and funding to drive the global health research agenda in these countries. Additionally, research training programs should be evaluated not only by numbers of individuals graduated but

Should they stay or should they go? Leader duration and financial performance in local health departments.

Science.gov (United States)

Jadhav, Emmanuel D; Holsinger, James W; Mays, Glen; Fardo, David

2015-01-01

The delivery of programs by local health departments (LHDs) has shifted from "if we do not have the money we don't do it" to LHD directors should "identify and fund public health priorities." This shift has subsequently increased performance expectations of LHD leaders. In the for-profit sector the leaders' failure to perform has resulted in a shortening tenure trend. Tenure is a proxy for human capital accumulation. In LHDs, the nature of association, if any, between leader tenure and agency performance is unknown. Examine association between financial performance of LHDs with short-, average-, and long-tenured LHD leaders. Variation in leader characteristics and percent change in expenditure were examined using a longitudinal cohort design and positive deviance methodology. Bivariate analysis of LHD financial performance and leader characteristics was conducted, and a logistic regression model was developed to test association between leader tenure and LHDs that experienced a positive percentage expenditure change. From a total of 2523 LHDs, 1453 were examined. The cross-sectional surveys of US public health agencies conducted by the National Association of County and City Health Officials in 2008 and 2010 contain the leader and LHD variables. Approximately 44% of LHDs experienced a positive percentage expenditure change. Leader tenure, age, gender, and education status were significantly associated with a positive percentage expenditure change using a chi-square test of independence. From the logistic regression analysis tenure, educational status, employment status, area population, governance, classification, and jurisdiction were statistically significant. Local health departments with leaders whose tenure was less than 2 years were less likely than those with average tenure to experience a positive percentage expenditure change. The odds ratios for tenure suggest that tenure is positively associated up to a threshold level and then declines. Implying that

Participatory health impact assessment for the development of local government regulation on hazard control

International Nuclear Information System (INIS)

Inmuong, Uraiwan; Rithmak, Panee; Srisookwatana, Soomol; Traithin, Nathathai; Maisuporn, Pornpun

2011-01-01

The Thai Public Health Act 1992 required the Thai local governments to issue respective regulations to take control of any possible health-hazard related activities, both from commercial and noncommercial sources. Since 1999, there has been centrally decentralized of power to a new form of local government establishment, namely Sub-district Administrative Organization (SAO). The SAO is asmall-scale local governing structure while its legitimate function is for community services, including control of health impact related activities. Most elected SAO administrators and officers are new and less experience with any of public health code of practice, particularly on health-hazard control. This action research attempted to introduce and apply a participatory health impact assessment (HIA) tool for the development of SAO health-hazard control regulation. The study sites were at Ban Meang and Kok See SAOs, Khon Kaen Province, Thailand, while all intervention activities conducted during May 2005-April 2006. A set of cooperative activities between researchers and community representatives were planned and organized by; surveying and identifying place and service base locally causing local environmental health problems, organizing community participatory workshops for drafting and proposing the health-hazard control regulation, and appropriate practices for health-hazard controlling measures. This action research eventually could successfully enable the SAO administrators and officers understanding of local environmental-related health problem, as well as development of imposed health-hazard control regulation for local community.

National public health policy in a local context--implementation in two Swedish municipalities.

Science.gov (United States)

Jansson, Elisabeth; Fosse, Elisabeth; Tillgren, Per

2011-12-01

In 2003 the wide-ranging Swedish National Public Health Policy (SNPHP), with a focus on health determinants, was adopted by the Swedish parliament. In the context of multilevel governance, SNPHP implementation is dependent on self-governed municipalities and counties. The aim of the study is, from a municipal perspective, to investigate public-health policies in two municipalities. Content analysis of documents and interviews provided a foundation for an explorative case study. The SNPHP at national level is overriding but politically controversial. At local level, a health-determinants perspective was detectable in the policies implemented, but none regarding to health equality. At local level, the SNPHP is not regarded as implementable; rather, limited parts have, to varying degrees, been reconciled with local public-health goals, according to municipal needs and conditions. A success-promoting factor in the two municipalities was the presence of committed and knowledgeable actors/implementers. Also, the municipality with a more centrally controlled and stable party-political leadership succeeded better in implementing structural and intersectoral community-wide policies for coordinated local health promotion. The contents of national and local public-health policies differ, and municipalities that have implemented their own local health policies do not seem to regard the SNPHP as justifiable or adoptable. If the SNPHP overall aim regarding equal health is to be achieved homogeneously in Swedish municipalities, its contents and purpose need clearer management and negotiation, so that implementation of the national policy locally is understandable and motivated. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Strengthening capacity for local evidence to inform local responders to HIV in a remote Solomon Island health service

Directory of Open Access Journals (Sweden)

David MacLaren

2015-04-01

Full Text Available Background: Documenting specific knowledge and attitudes about HIV in the culturally diverse nation of Solomon Islands is essential to inform locally targeted public health responses. As part of a large capacity-strengthening project at Atoifi Adventist Hospital in East Kwaio, Solomon Islands, researchers, using a ‘learn-by-doing’ process, worked with participants in public health research methods. Methods: Overall, 43 people attended research capacity building workshops in 2011; eight joined the HIV study group. A cross-sectional survey including semi-structured interviews on HIV was conducted by the group. In February 2014, a hospital administrator was interviewed about how the 2011 study informed local HIV responses. Results: Of the 53 survey participants, 64% self-assessed as having little or no HIV knowledge, but 90% knew HIV could be transmitted between men and women during sex. Less than 50% knew HIV could be transmitted between two men having sex, 45% thought HIV could be transmitted by mosquitoes and 55% agreed condoms help protect from HIV. Most participants reported negative attitudes towards people with HIV. Three years later the health administrator reported ad hoc responses to HIV because of low HIV prevalence, increasing noncommunicable diseases, staff turnover and resource shortages. Discussion: This HIV study was used to strengthen research skills in local health professionals and community members in Solomon Islands. It showed that community members require accurate information about HIV transmission and that entrenched stigma is an issue. Although results provided local evidence for local response, ongoing health system challenges and little local HIV transmission meant HIV services remain rudimentary.

Can voter-approved tax levies provide fiscal advantages and stability for local public health agencies?

Science.gov (United States)

Schmalzried, Hans D; Fallon, L Fleming

2013-01-01

Major funding cuts have occurred throughout the United States public health system during the past several years. Funding for local public health agency (LPHA) services and programs is obtained through a patchwork of sources that vary both within and among states. Even though local city and county sources provide a significant proportion of funding for LPHAs, information available in the literature about these revenues is sparse and is not clearly described. This study focused on a single specific revenue stream included in the local sources (local city and county) category: funds voted on directly by the public. The primary purpose of this study was to examine whether this type of funding source provided fiscal advantages for LPHAs. Specifically, we wanted to see how sensitive levy votes were to changing general economic conditions. A questionnaire to collect LPHA levy data was developed, approved, and mailed to county boards of elections in Ohio (n = 88). Elections officials were asked to provide voting results for all LPHA levy ballot attempts since 1994 regardless of outcome. In the study period (1994 through 2011), 250 LPHA property tax levies were placed on election ballots in Ohio. LPHAs were successful in 155 (62.0%) and unsuccessful in 95 (38.0%) attempts. Over the 18-year period, the most noteworthy outcome was a 94.6% pass rate for renewal levies. Our study demonstrated that voter-approved tax levies provide some fiscal advantages for LPHAs: higher per capita revenues than those who have to rely on other sources of income and predictable revenue streams. This translates into more funds being available for public health programs and services. Property tax levies allow citizens to make direct investments in their local health departments.

National Health and Nutrition Examination Survey (NHANES), 2009-2010

Data.gov (United States)

U.S. Department of Health & Human Services — The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in...

Describing the continuum of collaboration among local health departments with hospitals around the community health assessments.

Science.gov (United States)

Wilson, Kristin D; Mohr, Lisa Buettner; Beatty, Kate E; Ciecior, Amanda

2014-01-01

Hospitals and local health departments (LHDs) are under policy requirements from the Affordable Care Act and accreditation standards through the Public Health Accreditation Board. Tax exempt hospitals must perform a community health needs assessment (CHNA), similar to the community health assessment (CHA) required for LHDs. These efforts have led to a renewed interest in hospitals and LHDs working together to achieve common goals. The purpose of this study is to gain a better understanding of levels of joint action leading toward collaboration between LHDs and hospitals and describe collaboration around CHAs. Local health departments were selected on the basis of reporting collaboration (n = 26) or unsure about collaboration (n = 29) with local hospitals. Local health departments were surveyed regarding their relationship with local hospitals. For LHDs currently collaborating with a hospital, a collaboration continuum scale was calculated. Appropriate nonparametric tests, chi-squares, and Spearman's rank correlations were conducted to determine differences between groups. A total of 44 LHDs responded to the survey (80.0%). Currently collaborating LHDs were more likely to be interested in accreditation and to refer to their CHA 5 or more times a year compared to the unsure LHDs. In the analysis, a collaboration continuum was created and is positively correlated with aspects of the CHA and CHA process. This study is the first attempt to quantify the level of collaboration between LHDs and hospitals around CHAs. Better understanding of the levels of joint action required may assist LHDs in making informed decisions regarding deployment of resources on the path to accreditation.

The value of physical examination in mental health nursing.

Science.gov (United States)

Martin, Carolyn T

2016-03-01

This article explores the use of a physical examination assignment in a mental health general nursing clinical placement course that addresses the poor physical health of people with mental illness and the barriers traditionally impeding health care provision for this population. A descriptive qualitative approach utilizes inductive content analysis to investigate 145 student survey responses. The assignment assists student nurses in understanding that physical and mental well-being are intrinsically linked. Students report increased comfort performing a physical examination on patients with mental illness post assignment. Students' initial bias towards this population was minimized post the clinical assignment. Poor physical health is common among people with mental health problems. Many view the provision of care as a major public health issue. Nurses are the front line caregivers of mental health service consumers and are well positioned to assess their physical needs. Their assessment may be the first step in recognizing health care issues in this population. Copyright © 2015 Elsevier Ltd. All rights reserved.

Estimating the financial resources needed for local public health departments in Minnesota: a multimethod approach.

Science.gov (United States)

Riley, William; Briggs, Jill; McCullough, Mac

2011-01-01

This study presents a model for determining total funding needed for individual local health departments. The aim is to determine the financial resources needed to provide services for statewide local public health departments in Minnesota based on a gaps analysis done to estimate the funding needs. We used a multimethod analysis consisting of 3 approaches to estimate gaps in local public health funding consisting of (1) interviews of selected local public health leaders, (2) a Delphi panel, and (3) a Nominal Group Technique. On the basis of these 3 approaches, a consensus estimate of funding gaps was generated for statewide projections. The study includes an analysis of cost, performance, and outcomes from 2005 to 2007 for all 87 local governmental health departments in Minnesota. For each of the methods, we selected a panel to represent a profile of Minnesota health departments. The 2 main outcome measures were local-level gaps in financial resources and total resources needed to provide public health services at the local level. The total public health expenditure in Minnesota for local governmental public health departments was $302 million in 2007 ($58.92 per person). The consensus estimate of the financial gaps in local public health departments indicates that an additional $32.5 million (a 10.7% increase or $6.32 per person) is needed to adequately serve public health needs in the local communities. It is possible to make informed estimates of funding gaps for public health activities on the basis of a combination of quantitative methods. There is a wide variation in public health expenditure at the local levels, and methods are needed to establish minimum baseline expenditure levels to adequately treat a population. The gaps analysis can be used by stakeholders to inform policy makers of the need for improved funding of the public health system.

Public Health Employees' Perception of Workplace Environment and Job Satisfaction: The Role of Local Health Departments' Engagement in Accreditation.

Science.gov (United States)

Ye, Jiali; Verma, Pooja; Leep, Carolyn; Kronstadt, Jessica

To examine the association between local health departments' (LHDs') engagement in accreditation and their staffs' perceptions of workplace environment and the overall satisfaction with their jobs. Data from the 2014 Public Health Workforce Interests and Needs Survey (PH WINS) (local data only) and the 2014 Forces of Change survey were linked using LHDs' unique ID documented by the National Association of County & City Health Officials. The Forces of Change survey assessed LHDs' accreditation status. Local health departments were classified as "formally engaged" in the Public Health Accreditation Board accreditation process if they had achieved accreditation, submitted an application, or submitted a statement of intent. The PH WINS survey measured employees' perception of 3 aspects of workplace environment, including supervisory support, organizational support, and employee engagement. The overall satisfaction was measured using the Job in General Scale (abridged). There are 1884 LHD employees who completed PH WINS and whose agencies responded to the question on the accreditation status of the Forces of Change survey. When compared with employees from LHDs less engaged in accreditation, employees from LHDs that were formally engaged in accreditation gave higher ratings to all 3 aspects of workplace environment and overall job satisfaction. Controlling for employee demographic characteristics and LHD jurisdiction size, the agency's formal engagement in accreditation remained related to a higher score in perceived workplace environment and job satisfaction. After controlling for perceived workplace environment, accreditation status was marginally associated with job satisfaction. The findings provide support for previous reports by LHD leaders on the benefits of accreditation related to employee morale and job satisfaction. The results from this study allow us to further catalog the benefits of accreditation in workforce development and identify factors that may

Analysing local-level responses to migration and urban health in Hillbrow: the Johannesburg Migrant Health Forum

Directory of Open Access Journals (Sweden)

Jo Vearey

2017-07-01

Full Text Available Abstract Johannesburg is home to a diverse migrant population and a range of urban health challenges. Locally informed and implemented responses to migration and health that are sensitive to the particular needs of diverse migrant groups are urgently required. In the absence of a coordinated response to migration and health in the city, the Johannesburg Migrant Health Forum (MHF – an unfunded informal working group of civil society actors – was established in 2008. We assess the impact, contributions and challenges of the MHF on the development of local-level responses to migration and urban health in Johannesburg to date. In this Commentary, we draw on data from participant observation in MHF meetings and activities, a review of core MHF documents, and semi-structured interviews conducted with 15 MHF members. The MHF is contributing to the development of local-level migration and health responses in Johannesburg in three key ways: (1 tracking poor quality or denial of public services to migrants; (2 diverse organisational membership linking the policy process with community experiences; and (3 improving service delivery to migrant clients through participation of diverse service providers and civil society organisations in the Forum. Our findings indicate that the MHF has a vital role to play in supporting the development of appropriate local responses to migration and health in a context of continued – and increasing – migration, and against the backdrop of rising anti-immigrant sentiments.

From Sociocultural Disintegration to Community Connectedness Dimensions of Local Community Concepts and Their Effects on Psychological Health of Its Residents

Directory of Open Access Journals (Sweden)

Tom Sørensen

2013-01-01

Full Text Available In a series of community mental health promotion studies in Lofoten, Norway, the concept of sociocultural integration is used to describe properties of a local community that are related to people's psychological health. Starting with Durkheim's description of a cohesive society, we compare different concepts that are related to sociocultural integration, for example, sense of community, social capital, and social cohesion. We then examine the relationship of various individual oriented social psychological concepts to sociocultural integration. These concepts often share theoretical and operational definitions. The concept of sociocultural integration in the Lofoten studies was proved to be very valuable in understanding how the properties of a community can affect people's mental health and their social psychological properties. It has also shown its value in the planning of mental health services and demonstrating its success in concrete community-based mental health promotion projects. Thus they could make important contributions to further studies and actions in local communities where the intersection between the individual, their social network, and their local community occurs.

Local leadership in public health: the role of the medical officer of health in Britain, 1872–1974

Science.gov (United States)

Gorsky, Martin

2007-01-01

The recent policy focus in British public health on the importance of local action invites consideration of historical precedent. The role and achievements of the medical officer of health (MOH), the local government official charged with public health responsibilities, is discussed. The gradual accretion of duties is traced in the first section: the mid‐Victorian concern with urban sanitation; the preventive strategies adopted after the bacteriological revolution; the extension of personal health services in the early 20th century; and the more diminished role under the National Health Service (NHS), when infectious diseases retreated. The historical verdicts passed on the MOsH are reviewed in the second section. The leading role of the MOsH in the late 19th‐century mortality decline has been reasserted, and although there is some justification in the argument that in the 20th century public health lost its focus, it is important to recall that the extension of personal health services under MOH direction signified a major extension of access to care. Similarly, the charge that MOsH did not redefine their role in the period before their final demise in 1974 is not entirely justified. The emphasis of the NHS on curative rather than preventive medicine, and the economic constraints on local authority health service expansion limited their room for manoeuvre. The history of local leadership in public health may offer some enduring lessons. These include the importance of monitoring local population health, acting as a public interface between medicine and the community, facilitating joined‐up working and confronting vested interests. PMID:17496253

Improving local health through community health workers in Cambodia: challenges and solutions.

Science.gov (United States)

Ozano, Kim; Simkhada, Padam; Thann, Khem; Khatri, Rose

2018-01-06

Volunteer community health workers (CHWs) are an important link between the public health system and the community. The 'Community Participation Policy for Health' in Cambodia identifies CHWs as key to local health promotion and as a critical link between district health centres and the community. However, research on the challenges CHWs face and identifying what is required to optimise their performance is limited in the Cambodian context. This research explores the views of CHWs in rural Cambodia, on the challenges they face when implementing health initiatives. Qualitative methodology was used to capture the experiences of CHWs in Kratie and Mondulkiri provinces. Two participatory focus groups with CHWs in Mondulkiri and ten semi-structured interviews in Kratie were conducted. Results from both studies were used to identify common themes. Participants were CHWs, male and female, from rural Khmer and Muslim communities and linked with seven different district health centres. Findings identify that CHWs regularly deliver health promotion to communities. However, systemic, personal and community engagement challenges hinder their ability to function effectively. These include minimal leadership and support from local government, irregular training which focuses on verticalised health programmes, inadequate resources, a lack of professional identity and challenges to achieving behaviour change of community members. In addition, the CHW programme is delivered in a fragmented way that is largely influenced by external aid objectives. When consulted, however, CHWs demonstrate their ability to develop realistic practical solutions to challenges and barriers. The fragmented delivery of the CHW programme in Cambodia means that government ownership is minimal. This, coupled with the lack of defined core training programme or adequate resources, prevents CHWs from reaching their potential. CHWs have positive and realistic ideas on how to improve their role and, subsequently

Local self governance in health - a study of it's functioning in Odisha, India.

Science.gov (United States)

Panda, Bhuputra; Zodpey, Sanjay P; Thakur, Harshad P

2016-10-31

Local decision making is linked to several service quality improvement parameters. Rogi Kalyan Samitis (RKS) at peripheral decision making health units (DMHU) are composite bodies that are mandated to ensure accountability and transparency in governance, improve quality of services, and facilitate local responsiveness. There is scant literature on the nature of functioning of these institutions in Odisha. This study aimed to assess the perception of RKS members about their roles, involvement and practices with respect to local decision making and management of DMHUs; it further examined perceptual and functional differences between priority and non-priority district set-ups; and identified predictors of involvement of RKS members in local governance of health units. As members of RKS, health service providers, officials in administrative/managerial role, elected representatives, and officials from other departments (including independent members) constituted our study sample. A total of 112 respondents were interviewed across 6 districts, through a multi-stage stratified random sampling; we used a semi-structured interview schedule that comprised mainly of close-ended and some open-ended questions. Descriptive and inferential statistics were used to compare 3 priority (PD) and 3 non-priority districts (NPD), categorized on the basis of Infant Mortality Rate (IMR) estimates of 2011 as proxy of population health. Governance, human resource management, financial management and quality improvement functions were studied in detail. Opinion about various individual and organizational factors in local self-governance and predictors of involvement were identified. The socio-demographic profile and composition of respondents were comparable between PD and NPD. Majority of respondents were 'satisfied' with their current roles in the governance of local health institutions. About one-fourth opined that the amount of funds allocated to RKS under National Health Mission (NHM

Local health practices and the knowledge of medicinal plants in a Brazilian semi-arid region: environmental benefits to human health.

Science.gov (United States)

Zank, Sofia; Peroni, Nivaldo; de Araújo, Elcida Lima; Hanazaki, Natalia

2015-02-23

The concept of eco-cultural health considers the dynamic interaction between humans and ecosystems, emphasizing the implications of the health of the ecosystem for the health and well-being of human populations. Ethnobotanical studies focusing on folk medicine and medicinal plants can contribute to the field of eco-cultural health if they incorporate the perspective and local knowledge of communities. We investigated the local health practices in three rural communities living within the vicinity of a protected area of sustainable use in a semi-arid region of Brazil. We analyzed the opinions of local health experts on the elements that influence human health and on how the environment contributes to this influence. We also analyzed and compared the local knowledge of medicinal plants, as knowledge of this type is an important factor when considering the interaction between environmental and human health. We performed structured interviews and free-listings with 66 local health experts. We used content analysis to systematize the elements of the influences on human health. We compared the richness of the plants cited among communities and analyzed the differences among the three communities regarding the ways in which the plants were obtained and the environments in which plants were collected. The local experts identified several influences of the environment on human health. These influences can be associated with ecosystem services, such as climatic conditions, water and air quality, recreation and medicinal and food resources. We identified 192 medicinal plant species, most of which were gathered from wild ecosystems. The most important environments for the three communities were the plateau mountain and backyards. The informants had a broad and integrated view of health, perceiving the importance of conserving the environment within the National Forest of Araripe for the health and well-being of the local populations.

Local television news coverage of President Clinton's introduction of the Health Security Act.

Science.gov (United States)

Dorfman, L; Schauffler, H H; Wilkerson, J; Feinson, J

1996-04-17

To investigate how local television news reported on health system reform during the week President Clinton presented his health system reform bill. Retrospective content analysis of the 1342-page Health Security Act of 1993, the printed text of President Clinton's speech before Congress on September 22, 1993, and a sample of local television news stories on health system reform broadcast during the week of September 19 through 25, 1993. The state of California. During the week, 316 television news stories on health system reform were aired during the 166 local news broadcasts sampled. Health system reform was the second most frequently reported topic, second to stories on violent crime. News stories on health system reform averaged 1 minute 38 seconds in length, compared with 57 seconds for violent crime. Fifty-seven percent of the local news stories focused on interest group politics. Compared with the content of the Health Security Act, local news broadcasts devoted a significantly greater portion of their stories to financing, eligibility, and preventive services. Local news stories gave significantly less attention to cost-saving mechanisms, long-term care benefits, and changes in Medicare and Medicaid, and less than 2% of stories mentioned quality assurance mechanisms, malpractice reform, or new public health initiatives. Of the 316 televised news stories, 53 reported on the president's speech, covering many of the same topics emphasized in the speech (financing, organization and administration, and eligibility) and de-emphasizing many of the same topics (Medicare and Medicaid, quality assurance, and malpractice reform). Two percent of the president's speech covered partisan politics; 45% of the local news stories on the speech featured challenges from partisan politicians. Although health system reform was the focus of a large number of local television news stories during the week, in-depth explanation was scarce. In general, the news stories provided

Service utilization in community health centers in China: a comparison analysis with local hospitals

Directory of Open Access Journals (Sweden)

Wang Xiaohang

2006-08-01

Full Text Available Abstract Background Being an important part of China's Urban Health Care Reform System, Community Health Centers (CHCs have been established throughout the entire country and are presently undergoing substantial reconstruction. However, the services being delivered by the CHCs are far from reaching their performance targets. In order to assess the role of the CHCs, we examined their performance in six cities located in regions of South-East China. The purpose of this investigation was to identify the utilization and the efficiency of community health resources that are able to provide basic medical and public health services. Methods The study was approved by Peking University Health Science Center Institutional Reviewing Board (NO: IRB00001052-T1. Data were collected from all the local health bureaux and processed using SPSS software. Methods of analysis mainly included: descriptive analysis, paired T-test and one-way ANOVA. Results The six main functions of the CHCs were not fully exploited and the surveys that were collected on their efficiency and utilization of resources indicate that they have a low level of performance and lack the trust of local communities. Furthermore, the CHCs seriously lack funding support and operate under difficult circumstances, and residents have less positive attitudes towards them. Conclusion The community health service must be adjusted according to the requirements of urban medical and health reform, taking into account communities' health needs. More research is required on the living standards and health needs of residents living within the CHC's range, taking into consideration the users' needs in expanding the newly implemented service, and at the same time revising the old service system so as to make the development of CHCs realistic and capable of providing a better service to patients. Several suggestions are put forward for an attainable scheme for developing a community health service.

Applying social innovation theory to examine how community co-designed health services develop: using a case study approach and mixed methods.

Science.gov (United States)

Farmer, Jane; Carlisle, Karen; Dickson-Swift, Virginia; Teasdale, Simon; Kenny, Amanda; Taylor, Judy; Croker, Felicity; Marini, Karen; Gussy, Mark

2018-01-31

Citizen participation in health service co-production is increasingly enacted. A reason for engaging community members is to co-design services that are locally-appropriate and harness local assets. To date, much literature examines processes of involving participants, with little consideration of innovative services are designed, how innovations emerge, develop and whether they sustain or diffuse. This paper addresses this gap by examining co-designed initiatives through the lens of social innovation - a conceptualisation more attuned to analysing grassroots innovation than common health services research approaches considering top-down, technical innovations. This paper considers whether social innovation is a useful frame for examining co-designed services. Eighty-eight volunteer community-based participants from six rural Australian communities were engaged using the same, tested co-design framework for a 12-month design and then 12-month implementation phase, in 24 workshops (2014-16). Mixed, qualitative data were collected and used to formulate five case studies of community co-designed innovations. A social innovation theory, derived from literature, was applied as an analytical frame to examine co-design cases at 3 stages: innovation growth, development and sustainability/diffusion. Social innovation theory was found relevant in examining and understanding what occurred at each stage of innovation development. Innovations themselves were all adaptations of existing ideas. They emerged due to local participants combining knowledge from local context, own experiences and exemplars. External facilitation brought resources together. The project provided a protective niche in which pilot innovations developed, but they needed support from managers and/or policymakers to be implemented; and to be compatible with existing health system practices. For innovations to move to sustainability/diffusion required political relationships. Challenging existing practice

CDC’s National Environmental Public Health Tracking Program in Action: Case Studies From State and Local Health Departments

Science.gov (United States)

Eatman, Shana; Strosnider, Heather M.

2017-01-01

The Centers for Disease Control and Prevention’s (CDC’s) National Environmental Public Health Tracking Program (Tracking Program) is a multidisciplinary collaboration that involves the ongoing collection, integration, analysis, interpretation, and dissemination of data from environmental hazard monitoring, human exposure surveillance, and health effects surveillance. With a renewed focus on data-driven decision-making, the CDC’s Tracking Program emphasizes dissemination of actionable data to public health practitioners, policy makers, and communities. The CDC’s National Environmental Public Health Tracking Network (Tracking Network), a Web-based system with components at the national, state, and local levels, houses environmental public health data used to inform public health actions (PHAs) to improve community health. This article serves as a detailed landscape on the Tracking Program and Tracking Network and the Tracking Program’s leading performance measure, “public health actions.” Tracking PHAs are qualitative statements addressing a local problem or situation, the role of the state or local Tracking Program, how the problem or situation was addressed, and the action taken. More than 400 PHAs have been reported by funded state and local health departments since the Tracking Program began collecting PHAs in 2005. Three case studies are provided to illustrate the use of the Tracking Program resources and data on the Tracking Network, and the diversity of actions taken. Through a collaborative network of experts, data, and tools, the Tracking Program and its Tracking Network are actively informing state and local PHAs. In a time of competing priorities and limited funding, PHAs can serve as a powerful tool to advance environmental public health practice. PMID:28763381

Preparing for climate change: a perspective from local public health officers in California.

Science.gov (United States)

Bedsworth, Louise

2009-04-01

The most recent scientific findings show that even with significant emission reductions, some amount of climate change is likely inevitable. The magnitude of the climate changes will depend on future emissions and climate sensitivity. These changes will have local impacts, and a significant share of coping with these changes will fall on local governmental agencies. Public health is no exception, because local public health agencies are crucial providers of disease prevention, health care, and emergency preparedness services. This article presents the results of a survey of California's local pubic health officers conducted between August and October 2007. The survey gauged health officers' concerns about the public health impacts of climate change, programs in place that could help to mitigate these health effects, and information and resource needs for better coping with a changing climate. The results of this survey show that most public health officers feel that climate change poses a serious threat to public health but that they do not feel well equipped in terms of either resources or information to cope with that threat. Nonetheless, public health agencies currently implement a number of programs that will help these agencies handle some of the challenges posed by a changing climate. Overall, the results suggest that local public health agencies in California are likely in a better position than they perceive to address the threats associated with climate change but that there is a larger role for them to play in climate policy.

Ingredients for Success: Strategies to Support Local Food Use in Health Care Institutions.

Science.gov (United States)

Linton, Emily; Keller, Heather; Duizer, Lisa

2018-06-12

There is growing interest in use of local food within health care institutions such as hospitals and long-term care homes. This study explored stakeholder perspectives on (i) influences on local food use and (ii) strategies that support success and sustainability of use in health care institutions. Fifteen participants who were institutional leaders with experience in implementing or supporting local food use in health care institutions in Ontario were recruited through purposeful and snowball sampling. A semi-structured interview was conducted by telephone and audio-recorded. Qualitative content analysis identified that influences on local food use were: product availability, staff and management engagement, and legislation and resources (e.g., funding, labour). Several strategies were offered for building and sustaining success including: setting goals, requesting local food availability from suppliers, and more clearly identifying local foods in product lists. The influences and potential strategies highlighted in this paper provide a greater understanding for dietitians and food service managers on how local foods can be incorporated into health care institutions.

Therapeutic Value of the Periodic Health Examination

Energy Technology Data Exchange (ETDEWEB)

Lincoln, T. A.; Hurt, H. B.

1965-09-01

The Oak Ridge National Laboratory has been conducting periodic health examinations on all of its employees for over 10 years. The original purpose of this program was the early detection of disease to be followed by referral or appropriate counseling. Because of the relatively young age of this group, we expected that this service would be of greatest benefit to only the small percentage who had significant findings. However, over this 10 year period we have been increasingly impressed that those who had no significant findings have expressed almost as much enthusiasm and gratitude as those in whom we found early but potentially serious disease. This response caused us to look more critically at the reasons for this favorable reaction. As a result, we have become convinced that these examinations have an important therapeutic value to the healthy, as well as the sick, and that this fact should be considered in their justification. A health examination can quite properly be considered therapeutic, even though no disease is found or treated, providing it "serves" or meets some of the needs of the person being examined. After all, the literal definition of the word therapeutic is service, since it is derived from the Greek word therapeutikos, which means an attendant or servant.

Management of health and safety in the organization of worktime at the local level.

Science.gov (United States)

Jeppesen, H J; Bøggild, H

1998-01-01

This study examined the consideration of health and safety issues in the local process of organizing worktime within the framework of regulations. The study encompassed all 7 hospitals in one region of Denmark. Twenty-three semi-structured interviews were carried out with 2 representatives from the different parties involved (management, cooperation committees, health and safety committees from each hospital, and 2 local unions). Furthermore, a questionnaire was sent to all 114 wards with day and night duty. The response rate was 84%. Data were collected on alterations in worktime schedules, responsibilities, reasons for the present design of schedules, and use of inspection reports. The organization of worktime takes place in single wards without external interference and without guidelines other than the minimum standards set in regulations. At the ward level, management and employees were united in a mutual desire for flexibility, despite the fact that regulations were not always followed. No interaction was found in the management of health and safety factors between the parties concerned at different levels. The demands for flexibility in combination with the absence of guidelines and the missing dynamics between the parties involved imply that the handling of health and safety issues in the organization of worktime may be accidental and unsystematic. In order to consider the health and safety of night and shift workers within the framework of regulations, a clarification of responsibilities, operational levels, and cooperation is required between the parties concerned.

Teacher stress and health; examination of a model.

Science.gov (United States)

DeFrank, R S; Stroup, C A

1989-01-01

Stress in teaching derives from a variety of sources, and evidence exists linking such stress to physical and mental health concerns. Detailed examination of the linkages among personal factors, job stress, job satisfaction and symptomatology have not been done in this occupation, however, and the present study examines a model interrelating these variables. A survey of 245 predominantly female elementary school teachers in southeast Texas suggested that demographic factors and teaching background do not influence stress, satisfaction or health concerns. However, while job stress was the strongest predictor of job satisfaction, this stress had no direct relationship with health problems, an unexpected finding. Write-in responses by teachers indicated additional sources of stress, many of which were environmental or policy-based in nature. The implications of these findings for future research and stress management interventions for teachers are discussed.

Adapting to the Changing Climate: An Assessment of Local Health Department Preparations for Climate Change-Related Health Threats, 2008-2012.

Science.gov (United States)

Roser-Renouf, Connie; Maibach, Edward W; Li, Jennifer

2016-01-01

Climate change poses a major public health threat. A survey of U.S. local health department directors in 2008 found widespread recognition of the threat, but limited adaptive capacity, due to perceived lack of expertise and other resources. We assessed changes between 2008 and 2012 in local public health departments' preparedness for the public health threats of climate change, in light of increasing national polarization on the issue, and widespread funding cutbacks for public health. A geographically representative online survey of directors of local public health departments was conducted in 2011-2012 (N = 174; response rate = 50%), and compared to the 2008 telephone survey results (N = 133; response rate = 61%). Significant polarization had occurred: more respondents in 2012 were certain that the threat of local climate change impacts does/does not exist, and fewer were unsure. Roughly 10% said it is not a threat, compared to 1% in 2008. Adaptation capacity decreased in several areas: perceived departmental expertise in climate change risk assessment; departmental prioritization of adaptation; and the number of adaptation-related programs and services departments provided. In 2008, directors' perceptions of local impacts predicted the number of adaptation-related programs and services their departments offered, but in 2012, funding predicted programming and directors' impact perceptions did not. This suggests that budgets were constraining directors' ability to respond to local climate change-related health threats. Results also suggest that departmental expertise may mitigate funding constraints. Strategies for overcoming these obstacles to local public health departments' preparations for climate change are discussed.

NSAID is inversely associated with asymptomatic gastric ulcer: local health examination data from the Korean National Health Insurance Corporation.

Science.gov (United States)

Kim, Hee Man; Cho, Jae Hee; Choi, Jin Yi; Chun, Song Wook; Kim, Yu Jin; Cho, Hyeon Geun; Song, Si Young; Han, Ki Jun

2013-12-01

BACKGROUND. Silent peptic ulcer has been considered to be associated with nonsteroidal anti-inflammatory drug (NSAID). The recent studies have reported no relationship between them. AIM. We attempted to investigate an association between asymptomatic peptic ulcer and NSAID in Korean adults. METHODS. The subjects were enrolled from participants visiting Myongji Hospital for health examination program of the Korean National Health Insurance Corporation. The questionnaires were designed to investigate individual medical information and gastroduodenal symptoms. RESULTS. From May 2005 to March 2009, 5459 participants were enrolled and 299 participants were excluded. Of 5160 participants, 3144 (60.9%) participants were asymptomatic and 424 (8.2%) participants had peptic ulcer. Among 3144 asymptomatic participants, NSAID-taking participants had the odds ratio of 1.4 [95% confidence interval (CI): 0.7-2.6, p = 0.339] for the risk of peptic ulcer. Among 424 peptic ulcer patients, 247 (58.3%) were asymptomatic. They had lower prevalence of NSAID use (4.9% vs. 14.7%). The asymptomatic gastric ulcer patients had smaller size and more frequent healing stage than the symptomatic gastric ulcer patients. In multivariable analysis of 424 peptic ulcer patients, NSAID patients had the odds ratio of 0.249 (95%CI: 0.115-0.536, p < 0.05) for asymptomatic peptic ulcer. In subgroup analysis of 284 gastric ulcer patients, NSAID-taking patients had the odds ratio of 0.263 (95% CI: 0.105-0.657, p = 0.004) for asymptomatic peptic ulcer. CONCLUSION. NSAID has an inverse association with asymptomatic patients with gastric peptic ulcer, but has no association with gastroduodenal symptoms in duodenal ulcer patients. These suggest that NSAID may be associated with gastroduodenal symptoms rather than masking symptoms, at least in gastric ulcer patients.

Assessing STD Partner Services in State and Local Health Departments.

Science.gov (United States)

Cuffe, Kendra M; Leichliter, Jami S; Gift, Thomas L

2018-02-07

State and local health department STD programs provide several partner services to reduce disease transmission. Budget cuts and temporary staff reassignments for public health emergencies may affect the provision of partner services. Determining the impact of staffing reductions on STD rates and public health response should be further assessed.

Capital dynamics and local health systems: searching for a comprehensive analysis of the health sector

Directory of Open Access Journals (Sweden)

Maria de Fátima Siliansky de Andreazzi

2006-01-01

Full Text Available The article presents a proposal of a methodology aimed to analyze the health care sector according to the dynamics of capital accumulation. That approach could be summed up to more traditional approaches founded in the Public Health field, based in a political perspective. The proposal departs from concepts and methods of Industrial Organization, already used for health care markets, in the European and Latin-American (CEPAL contexts. We aggregated economic and historical variables to these approaches, which delimitate possibilities and impose constraints to the strategies of the local agents. The objective of the paper is to give methodological support to public managers at state and local level, whose role as the single commander in their territories is prescribed by the present health policy in Brazil. That includes all the fields related to private sector regulation in health: from planning the supply to quality control of providers.

A health impact assessment of a proposed bill to decrease speed limits on local roads in Massachusetts (U.S.A.).

Science.gov (United States)

James, Peter; Ito, Kate; Banay, Rachel F; Buonocore, Jonathan J; Wood, Benjamin; Arcaya, Mariana C

2014-10-02

Decreasing traffic speeds increases the amount of time drivers have to react to road hazards, potentially averting collisions, and makes crashes that do happen less severe. Boston's regional planning agency, the Metropolitan Area Planning Council (MAPC), in partnership with the Massachusetts Department of Public Health (MDPH), conducted a Health Impact Assessment (HIA) that examined the potential health impacts of a proposed bill in the state legislature to lower the default speed limits on local roads from 30 miles per hour (mph) to 25 mph. The aim was to reduce vehicle speeds on local roads to a limit that is safer for pedestrians, cyclists, and children. The passage of this proposed legislation could have had far-reaching and potentially important public health impacts. Lower default speed limits may prevent around 18 fatalities and 1200 serious injuries to motorists, cyclists and pedestrians each year, as well as promote active transportation by making local roads feel more hospitable to cyclists and pedestrians. While a lower speed limit would increase congestion and slightly worsen air quality, the benefits outweigh the costs from both a health and economic perspective and would save the state approximately $62 million annually from prevented fatalities and injuries.

The Danish preventive child health examination should expand on mental health and the well-being of the family

DEFF Research Database (Denmark)

Nielsen, Kirsten Lykke; Graungaard, Anette Hauskov; Ertmann, Ruth

2015-01-01

. CONCLUSION: The preventive child health examination is animportant platform for examination and dialogue concerninga child’s health. The physical aspect works well, butthere is a need for development of the assessment of thechild’s mental health and the well-being of the family. FUNDING: Postdoctoral......INTRODUCTION: In Denmark, around one in six children hassignificant somatic, psychological or social health problems,often in combination. The preventive child health examinationshave a high participation rate; and they produce significantfindings, predominantly concerning the child...... of ninedoctors from seven clinics participated. We included 21 casesin our study, each consisting of a consultation and subsequentinterviews with the child’s parents and with thedoctor. RESULTS: The examination of the child’s physical health anddevelopment is an important feature of the health examination...

Local food policies can help promote local foods and improve health: a case study from the Federated States of Micronesia.

Science.gov (United States)

Englberger, Lois; Lorens, Adelino; Pretrick, Moses; Tara, Mona J; Johnson, Emihner

2011-11-01

The Federated States of Micronesia (FSM) and other countries throughout the Pacific are facing an epidemic of non-communicable disease health problems. These are directly related to the increased consumption of unhealthy imported processed foods, the neglect of traditional food systems, and lifestyle changes, including decreased physical activity. The FSM faces the double burden of malnutrition with both non-communicable diseases and micronutrient deficiencies, including vitamin A deficiency and anemia. To help increase the use of traditional island foods and improve health, the Island Food Community of Pohnpei has initiated a program in the FSM to support and promote local food policies, along with its Go Local awareness campaign. Such local food policies are defined broadly and include individual and family commitments, community group local food policies and policies established by government, including presidential proclamations and increased taxation on soft drinks. The aim of this paper is to describe this work. An inter-agency, community- and research-based, participatory and media approach was used. Partners are both non-governmental and governmental. The use of continuing awareness work along with local food policy establishment and the acknowledgement of the individuals and groups involved are essential. The work is still in the preliminary stage but ad hoc examples show that this approach has had success in increased awareness on health issues and improving dietary intake on both an individual and group basis. This indicates that further use of local food policies could have an instrumental impact in FSM as well as other Pacific Island countries in promoting local foods and improving dietary intake and health, including the control of non-communicable diseases and other dietary-related health problems.

Georgia Health - Go Local: Using Multidisciplinary Partnerships to Promote a Statewide Consumer Health Website.

Science.gov (United States)

Smith, Rita B

2011-01-01

The National Library of Medicine ended its support of the Go Local program in 2010 due to declining usage, but in many ways Georgia's project was a success. From its beginning, Georgia Health - Go Local was a model of successful collaboration among a variety of partners and institutions throughout the state. The high usage statistics for the Go Local website and the support garnered by the project exemplify the positive nature of the collaborations that made the project possible.

Local Health Integration Networks: Build on their purpose.

Science.gov (United States)

MacLeod, Hugh

2015-11-01

This article provides a high-level overview on the creation of Local Health Integration Networks (LHINs) and illustrates the complexities involved in their implementation. To understand regional structures such as LHINs, one must understand the context in which design and execution takes place. The article ends with a commentary on how Ontario is performing post-LHINs and discusses next steps. © 2015 The Canadian College of Health Leaders.

Global frameworks, local strategies: Women's rights, health, and the tobacco control movement in Argentina.

Science.gov (United States)

Muñoz Martínez, Hepzibah; Pederson, Ann

2018-02-23

The article examines how civil society organisations in Argentina used the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) to frame the country's failure to enact strong national tobacco control legislation as a violation of women's rights in the late 2000s. We analyze this case study through the politics of scale, namely the social processes that produce, reproduce, and contest the boundaries of policies and socio-economic relations. This approach understands how multiple scales overlap and connect to obstruct or enhance the right to health in Latin America. In Argentina, the global organisation of tobacco companies, the reach of international financial institutions and the national dynamics of economic austerity and export-orientation promoted the local production and use of tobacco (leaf and cigarettes) and reproduced health inequalities in the country throughout the 1990s and the early 2000s. Yet, the visible legacy of local and national human rights struggles in the adoption of international human rights treaties into Argentina's national constitution allowed the tobacco control movement to link the scale of women's bodies to the right to health through the use of CEDAW to change national legislation, tackling the social determinants of the tobacco epidemic.

Family characteristics and parents' and children's health behaviour are associated with public health nurses' concerns at children's health examinations.

Science.gov (United States)

Poutiainen, Hannele; Hakulinen, Tuovi; Mäki, Päivi; Laatikainen, Tiina

2016-12-01

The study aimed to establish whether family characteristics and the health behaviour and illnesses of parents and children are associated with public health nurses' (PHNs') concerns about children's physical health and psychosocial development in the context of health examinations. Factors affecting children's health and well-being should be identified as early as possible to provide children and families appropriate support. In 2007-2009, a cross-sectional study in Finland collected information about PHNs' concerns, children's health and well-being as well as the background factors affecting them during health examinations of preschool-age children and school-aged children (n = 4795). Associations between family characteristics, parents' and children's behaviour and diseases, and PHNs' concerns were assessed using logistic regression analysis. Overweight in children, the long-term illnesses of both children and parents, and parental smoking were the factors most strongly associated with PHNs' concerns about a child's physical health whereas non-nuclear family types, the father's low educational level and unemployment, the child's lack of sleep, and bullying were associated with concerns about the child's psychosocial development. The connections found demonstrate that health examinations should address factors that affect the whole family's well-being so as to comprehensively promote children's health, growth and development. © 2016 John Wiley & Sons Australia, Ltd.

Examining national trends in worker health with the National Health Interview Survey.

Science.gov (United States)

Luckhaupt, Sara E; Sestito, John P

2013-12-01

To describe data from the National Health Interview Survey (NHIS), both the annual core survey and periodic occupational health supplements (OHSs), available for examining national trends in worker health. The NHIS is an annual in-person household survey with a cross-sectional multistage clustered sample design to produce nationally representative health data. The 2010 NHIS included an OHS. Prevalence rates of various health conditions and health behaviors among workers based on multiple years of NHIS core data are available. In addition, the 2010 NHIS-OHS data provide prevalence rates of selected health conditions, work organization factors, and occupational exposures among US workers by industry and occupation. The publicly available NHIS data can be used to identify areas of concern for various industries and for benchmarking data from specific worker groups against national averages.

Responsibility without legal authority? Tackling alcohol-related health harms through licensing and planning policy in local government.

Science.gov (United States)

Martineau, F P; Graff, H; Mitchell, C; Lock, K

2014-09-01

The power to influence many social determinants of health lies within local government sectors that are outside public health's traditional remit. We analyse the challenges of achieving health gains through local government alcohol control policies, where legal and professional practice frameworks appear to conflict with public health action. Current legislation governing local alcohol control in England and Wales is reviewed and analysed for barriers and opportunities to implement effective population-level health interventions. Case studies of local government alcohol control practices are described. Addressing alcohol-related health harms is constrained by the absence of a specific legal health licensing objective and differences between public health and legal assessments of the relevance of health evidence to a specific place. Local governments can, however, implement health-relevant policies by developing local evidence for alcohol-related health harms; addressing cumulative impact in licensing policy statements and through other non-legislative approaches such as health and non-health sector partnerships. Innovative local initiatives-for example, minimum unit pricing licensing conditions-can serve as test cases for wider national implementation. By combining the powers available to the many local government sectors involved in alcohol control, alcohol-related health and social harms can be tackled through existing local mechanisms. © The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health.

Management continuity in local health networks

Directory of Open Access Journals (Sweden)

Mylaine Breton

2012-04-01

Full Text Available Introduction: Patients increasingly receive care from multiple providers in a variety of settings. They expect management continuity that crosses boundaries and bridges gaps in the healthcare system. To our knowledge, little research has been done to assess coordination across organizational and professional boundaries from the patients' perspective. Our objective was to assess whether greater local health network integration is associated with management continuity as perceived by patients. Method: We used the data from a research project on the development and validation of a generic and comprehensive continuity measurement instrument that can be applied to a variety of patient conditions and settings. We used the results of a cross-sectional survey conducted in 2009 with 256 patients in two local health networks in Quebec, Canada. We compared four aspects of management continuity between two contrasting network types (highly integrated vs. poorly integrated. Results: The scores obtained in the highly integrated network are better than those of the poorly integrated network on all dimensions of management continuity (coordinator role, role clarity and coordination between clinics, and information gaps between providers except for experience of care plan. Conclusion: Some aspects of care coordination among professionals and organizations are noticed by patients and may be valid indicators to assess care coordination.

Local self governance in health - a study of it’s functioning in Odisha, India

Directory of Open Access Journals (Sweden)

Bhuputra Panda

2016-10-01

Full Text Available Abstract Background Local decision making is linked to several service quality improvement parameters. Rogi Kalyan Samitis (RKS at peripheral decision making health units (DMHU are composite bodies that are mandated to ensure accountability and transparency in governance, improve quality of services, and facilitate local responsiveness. There is scant literature on the nature of functioning of these institutions in Odisha. This study aimed to assess the perception of RKS members about their roles, involvement and practices with respect to local decision making and management of DMHUs; it further examined perceptual and functional differences between priority and non-priority district set-ups; and identified predictors of involvement of RKS members in local governance of health units. Methods As members of RKS, health service providers, officials in administrative/managerial role, elected representatives, and officials from other departments (including independent members constituted our study sample. A total of 112 respondents were interviewed across 6 districts, through a multi-stage stratified random sampling; we used a semi-structured interview schedule that comprised mainly of close-ended and some open-ended questions. Descriptive and inferential statistics were used to compare 3 priority (PD and 3 non-priority districts (NPD, categorized on the basis of Infant Mortality Rate (IMR estimates of 2011 as proxy of population health. Governance, human resource management, financial management and quality improvement functions were studied in detail. Opinion about various individual and organizational factors in local self-governance and predictors of involvement were identified. Results The socio-demographic profile and composition of respondents were comparable between PD and NPD. Majority of respondents were ‘satisfied’ with their current roles in the governance of local health institutions. About one-fourth opined that the amount of funds

The Danish Health Examination Survey 2007-2008 (DANHES 2007-2008)

DEFF Research Database (Denmark)

Eriksen, Louise; Grønbæk, Morten; Helge, Jørn Wulff

2011-01-01

AIMS: The Danish Health Examination Survey (DANHES 2007-2008) was carried out by the National Institute of Public Health, University of Southern Denmark, in 13 Danish municipalities in 2007-2008. The focus of the survey was diet, smoking, alcohol, and physical activity. The aim of the survey......, and living conditions, and a supplementary food frequency questionnaire. The health examination contained measurements of blood pressure, resting heart rate, height, weight, fat percentage, waist and hip circumference, blood and hair samples, spirometry, bone mineral density, physical performance, muscle...

Unravelling networks in local public health policymaking in three European countries - a systems analysis.

Science.gov (United States)

Spitters, Hilde P E M; Lau, Cathrine J; Sandu, Petru; Quanjel, Marcel; Dulf, Diana; Glümer, Charlotte; van Oers, Hans A M; van de Goor, Ien A M

2017-02-03

Facilitating and enhancing interaction between stakeholders involved in the policymaking process to stimulate collaboration and use of evidence, is important to foster the development of effective Health Enhancing Physical Activity (HEPA) policies. Performing an analysis of real-world policymaking processes will help reveal the complexity of a network of stakeholders. Therefore, the main objectives were to unravel the stakeholder network in the policy process by conducting three systems analyses, and to increase insight into the similarities and differences in the policy processes of these European country cases. A systems analysis of the local HEPA policymaking process was performed in three European countries involved in the 'REsearch into POlicy to enhance Physical Activity' (REPOPA) project, resulting in three schematic models showing the main stakeholders and their relationships. The models were used to compare the systems, focusing on implications with respect to collaboration and use of evidence in local HEPA policymaking. Policy documents and relevant webpages were examined and main stakeholders were interviewed. The systems analysis in each country identified the main stakeholders involved and their position and relations in the policymaking process. The Netherlands and Denmark were the most similar and both differed most from Romania, especially at the level of accountability of the local public authorities for local HEPA policymaking. The categories of driving forces underlying the relations between stakeholders were formal relations, informal interaction and knowledge exchange. A systems analysis providing detailed descriptions of positions and relations in the stakeholder network in local level HEPA policymaking is rather unique in this area. The analyses are useful when a need arises for increased interaction, collaboration and use of knowledge between stakeholders in the local HEPA network, as they provide an overview of the stakeholders involved and

Examining the association between oral health and oral HPV infection.

Science.gov (United States)

Bui, Thanh Cong; Markham, Christine M; Ross, Michael Wallis; Mullen, Patricia Dolan

2013-09-01

Oral human papillomavirus (HPV) infection is the cause of 40% to 80% of oropharyngeal cancers; yet, no published study has examined the role of oral health in oral HPV infection, either independently or in conjunction with other risk factors. This study examined the relation between oral health and oral HPV infection and the interactive effects of oral health, smoking, and oral sex on oral HPV infection. Our analyses comprised 3,439 participants ages 30 to 69 years for whom data on oral HPV and oral health were available from the nationally representative 2009-2010 National Health and Nutrition Examination Survey. Results showed that higher unadjusted prevalence of oral HPV infection was associated with four measures of oral health, including self-rated oral health as poor-to-fair [prevalence ratio (PR) = 1.56; 95% confidence interval (CI), 1.25-1.95], indicated the possibility of gum disease (PR = 1.51; 95% CI, 1.13-2.01), reported use of mouthwash to treat dental problems in the past week (PR = 1.28; 95% CI, 1.07-1.52), and higher number of teeth lost (Ptrend = 0.035). In multivariable logistic regression models, oral HPV infection had a statistically significant association with self-rated overall oral health (OR = 1.55; 95% CI, 1.15-2.09), independent of smoking and oral sex. In conclusion, poor oral health was an independent risk factor of oral HPV infection, irrespective of smoking and oral sex practices. Public health interventions may aim to promote oral hygiene and oral health as an additional measure to prevent HPV-related oral cancers.

Public health and English local government: historical perspectives on the impact of 'returning home'.

Science.gov (United States)

Gorsky, Martin; Lock, Karen; Hogarth, Sue

2014-12-01

This article uses history to stimulate reflection on the present opportunities and challenges for public health practice in English local government. Its motivation is the paradox that despite Department of Health policy-makers' allusions to 'a long and proud history' and 'returning public health home' there has been no serious discussion of that past local government experience and what we might learn from it. The article begins with a short resumé of the achievements of Victorian public health in its municipal location, and then considers the extensive responsibilities that it developed for environmental, preventive and health services by the mid-twentieth century. The main section discusses the early NHS, explaining why historians see the era as one of decline for the speciality of public health, leading to the reform of 1974, which saw the removal from local government and the abolition of the Medical Officer of Health role. Our discussion focuses on challenges faced before 1974 which raise organizational and political issues relevant to local councils today as they embed new public health teams. These include the themes of leadership, funding, integrated service delivery, communication and above all the need for a coherent vision and rationale for public health action in local authorities. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health.

Local health systems in 21st century: who cares?-An exploratory study on health system governance in Amsterdam.

Science.gov (United States)

Plochg, T; Delnoij, D M J; Hogervorst, W V G; van Dijk, P; Belleman, S; Klazinga, N S

2006-10-01

There is a growing awareness that there should be a public health perspective to health system governance. Its intrinsic population health orientation provides the ultimate ground for determining the health needs and governing collaborative care arrangements within which these needs can be met. Notwithstanding differences across countries, population health concerns are not central to European health reforms. Governments currently withdraw leaving governance roles to care providers and/or financiers. Thereby, incentives that trigger the uptake of a public health perspective are often ignored. In this study we addressed this issue in the city of Amsterdam. Using a qualitative study design, we explored whether there is a public health perspective to the governance practices of the municipality and the major sickness fund in Amsterdam. And if so, what the scope of this perspective is. And if not, why not. Findings indicate that the municipality has a public health perspective to local health system governance, but its scope is limited. The municipality facilitates rather than governs health care provision in Amsterdam. Furthermore, the sickness fund runs major financial risks when adapting a public health perspective. It covers an insured population that partly overlaps the Amsterdam population. Returns on investments in population health are therefore uncertain, as competitors would also profit from the sickness fund's investments. The local health system in Amsterdam is not consistently aligned to the health needs of the Amsterdam population. The Amsterdam case is not unique and general consequences for local health system governance are discussed.

Challenges in developing health promoting schools' project: application of global traits in local realm.

Science.gov (United States)

Fathi, Behrouz; Allahverdipour, Hamid; Shaghaghi, Abdolreza; Kousha, Ahmad; Jannati, Ali

2014-01-01

Despite the importance of student health and school hygiene as an aspect of the infrastructure of community health, few feasibility studies have been conducted on school health programs in developing countries. This study examined possible barriers to and challenges of such programs from the executive perspective in East Azerbaijan Province in Iran. This qualitative study used the content analysis approach to recognize barriers to and challenges of health promoting school program from the executive perspective. Fourteen experts were selected in the areas of children and adolescents and school health, physical education and school headmasters. Data were collected using semi-structured interviews and analyzed using the content analysis method. Five themes were extracted as major barriers and challenges: 1. Intraand inter-sectorial collaboration; 2. Policy and rule formulation; 3. Infrastructure and capacity; 4. Human resources; 5. Community involvement. The localized version of the current health promoting school program had major faults. If this program is considered to be a healthcare system priority, it should be revised to set effective policies for implementation and to sustain school health programs based on the capacities and objectives of each country.

Challenges in Developing Health Promoting Schools’ Project: Application of Global Traits in Local Realm

Directory of Open Access Journals (Sweden)

Behrouz Fathi

2014-07-01

Full Text Available Background: Despite the importance of student health and school hygiene as an aspect of the infrastructure of community health, few feasibility studies have been conducted on school health programs in developing countries. This study examined possible barriers to and challenges of such programs from the executive perspective in East Azerbaijan Province in Iran. Methods: This qualitative study used the content analysis approach to recognize barriers to and challenges of health promoting school program from the executive perspective. Fourteen experts were selected in the areas of children and adolescents and school health, physical education and school headmasters. Data were collected using semi-structured interviews and analyzed using the content analysis method. Results: Five themes were extracted as major barriers and challenges: 1. Intraand inter-sectorial collaboration; 2. Policy and rule formulation; 3. Infrastructure and capacity; 4. Human resources; 5. Community involvement. Conclusion: The localized version of the current health promoting school program had major faults. If this program is considered to be a healthcare system priority, it should be revised to set effective policies for implementation and to sustain school health programs based on the capacities and objectives of each country.

Perceived Facilitators and Barriers to Local Health Department Workers' Participation in Infectious Disease Emergency Responses.

Science.gov (United States)

Rutkow, Lainie; Paul, Amy; Taylor, Holly A; Barnett, Daniel J

Local health departments play a key role in emergency preparedness and respond to a wide range of threats including infectious diseases such as seasonal influenza, tuberculosis, H1N1, Ebola virus disease, and Zika virus disease. To successfully respond to an infectious disease outbreak, local health departments depend upon the participation of their workforce; yet, studies indicate that sizable numbers of workers would not participate in such a response. The reasons why local health department workers participate, or fail to participate, in infectious disease responses are not well understood. To understand why local health department workers are willing, or not willing, to report to work during an infectious disease response. From April 2015 to January 2016, we conducted 28 semistructured interviews with local health department directors, preparedness staff, and nonpreparedness staff. Interviews were conducted with individuals throughout the United States. We interviewed 28 individuals across 3 groups: local health department directors (n = 8), preparedness staff (n = 10), and nonpreparedness staff (n = 10). Individuals' descriptions of why local health department workers are willing, or not willing, to report to work during an infectious disease response. Factors that facilitate willingness to respond to an infectious disease emergency included availability of vaccines and personal protective equipment; flexible work schedule and childcare arrangements; information sharing via local health department trainings; and perceived commitments to one's job and community. Factors that hinder willingness to respond to an infectious disease emergency included potential disease exposure for oneself and one's family; logistical considerations for care of children, the elderly, and pets; and perceptions about one's role during an infectious disease response. Our findings highlight opportunities for local health departments to revisit their internal policies and engage in

The Danish preventive child health examination should expand on mental health and the well-being of the family

DEFF Research Database (Denmark)

Lykke Nielsen, Kirsten Lykke; Graungaard, Anette Hauskov; Ertmann, Ruth

2015-01-01

aware of problems in the family. CONCLUSION: The preventive child health examination is an important platform for examination and dialogue concerning a child's health. The physical aspect works well, but there is a need for development of the assessment of the child's mental health and the well....... A total of nine doctors from seven clinics participated. We included 21 cases in our study, each consisting of a consultation and subsequent interviews with the child's parents and with the doctor. RESULTS: The examination of the child's physical health and development is an important feature......INTRODUCTION: In Denmark, around one in six children has significant somatic, psychological or social health problems, often in combination. The preventive child health examinations have a high participation rate; and they produce significant findings, predominantly concerning the child's physical...

Local health and social care responses to implementing the national cold weather plan.

Science.gov (United States)

Heffernan, C; Jones, L; Ritchie, B; Erens, B; Chalabi, Zaid; Mays, N

2017-09-18

The Cold Weather Plan (CWP) for England was launched by the Department of Health in 2011 to prevent avoidable harm to health by cold weather by enabling individuals to prepare and respond appropriately. This study sought the views of local decision makers involved in the implementation of the CWP in the winter of 2012/13 to establish the effects of the CWP on local planning. It was part of a multi-component independent evaluation of the CWP. Ten LA areas were purposively sampled which varied in level of deprivation and urbanism. Fifty-two semi-structured interviews were held with health and social care managers involved in local planning between November 2012 and May 2013. Thematic analysis revealed that the CWP was considered a useful framework to formalize working arrangements between agencies though local leadership varied across localities. There were difficulties in engaging general practitioners, differences in defining vulnerable individuals and a lack of performance monitoring mechanisms. The CWP was welcomed by local health and social care managers, and improved proactive winter preparedness. Areas for improvement include better integration with general practice, and targeting resources at socially isolated individuals in cold homes with specific interventions aimed at reducing social isolation and building community resilience. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Advancing the Certified in Public Health Examination: A Job Task Analysis.

Science.gov (United States)

Kurz, Richard S; Yager, Christopher; Yager, James D; Foster, Allison; Breidenbach, Daniel H; Irwin, Zachary

In 2014, the National Board of Public Health Examiners performed a job task analysis (JTA) to revise the Certified in Public Health (CPH) examination. The objectives of this study were to describe the development, administration, and results of the JTA survey; to present an analysis of the survey results; and to review the implications of this first-ever public health JTA. An advisory committee of public health professionals developed a list of 200 public health job tasks categorized into 10 work domains. The list of tasks was incorporated into a web-based survey, and a snowball sample of public health professionals provided 4850 usable responses. Respondents rated job tasks as essential (4), very important (3), important (2), not very important (1), and never performed (0). The mean task importance ratings ranged from 2.61 to 3.01 (important to very important). The highest mean ratings were for tasks in the ethics domain (mean rating, 3.01). Respondents ranked 10 of the 200 tasks as the most important, with mean task rankings ranging from 2.98 to 3.39. We found subtle differences between male and female respondents and between master of public health and doctor of public health respondents in their rankings. The JTA established a set of job tasks in 10 public health work domains, and the results provided a foundation for refining the CPH examination. Additional steps are needed to further modify the content outline of the examination. An empirical assessment of public health job tasks, using methods such as principal components analysis, may provide additional insight.

Local connectome phenotypes predict social, health, and cognitive factors

Directory of Open Access Journals (Sweden)

Michael A. Powell

2018-03-01

Full Text Available The unique architecture of the human connectome is defined initially by genetics and subsequently sculpted over time with experience. Thus, similarities in predisposition and experience that lead to similarities in social, biological, and cognitive attributes should also be reflected in the local architecture of white matter fascicles. Here we employ a method known as local connectome fingerprinting that uses diffusion MRI to measure the fiber-wise characteristics of macroscopic white matter pathways throughout the brain. This fingerprinting approach was applied to a large sample (N = 841 of subjects from the Human Connectome Project, revealing a reliable degree of between-subject correlation in the local connectome fingerprints, with a relatively complex, low-dimensional substructure. Using a cross-validated, high-dimensional regression analysis approach, we derived local connectome phenotype (LCP maps that could reliably predict a subset of subject attributes measured, including demographic, health, and cognitive measures. These LCP maps were highly specific to the attribute being predicted but also sensitive to correlations between attributes. Collectively, these results indicate that the local architecture of white matter fascicles reflects a meaningful portion of the variability shared between subjects along several dimensions. The local connectome is the pattern of fiber systems (i.e., number of fibers, orientation, and size within a voxel, and it reflects the proximal characteristics of white matter fascicles distributed throughout the brain. Here we show how variability in the local connectome is correlated in a principled way across individuals. This intersubject correlation is reliable enough that unique phenotype maps can be learned to predict between-subject variability in a range of social, health, and cognitive attributes. This work shows, for the first time, how the local connectome has both the sensitivity and the specificity to

Examination of Local Functional Homogeneity in Autism

Directory of Open Access Journals (Sweden)

Lili Jiang

2015-01-01

Full Text Available Increasing neuroimaging evidence suggests that autism patients exhibit abnormal brain structure and function. We used the Autism Brain Imaging Data Exchange (ABIDE sample to analyze locally focal (~8 mm functional connectivity of 223 autism patients and 285 normal controls from 15 international sites using a recently developed surface-based approach. We observed enhanced local connectivity in the middle frontal cortex, left precuneus, and right superior temporal sulcus, and reduced local connectivity in the right insular cortex. The local connectivity in the right middle frontal gyrus was positively correlated with the total score of the autism diagnostic observation schedule whereas the local connectivity within the right superior temporal sulcus was positively correlated with total subscores of both the communication and the stereotyped behaviors and restricted interests of the schedule. Finally, significant interactions between age and clinical diagnosis were detected in the left precuneus. These findings replicated previous observations that used a volume-based approach and suggested possible neuropathological impairments of local information processing in the frontal, temporal, parietal, and insular cortices. Novel site-variability analysis demonstrated high reproducibility of our findings across the 15 international sites. The age-disease interaction provides a potential target region for future studies to further elucidate the neurodevelopmental mechanisms of autism.

The Impact of The Quality of Financial Statements on Local Revenue Using Examination Opinion Results as Moderating Variable

Directory of Open Access Journals (Sweden)

Arik - Susbiyani

2017-02-01

Full Text Available Abstract   This study aimed to examine the influence of the financial statements on local revenue by using the results of the examination opinion as moderating variable. The study used Legitimacy Theory to explain and analyze the relationship between variables. The population in the study was all the districts and cities in Indonesia totaling 497 county and city governments. The sampling method used in the study was judgment sampling. Samples that met the criteria of the study were 116 local governments. The analytical tool used in this research was the analysis of MRA (Moderated Regression Analysis. The results showed that the effects of the partial test of the quality of financial reports to local revenues were not significant positive effects. While the partial test results stating the influence of audit opinion on local revenue having positive effects were not significant. Other results showed that the interaction between the results of the examination opinion to the quality of financial statements was  insignificant on the quality of financial statements. In other words, the results of the examination opinions moderated (strengthened the relationship between quality of financial report on local revenue of district and city governments in Indonesia.

Developing a Customer Relationship Management Model for Better Health Examination Service

Directory of Open Access Journals (Sweden)

Lyu Jr-Jung

2014-11-01

Full Text Available People emphasize on their own health and wish to know more about their conditions. Chronic diseases now take up to 50 percent of top 10 causes of death. As a result, the health-care industry has emerged and kept thriving. This work adopts a customer-oriented business model since most clients are proactive and spontaneous in taking the “distinguished” health examination programs. We adopt the soft system dynamics methodology (SSDM to develop and to evaluate the steps of introducing customer relationship management model into a case health examination organization. Quantitative results are also presented for a case physical examination center and to assess the improved efficiency. The case study shows that the procedures developed here could provide a better service.

Public Health Response Systems In-Action: Learning from Local Health Departments’ Experiences with Acute and Emergency Incidents

Science.gov (United States)

Hunter, Jennifer C.; Yang, Jane E.; Crawley, Adam W.; Biesiadecki, Laura; Aragón, Tomás J.

2013-01-01

As part of their core mission, public health agencies attend to a wide range of disease and health threats, including those that require routine, acute, and emergency responses. While each incident is unique, the number and type of response activities are finite; therefore, through comparative analysis, we can learn about commonalities in the response patterns that could improve predictions and expectations regarding the resources and capabilities required to respond to future acute events. In this study, we interviewed representatives from more than 120 local health departments regarding their recent experiences with real-world acute public health incidents, such as infectious disease outbreaks, severe weather events, chemical spills, and bioterrorism threats. We collected highly structured data on key aspects of the incident and the public health response, particularly focusing on the public health activities initiated and community partners engaged in the response efforts. As a result, we are able to make comparisons across event types, create response profiles, and identify functional and structural response patterns that have import for future public health preparedness and response. Our study contributes to clarifying the complexity of public health response systems and our analysis reveals the ways in which these systems are adaptive to the character of the threat, resulting in differential activation of functions and partners based on the type of incident. Continued and rigorous examination of the experiences of health departments throughout the nation will refine our very understanding of what the public health response system is, will enable the identification of organizational and event inputs to performance, and will allow for the construction of rich, relevant, and practical models of response operations that can be employed to strengthen public health systems. PMID:24236137

A partial solution: a local mental health authority for the UK.

Science.gov (United States)

Hadley, Trevor R.; Goldman, Howard H.

1998-07-01

BACKGROUND: the structural problems of the mental health system in the UK have been analyzed by a number of authors over the past several years as the "reforms" of the health and social service systems have continued (Kavanagh and Knapp, 1995; Mechanic, 1995). In a recent article, Hadley and Goldman (1995) suggest that one possible solution to some of these issues may be the creation of a local mental health authority. Such an authority would consolidate the funding, authority and responsibility in a single entity. We believe this model, which is typical of many local public mental health systems in the US, is at least part of the solution to the current problem of financial and service fragmentation of the current system in the UK. The numerous "reforms" of the health and social service systems (which include the Community Care Act, the development of the Internal Market, GP fundholding and the purchaser-provider split) were not designed for the care of the mentally ill (Han, 1996). These policy changes in the design of health and social services have created a complicated and difficult context in which services must be delivered. Too many agencies play a significant role in the delivery and management of mental health services. Health authorities, social service agencies and GP fundholders are direct and indirect funders of the system while community care trusts, social service agencies and GPs are service providers (Hadley, 1996a). RESULTS AND A PROPOSAL: We believe that the development of local mental health authorities may be part of the solution to the structural and economic problems of the current system in the UK. It is not the answer to limited resources or limited skills, but can create a new structure, which will permit and encourage the cooperation and innovation that is now possible only with unusual effort. Local mental health authorities have a number of crucial characteristics, but, most importantly, they refocus the system on the provision of care

Extent and patterns of community collaboration in local health departments: An exploratory survey

Directory of Open Access Journals (Sweden)

Fisher John W

2011-10-01

Full Text Available Abstract Background Local public health departments (LHDs in the United States have been encouraged to collaborate with various other community organizations and individuals. Current research suggests that many forms of active partnering are ongoing, and there are numerous examples of LHD collaboration with a specific organization for a specific purpose or program. However, no existing research has attempted to characterize collaboration, for the defined purpose of setting community health status priorities, between a defined population of local officials and a defined group of alternative partnering organizations. The specific aims of this study were to 1 determine the range of collaborative involvement exhibited by a study population of local public health officials, and, 2 characterize the patterns of the selection of organizations/individuals involved with LHDs in the process of setting community health status priorities. Methods Local health department officials in North Carolina (n = 53 responded to an exploratory survey about their levels of involvement with eight types of possible collaborator organizations and individuals. Descriptive statistics and the stochastic clustering technique of Self-Organizing Maps (SOM were used to characterize their collaboration. Results Local health officials vary extensively in their level of collaboration with external collaborators. While the range of total involvement varies, the patterns of involvement for this specific function are relatively uniform. That is, regardless of the total level of involvement (low, medium or high, officials maintain similar hierarchical preference rankings with Community Advisory Boards and Local Boards of Health most involved and Experts and Elected Officials least involved. Conclusion The extent and patterns of collaboration among LHDs with other community stakeholders for a specific function can be described and ultimately related to outcome measures of LHD performance.

The power of local action in occupational health: the adoption of local exhaust ventilation in the Chicago tuckpointing trade.

Science.gov (United States)

Weinstein, Marc; Susi, Pam; Goldberg, Mark

2016-04-01

Silica is a pervasive and potentially deadly occupational hazard in construction. The occupational risk posed by silica has long been known, but efforts to use engineering controls to minimize dust generation in tuckpointing operations, a masonry restoration specialty, have been slow. The objective of this study is to explore how local innovation in occupational safety and health may emerge, absent the establishment of national standards. This study uses a case study to explore the adoption of local exhaust ventilation in tuckpointing operations in the Chicago area. Sources of data for this research include interviews with a diverse range of key informants and the review of archival material. This case study found local unions, municipal regulators, contractors, and major public users of construction services played a central role in the events and milestones that led to the early adoption of local exhaust ventilation in Chicago. The adoption of local exhaust ventilation technology in Chicago demonstrates the potential for local actors to fill an important void when rulemaking in vital areas of occupational of health impedes effective national regulation.

International trade of health services: global trends and local impact.

Science.gov (United States)

Lautier, Marc

2014-10-01

Globalization is a key challenge facing health policy-makers. A significant dimension of this is trade in health services. Traditionally, the flow of health services exports went from North to South, with patients travelling in the opposite direction. This situation is changing and a number of papers have discussed the growth of health services exports from Southern countries in its different dimensions. Less attention has been paid to assess the real scope of this trade at the global level and its potential impact at the local level. Given the rapid development of this area, there are little empirical data. This paper therefore first built an estimate of the global size and of the growth trend of international trade in health services since 1997, which is compared with several country-based studies. The second purpose of the paper is to demonstrate the significant economic impact of this trade at the local level for the exporting country. We consider the case of health providers in the South-Mediterranean region for which the demand potential, the economic effects and the consequence for the health system are presented. These issues lead to the overall conclusion that different policy options would be appropriate, in relation to the nature of the demand. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Local Health Departments’ Use of Twitter

Centers for Disease Control (CDC) Podcasts

2013-05-02

This podcast is an interview with Jenine K. Harris, PhD, from the Brown School at Washington University in St. Louis, MO, about local health departments’ use of Twitter to disseminate diabetes information.  Created: 5/2/2013 by Preventing Chronic Disease (PCD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/2/2013.

Health Status, Intention to Seek Health Examination, and Participation in Health Education Among Taxi Drivers in Jinan, China

Science.gov (United States)

Yang, Yan; Fan, Xiao-sheng; Tian, Cui-huan; Zhang, Wei; Li, Jie; Li, Shu-qing

2014-01-01

Background: Taxi drivers are exposed to various risk factors such as work overload, stress, an irregular diet, and a sedentary lifestyle, which make these individuals vulnerable to many diseases. This study was designed to assess the health status of this occupational group. Objectives: The objective was to explore the health status, the intention to seek health examination, and participation in health education among taxi drivers in Jinan, China. Patients and Methods: The sample-size was determined scientifically. The systematic sampling procedure was used for selecting the sample. Four hundred taxi drivers were randomly selected from several taxi companies in Jinan. In total, 396 valid questionnaires (from 370 males and 26 females) were returned. Health status, intention to seek health examination, and participation in health education were assessed by a self-designed questionnaire. Other personal information including sex, age, ethnicity, marital status, years of employment as a taxi driver, education level, and habits were also collected. Results: This survey revealed that 54.8% of taxi drivers reported illness in the last two weeks and 44.7% of participants reported chronic diseases. The prevalence rates of hypertension, diabetes mellitus, gastroenteritis, arthritis, and heart disease were 18.2%, 8.8%, 26%, 18.4%, and 4.8% of questioned taxi drivers, respectively. Significant self-reported symptoms included fatigue, waist and back pain, headache, dyspepsia, and dry throat affecting 49.7%, 26.2%, 23.5%, 26%, and 27% of participants, respectively. In total, 90.1% of subjects thought that it was necessary to receive a regular health examination. Only 17.9% of subjects had been given information about health education, and significantly, more than 87% of subjects who had been given information about health education reported that the information had been helpful. Conclusions: Taxi drivers’ health was poor in our survey. Thus, using health education interventions

Georgia Health – Go Local: Using Multidisciplinary Partnerships to Promote a Statewide Consumer Health Website

OpenAIRE

Smith, Rita B.

2011-01-01

The National Library of Medicine ended its support of the Go Local program in 2010 due to declining usage, but in many ways Georgia's project was a success. From its beginning, Georgia Health – Go Local was a model of successful collaboration among a variety of partners and institutions throughout the state. The high usage statistics for the Go Local website and the support garnered by the project exemplify the positive nature of the collaborations that made the project possible.

A critical examination of the health workers\\' civil and criminal liabilities

African Journals Online (AJOL)

This paper set out to examine the subject matter of health and welfare administration and the human resources thereto to achieve the set objectives of health and welfare policies of the Government. It also aimed at examining the behaviour of the professionals in the hospitals, the ethical principles, law guiding their behavior ...

Health examination for A-bomb survivors

International Nuclear Information System (INIS)

Ito, Chikako

1996-01-01

The health examination for A-bomb survivors by national, prefectural and city administrations was described and discussed on its general concept, history, time change of examinee number, improvement of examination, prevalence of individual diseases, significance of cancer examinations, examinees' point of view and future problems. Subjects were the survivors living in Hiroshima city: in 1994, their number was 100,188, whose ages were 63 y in average for males consisting of 39.5% and 67 y for females of 60.5%. The examination was begun in 1957 on the law for medical care for the survivors firstly and then systematically in 1961. From 1965, it was performed 4 times a year, and in 1988, one examination in the four was made for cancer. Authors' Center examined previously 90% but recently 70% of the examinees. The remainder underwent the examination in other medical facilities. Tests are blood analysis, electrocardiography and computed radiography of chest with imaging plate, of which data have been accumulated either in photodisc or in host computer. From 1973 to 1993, the cardiovascular diseases increased from 6.1% to 26.9%, metabolic and endocrinic ones like diabetes, 3.6% to 19.7%, and bowel ones, 0.9% to 12.3%. Correlations of these diseases with A-bomb irradiation are not elucidated and possibly poor. Five classes of cancer examinations are performed but the examinee rate in the survivors is as low as 7.6-21.8% (1993). The cancer of the large intestine is increasing. The overall examinee rates in the survivors were 70.6% in 1965-1967, 69.5% in 1976-1977 and 58.2% in 1990. In conclusion, how to examine the survivors, who are getting older, as many as possible is the future problem. (H.O.)

The relationship between local area labor market conditions and the use of Veterans Affairs health services.

Science.gov (United States)

Wong, Edwin S; Liu, Chuan-Fen

2013-03-13

In the U.S., economic conditions are intertwined with labor market decisions, access to health care, health care utilization and health outcomes. The Veterans Affairs (VA) health care system has served as a safety net provider by supplying free or reduced cost care to qualifying veterans. This study examines whether local area labor market conditions, measured using county-level unemployment rates, influence whether veterans obtain health care from the VA. We used survey data from the Behavioral Risk Factor Surveillance System in years 2000, 2003 and 2004 to construct a random sample of 73,964 respondents self-identified as veterans. VA health service utilization was defined as whether veterans received all, some or no care from the VA. Hierarchical ordered logistic regression was used to address unobserved state and county random effects while adjusting for individual characteristics. Local area labor market conditions were defined as the average 12-month unemployment rate in veterans' county of residence. The mean unemployment rate for veterans receiving all, some and no care was 5.56%, 5.37% and 5.24%, respectively. After covariate adjustment, a one percentage point increase in the unemployment rate in a veteran's county of residence was associated with an increase in the probability of receiving all care (0.34%, p-value = 0.056) or some care (0.29%, p-value = 0.023) from the VA. Our findings suggest that the important role of the VA in providing health care services to veterans is magnified in locations with high unemployment.

A survey of local health promotion initiatives for older people in Wales

Directory of Open Access Journals (Sweden)

Williams Nefyn H

2008-06-01

Full Text Available Abstract Background As the demographic profile of the UK changes, policy makers and practitioners have to respond to health challenges presented by a progressively ageing population. The health promotion plan for older people, aged over 50 years, in Wales included eight key areas: physical activity, healthy eating, home safety and warmth, emotional health, health protection, smoking, alcohol and sexual health. The aim of this study was to describe the extent, content and regional variation of existing health promotion initiatives for older people in Wales, provided by statutory, voluntary and private sector agencies. Method A questionnaire was sent to senior health promotion specialists employed in the 22 local authority areas in Wales to ascertain details of all projects promoting health and wellbeing in the eight key areas where the priority population was aged over 50, or the majority of users were older people. Additional information was sought from project leads and websites. Results Eighteen questionnaires were returned; not all were fully completed. Four areas did not return a questionnaire. Additional information was obtained from internet searches but this mainly concerned national initiatives rather than local projects. In all, 120 projects were included, 11 were throughout Wales. Best provision was for physical activity, with 3 national and 42 local initiatives, but local provision was patchy. Healthy eating, and home safety and warmth had far fewer initiatives, as did health protection, which comprised two national immunisation campaigns. Smoking and alcohol misuse were poorly provided for, and there was no provision for older people's sexual health. Evaluation arrangements were poorly described. Half of those who responded identified unmet training needs. Conclusion The reasons for patchy provision of services were not clear. Increased efforts to improve the coverage of interventions known to be effective should be made. Rigorous

Asset-Based Community Development as a Strategy for Developing Local Global Health Curricula.

Science.gov (United States)

Webber, Sarah; Butteris, Sabrina M; Houser, Laura; Coller, Karen; Coller, Ryan J

2018-02-07

A significant and growing proportion of US children have immigrant parents, an issue of increasing importance to pediatricians. Training globally minded pediatric residents to address health inequities related to globalization is an important reason to expand educational strategies around local global health (LGH). We developed a curriculum in the pediatric global health residency track at the University of Wisconsin in an effort to address gaps in LGH education and to increase resident knowledge about local health disparities for global community members. This curriculum was founded in asset-based community development (ABCD), a strategy used in advocacy training but not reported in global health education. The initial curriculum outputs have provided the foundation for a longitudinal LGH curriculum and a community-academic partnership. Supported by a community partnership grant, this partnership is focused on establishing a community-based postpartum support group for local Latinos, with an emphasis on building capacity in the Latino community. Aspects of this curriculum can serve other programs looking to develop LGH curricula rooted in building local partnerships and capacity using an ABCD model. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Relationships between female tourists and male locals in Cuzco/Peru: implications for travel health education.

Science.gov (United States)

Bauer, Irmgard

2009-11-01

Health concerns regarding casual sexual encounters during travel have been recognized for some time. The perception that female travellers' motivations are more romantic rather than sexual when entering a relationship with local men may exclude them from receiving appropriate travel health advice. This may pose even greater health risks, not only to themselves but also to their local partners. This paper presents 11 Western female tourists' perceptions of their relationships with local men in Cuzco/Peru, based on in-depth interviews, observations, and informal discussions. Relationships with local men were often triggered by their physical appearance. Other themes identified were: methods and location of first contact, benefits for the local men, safe sex/condom use, and travel health advice received. The findings support calls for more emphasis on sexual health in travel health education. Three aspects should be included: 1) an awareness that unfamiliar environment can cause 'out of character' behaviour, 2) an emphasis on not only to use but to not stop using condoms, and 3) the need to acquire negotiation skills.

A CLAS act? Community-based organizations, health service decentralization and primary care development in Peru. Local Committees for Health Administration.

Science.gov (United States)

Iwami, Michiyo; Petchey, Roland

2002-12-01

In 1994 Peru embarked on a programme of health service reform, which combined primary care development and community participation through Local Committees for Health Administration (CLAS). They are responsible for carrying out local health needs assessments and identifying unmet health needs through regular household surveys. These enable them to determine local health provision and tailor services to local requirements. CLAS build on grassroots self-help circles that developed during the economic and political crises of the 1980s, and in which women have been prominent. However, they function under a 3 year contract with the Ministry of Health and within a framework of centrally determined guidelines and regulations. These reforms were implemented in the context of neo-liberal economic policies, which stressed financial deregulation and fiscal and monetary restraint, and were aimed at reducing foreign indebtedness and inflation. We evaluate the achievements of the CLAS and analyse the relationship between health and economic policy in Peru, with the aid of two contrasting models of the role of the state - 'agency' and 'stewardship'. We argue that Peru's experience holds valuable lessons for other countries seeking to foster community involvement. These include the need for community capacity building and partnership between community organizations and state (and other civil) agencies.

An exploratory study identifying where local government public health decision makers source their evidence for policy.

Science.gov (United States)

Stoneham, Melissa; Dodds, James

2014-08-01

The Western Australian (WA) Public Health Bill will replace the antiquated Health Act 1911. One of the proposed clauses of the Bill requires all WA local governments to develop a Public Health Plan. The Bill states that Public Health Plans should be based on evidence from all levels, including national and statewide priorities, community needs, local statistical evidence, and stakeholder data. This exploratory study, which targeted 533 WA local government officers, aimed to identify the sources of evidence used to generate the list of public health risks to be included in local government Public Health Plans. The top four sources identified for informing local policy were: observation of the consequences of the risks in the local community (24.5%), statewide evidence (17.6%), local evidence (17.6%) and coverage in local media (16.2%). This study confirms that both hard and soft data are used to inform policy decisions at the local level. Therefore, the challenge that this study has highlighted is in the definition or constitution of evidence. SO WHAT? Evidence is critical to the process of sound policy development. This study highlights issues associated with what actually constitutes evidence in the policy development process at the local government level. With the exception of those who work in an extremely narrow field, it is difficult for local government officers, whose role includes policymaking, to read the vast amount of information that has been published in their area of expertise. For those who are committed to the notion of evidence-based policymaking, as advocated within the WA Public Health Bill, this presents a considerable challenge.

Health consequences of road accidents: insights from local health authority registries.

Science.gov (United States)

Bertoncello, C; Furlan, P; Baldovin, T; Marcolongo, A; Casale, P; Cocchio, S; Buja, A; Baldo, V

2013-01-01

Road accidents are a major public health problem that affect all age groups but their impact is most striking among the young. The aim of this study is to quantify the burden of road traffic injuries, their mortality and direct in-patient economic costs and to identify the age classes at highest risk for severe road traffic injuries, through analysis of data collected by information systems of an Italian Local Health Authority. The study was conducted in a Local Health Authority of Veneto Region. Injured people were selected from Emergency Department (2006-2010). Data were linked to the Hospital Information System for hospital admissions and to the Mortality Registry to check 30-day mortality. The direct costs associated to hospitalizations were estimated through Diagnosis Related Group reimbursement rates. Multivariate analysis was performed using hospitalization and mortality as the dependent variables and gender, age, day of week when accident occurred as the independent variables. Traffic injury, hospitalization and mortality incidence rates were calculated by gender and age per 100,000 residents per year. The road traffic injuries were 9,192, decreasing from 2,112 in 2006 to 1,980 in 2010. Among injured persons 55.3% were male (68.1% among 15-19 age class); 41.7% young people aged 15-34 years (43.9% among male, 39.0% among female). Total hospitalisation rate was 5.9%. Overall mortality rate was 0.3% (0.9% among aged 65 or older). The cost of hospital admission was euro 2,742,505 (hospitalization mean cost euro 5,097). Risk of hospitalization and death was higher in male, in elderly and during week end. Young people aged 15-19 had the highest incidence of visits (2,258.4 per 100,000) and high hospitalisation weekend and mortality rates (respectively 101.5 and 8.5). Analysis at local level, using current data sources, permits to estimate the burden of injuries caused by road-traffic, to describe the characteristics of injured persons and finally to estimate

Local Health Departments’ Use of Twitter

Centers for Disease Control (CDC) Podcasts

This podcast is an interview with Jenine K. Harris, PhD, from the Brown School at Washington University in St. Louis, MO, about local health departments’ use of Twitter to disseminate diabetes information.

Delivering on a gendered definition of health needs in local government budgeting: experiences and concepts.

Science.gov (United States)

Buyana, K

2009-10-01

Local governments are granted budgetary power in the Local Governments Act of the Republic of Uganda, which allows for local-level participation and flexibility in the allocation of financial grants channelled annually from central to local governments. The act prescribes a legal mandate to allocate public resources based on local priorities including the health needs of women compared with men. This study investigated the responsiveness of local government budgeting to the health needs of women as compared to men. A qualitative study was conducted in Mpigi district using a set of data collection methods including: a) three (3) focus group discussions with 8 female and 8 male respondents in each group; b) face-to-face interviews with a random sample of 120 households, 75% of which were male-headed and 25% female-headed ; c) key informant interviews with a sample of 10 administrative officers in Mpigi district ; and d) desk-review of the Mpigi district Budget Framework Paper. Health needs consist of the daily requirements, which, arise out of common disease infections and the socioeconomic constraints that affect the well-being of women and men. However, the primary concern of the district health sector is disease control measures, without emphasis on the differing socio-economic interests of women as compared to men. Local government budgeting, therefore, does not reflect the broad community-wide understanding of health needs. Local government budgeting should be informed by a two-fold framework for the gendered definition of health needs. The two-fold framework combines both disease-based health needs and socio-economic needs of women as compared to men.

[Health inequality gap in inmigrant versus local children in Chile].

Science.gov (United States)

Cabieses, Baltica; Chepo, Macarena; Oyarte, Marcela; Markkula, Niina; Bustos, Patricia; Pedrero, Víctor; Delgado, Iris

2017-12-01

Children and young international migrants face different health challenges compa red with the local population, particularly if they live in insecure environments or adverse social conditions. This study seeks to identify gaps in health outcomes of children between immigrant and local population in Chile. This study analyses data from three sources: (i) Born in Chile: Electronic records of antenatal visits from all municipal antenatal clinics of Recoleta in 2012; (ii) Growing up in Chile: Population survey "National Socioeconomic Characterization" (CASEN) from 2013 and (iii) Getting sick in Chile: Data of all hospital discharges in 2012, provided by the department of statistics and health information (DEIS) of the Ministry of Health. (I) Born in Chile: Im migrants more frequently have psychosocial risk (62.3% vs 50.1% in Chileans) and enter later into the program (63.1% vs 33.4% enter later than 14 weeks of pregnancy). All birth outcomes were better among immigrants (e.g. caesarean sections rates: 24.2% immigrants vs % Chileans). (ii) Growing up in Chile: A higher proportion of migrant children is outside the school system and lives in multidi mensional poverty (40% immigrants vs 23.2% Chileans). (iii) Getting sick in Chile: Injuries and other external causes were more frequent cause of hospitalisation among migrants (23.6%) than the local population (16.7%) aged between 7 and 14 years. Addressing the needs of the children in Chile, regardless of their immigration status, is an ethical, legal and moral imperative.

Developing an Innovative Customer Relationship Management Model for Better Health Examination Service

Directory of Open Access Journals (Sweden)

Lyu JrJung

2014-11-01

Full Text Available People emphasize on their own health and wish to know more about their conditions. Chronic diseases now take up to 50 percent of top 10 causes of death. As a result, the health-care industry has emerged and kept thriving. This work adopts an innovative customer-oriented business model since most clients are proactive and spontaneous in taking the “distinguished” health examination programs. We adopt the soft system dynamics methodology (SSDM to develop and to evaluate the steps of introducing customer relationship management model into a case health examination organization. Quantitative results are also presented for a case physical examination center and to assess the improved efficiency. The case study shows that the procedures developed here could provide a better service.

Integrating Local Public Health Agencies into the Homeland Security Community

National Research Council Canada - National Science Library

Reed, Patricia D

2007-01-01

After more than seven years of funding through The Centers for Disease Control and Prevention, local public health agencies have made inconsistent progress in fulfilling their Homeland Security objectives...

An examination of sleep health, lifestyle and mental health in junior high school students.

Science.gov (United States)

Tanaka, Hideki; Taira, Kazuhiko; Arakawa, Masashi; Masuda, Atushi; Yamamoto, Yukari; Komoda, Yoko; Kadegaru, Hathuko; Shirakawa, Shuichiro

2002-06-01

The factors that influence sleep health and mental health in junior high school students' lifestyles was examined. The proportion of students who replied that they feel bad in the morning, and who do not have breakfast was significantly higher in poor sleepers. The proportion of students who regularly take exercise was significantly lower among poor sleepers. Compared with good sleepers, poor sleepers had a higher number of illnesses and their General Health Questionnaire score was worse. The study's results suggest that sleep health is closely related to both physical and mental health, and that habits such as exercise, and regular sleeping and eating, are important for maintaining and improving students' sleep health.

Clinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices.

Science.gov (United States)

Weinstein, Ronald S; Krupinski, Elizabeth A; Doarn, Charles R

2018-05-01

Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. However, components of a more traditional clinical examination are part of the telemedicine workup for specific conditions. Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health care service industry. Copyright © 2018 Elsevier Inc. All rights reserved.

Building sustainable health and education partnerships: stories from local communities.

Science.gov (United States)

Blank, Martin J

2015-11-01

Growing health disparities have a negative impact on young people's educational achievement. Community schools that involve deep relationships with partners across multiple domains address these disparities by providing opportunities and services that promote healthy development of young people, and enable them to graduate from high school ready for college, technical school, on-the-job training, career, and citizenship. Results from Milwaukie High School, North Clackamas, OR; Oakland Unified School District, Oakland, CA; and Cincinnati Community Learning Centers, Cincinnati, OH were based on a review of local site documents, web-based information, interviews, and e-mail communication with key local actors. The schools and districts with strong health partnerships reflecting community schools strategy have shown improvements in attendance, academic performance, and increased access to mental, dental, vision, and health supports for their students. To build deep health-education partnerships and grow community schools, a working leadership and management infrastructure must be in place that uses quality data, focuses on results, and facilitates professional development across sectors. The leadership infrastructure of community school initiatives offers a prototype on which others can build. Moreover, as leaders build cross-sector relationships, a clear definition of what scaling up means is essential for subsequent long-term systemic change. © 2015 Institute for Educational Leadership. Journal of School Health published by Wiley Periodicals, Inc. on behalf of American School Health Association.

Performance of the local health system and contingent influences in Northeast-Brazil: breaking vicious and virtuous circles

Directory of Open Access Journals (Sweden)

Regianne Leila Rolim Medeiros

2013-11-01

Full Text Available Organizational theory has long emphasized the importance of contingent, environmental influences on organizational performance. Similarly, research has demonstrated the importance of local political culture and informal management on the performance of the local health system, establishing vicious and virtuous circles of influence that contribute to increasing inequalities in performance among decentralized local health systems. A longitudinal ethnography studied the relationship between these elements in the same rural municipality in Northeast Brazil after a four-year interval. The second study found the local health system performance much improved. Two main factors appear to have interacted to bring this about: leadership vision and power to implement of one individual; professionalization of the local health system by hiring a significant number of senior health staff. The origins of these influences combine initiatives at local, state and federal levels.

Examining levels, distribution and correlates of health insurance coverage in Kenya.

Science.gov (United States)

Kazungu, Jacob S; Barasa, Edwine W

2017-09-01

To examine the levels, inequalities and factors associated with health insurance coverage in Kenya. We analysed secondary data from the Kenya Demographic and Health Survey (KDHS) conducted in 2009 and 2014. We examined the level of health insurance coverage overall, and by type, using an asset index to categorise households into five socio-economic quintiles with quintile 5 (Q5) being the richest and quintile 1 (Q1) being the poorest. The high-low ratio (Q5/Q1 ratio), concentration curve and concentration index (CIX) were employed to assess inequalities in health insurance coverage, and logistic regression to examine correlates of health insurance coverage. Overall health insurance coverage increased from 8.17% to 19.59% between 2009 and 2014. There was high inequality in overall health insurance coverage, even though this inequality decreased between 2009 (Q5/Q1 ratio of 31.21, CIX = 0.61, 95% CI 0.52-0.0.71) and 2014 (Q5/Q1 ratio 12.34, CIX = 0.49, 95% CI 0.45-0.52). Individuals that were older, employed in the formal sector; married, exposed to media; and male, belonged to a small household, had a chronic disease and belonged to rich households, had increased odds of health insurance coverage. Health insurance coverage in Kenya remains low and is characterised by significant inequality. In a context where over 80% of the population is in the informal sector, and close to 50% live below the national poverty line, achieving high and equitable coverage levels with contributory and voluntary health insurance mechanism is problematic. Kenya should consider a universal, tax-funded mechanism that ensures revenues are equitably and efficiently collected, and everyone (including the poor and those in the informal sector) is covered. © 2017 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd.

Structural Health Monitoring Based on Combined Structural Global and Local Frequencies

Directory of Open Access Journals (Sweden)

Jilin Hou

2014-01-01

Full Text Available This paper presents a parameter estimation method for Structural Health Monitoring based on the combined measured structural global frequencies and structural local frequencies. First, the global test is experimented to obtain the low order modes which can reflect the global information of the structure. Secondly, the mass is added on the member of structure to increase the local dynamic characteristic and to make the member have local primary frequency, which belongs to structural local frequency and is sensitive to local parameters. Then the parameters of the structure can be optimized accurately using the combined structural global frequencies and structural local frequencies. The effectiveness and accuracy of the proposed method are verified by the experiment of a space truss.

The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms.

Science.gov (United States)

Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai

2012-01-01

This paper examines the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003-2005 and 2008-2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for primary care (CUPs) responsible for managing local service networks. The two studies document a striking change in the balance of power in the local healthcare system over the 8-year period. Initially, the newly formed CUPs gained influence as 'power followed the money', and the provincial health offices (PHOs), which had commanded the service units, were left with a weaker co-ordination role. However, the situation changed as a new insurance purchaser, the National Health Security Office, took financial control and established regional outposts. National Health Security Office outposts worked with PHOs to develop rationalised management tools-strategic plans, targets, KPIs and benchmarking-that installed the PHOs as performance managers of local healthcare systems. New lines of accountability and changed budgetary systems reduced the power of the CUPs to control resource allocation and patterns of services within CUP networks. Whereas some CUPs fought to retain limited autonomy, the PHO has been able to regain much of its former control. We suggest that implementation theory needs to take a long view to capture the complexity of a major reform initiative and argue for an analysis that recognises the key role of policy networks and advocacy coalitions that span national and local levels and realign over time. Copyright © 2012 John Wiley & Sons, Ltd.

Examining the Pathways between Gratitude and Self-Rated Physical Health across Adulthood

Science.gov (United States)

Hill, Patrick L.; Allemand, Mathias; Roberts, Brent W.

2012-01-01

The current study examined whether dispositional gratitude predicts physical health among adults, and if so, whether this relationship occurs because grateful individuals lead healthier lives, either psychologically or physically. Specifically, we examined whether psychological health, healthy activities, and willingness to seek help for health concerns mediated the link between gratitude and self-reported physical health, as well as if these mediational pathways are moderated by age, in a broad sample of Swiss adults (N = 962, Mage = 52 years, age range: 19 to 84). Dispositional gratitude correlated positively with self-reported physical health, and this link was mediated by psychological health, healthy activities, and willingness to seek help for health concerns. However, the indirect effects for psychological health and healthy activities were stronger for older than younger adults. In other words, the mechanisms explaining why gratitude predicts health appear to differ across adulthood. PMID:23139438

Hot yoga establishments in local communities serving pregnant women: a pilot study on the health implications of its practice and environmental conditions.

Science.gov (United States)

Nguyen-Feng, Viann N; Feng, Steven L; Babbar, Shilpa; Rankins, Nicole Calloway; Blando, James D

2014-10-01

Hot yoga establishments have been increasing in popularity in local communities. Studios may support participation among pregnant women though no clinical studies currently exist that examine prenatal hot yoga effects. The pilot study described in this article aimed to assess the spread of prenatal hot yoga and to provide information on the environmental conditions and practices of those who engage in hot yoga within a local community. A thermal environment meter was used to measure ambient air conditions during three 90-minute hot yoga classes. Mothers who practiced prenatal hot yoga were more likely than non-hot yoga practitioners to have someone aside from an obstetrician/gynecologist discuss prenatal exercise safety with them. Prenatal public health education campaigns need to be refined. Public health officials and obstetricians/gynecologists need to be aware that those who engage in a hot yoga practice are more likely to trust someone other than their health care provider or public health professional regarding safety of this practice.

Use of international foundations of medicine clinical sciences examination to evaluate students' performance in the local examination at the University of Sharjah, United Arab Emirates.

Science.gov (United States)

Dash, Nihar Ranjan; Abdalla, Mohamed Elhassan; Hussein, Amal

2017-01-01

Several medical schools around the world are moving away from isolated, locally developed in-house assessments to the introduction of external examinations into their curriculum. Although the objective varies, it is typically done to evaluate, audit, and compare students' performance to international standards. Similarly, the International Foundations of Medicine-Clinical Sciences Examination (IFOM-CSE) was introduced in the College of Medicine at the University of Sharjah as an external assessment criterion in addition to the existing in-house assessments. The aim of this study was to compare the student performance in this newly introduced IFOM-CSE examination and the existing in-house final examination in the college. The scores of three consecutive final-year undergraduate medical student batches (2013-2015) who took both the IFOM-CSE and the existing in-house final examination were analyzed. Pearson correlation and one-way analysis of variance test were conducted using SPSS 22. The students' scores in the IFOM-CSE and in the final examination prepared locally were highly correlated with Pearson correlation coefficients of 0.787 for batch 2013, 0.827 for batch 2014, and 0.830 for batch 2015 (P correlated with their scores in the IFOM-CSE over all the three batches. Thus, introduction of external examination can be an important evaluation tool to a comprehensive internal assessment system providing evidence of external validity.

[Local public health networks. Apropos of an experience].

Science.gov (United States)

Guix, Joan; Bocio, Ana; Ferràs, Joaquim; Margalef, Jordi; Osanz, Anna C; Serrano, Mónica; Sentenà, Anna

2013-01-01

Public health action on a territory is complex and requires the involvement of multiple actors, who do not always act coordinately. Networks of organizations structures including the whole of the local actors facilitate the generation of synergies and enable greater effectiveness and efficiency of the joint action from the different actors on a same landscape. We present 3 years experience of four Public Health Committees in a region of Catalonia (Spain), composed by the main actors in public health planning. Each of the committees is organized on a plenary and working groups on issues arising from the regional health diagnosis, and coincident with the Health Plan of the Region. Coordination in no case implies the loss or dilution of the firm of the actor generator of intervention initiative in public health, but their empowerment and collaboration by the other actors. In conclusion welcomes the creation of a culture of collaboration and synergies between the different organizations concerned. Lack of specificity is observed in establishing operational objectives, and the need for greater coordination and involvement of the components of the various working groups. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

Interactions between global processes and local health problems. A human ecology approach to health among indigenous groups in the Amazon

Directory of Open Access Journals (Sweden)

Maj-Lis Follér

Full Text Available This article deals with methodological issues and how to link global processes - social and ecological - with environmental changes and human health in local communities. The discussion concerns how interdisciplinary approaches can help us find tools to develop new knowledge. Scientific knowledge and local knowledge are not seen as opposite epistemological forms, but as socially and culturally constructed. Power and social legitimacy have to be included when analyzing how to deal with the interaction between global processes and local environmental change and the health/disease interface.

Health promotion at local level: a case study of content, organization and development in four Swedish municipalities

Directory of Open Access Journals (Sweden)

Jansson Elisabeth VG

2010-08-01

Full Text Available Abstract Background Several health determinants are related to local conditions and prerequisites at community level. For this reason, strengthening community action has been one of five strategies implemented in health promotion since the end of the 1980s. Such action includes setting priorities, making decisions, planning strategies, and implementing them to achieve better health. The aim of this paper is to obtain a deeper understanding of content, organization and processes in the development of local health promotion. Methods A qualitative multiple case study of four Swedish municipalities. The cases were analyzed in accordance with the principles of cross-case study analysis, and a content analysis of documents and interviews was conducted in two steps. First, a manifest content analysis was performed to identify present and former actors and measures. Thereafter, a latent content analysis was performed to investigate structures and processes in local contexts. Results The results of the inductive content analysis showed development of local health promotion in three phases: initiation, action, and achievement. Strengthening factors were local actors, health statistics and events. Hindering factors were lack of resources and vague objectives. External factors, e.g. national policies, were not perceived as prominent influencing factors. Media reports were regarded as having had an influence, but only to some extent. The content of local health promotion has developed from ad-hoc lifestyle and behaviour-related actions into structural, intersectoral actions related to determinants of health. Conclusions The municipalities have organized and developed their health promotion targets, actions and priorities on the basis of local needs and prerequisites. The three phases in the identified health promotion processes were experienced and documented as being subject to greater influence from internal rather than external strengthening and hindering

Evaluation of a model training program for respiratory-protection preparedness at local health departments.

Science.gov (United States)

Alfano-Sobsey, Edie; Kennedy, Bobby; Beck, Frank; Combs, Brian; Kady, Wendy; Ramsey, Steven; Stockweather, Allison; Service, Will

2006-04-01

Respiratory-protection programs have had limited application in local health departments and have mostly focused on protecting employees against exposure to tuberculosis (TB). The need to provide the public health workforce with effective respiratory protection has, however, been underscored by recent concerns about emerging infectious diseases, bioterrorism attacks, drug-resistant microbes, and environmental exposures to microbial allergens (as in recent hurricane flood waters). Furthermore, OSHA has revoked the TB standard traditionally followed by local health departments, replacing it with a more stringent regulation. The additional OSHA requirements may place increased burdens on health departments with limited resources and time. For these reasons, the North Carolina Office of Public Health Preparedness and Response and industrial hygienists of the Public Health Regional Surveillance Teams have developed a training program to facilitate implementation of respiratory protection programs at local health departments. To date, more than 1,400 North Carolina health department employees have been properly fit-tested for respirator use and have received training in all aspects of respiratory protection. This article gives an overview of the development and evaluation of the program. The training approach presented here can serve as a model that other health departments and organizations can use in implementing similar respiratory-protection programs.

Billing third party payers for vaccines: state and local health department perspectives.

Science.gov (United States)

Quintanilla, Carlos; Duncan, Lorraine; Luther, Lydia

2009-01-01

The cost of adequately immunizing a child has risen steadily with recommendations of new, more expensive vaccines. The Vaccines for Children (VFC) program, a federal entitlement, has continued to fund all recommended vaccines for eligible children. The one other federal vaccine-funding source, Section 317 of the Public Health Service Act, has not kept pace with rising vaccine costs. For local health departments to immunize children not eligible for VFC, but whose families are underinsured or otherwise unable to pay for vaccines, state immunization programs have often relied on Section 317 funds. Recognizing this funding challenge and having learned that children covered by health insurance were being immunized in public clinics with publicly supplied vaccines, the Oregon Immunization Program (OIP) launched a project to expand billing of health plans by local health departments for vaccines administered to covered persons. This has resulted in significant savings of Section 317 funds, allowing the Oregon program to provide more vaccines for high-need persons.

20 years of local ecological public health: the experience of Sandwell in the English West Midlands.

Science.gov (United States)

Middleton, J; Saunders, P

2015-10-01

A long-term picture of the economy and living conditions of Sandwell, an area of England's industrial Midlands, is presented to explore how these underpin and influence its 'health economy'. Sandwell's experience illustrates how public health actors have to tackle industrial and other factors which shape human health. The paper explores how the ecological public health perspective has helped inform the modern public health task in an area such as Sandwell. Some lessons are offered, including: the need to understand the specific economic legacy of a local area (in Sandwell, principally one of polluting and then declining manufacturing industries); the continuing story of infection control; the complexity of tackling poor diet; and the importance of the built environment and town planning. Faced by such challenges, local public health action represents, in effect, an attempt to transcend unecological public health. This can be exciting, innovative and ultimately successful; but it also means being prepared to face daunting and politically charged obstacles and superior national or international forces over which local public health practitioners conventionally have little leverage. The paper argues that, in such unequal power circumstances, public health practitioners have to draw on the creativity within the local population and build a facilitative alliance of formal and informal pro-public health actors. Despite the confounding odds and ever-present stretched resources, the Sandwell experience gives grounds for optimism, being a story of constant creativity and effective local alliances. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Health and equity in all policies in local government: processes and outcomes in two Norwegian municipalities.

Science.gov (United States)

Von Heimburg, Dina; Hakkebo, Berit

2017-08-01

To identify key factors in implementing Health and Equity in All Policies (HEiAP) at the local level in two Norwegian municipalities in order to accelerate the progress of promoting health, well-being and equity in other local governments. This case study is presented as a narrative from policy-making processes in two Norwegian municipalities. The story is told from an insider perspective, with a focus on HEiAP policy makers in these two municipalities. The narrative identified key learning from implementing HEiAP at the local level, i.e. the importance of strengthening system and human capacities. System capacity is strengthened by governing HEiAP according to national legislation and a holistic governance system at the local level. Municipal plans are based on theory, evidence and local data. A 'main story' is developed to support the vision, defining joint societal goals and co-creation strategies. Policies are anchored by measuring and monitoring outcomes, sharing accountability and continuous dialogue to ensure political commitment. Human capacity is strengthened through participatory leadership, soft skills and health promotion competences across sectors. Health promotion competence at a strategic level in the organization, participation in professional networks, crowd sourcing toward common goals, and commitment through winning hearts and minds of politicians and other stakeholders are vital aspects. Our experience pinpoints the importance of strengthening system and human capacity in local governments. Further, we found it important to focus on the two strategic objectives in the European strategy 'Health 2020': (1) Improving health for all and reducing health inequalities; (2) improving leadership and participatory governance for health.

HIV Services Provided by STD Programs in State and Local Health Departments - United States, 2013-2014.

Science.gov (United States)

Cuffe, Kendra M; Esie, Precious; Leichliter, Jami S; Gift, Thomas L

2017-04-07

The incidence of human immunodeficiency virus (HIV) infection in the United States is higher among persons with other sexually transmitted diseases (STDs), and the incidence of other STDs is increased among persons with HIV infection (1). Because infection with an STD increases the risk for HIV acquisition and transmission (1-4), successfully treating STDs might help reduce the spread of HIV among persons at high risk (1-4). Because health department STD programs provide services to populations who are at risk for HIV, ensuring service integration and coordination could potentially reduce the incidence of STDs and HIV. Program integration refers to the combining of STD and HIV prevention programs through structural, service, or policy-related changes such as combining funding streams, performing STD and HIV case matching, or integrating staff members (5). Some STD programs in U.S. health departments are partially or fully integrated with an HIV program (STD/HIV program), whereas other STD programs are completely separate. To assess the extent of provision of HIV services by state and local health department STD programs, CDC analyzed data from a sample of 311 local health departments and 56 state and directly funded city health departments derived from a national survey of STD programs. CDC found variation in the provision of HIV services by STD programs at the state and local levels. Overall, 73.1% of state health departments and 16.1% of local health departments matched STD case report data with HIV data to analyze possible syndemics (co-occurring epidemics that exacerbate the negative health effects of any of the diseases) and overlaps. Similarly, 94.1% of state health departments and 46.7% of local health departments performed site visits to HIV care providers to provide STD information or public health updates. One fourth of state health departments and 39.4% of local health departments provided HIV testing in nonclinical settings (field testing) for STD

The role of a local mammography workshop, considered from the results of reading examinations and associated questionnaires

International Nuclear Information System (INIS)

Matsunami, Nobuki; Tatsuta, Masayuki; Nishi, Toshio

2011-01-01

The mammography workshop group for the southern Osaka prefectural area (Hannan Mammography Workshop Group) started in April, 2001, and reading examinations have been carried out periodically since the 9th workshop held in April, 2004, in order to promote mammography breast cancer screening and improve quality control. Questionnaire studies were performed in association with the 3rd (December, 2006) and 4th (March, 2008) reading examinations in order to analyze the role of the local workshop. The questionnaires included items inquiring about the examinee's sex, age, institution location, type of occupation, attendance at mammography training courses provided by the Central Committee for Quality Control, the number of attendances at the local workshop, performance of breast cancer screening, experience of recall examinations, and the number of readings performed. In addition, the questions that yielded varied interpretations at reading examinations were carefully checked in order to better manage subsequent workshops. Examinees who had attended the workshops more than 6 times tended to have a high category sensitivity (62.2% at the 3rd reading examination, and 58.9% at the 4th). Test cases that showed a low conformity rate of category judgment were as follows: judgment of typically benign calcifications, distinction between amorphous or indistinct calcifications and pleomorphic or heterogeneous calcifications, judgment of focal asymmetric density (FAD) and architectural distortion. We intend to use these results to improve the quality control of breast cancer screening through our local mammography workshop activity. (author)

Microbiological quality of local soymilk: a public health appraisal ...

African Journals Online (AJOL)

The ubiquity in the hawking of locally produced soymilk, packaged in different forms, was considered a public health concern. The attendant increase in the rate of soymilk consumption has encouraged low scale production of the milk under household condition with little or no regard to quality control measures. Accordingly ...

Demarcation of local neighborhoods to study relations between contextual factors and health

Directory of Open Access Journals (Sweden)

Chor Dora

2010-06-01

Full Text Available Abstract Background Several studies have highlighted the importance of collective social factors for population health. One of the major challenges is an adequate definition of the spatial units of analysis which present properties potentially related to the target outcomes. Political and administrative divisions of urban areas are the most commonly used definition, although they suffer limitations in their ability to fully express the neighborhoods as social and spatial units. Objective This study presents a proposal for defining the boundaries of local neighborhoods in Rio de Janeiro city. Local neighborhoods are constructed by means of aggregation of contiguous census tracts which are homogeneous regarding socioeconomic indicators. Methodology Local neighborhoods were created using the SKATER method (TerraView software. Criteria used for socioeconomic homogeneity were based on four census tract indicators (income, education, persons per household, and percentage of population in the 0-4-year age bracket considering a minimum population of 5,000 people living in each local neighborhood. The process took into account the geographic boundaries between administrative neighborhoods (a political-administrative division larger than a local neighborhood, but smaller than a borough and natural geographic barriers. Results The original 8,145 census tracts were collapsed into 794 local neighborhoods, distributed along 158 administrative neighborhoods. Local neighborhoods contained a mean of 10 census tracts, and there were an average of five local neighborhoods per administrative neighborhood. The local neighborhood units demarcated in this study are less socioeconomically heterogeneous than the administrative neighborhoods and provide a means for decreasing the well-known statistical variability of indicators based on census tracts. The local neighborhoods were able to distinguish between different areas within administrative neighborhoods

Demarcation of local neighborhoods to study relations between contextual factors and health.

Science.gov (United States)

Santos, Simone M; Chor, Dora; Werneck, Guilherme Loureiro

2010-06-29

Several studies have highlighted the importance of collective social factors for population health. One of the major challenges is an adequate definition of the spatial units of analysis which present properties potentially related to the target outcomes. Political and administrative divisions of urban areas are the most commonly used definition, although they suffer limitations in their ability to fully express the neighborhoods as social and spatial units. This study presents a proposal for defining the boundaries of local neighborhoods in Rio de Janeiro city. Local neighborhoods are constructed by means of aggregation of contiguous census tracts which are homogeneous regarding socioeconomic indicators. Local neighborhoods were created using the SKATER method (TerraView software). Criteria used for socioeconomic homogeneity were based on four census tract indicators (income, education, persons per household, and percentage of population in the 0-4-year age bracket) considering a minimum population of 5,000 people living in each local neighborhood. The process took into account the geographic boundaries between administrative neighborhoods (a political-administrative division larger than a local neighborhood, but smaller than a borough) and natural geographic barriers. The original 8,145 census tracts were collapsed into 794 local neighborhoods, distributed along 158 administrative neighborhoods. Local neighborhoods contained a mean of 10 census tracts, and there were an average of five local neighborhoods per administrative neighborhood.The local neighborhood units demarcated in this study are less socioeconomically heterogeneous than the administrative neighborhoods and provide a means for decreasing the well-known statistical variability of indicators based on census tracts. The local neighborhoods were able to distinguish between different areas within administrative neighborhoods, particularly in relation to squatter settlements. Although the literature on

[Age- and sex-specific reference intervals for 10 health examination items: mega-data from a Japanese Health Service Association].

Science.gov (United States)

Suka, Machi; Yoshida, Katsumi; Kawai, Tadashi; Aoki, Yoshikazu; Yamane, Noriyuki; Yamauchi, Kuniaki

2005-07-01

To determine age- and sex-specific reference intervals for 10 health examination items in Japanese adults. Health examination data were accumulated from 24 different prefectural health service associations affiliated with the Japan Association of Health Service. Those who were non-smokers, drank less than 7 days/week, and had a body mass index of 18.5-24.9kg/m2 were sampled as a reference population (n = 737,538; 224,947 men and 512,591 women). After classified by age and sex, reference intervals for 10 health examination items (systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, glucose, uric acid, AST, ALT, gamma-GT, and hemoglobin) were estimated using the parametric and nonparametric methods. In every item except for hemoglobin, men had higher reference intervals than women. Systolic blood pressure, total cholesterol, and glucose showed an upward trend in values with increasing age. Hemoglobin showed a downward trend in values with increasing age. Triglyceride, ALT, and gamma-GT reached a peak in middle age. Overall, parametric estimates showed narrower reference intervals than non-parametric estimates. Reference intervals vary with age and sex. Age- and sex-specific reference intervals may contribute to better assessment of health examination data.

Estimating the Health and Economic Impacts of Changes in Local Air Quality

Science.gov (United States)

Carvour, Martha L.; Hughes, Amy E.; Fann, Neal

2018-01-01

Objectives. To demonstrate the benefits-mapping software Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE), which integrates local air quality data with previously published concentration–response and health–economic valuation functions to estimate the health effects of changes in air pollution levels and their economic consequences. Methods. We illustrate a local health impact assessment of ozone changes in the 10-county nonattainment area of the Dallas–Fort Worth region of Texas, estimating the short-term effects on mortality predicted by 2 scenarios for 3 years (2008, 2011, and 2013): an incremental rollback of the daily 8-hour maximum ozone levels of all area monitors by 10 parts per billion and a rollback-to-a-standard ambient level of 65 parts per billion at only monitors above that level. Results. Estimates of preventable premature deaths attributable to ozone air pollution obtained by the incremental rollback method varied little by year, whereas those obtained by the rollback-to-a-standard method varied by year and were sensitive to the choice of ordinality and the use of preloaded or imported data. Conclusions. BenMAP-CE allows local and regional public health analysts to generate timely, evidence-based estimates of the health impacts and economic consequences of potential policy options in their communities. PMID:29698094

Non-participation in preventive child health examinations at the general practitioner in Denmark

DEFF Research Database (Denmark)

Søndergaard, Grethe; Biering-Sørensen, Sofie; Michelsen, Susan Ishøy

2008-01-01

Objective. To examine demographic and socioeconomic characteristics of parents and children in families not participating in preventive child health examinations at the general practitioner in a society with free and easy access to healthcare. Design. Population-covering register linkage study...... free and easy access to the GP, the utilization of preventive child health examinations is lower among the more deprived part of the population....

Health promotion in Danish schools: local priorities, policies and practices.

Science.gov (United States)

Simovska, Venka; Nordin, Lone Lindegaard; Madsen, Katrine Dahl

2016-06-01

This article discusses the findings from a study mapping out the priorities, policies and practices of local authorities concerning health promotion (HP) and health education (HE) in primary and lower secondary schools in Denmark. The aim of the study was to identify the gaps, tensions and possibilities associated with the demand to increase the quality and effectiveness of HP in schools. The recent national school reform, which emphasizes the importance of health and well-being while simultaneously increasing the focus on performance and accountability in terms of subject proficiency and narrowly defined academic attainment, provides the broader political context for the study. Data were generated through a structured online survey administered to all 98 Danish municipalities. Respondents were educational consultants or others representing the administrative units responsible for the municipality's schools. The findings were discussed within the conceptual framework of Health Promoting Schools. The study points to a potential tension between the health and education sectors, despite evidence of intersectoral collaboration. While there is a strong policy focus on health and well-being in schools, it is disconnected from the utilization of the HE curriculum by the municipal consultants. The study also points to a lack of professional development opportunities for teachers in the field of HP in schools. On the basis of these findings and theoretical perspectives used, we argue that HP in schools needs to (re)connect with the core task of the school, education, and to integrate both health and education goals in local priorities, policies and practices. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Integration of environmental stewardship and local economic development to enhance community health.

Science.gov (United States)

Levine, Jay F

2011-01-01

Environmental groups working to preserve natural ecosystems and groups working to enhance local economic development often find themselves on philosophically opposite sides of the negotiation table. Case histories of cooperative engagement are provided that serve as examples of how environmental stewardship is compatible with local economic development and community health.

Revision of the occupational health examination form for radiation workers

International Nuclear Information System (INIS)

Liu Chang'an; Chen Erdong

2005-01-01

Objective: To revise the Occupational Health Examination Form for Radiation Workers, which is served as annex 3 of Management Regulations for Occupational Health Surveillance (Decree No.23 of Ministry of Health, P.R. China), so as to further improve and standardize the occupational health management for radiation workers. Methods: Based on corresponding laws, standards and general principles of occupational medicine. Results: The new version of the Form was established and passed auditing. Conclusion: The theoretical foundation, intention and methods of the revision process are briefly introduced. Requirements and necessary recommendations for implement the new Form are also described. (authors)

[Local planning: the speech of basic health care center manager].

Science.gov (United States)

Cubas, Márcia Regina

2005-01-01

As planning is understood as a management tool, this article offers an argument through the speech framework of Basic Health Care Center Managers in the city of Curitiba-PR, by means of the Collective Subject Speech Methodology on local planning aspects. Its purpose is to bring local managers to a reflection concerning their styles, practices and experiences, as well as to collaborate with central level leading teams towards building their planning processes in an upward, participatory, communicative and strategic way. Considerations of the speeches built from central ideas are presented: planning methodology; inter-sectoriality; territorial basis; team and community participation; training, autonomy and particular profile of local managers; the manager's agenda; and institutional culture.

Managing health physics departmental data via a local area network

International Nuclear Information System (INIS)

Weber, P.J.; Castronovo, F.P. Jr.

1993-01-01

The authors describe the multiuser data management system that can be accessed simultaneously by all department members, in use at the Dept of Health Physics, Brigham and Women's Hospital, U.S.A., which makes use of the Local Area Network. (UK)

[Local health promotion plans: intersetoralities created in the territory].

Science.gov (United States)

Moysés, Simone Tetu; Franco de Sá, Ronice

2014-11-01

The article highlights the importance of considering the specificities of spaces/territories/ locations of individual and collective life in creating health promotion actions. It explores how this approach has conceptually consolidated respect for territoriality and territorial actions as a principle and an operational health promotion strategy. Based on the literature, the article also points to the need to envision the territory occupied as a locus to put intersetorialities into practice, giving a voice to people who live there, seek to and solve their complex problems, to existing and emerging social networks. It also presents a nationally and internationally validated strategy/method (Bamboo Method) for the development of local health promotion plans, which enables the prioritization of actions by listening to the people and to the managers.

Implementation of a guideline for local health policy making by regional health services: exploring determinants of use by a web survey

NARCIS (Netherlands)

Kuunders, T.J.M.; Jacobs, M.A.M.; Goor, I.A.M. van de; Bon-Martens, M.J.H. van; Oers, H.A.M. van; Paulussen, T.G.W.M.

2017-01-01

Background. Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This

Examining the Role of Anxiety and Apathy in Health Consumers' Intentions to Use Patient Health Portals for Personal Health Information Management

Science.gov (United States)

Torres, Carlos A.

2011-01-01

This study investigated college students' attitudes toward and intentions to use personal health portals (PHPs) for managing their personal health information using a survey method. The study also aimed to examine the roles electronic Personal Health Information Management (PHIM) anxiety and apathy play in influencing students' attitudes toward…

Rural health care bypass behavior: how community and spatial characteristics affect primary health care selection.

Science.gov (United States)

Sanders, Scott R; Erickson, Lance D; Call, Vaughn R A; McKnight, Matthew L; Hedges, Dawson W

2015-01-01

(1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass. Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass. Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows. Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior. © 2014 National Rural Health Association.

Examining participation in relation to students’ development of health-related action competence in a school food setting

DEFF Research Database (Denmark)

Ruge, Dorte; Nielsen, Morten Kromann; Mikkelsen, Bent Egberg

2016-01-01

: Current study is an example of how the IVACE matrix can be applied in order to plan, conduct and evaluate LOMA educational activities. It is an aspiration of the authors that this could be considered as a contribution to the HPS scientific community. Also, this would be useful for other schools...... skills that made students able to take action regarding food and health in everyday life. Methods: Research was undertaken as a single case study of the development of an integrated education and health program called LOMA-Local Food (LOMA) in a secondary school in Denmark. Qualitative methods were...... applied, including an action research component, where researcher and teachers examined how students developed action competence. The program was based on a whole school approach with the aim of improving F&HRAC. As a way to obtain this, students participated in planning, preparing, cooking and serving...

Local health care expenditure plans and their opportunity costs.

Science.gov (United States)

Karlsberg Schaffer, Sarah; Sussex, Jon; Devlin, Nancy; Walker, Andrew

2015-09-01

In the UK, approval decisions by Health Technology Assessment bodies are made using a cost per quality-adjusted life year (QALY) threshold, the value of which is based on little empirical evidence. We test the feasibility of estimating the "true" value of the threshold in NHS Scotland using information on marginal services (those planned to receive significant (dis)investment). We also explore how the NHS makes spending decisions and the role of cost per QALY evidence in this process. We identify marginal services using NHS Board-level responses to the 2012/13 Budget Scrutiny issued by the Scottish Government, supplemented with information on prioritisation processes derived from interviews with Finance Directors. We search the literature for cost-effectiveness evidence relating to marginal services. The cost-effectiveness estimates of marginal services vary hugely and thus it was not possible to obtain a reliable estimate of the threshold. This is unsurprising given the finding that cost-effectiveness evidence is rarely used to justify expenditure plans, which are driven by a range of other factors. Our results highlight the differences in objectives between HTA bodies and local health service decision makers. We also demonstrate that, even if it were desirable, the use of cost-effectiveness evidence at local level would be highly challenging without extensive investment in health economics resources. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Implementation of a guideline for local health policy making by regional health services : Exploring determinants of use by a web survey

NARCIS (Netherlands)

Kuunders, T.J.M.; Jacobs, M.A.M.; Paulussen, T.G.W.M.; van de Goor, L.A.M.; van Bon, M.J.H.; van Oers, J.A.M.

Background Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This study

Profile-IQ: Web-based data query system for local health department infrastructure and activities.

Science.gov (United States)

Shah, Gulzar H; Leep, Carolyn J; Alexander, Dayna

2014-01-01

To demonstrate the use of National Association of County & City Health Officials' Profile-IQ, a Web-based data query system, and how policy makers, researchers, the general public, and public health professionals can use the system to generate descriptive statistics on local health departments. This article is a descriptive account of an important health informatics tool based on information from the project charter for Profile-IQ and the authors' experience and knowledge in design and use of this query system. Profile-IQ is a Web-based data query system that is based on open-source software: MySQL 5.5, Google Web Toolkit 2.2.0, Apache Commons Math library, Google Chart API, and Tomcat 6.0 Web server deployed on an Amazon EC2 server. It supports dynamic queries of National Profile of Local Health Departments data on local health department finances, workforce, and activities. Profile-IQ's customizable queries provide a variety of statistics not available in published reports and support the growing information needs of users who do not wish to work directly with data files for lack of staff skills or time, or to avoid a data use agreement. Profile-IQ also meets the growing demand of public health practitioners and policy makers for data to support quality improvement, community health assessment, and other processes associated with voluntary public health accreditation. It represents a step forward in the recent health informatics movement of data liberation and use of open source information technology solutions to promote public health.

Health of the Elderly Migration Population in China: Benefit from Individual and Local Socioeconomic Status?

Science.gov (United States)

Wang, Qing

2017-04-01

The study aims to estimate the relationship between the individual/local socioeconomic status and the health of internal elderly migrants in China. A multilevel logistic model was used to estimate this association. The estimations were undertaken for 11,111 migrants aged over 60 years, using nationally representative data: the 2015 Migrant Dynamics Monitoring Survey (MDMS), which was carried out in China. Odds ratios with 95% confidence intervals were reported. Both the household income per capita and the area-level average wage were positively associated with migrants' self-reported health; however, public service supply was not significantly related to their health. In addition, given the household income, migrants living in communities with a higher average wage were more likely to report poor health. Migrants' health benefited from individual socioeconomic status, but not from the local socioeconomic status, which the migrants cannot enjoy. This study highlights the importance of multilevel and non-discriminatory policies between migrants and local residents.

[Factors Associated with Stress Check Attendance: Possible Effect of Timing of Annual Health Examination].

Science.gov (United States)

Ishimaru, Tomohiro; Hattori, Michihiro; Nagata, Masako; Kuwahara, Keisuke; Watanabe, Seiji; Mori, Koji

2018-01-01

The stress check program has been part of annual employees' health screening since 2015. Employees are recommended, but not obliged, to undergo the stress check offered. This study was designed to examine the factors associated with stress check attendance. A total of 31,156 Japanese employees who underwent an annual health examination and a stress check service at an Occupational Health Service Center in 2016 participated in this study. Data from the annual health examination and stress check service included stress check attendance, date of attendance (if implemented), gender, age, workplace industry, number of employees at the workplace, and tobacco and alcohol consumption. Data were analyzed using multiple logistic regression. The mean rate of stress check attendance was 90.8%. A higher rate of stress check attendance was associated with a lower duration from the annual health examination, age ≥30 years, construction and transport industry, and 50-999 employees at the workplace. A lower rate of stress check attendance was associated with medical and welfare industry and ≥1,000 employees at the workplace. These findings provide insights into developing strategies for improving the rate of stress check attendance. In particular, stress check attendance may improve if the stress check service and annual health examination are conducted simultaneously.

The NIHR Public Health Research Programme: responding to local authority research needs in the United Kingdom.

Science.gov (United States)

Dorling, Hannah; Cook, Andrew; Ollerhead, Liz; Westmore, Matt

2015-12-11

The remit of the National Institute for Health Research Public Health Research (PHR) Programme is to evaluate public health interventions, providing new knowledge on the benefits, costs, acceptability and wider impacts of interventions, set outside of the National Health Service, intended to improve the health of the public and reduce inequalities. This paper illustrates how the PHR Programme is providing new knowledge for public health decision makers, based on the nine key areas for local authority public health action, described by the King's Fund. Many funded PHR projects are evaluating interventions, applied in a range of settings, across the identified key areas for local authority influence. For example, research has been funded on children and young people, and for some of the wider determinants of health, such as housing and travel. Other factors, such as spatial planning, or open and green spaces and leisure, are less represented in the PHR Programme. Further opportunities in research include interventions to improve the health of adolescents, adults in workplaces, and communities. Building evidence for public health interventions at local authority level is important to prioritise and implement effective changes to improve population health.

School buses, air pollution and children's health : improving children's health and local air quality by reducing school bus emissions

Energy Technology Data Exchange (ETDEWEB)

Perrotta, K. [Ontario Public Health Association, Toronto, ON (Canada)

2005-11-01

The exhaust gases from school buses was examined and recommendations were presented for the establishment of a healthy school bus program in Ontario that is directed at improving children's health and local air quality. The Ontario Public Health Association is concerned with school bus emissions because they are heavy-duty vehicles that emit large quantities of diesel-related air pollutants such as fine particulate matter, nitrogen oxides and diesel particulates. In addition, school buses can be self-polluting vehicles that expose children on-board to high levels of fine particulates and diesel particulate matter. Both these pollutants have been associated with a range of acute and chronic health problems such as asthma, respiratory infections, allergies, and school absences. With nearly 800,000 Ontario children being transported on school buses annually, these exposures can represent a serious public health concern, as childhood exposures can also influence the health of exposed individuals later in life. Exposure studies have found that tailpipe and engine emissions contribute greatly to concentrations of air pollutants on-board school buses. The studies also showed that on-board concentrations were also influenced by local air quality in the communities studied, traffic density, wind direction, the configuration of windows, idling and queuing patterns. It was recommended that the use of ultra-low sulphur diesel fuel along with the installation of diesel particulate filters and closed crankcase filters can reduce the concentrations of air pollutants on-board school buses to almost ambient air levels, even under idling conditions. This report recommended the replacement of pre-1994 school buses, the retrofitting of 1994-2003 school buses with filters, and maintaining proper maintenance, idling and vehicle operation practices. refs., tabs., figs.

An examination of electronic health information privacy in older adults.

Science.gov (United States)

Le, Thai; Thompson, Hilaire; Demiris, George

2013-01-01

Older adults are the quickest growing demographic group and are key consumers of health services. As the United States health system transitions to electronic health records, it is important to understand older adult perceptions of privacy and security. We performed a secondary analysis of the Health Information National Trends Survey (2012, Cycle 1), to examine differences in perceptions of electronic health information privacy between older adults and the general population. We found differences in the level of importance placed on access to electronic health information (older adults placed greater emphasis on provider as opposed to personal access) and tendency to withhold information out of concerns for privacy and security (older adults were less likely to withhold information). We provide recommendations to alleviate some of these privacy concerns. This may facilitate greater use of electronic health communication between patient and provider, while promoting shared decision making.

What are the health needs, familial and social problems of Thai migrants in a local community in Australia? A focus group study.

Science.gov (United States)

Vatcharavongvan, Pasitpon; Hepworth, Julie; Lim, Joanne; Marley, John

2014-02-01

This study explored the health needs, familial and social problems of Thai migrants in a local community in Brisbane, Australia. Five focus groups with Thai migrants were conducted. The qualitative data were examined using thematic content analysis that is specifically designed for focus group analysis. Four themes were identified: (1) positive experiences in Australia, (2) physical health problems, (3) mental health problems, and (4) familial and social health problems. This study revealed key health needs related to chronic disease and mental health, major barriers to health service use, such as language skills, and facilitating factors, such as the Thai Temple. We concluded that because the health needs, familial and social problems of Thai migrants were complex and culture bound, the development of health and community services for Thai migrants needs to take account of the ways in which Thai culture both negatively impacts health and offer positive solutions to problems.

Using quantile regression to examine health care expenditures during the Great Recession.

Science.gov (United States)

Chen, Jie; Vargas-Bustamante, Arturo; Mortensen, Karoline; Thomas, Stephen B

2014-04-01

To examine the association between the Great Recession of 2007-2009 and health care expenditures along the health care spending distribution, with a focus on racial/ethnic disparities. Secondary data analyses of the Medical Expenditure Panel Survey (2005-2006 and 2008-2009). Quantile multivariate regressions are employed to measure the different associations between the economic recession of 2007-2009 and health care spending. Race/ethnicity and interaction terms between race/ethnicity and a recession indicator are controlled to examine whether minorities encountered disproportionately lower health spending during the economic recession. The Great Recession was significantly associated with reductions in health care expenditures at the 10th-50th percentiles of the distribution, but not at the 75th-90th percentiles. Racial and ethnic disparities were more substantial at the lower end of the health expenditure distribution; however, on average the reduction in expenditures was similar for all race/ethnic groups. The Great Recession was also positively associated with spending on emergency department visits. This study shows that the relationship between the Great Recession and health care spending varied along the health expenditure distribution. More variability was observed in the lower end of the health spending distribution compared to the higher end. © Health Research and Educational Trust.

Examining spectral variations in localized lunar dark mantle deposits

Science.gov (United States)

Jawin, Erica; Besse, Sebastien; Gaddis, Lisa R.; Sunshine, Jessica; Head, James W.; Mazrouei, Sara

2015-01-01

The localized lunar dark mantle deposits (DMDs) in Alphonsus, J. Herschel, and Oppenheimer craters were analyzed using visible-near-infrared spectroscopy data from the Moon Mineralogy Mapper. Spectra of these localized DMDs were analyzed for compositional and mineralogical variations within the deposits and were compared with nearby mare basalt units. Spectra of the three localized DMDs exhibited mafic absorption features indicating iron-rich compositions, although the DMDs were spectrally distinct from nearby mare basalts. All of the DMDs contained spectral signatures of glassy materials, suggesting the presence of volcanic glass in varying concentrations across the individual deposits. In addition, the albedo and spectral signatures were variable within the Alphonsus and Oppenheimer crater DMDs, suggesting variable deposit thickness and/or variations in the amount of mixing with the local substrate. Two previously unidentified localized DMDs were discovered to the northeast of Oppenheimer crater. The identification of high concentrations of volcanic glass in multiple localized DMDs in different locations suggests that the distribution of volcanic glass across the lunar surface is much more widespread than has been previously documented. The presence of volcanic glass implies an explosive, vulcanian eruption style for localized DMDs, as this allows volcanic glass to rapidly quench, inhibiting crystallization, compared to the larger hawaiian-style eruptions typical of regional DMD emplacement where black beads indicate a higher degree of crystallization. Improved understanding of the local and global distributions of volcanic glass in lunar DMDs will further constrain lunar degassing and compositional evolution throughout lunar volcanic history.

Effect of additional brief counselling after periodic health examination on motivation for health behavior change [corrected].

Science.gov (United States)

Son, Ki Young; Lee, Cheol Min; Cho, BeLong; Lym, Youl Lee; Oh, Seung Won; Chung, Wonjoo; Lee, Jin-Seok; Park, DuShin; Kim, Han Suk

2012-11-01

This study was to evaluate the effect of additional brief counseling by a primary care physician on lifestyle modification of examinees after a periodic health examination. 1,000 participants of the 2007 Korean national health screening program were asked to note any variation in their health behavior after participating in the screening program. The degree of comprehensive motivation for lifestyle modification was assessed in terms of stages of health behavior change. We calculated odds ratio of positive change (enhanced stage of change) with multiple logistic regression analysis and age-adjusted proportion of positive changers. Of 989 respondents, 486 and 503 received the basic and additional programs, respectively. Additional group were more likely to be positive changer than basic group (adjusted OR 1.78; 95% CI 1.19-2.65), and this was more prominent in older age group (adjusted OR 2.38, 95% CI 1.23-4.58). The age-adjusted proportions of positive changers were 22.7% (95% CI, 17.9-28.3) and 36.2% (95% CI, 30.4-42.4) in the basic and additional groups, respectively (P behavior change after the health examination. Thus, such a consultation should be considered when designing a health-screening program.

Is Aboriginal nutrition a priority for local government? A policy analysis.

Science.gov (United States)

Helson, Catherine; Walker, Ruth; Palermo, Claire; Rounsefell, Kim; Aron, Yudit; MacDonald, Catherine; Atkinson, Petah; Browne, Jennifer

2017-11-01

The present study aimed to explore how Australian local governments prioritise the health and well-being of Aboriginal populations and the extent to which nutrition is addressed by local government health policy. In the state of Victoria, Australia, all seventy-nine local governments' public health policy documents were retrieved. Inclusion of Aboriginal health and nutrition in policy documents was analysed using quantitative content analysis. Representation of Aboriginal nutrition 'problems' and 'solutions' was examined using qualitative framing analysis. The socio-ecological framework was used to classify the types of Aboriginal nutrition issues and strategies within policy documents. Victoria, Australia. Local governments' public health policy documents (n 79). A small proportion (14 %, n 11) of local governments addressed Aboriginal health and well-being in terms of nutrition. Where strategies aimed at nutrition existed, they mostly focused on individual factors rather than the broader macroenvironment. A limited number of Victorian local governments address nutrition as a health issue for their Aboriginal populations in policy documents. Nutrition needs to be addressed as a community and social responsibility rather than merely an individual 'behaviour'. Partnerships are required to ensure Aboriginal people lead government policy development.

State practitioner insights into local public health challenges and opportunities in obesity prevention: a qualitative study.

Science.gov (United States)

Stamatakis, Katherine A; Lewis, Moira; Khoong, Elaine C; Lasee, Claire

2014-03-13

The extent of obesity prevention activities conducted by local health departments (LHDs) varies widely. The purpose of this qualitative study was to characterize how state obesity prevention program directors perceived the role of LHDs in obesity prevention and factors that impact LHDs' success in obesity prevention. From June 2011 through August 2011, we conducted 28 semistructured interviews with directors of federally funded obesity prevention programs at 22 state and regional health departments. Interviews were transcribed verbatim, coded, and analyzed to identify recurring themes and key quotations. Main themes focused on the roles of LHDs in local policy and environmental change and on the barriers and facilitators to LHD success. The role LHDs play in obesity prevention varied across states but generally reflected governance structure (decentralized vs centralized). Barriers to local prevention efforts included competing priorities, lack of local capacity, siloed public health structures, and a lack of local engagement in policy and environmental change. Structures and processes that facilitated prevention were having state support (eg, resources, technical assistance), dedicated staff, strong communication networks, and a robust community health assessment and planning process. These findings provide insight into successful strategies state and local practitioners are using to implement innovative (and evidence-informed) community-based interventions. The change in the nature of obesity prevention requires a rethinking of the state-local relationship, especially in centralized states.

Enhancing elderly health examination effectiveness by adding physical function evaluations and interventions.

Science.gov (United States)

Li, Chia-Ming; Chang, Ching-I; Yu, Wen-Ruey; Yang, Winnie; Hsu, Chih-Cheng; Chen, Ching-Yu

This study aimed to assess the benefit of adding physical function evaluations and interventions to routine elderly health examination. This is a Quasi-experimental controlled trial. 404 elderly adults (aged 70 and over) scoring 3-6 on the Canadian Study of Health and Aging Clinical Frailty Scale Chinese In-Person Interview Version (CSHA-CFS) in a 2012 annual elderly health examination were enrolled. Both the control and experimental groups received the routine annual health examination with the latter further provided with functional evaluations, exercise instruction, and nutrition education. 112 (84.8%) persons in the experiment group and 267 (98.2%) in the control group completed the study. CSHA-CFS performance of the experimental group was more likely to improve (odds ratio=9.50, 95% confidence interval (CI)=4.62-19.56) and less likely to deteriorate (OR=0.04, 95% CI=0.01-0.31) one year after intervention. Within the experimental group, Fried Frailty Index improvement percentage surpassed the deterioration percentage (29.5% vs. 0.9%, pPhysical Performance Battery increased from 10.0±1.6 to 11.6±0.9 (pexamination appeared to benefit the health of adults aged 70 years and older. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Utility of local health registers in measuring perinatal mortality: a case study in rural Indonesia.

Science.gov (United States)

Burke, Leona; Suswardany, Dwi Linna; Michener, Keryl; Mazurki, Setiawaty; Adair, Timothy; Elmiyati, Catur; Rao, Chalapati

2011-03-17

Perinatal mortality is an important indicator of obstetric and newborn care services. Although the vast majority of global perinatal mortality is estimated to occur in developing countries, there is a critical paucity of reliable data at the local level to inform health policy, plan health care services, and monitor their impact. This paper explores the utility of information from village health registers to measure perinatal mortality at the sub district level in a rural area of Indonesia. A retrospective pregnancy cohort for 2007 was constructed by triangulating data from antenatal care, birth, and newborn care registers in a sample of villages in three rural sub districts in Central Java, Indonesia. For each pregnancy, birth outcome and first week survival were traced and recorded from the different registers, as available. Additional local death records were consulted to verify perinatal mortality, or identify deaths not recorded in the health registers. Analyses were performed to assess data quality from registers, and measure perinatal mortality rates. Qualitative research was conducted to explore knowledge and practices of village midwives in register maintenance and reporting of perinatal mortality. Field activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Stillbirth rates for the study population were about four times the rates reported in the routine Maternal and Child Health program information system. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting. Local maternal and child health registers are a useful source of information on perinatal mortality in rural Indonesia. Suitable training, supervision, and quality control, in conjunction with computerisation to

Examining the Relationship between Instructional Leadership and Organizational Health

Science.gov (United States)

Parlar, Hanifi; Cansoy, Ramazan

2017-01-01

The aim of this study was to examine the relationship between school administrators' instructional leadership behaviours, and organizational health of schools. The participants were 538 teachers working in elementary, middle and high schools located in the Umraniye district of Istanbul. The data was gathered through the "School Principals'…

Does gender modify associations between self rated health and the social and economic characteristics of local environments?

Science.gov (United States)

Kavanagh, Anne M; Bentley, Rebecca; Turrell, Gavin; Broom, Dorothy H; Subramanian, S V

2006-06-01

To examine whether area level socioeconomic disadvantage and social capital have different relations with women's and men's self rated health. The study used data from 15 112 respondents to the 1998 Tasmanian (Australia) healthy communities study (60% response rate) nested within 41 statistical local areas. Gender stratified analyses were conducted of the associations between the index of relative socioeconomic disadvantage (IRSD) and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, political participation, social trust, trust in institutions) and individual level self rated health using multilevel logistic regression analysis before (age only) and after adjustment for individual level confounders (marital status, indigenous status, income, education, occupation, smoking). The study also tested for interactions between gender and area level variables. IRSD was associated with poor self rated health for women (age adjusted plevel variables. Political participation and neighbourhood safety were protective for women's self rated health but not for men's. Interactions between gender and political participation (p = 0.010) and neighbourhood safety (p = 0.023) were significant. These finding suggest that women may benefit more than men from higher levels of area social capital.

Using Participatory System Dynamics Modeling to Examine the Local HIV Test and Treatment Care Continuum in Order to Reduce Community Viral Load.

Science.gov (United States)

Weeks, Margaret R; Li, Jianghong; Lounsbury, David; Green, Helena Danielle; Abbott, Maryann; Berman, Marcie; Rohena, Lucy; Gonzalez, Rosely; Lang, Shawn; Mosher, Heather

2017-12-01

Achieving community-level goals to eliminate the HIV epidemic requires coordinated efforts through community consortia with a common purpose to examine and critique their own HIV testing and treatment (T&T) care system and build effective tools to guide their efforts to improve it. Participatory system dynamics (SD) modeling offers conceptual, methodological, and analytical tools to engage diverse stakeholders in systems conceptualization and visual mapping of dynamics that undermine community-level health outcomes and identify those that can be leveraged for systems improvement. We recruited and engaged a 25-member multi-stakeholder Task Force, whose members provide or utilize HIV-related services, to participate in SD modeling to examine and address problems of their local HIV T&T service system. Findings from the iterative model building sessions indicated Task Force members' increasingly complex understanding of the local HIV care system and demonstrated their improved capacity to visualize and critique multiple models of the HIV T&T service system and identify areas of potential leverage. Findings also showed members' enhanced communication and consensus in seeking deeper systems understanding and options for solutions. We discuss implications of using these visual SD models for subsequent simulation modeling of the T&T system and for other community applications to improve system effectiveness. © Society for Community Research and Action 2017.

Addressing the social determinants of health at the local level: Opportunities and challenges.

Science.gov (United States)

Fosse, E; Helgesen, M K; Hagen, S; Torp, S

2018-02-01

The gradient in health inequalities reflects a relationship between health and social circumstance, demonstrating that health worsens as you move down the socio-economic scale. For more than a decade, the Norwegian National government has developed policies to reduce social inequalities in health by levelling the social gradient. The adoption of the Public Health Act in 2012 was a further movement towards a comprehensive policy. The main aim of the act is to reduce social health inequalities by adopting a Health in All Policies approach. The municipalities are regarded key in the implementation of the act. The SODEMIFA project aimed to study the development of the new public health policy, with a particular emphasis on its implementation in municipalities. In the SODEMIFA project, a mixed-methods approach was applied, and the data consisted of surveys as well as qualitative interviews. The informants were policymakers at the national and local level. Our findings indicate that the municipalities had a rather vague understanding of the concept of health inequalities, and even more so, the concept of the social gradient in health. The most common understanding was that policy to reduce social inequalities concerned disadvantaged groups. Accordingly, policies and measures would be directed at these groups, rather than addressing the social gradient. A movement towards an increased understanding and adoption of the new, comprehensive public health policy was observed. However, to continue this process, both local and national levels must stay committed to the principles of the act.

The Organisation of Local Mental Health Services in Norway: Evidence, Uncertainty and Policy

Science.gov (United States)

Ramsdal, Helge; Hansen, Gunnar Vold

2017-01-01

This article addresses questions about health authorities' recommendations on the local organisation of services for people with mental health disorders in Norway. Analysis is made of the dynamic relationship between different evaluations, national guidelines and other knowledge that influence the organisation of services. The analysis is based…

Social capital, neighbourhood characteristics and utilisation of local public health services among domestic migrants in China: a cross-sectional study

Science.gov (United States)

Hou, Zhiyuan; Lin, Senlin; Zhang, Donglan

2017-01-01

Objectives We examined the association between structural social capital and public health services use, and explored the modifiable effect of neighbourhood factors on this association among domestic migrants in China. Methods Data were from a 2014 nationally representative cross-sectional sample of domestic migrants aged 15–59 years in China. Survey-weighted logistic regression models were applied to assess the association between structural social capital, measured by participation in social organisations and social activities, and use of public health services. Interaction terms between neighbourhood urban status, neighbourhood composition and social capital were further assessed in the models. Results Migrants who participated in social organisations were more likely to establish health records (OR 1.467, 95% CI 1.201 to 1.793) and receive health education information (OR 1.729, 95% CI 1.484 to 2.016) than those who did not. Participation in social activities was positively associated with establishing health records only in urban communities (OR 1.853, 95% CI 1.060 to 3.239), and it was positively linked to receiving health education information among those living with a higher percentage of local neighbours (OR 1.451, 95% CI 1.044 to 2.017). Conclusions Structural social capital was related to an increased utilisation of local public health services among migrants. The findings of this study provided new evidence for the differential influences of social capital by neighbourhood characteristics in China, which suggested the importance to enhance social capital in rural/suburban communities and communities where the majority of the residents were migrants. PMID:28821507

Examination of human brain tumors in situ with image-localized H-1 MR spectroscopy

International Nuclear Information System (INIS)

Luyten, P.R.; Segebarth, C.; Baleriaux, D.; Den Hollander, J.A.

1987-01-01

Human brain tumors were examined in situ by combined imaging and H-1 MR spectroscopy at 1.5 T. Water-suppressed localized H-1 MR spectra obtained from the brains of normal volunteers show resonances from lactate, N-acetyl aspartate (NAA), creatine, and choline. Several patients suffering from different brain tumors were examined, showing spectral changes in the region of 0.5-1.5 ppm; spectral editing showed that these changes were not due to lactic acid, but to lipid signals. The NAA signal was decreased in the tumors as compared with normal brain. This study shows that H-1 MR spectroscopy can monitor submillimolar changes in chemical composition of human brain tumors in situ

Full-Range Public Health Leadership, Part 1: Quantitative Analysis

Directory of Open Access Journals (Sweden)

Erik L. Carlton

2015-04-01

Full Text Available Background. Workforce and leadership development are central to the future of public health. However, public health has been slow to translate and apply leadership models from other professions and to incorporate local perspectives in understanding public health leadership. Purpose. This study utilized the full-range leadership model in order to examine public health leadership. Specifically, it sought to measure leadership styles among local health department directors and to understand the context of leadership local health departments.Methods. Leadership styles among local health department directors (n=13 were examined using survey methodology. Quantitative analysis methods included descriptive statistics, boxplots, and Pearson bivariate correlations using SPSS v18.0. Findings. Self-reported leadership styles were highly correlated to leadership outcomes at the organizational level. However, they were not related to county health rankings. Results suggest the preeminence of leader behaviors and providing individual consideration to staff as compared to idealized attributes of leaders, intellectual stimulation, or inspirational motivation. Implications. Holistic leadership assessment instruments, such as the Multifactor Leadership Questionnaire (MLQ can be useful in assessing public health leaders approaches and outcomes. Comprehensive, 360-degree reviews may be especially helpful. Further research is needed to examine the effectiveness of public health leadership development models, as well as the extent that public health leadership impacts public health outcomes.

Political ideologies and health-oriented beliefs and behaviors: an empirical examination of strategic issues.

Science.gov (United States)

Murrow, J J; Coulter, R L; Coulter, M K

2000-01-01

The area of health care has been called the most important political issue of the 1990s. Attitudes toward health care reform, increasing health costs, and defensive medical practices have been examined in the public press and by academicians. In addition, a substantial amount of research has been directed toward the improvement of individual personal health due to changes in personal health-related habits and behaviors. To date, there are relatively few studies which have attempted to examine the political tendencies of a nationwide sample of respondents as they relate to personal health-related beliefs and behaviors. This article explores the consumer's views on critical questions relating to health orientations and political tendencies. The results indicate a divergence between the political orientations of respondents and their beliefs and behaviors associated with health and wellness. Implications for policy-makers are discussed.

Modelo assistencial e estratégia saúde da família no nível local: análise de uma experiência Health care model and the family health strategy in the local level: analysis of an experience

Directory of Open Access Journals (Sweden)

Mônica de Castro Maia Senna

2002-01-01

Full Text Available Este artigo examina o impacto produzido pela implantação da estratégia saúde da família na organização dos serviços locais, tomando como referência a experiência do Programa Médico de Família (PMF em Niterói/ RJ. Parte-se do entendimento de que a adoção do PMF foi impulsionada pelo avanço do processo de descentralização setorial em curso no país. Discute-se a perspectiva de inauguração de um novo modelo assistencial com base em três temas centrais: a a relação com o sistema local de saúde; b a questão do controle social; e c a gestão de recursos humanos em saúde. Entende-se que o modelo assistencial não é dado a priori, mas construído no cotidiano das relações políticas entre atores sociais com graus diferenciados de incorporação de suas demandas pelo poder público, o que dá lugar a retraduções diversas do modelo proposto por esta política.This paper examines the impact produced by the implementation of the family's health strategy in the organization of the local services. It takes as reference the experience of the Family Doctor Program (PMF in Niterói/ RJ. According to the study, the adoption of PMF was stimulated by the progress of health decentralization in course in the country. It discusses the perspective of inauguration of a new health care model in basis of three central subjects: a the relationship with the local health system; b the social control and c the administration of human resources in health. The author conclude that the health care model is not given a priori, but it is built in the day by day of the political relationships among social actors with differentiated degrees of incorporation of its demands for the government. In consequence, various retranslations of the model originally proposed arise.

Local adaptations to a global health initiative: penalties for home births in Zambia.

Science.gov (United States)

Greeson, Dana; Sacks, Emma; Masvawure, Tsitsi B; Austin-Evelyn, Katherine; Kruk, Margaret E; Macwan'gi, Mubiana; Grépin, Karen A

2016-11-01

Global health initiatives (GHIs) are implemented across a variety of geographies and cultures. Those targeting maternal health often prioritise increasing facility delivery rates. Pressure on local implementers to meet GHI goals may lead to unintended programme features that could negatively impact women. This study investigates penalties for home births imposed by traditional leaders on women during the implementation of Saving Mothers, Giving Life (SMGL) in Zambia. Forty focus group discussions (FGDs) were conducted across four rural districts to assess community experiences of SMGL at the conclusion of its first year. Participants included women who recently delivered at home (3 FGDs/district), women who recently delivered in a health facility (3 FGDs/district), community health workers (2 FGDs/district) and local leaders (2 FGDs/district). Findings indicate that community leaders in some districts-independently of formal programme directive-used fines to penalise women who delivered at home rather than in a facility. Participants in nearly all focus groups reported hearing about the imposition of penalties following programme implementation. Some women reported experiencing penalties firsthand, including cash and livestock fines, or fees for child health cards that are typically free. Many women who delivered at home reported their intention to deliver in a facility in the future to avoid penalties. While communities largely supported the use of penalties to promote facility delivery, the penalties effectively introduced a new tax on poor rural women and may have deterred their utilization of postnatal and child health care services. The imposition of penalties is thus a punitive adaptation that can impose new financial burdens on vulnerable women and contribute to widening health, economic and gender inequities in communities. Health initiatives that aim to increase demand for health services should monitor local efforts to achieve programme targets in order

El abordaje epidemiológico de las desigualdades en salud a nivel local The epidemiological approach to health inequalities at the local level

Directory of Open Access Journals (Sweden)

Marcio Alazraqui

2007-02-01

Full Text Available Para responder la pregunta ¿cuáles son los usos y limitaciones de la epidemiología en la reducción de las desigualdades en el nivel local? se problematiza el "papel" de la epidemiología. La hipótesis es que la epidemiología produce conocimiento útil a la gestión en el nivel local para el desarrollo de intervenciones dirigidas a la reducción de desigualdades en salud. Estas desigualdades se expresan en un espacio construido por colectivos humanos en procesos sociales e históricos. La producción de conocimiento epidemiológico en el nivel local debe estar orientada a dar soporte a las acciones de un actor social en situación y en un determinado escenario. Por eso se revalorizan los estudios ecológicos y la georreferencia. Esta producción y aplicación de conocimiento es también un fenómeno organizacional. Se entienden las organizaciones como "redes de conversaciones". Se concluye que las acciones estratégicas y las acciones comunicativas de los trabajadores de salud deben constituirse como eje central en la definición de nuevos modelos de cuidado y de gestión comprometidos con la reducción de desigualdades en salud, donde la epidemiología cumple un rol relevante.What are the advantages and limitations of epidemiology for decreasing health inequalities at the local level? To answer this question, the current article discusses the role of epidemiology. The hypothesis is that epidemiology produces useful knowledge for local management of interventions aimed at reducing health inequalities, expressed in spaces built by human communities through social and historical processes. Local production of epidemiological knowledge should support action by social actors in specific situations and contexts, thus renewing the appreciation for ecological designs and georeference studies. Such knowledge output and application are also an organizational phenomenon. Organizations can be seen as "conversational networks". In conclusion, strategic

Health Examination by PET. (1) Cancer Examination

International Nuclear Information System (INIS)

Uno, Koichi

2006-01-01

Cancer examination by positron emission tomography (PET) started in Japan in 1994 and has been rapidly popularized. This paper describes author's experience of the examination in his hospital along the recent Japanese guideline for the PET cancer examination. Fluorodeoxyglucose (FDG) is intravenously injected at 3.7 (or 4.6, for diabetic patients) MBq/kg after 4-5 hr fasting and 40 min later, imaging is conducted with additional delayed scan at 2 hr to reduce the possible false positive. Image is taken by the equipment with PET-specific camera, of which quality assurance (QA) is maintained according to the guideline, and 3D image is constructed by the ordered subset expectation maximization method. Number of examinees during 4.5 years are 18,210 (M/F=9,735/8,475), and 236 (1.3%), together with use of other test measures like ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), biochemical marker and occult blood as well, are found to have cancer of thyroid, large bowel, lung, breast and others. The false negative rate by PET alone is 78/236 (33%) for cancer. PET examination has problems of image reading and specificity of organs, and tasks of informed consent, test cost, increased exchange of information and radiation exposure. However, PET cancer examination will be established as a routine diagnostic tool when the accumulated evidence of early cancer detection is shown useful for improving the survival rate and for reducing the medicare cost. (T.I.)

A comparison of prevalence estimates for selected health indicators and chronic diseases or conditions from the Behavioral Risk Factor Surveillance System, the National Health Interview Survey, and the National Health and Nutrition Examination Survey, 2007-2008.

Science.gov (United States)

Li, Chaoyang; Balluz, Lina S; Ford, Earl S; Okoro, Catherine A; Zhao, Guixiang; Pierannunzi, Carol

2012-06-01

To compare the prevalence estimates of selected health indicators and chronic diseases or conditions among three national health surveys in the United States. Data from adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2007 and 2008 (n=807,524), the National Health Interview Survey (NHIS) in 2007 and 2008 (n=44,262), and the National Health and Nutrition Examination Survey (NHANES) during 2007 and 2008 (n=5871) were analyzed. The prevalence estimates of current smoking, obesity, hypertension, and no health insurance were similar across the three surveys, with absolute differences ranging from 0.7% to 3.9% (relative differences: 2.3% to 20.2%). The prevalence estimate of poor or fair health from BRFSS was similar to that from NHANES, but higher than that from NHIS. The prevalence estimates of diabetes, coronary heart disease, and stroke were similar across the three surveys, with absolute differences ranging from 0.0% to 0.8% (relative differences: 0.2% to 17.1%). While the BRFSS continues to provide invaluable health information at state and local level, it is reassuring to observe consistency in the prevalence estimates of key health indicators of similar caliber between BRFSS and other national surveys. Published by Elsevier Inc.

Do Local Social Hierarchies Matter for Mental Health? A Study of Neighborhood Social Status and Depressive Symptoms in Older Adults

Science.gov (United States)

Cagney, Kathleen A.; Skarupski, Kimberly A.; Everson-Rose, Susan A.; Mendes de Leon, Carlos F.

2016-01-01

Abstract Objectives. Despite a well-established association between relative social position and health, stratification at smaller levels of social organization has received scant attention. Neighborhood is a localized context that has increasing relevance for adults as they age, thus one’s relative position within this type of mesolevel group may have an effect on mental health, independent of absolute level of social and economic resources. We examine the relationship between an older adult’s relative rank within their neighborhoods on two criteria and depressive symptoms. Method. Using data from the Chicago Health and Aging Project, neighborhood relative social position was ascertained for two social domains: income and social reputation (number of neighbors one knows well enough to visit). Using multilevel models, we estimated the effect of relative position within the neighborhood on depressive symptoms, net of absolute level for each domain and average neighborhood level. Results. Higher neighborhood relative rankings on both income and visiting neighbors were associated with fewer depressive symptoms. Although both were modest in effect, the gradient in depressive symptoms was three times steeper for the relative rank of visiting neighbors than for income. Men had steeper gradients than women in both domains, but no race differences were observed. Discussion. These findings suggest that an older adult’s relative position in a local social hierarchy is associated with his/her mental health, net of absolute position. PMID:26333821

Use of fees to fund local public health services in Western Massachusetts.

Science.gov (United States)

Shila Waritu, A; Bulzacchelli, Maria T; Begay, Michael E

2015-01-01

Recent budget cuts have forced many local health departments (LHDs) to cut staff and services. Setting fees that cover the cost of service provision is one option for continuing to fund certain activities. To describe the use of fees by LHDs in Western Massachusetts and determine whether fees charged cover the cost of providing selected services. A cross-sectional descriptive analysis was used to identify the types of services for which fees are charged and the fee amounts charged. A comparative cost analysis was conducted to compare fees charged with estimated costs of service provision. Fifty-nine LHDs in Western Massachusetts. Number of towns charging fees for selected types of services; minimum, maximum, and mean fee amounts; estimated cost of service provision; number of towns experiencing a surplus or deficit for each service; and average size of deficits experienced. Enormous variation exists both in the types of services for which fees are charged and fee amounts charged. Fees set by most health departments did not cover the cost of service provision. Some fees were set as much as $600 below estimated costs. These results suggest that considerations other than costs of service provision factor into the setting of fees by LHDs in Western Massachusetts. Given their limited and often uncertain funding, LHDs could benefit from examining their fee schedules to ensure that the fee amounts charged cover the costs of providing the services. Cost estimates should include at least the health agent's wage and time spent performing inspections and completing paperwork, travel expenses, and cost of necessary materials.

British Association for the Study of Community Dentistry (BASCD) guidance on the statistical aspects of training and calibration of examiners for surveys of child dental health. A BASCD coordinated dental epidemiology programme quality standard.

Science.gov (United States)

Pine, C M; Pitts, N B; Nugent, Z J

1997-03-01

The British Association for the Study of Community Dentistry (BASCD) is responsible for the coordination of locally based surveys of child dental health which permit local and national comparisons between health authorities and regions. These surveys began in 1985/86 in England and Wales, 1987/88 in Scotland and 1993/94 in Northern Ireland. BASCD has taken an increasing lead in setting quality standards in discussion with the NHS Epidemiology Coordinators of the Dental Epidemiology Programme. This paper comprises guidance on the statistical aspects of training and calibration of examiners for these surveys.

Examining the global health arena: strengths and weaknesses of a convention approach to global health challenges.

Science.gov (United States)

Haffeld, Just Balstad; Siem, Harald; Røttingen, John-Arne

2010-01-01

The article comprises a conceptual framework to analyze the strengths and weaknesses of a global health convention. The analyses are inspired by Lawrence Gostin's suggested Framework Convention on Global Health. The analytical model takes a starting-point in events tentatively following a logic sequence: Input (global health funding), Processes (coordination, cooperation, accountability, allocation of aid), Output (definition of basic survival needs), Outcome (access to health services), and Impact (health for all). It then examines to what degree binding international regulations can create order in such a sequence of events. We conclude that a global health convention could be an appropriate instrument to deal with some of the problems of global health. We also show that some of the tasks preceding a convention approach might be to muster international support for supra-national health regulations, negotiate compromises between existing stakeholders in the global health arena, and to utilize WHO as a platform for further discussions on a global health convention. © 2010 American Society of Law, Medicine & Ethics, Inc.

Relationships among providing maternal, child, and adolescent health services; implementing various financial strategy responses; and performance of local health departments.

Science.gov (United States)

Issel, L Michele; Olorunsaiye, Comfort; Snebold, Laura; Handler, Arden

2015-04-01

We explored the relationships between local health department (LHD) structure, capacity, and macro-context variables and performance of essential public health services (EPHS). In 2012, we assessed a stratified, random sample of 195 LHDs that provided data via an online survey regarding performance of EPHS, the services provided or contracted out, the financial strategies used in response to budgetary pressures, and the extent of collaborations. We performed weighted analyses that included analysis of variance, pairwise correlations by jurisdiction population size, and linear regressions. On average, LHDs provided approximately 13 (36%) of 35 possible services either directly or by contract. Rather than cut services or externally consolidating, LHDs took steps to generate more revenue and maximize capacity. Higher LHD performance of EPHS was significantly associated with delivering more services, initiating more financial strategies, and engaging in collaboration, after adjusting for the effects of the Affordable Care Act and jurisdiction size. During changing economic and health care environments, we found that strong structural capacity enhanced local health department EPHS performance for maternal, child, and adolescent health.

Perception of Workforce Skills Needed Among Public Health Professionals in Local Health Departments: Staff Versus Top Executives.

Science.gov (United States)

Ye, Jiali; Leep, Carolyn; Robin, Nathalie; Newman, Sarah

2015-01-01

To examine how top executives and staff from local health departments (LHDs) perceive the importance of various types of workforce skills, and to assess the differences in the perception of the importance of these workforce skills between these 2 groups and among LHDs serving different-sized jurisdictions. Data for this study were drawn from the 2014 Public Health Workforce Interests and Needs Survey (PH WINS) and the 2015 Forces of Change survey. While PH WINS collected data from LHD staff, the Forces of Change survey was administered to LHD top executives. Ratings of perceived importance of workforce skills from LHD staff and top executives were compared. Overall, LHD workers at all levels believe that core competencies are important for their jobs. The perceived importance of these skills differed somewhat across supervisory level (nonsupervisory staff vs supervisory staff vs top executives). Communication was rated as one of the most important skills by all groups. For top executives, ensuring that programs are managed within budget constraints was the most important skill for their employees. However, this skill was rated much lower among staff. Policy development skills were rated to be of lowest importance by LHD leaders and staff. LHD leaders and staff agree on the relative importance of some competencies, although they also show some clear differences in the relative importance that they place on other competencies. It is essential to strengthen the communication between public health leaders and staff regarding the importance of workforce skills. More investigation is needed to assess whether and how gaps in staff competencies are addressed in the workforce development strategies.

Structural and contextual dimensions of Iranian primary health care system at local level.

Science.gov (United States)

Zanganeh Baygi, Mehdi; Seyedin, Hesam; Salehi, Masoud; Jafari Sirizi, Mehdi

2015-01-01

In recent years, family physician plan was established as the main strategy of health system in Iran, while organizational structure of the primary health care system has remained the same as thirty years ago. This study was performed to illustrate structural and contextual dimensions of organizational structure and relationship between them in Iranian primary health care system at local level. A cross-sectional quantitative study was conducted from January to June 2013, during which 121 questionnaires were distributed among senior and junior managers of city health centers at Medical Sciences universities in Iran. Validity of the questionnaire was confirmed by experts (CVI = 0.089 and CVR more than 0.85) and Cronbach α was utilized for reliability (α = 0.904). We used multistage sampling method in this study and analysis of the data was performed by SPSS software using different tests. Local level of primary health care system in Iran had mechanical structure, but in contextual dimensions the results showed different types. There was a significant relationship between structural and contextual dimensions (r = 0.642, P value structural dimensions. Because of the changes in goals and strategies of Iranian health system in recent years, it is urgently recommended to reform the current structure to increase efficiency and effectiveness of the system.

Examining relationships between multiple health risk behaviors, well-being, and productivity.

Science.gov (United States)

Evers, Kerry E; Castle, Patricia H; Prochaska, James O; Prochaska, Janice M

2014-06-01

Traditionally, the concept of health promotion has emphasized the reduction of health risk behaviors to reduce disease and impairment. Well-being research expands this focus to include positive constructs such as thriving, productivity, life-evaluation, and emotional and physical health. The objective of the present study was to examine the relationships between health risk behaviors and specific measures of individual well-being. Participants (N = 790) from 49 states completed a one-time online assessment that included the Life-Evaluation Index, Emotional and Physical Health Ladders, the Health Risk Intervention Assessment, and the Work Productivity and Activity Improvement Questionnaire for General Health. Life Evaluation and physical and emotional health were all inversely related to the number of health risk behaviors, with higher well-being scores associated with lower number of risk behaviors. Across the three Life Evaluation categories (Suffering, Struggling, and Thriving) the number of health risk behaviors decreased, productivity loss decreased, and emotional and physical health increased. The results add to previous research on how reducing multiple health risk behaviors can be combined with well-being, i.e., an emphasis on increasing life-evaluation, emotional and physical health, better functioning, and productivity.

Further examination of predictors of turnover intention among mental health professionals.

Science.gov (United States)

Yanchus, N J; Periard, D; Osatuke, K

2017-02-01

WHAT IS KNOWN ON THE SUBJECT?: When mental health professionals leave organizations, detrimental effects on quality of patient care occur. Reasons for leaving include incivility, lack of autonomy, perceptions of unfair treatment and feeling psychologically unsafe at work. This paper sought to investigate additional reasons why mental health professionals intend to quit or to cognitively withdraw from their jobs. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Past research on this topic is limited in its scope and data. Mainly fragmented evidence is available about predictors of job satisfaction and turnover intention (i.e. different mental health occupations examined in separate studies). Only two existing studies that examined broader mental health provider groups were limited by including few workforce settings, small sample sizes and insufficiently rigorous statistical analyses. We examined four occupations (mental health nurses, social workers, psychologists and psychiatrists), each represented through a large sample in multiple settings, all within one large healthcare network with complex patients. Our contribution is finding additional predictors (supervisory support, emotional exhaustion) of job satisfaction/turnover intention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizations can consider using culture change initiatives to increase civility at work; this includes leadership support and role modelling of workplace behaviours. Leaders should monitor staffing levels and high workloads to pre-empt emotional exhaustion, which predicts turnover. Hiring and training supervisors should involve not only technical expertise, but also 'soft skills' necessary for creating civil and supportive work environments. Leaders and managers should use employee feedback data (e.g. organizational surveys) to learn about the workplace environments, and address areas of employees' concern. Introduction Given the global shortage of mental health professionals, high turnover

Forecasting the Revenues of Local Public Health Departments in the Shadows of the "Great Recession".

Science.gov (United States)

Reschovsky, Andrew; Zahner, Susan J

2016-01-01

The ability of local health departments (LHD) to provide core public health services depends on a reliable stream of revenue from federal, state, and local governments. This study investigates the impact of the "Great Recession" on major sources of LHD revenues and develops a fiscal forecasting model to predict revenues to LHDs in one state over the period 2012 to 2014. Economic forecasting offers a new financial planning tool for LHD administrators and local government policy makers. This study represents a novel research application for these econometric methods. Detailed data on revenues by source for each LHD in Wisconsin were taken from annual surveys conducted by the Wisconsin Department of Health Services over an 8-year period (2002-2009). A forecasting strategy appropriate for each revenue source was developed resulting in "base case" estimates. An analysis of the sensitivity of these revenue forecasts to a set of alternative fiscal policies by the federal, state, and local governments was carried out. The model forecasts total LHD revenues in 2012 of $170.5 million (in 2010 dollars). By 2014, inflation-adjusted revenues will decline by $8 million, a reduction of 4.7%. Because of population growth, per capita real revenues of LHDs are forecast to decline by 6.6% between 2012 and 2014. There is a great deal of uncertainty about the future of federal funding in support of local public health. A doubling of the reductions in federal grants scheduled under current law would result in an additional $4.4 million decline in LHD revenues in 2014. The impact of the Great Recession continues to haunt LHDs. Multiyear revenue forecasting offers a new financial tool to help LHDs better plan for an environment of declining resources. New revenue sources are needed if sharp drops in public health service delivery are to be avoided.

Waste dumps in local communities in developing countries and hidden danger to health.

Science.gov (United States)

Anetor, Gloria O

2016-07-01

The rapid industrialisation and urbanisation fuelled by a fast-growing population has led to the generation of a huge amount of waste in most communities in developing countries. The hidden disorders and health dangers in waste dumps are often ignored. The waste generated in local communities is usually of a mixed type consisting of domestic waste and waste from small-scale industrial activities. Among these wastes are toxic metals, lead (Pb), cadmium (Cd), arsenic (As), mercury (Hg), halogenated organic compounds, plastics, remnants of paints that are themselves mixtures of hazardous substances, hydrocarbons and petroleum product-contaminated devices. Therefore, there is the urgent need to create an awareness of the harmful health effect of toxic wastes in developing countries, especially Nigeria. This is a review aimed at creating awareness on the hidden dangers of waste dumps to health in local communities in developing countries. Many publications in standard outlets use the following keywords: cancer, chemical toxicity, modern environmental health hazards, waste management and waste speciation in PubMed, ISI, Toxbase environmental digest, related base journals, and some standard textbooks, as well as the observation of the researcher between 1959 and 2014. Studies revealed the preponderance of toxic chemicals such as Pb, Cd, As and Hg in dump sites that have the risk of entering food chain and groundwater supplies, and these can give rise to endemic malnutrition and may also increase susceptibility to mutagenic substances, thereby increasing the incidence of cancer in developing countries. Industrialisation and urbanisation have brought about a change in the waste that is generated in contemporary communities in developing countries. Therefore, there is the need to embrace speciation and sound management of waste, probably including bioremediation. The populations in the local communities need regulatory agencies who are health educators as positive change

Immigration, Statecraft and Public Health: The 1920 Aliens Order, Medical Examinations and the Limitations of the State in England

Science.gov (United States)

Taylor, Becky

2016-01-01

This article considers the medical measures of the 1920 Aliens Order barring aliens from Britain. Building on existing local and port public health inspection, the requirement for aliens to be medically inspected before landing significantly expanded the duties of these state agencies and necessitated the creation of a new level of physical infrastructure and administrative machinery. This article closely examines the workings and limitations of alien medical inspection in two of England’s major ports—Liverpool and London—and sheds light on the everyday working of the Act. In doing so it reflects on the ambitions, actions and limitations of the state and so extends research by historians of the nineteenth and early twentieth century on the disputed histories of public health and the complexities of statecraft. Overall it suggests the importance of developing nuanced understandings of the gaps and failures arising from the translation of legislation into practice. PMID:27482146

An analysis of local government health policy against state priorities and a social determinants framework.

Science.gov (United States)

Browne, Geoffrey R; Davern, Melanie T; Giles-Corti, Billie

2016-04-01

Victorian local governments are required to develop Municipal Public Health and Wellbeing Plans that incorporate state-level health planning priorities and address the social determinants of health. This paper describes a novel method for evaluating councils' performance against these requirements. Deductive content analysis was used to categorise all actions in 14 local government MPHWPs against Victorian state priorities as well as against social determinants of health policy areas. More than 1,000 actions were identified. However, fewer than half directly addressed a state priority, with many actions addressing policy areas known to be broader determinants of health. In particular, there was a marked focus on leisure and culture, and on building social cohesion through changes to living and working conditions. Councils are working beyond state priorities and there was a clear emphasis on addressing the diverse upstream 'causes of the causes' of health, rather than health promotion behaviour change programs. The approach for data analysis and presentation provides a useful method for rapid appraisal of health and wellbeing actions relative to councils', and the State's, responsibility and efficacy in public health. © 2015 Public Health Association of Australia.

Challenges in covering health disparities in local news media: an exploratory analysis assessing views of journalists.

Science.gov (United States)

Wallington, Sherrie Flynt; Blake, Kelly D; Taylor-Clark, Kalahn; Viswanath, K

2010-10-01

News coverage of health topics influences knowledge, attitudes, and behaviors at the individual level, and agendas and actions at the institutional and policy levels. Because disparities in health often are the result of social inequalities that require community-level or policy-level solutions, news stories employing a health disparities news frame may contribute to agenda-setting among opinion leaders and policymakers and lead to policy efforts aimed at reducing health disparities. This study objective was to conduct an exploratory analysis to qualitatively describe barriers that health journalists face when covering health disparities in local media. Between June and October 2007, 18 journalists from television, print, and radio in Boston, Lawrence, and Worcester, Massachusetts, were recruited using a purposive sampling technique. In-depth, semi-structured interviews were conducted by telephone, and the crystallization/immersion method was used to conduct a qualitative analysis of interview transcripts. Our results revealed that journalists said that they consider several angles when developing health stories, including public impact and personal behavior change. Challenges to employing a health disparities frame included inability to translate how research findings may impact different socioeconomic groups, and difficulty understanding how findings may translate across racial/ethnic groups. Several journalists reported that disparities-focused stories are "less palatable" for some audiences. This exploratory study offers insights into the challenges that local news media face in using health disparities news frames in their routine coverage of health news. Public health practitioners may use these findings to inform communication efforts with local media in order to advance the public dialogue about health disparities.

Role of mammography in evaluating residual cancer of locally advanced breast carcinoma after neo-adjuvant chemotherapy : compared with clinical examination

International Nuclear Information System (INIS)

Choi, Byoung Wook; Kim, Eun Kyung; Oh, Ki Keun; Cho, Jae Min; Chung, Hyun Cheol; Lee, Byung Chan; Lee, Kyong Sik; Lee, Yong Hee

1997-01-01

To compare the usefulness of mammography and clinical examination in the evaluation of residual cancer of locally-advanced breast carcinoma treated with neoadjuvant chemotherapy. Among 67 patients with locally advanced breast carcinoma who were treated with neoadjuvant chemotherapy, 18, aged 35-67 (mean, 48) years, underwent mammography before and after this therapy. The 18 sets of mammographs were analyzed retrospectively and compared with the results of clinical examination based on histologic diagnosis. On histologic examinations, 16 of 18 patients (89%) were found to have residual cancer, but in one of these 16, mammography did not show this same result. On mammography, residual cancer was found in 16 patients, but in one of this group, histologic examination did not reveal the same finding. Clinically, a complete response was shown by four patients, and a partial response by 11 ; three showed no response. On histolgogic examination, three of the four patients with complete clinical response were found to have residual cancer. Post-treatment mammographic findings showed that 11 patients had measurable mass ; all of these had residual cancer (positive predictive value : 100%). However, five of seven patients in whom no measurable mass was evident also had residual cancer. Seven of 8 patients in whom microcalcifications were seen on mammography were found to have residual cancer (positive predictive value : 88%). The sensitivity of mammography in predicting residual cancer was greater than that of clinical examination (94% vs 81%), even when microscopic residual cancer was considered as a complete response (92% vs 77%). The specificity of mammography was the same as that of clinical examination(50% vs 50%, 20% vs 20%). In evaluating residual cancer of locally-advanced breast carcinoma after neoadjuvant chemotheragy, mammography is more accurate and informative than clincal examination. In predicting residual cancer, however, it is not accurate enough to replace

Local sustainability and scaling up for user fee exemptions: medical NGOs vis-à-vis health systems.

Science.gov (United States)

Olivier de Sardan, Jean-Pierre; Diarra, Aïssa; Koné, Félix Yaouaga; Yaogo, Maurice; Zerbo, Roger

2015-01-01

Free healthcare obviously works when a partner from abroad supplies a health centre or a health district with medicines and funding on a regular basis, provides medical, administrative and managerial training, and gives incentive bonuses and daily subsistence allowances to staff. The experiments by three international NGO in Burkina Faso, Mali and Niger have all been success stories. But withdrawing NGO support means that health centres that have enjoyed a time of plenty under NGO management will return to the fold of health centres run by the state in its present condition and the health system in its present condition, with the everyday consequences of late reimbursements and stock shortages. The local support given by international NGOs has more often than not an effect of triggering an addiction to aid instead of inducing local sustainability without infusion. In the same way, scaling up to the entire country a local pilot experiment conducted under an NGO involves its insertion into a national bureaucratic machine with its multiple levels, all of which are potential bottlenecks. Only experiments carried out under the "ordinary" management of the state are capable of laying bare the problems associated with this process. Without reformers 'on the inside' (within the health system itself and among health workers), no real reform of the health system induced by reformers 'from the outside' can succeed.

[Boundaries of the autonomy of local health administration: innovation, creativity and evidence-based decision-making].

Science.gov (United States)

Silva, Silvio Fernandes da; Souza, Nathan Mendes; Barreto, Jorge Otávio Maia

2014-11-01

The scope of this article was to identify the boundaries of the autonomy of local administration in the context of the federal pact in the Brazilian Unified Health System and the importance and potential for promoting innovation, creativity and evidence-based decision-making by local governments. The methodology used was to ask questions that favored dialogue with the specific literature to identify the influence of centrally-formulated policies in spaces of local autonomy and then to identify strategies to foster innovation, creativity and the systematic use of evidence-based research in health policy implementation. A gradual reduction in municipal decision-making autonomy was detected due to increased financial commitment of the municipalities resulting from responsibilities assumed, albeit with the possibility of reverting this trend in the more recent context. Some determinants and challenges for the dissemination of innovative practices were analyzed and some relevant national and international experiences in this respect were presented. The conclusion drawn is that it is possible to make local decision-making more effective provided that initiatives are consolidated to promote this culture and the formulation and implementation of evidence-based health policies.

How can a policy foster local pharmaceutical production and still protect public health? Lessons from the health-industry complex in Brazil.

Science.gov (United States)

da Fonseca, Elize Massard

2018-04-01

The global health community is increasingly advocating for the local production of pharmaceuticals in developing countries as a way to promote technology transfer, capacity building and improve access to medicines. However, efforts to advance drug manufacturing in these countries revive an old dilemma of fostering technological development versus granting access to social services, such as healthcare. This paper explores the case of Brazil, a country that has developed large-scale health-inspired industrial policies, but is, yet, little understood. Brazil's experience suggests that progressive healthcare bureaucrats can create innovative practices for technology and knowledge transfers. It also demonstrates that highly competitive pharmaceutical firms can collaborate with each other, if a government provides them the right incentives. Reforming regulatory policies is crucial for guaranteeing high-quality products in developing countries, but governments must play a crucial role in supporting local firms to adapt to these regulations. These findings send a strong message to global health policymakers and practitioners on the conditions to create a suitable environment for local production of medical products.

National health and nutrition examination survey: plan and operations, 1999-2010.

Science.gov (United States)

Zipf, George; Chiappa, Michele; Porter, Kathryn S; Ostchega, Yechiam; Lewis, Brenda G; Dostal, Jennifer

2013-08-01

Background-Starting in 1999, the National Health and Nutrition Examination Survey (NHANES) became a continuous, ongoing annual survey of the noninstitutionalized civilian resident population of the United States. A continuous survey allowed content to change to meet emerging needs. Objective-This report describes how NHANES for 1999-2010 was designed and implemented. NHANES is a national survey designed to provide national estimates on various health-related topics. Methods-The survey used in-person face-to-face interviews and physical examinations for data collection. Approximately 5,000 people per year participated in NHANES. The 5,000 people surveyed each year are representative of the entire U.S. population. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Malaria in rural Burkina Faso: local illness concepts, patterns of traditional treatment and influence on health-seeking behaviour

Directory of Open Access Journals (Sweden)

Kouyaté Bocar

2007-08-01

Full Text Available Abstract Background The literature on health care seeking behaviour in sub-Saharan Africa for children suffering from malaria is quite extensive. This literature, however, is predominately quantitative and, inevitably, fails to explore how the local concepts of illness may affect people's choices. Understanding local concepts of illness and their influence on health care-seeking behaviour can complement existing knowledge and lead to the development of more effective malaria control interventions. Methods In a rural area of Burkina Faso, four local concepts of illness resembling the biomedical picture of malaria were described according to symptoms, aetiology, and treatment. Data were collected through eight focus group discussions, 17 semi-structured interviews with key informants, and through the analysis of 100 verbal autopsy questionnaires of children under-five diagnosed with malaria. Results Sumaya, dusukun yelema, kono, and djoliban were identified as the four main local illness concepts resembling respectively uncomplicated malaria, respiratory distress syndrome, cerebral malaria, and severe anaemia. The local disease categorization was found to affect both treatment and provider choice. While sumaya is usually treated by a mix of traditional and modern methods, dusukun yelema and kono are preferably treated by traditional healers, and djoliban is preferably treated in modern health facilities. Besides the conceptualization of illness, poverty was found to be another important influencing factor of health care-seeking behaviour. Conclusion The findings complement previous evidence on health care-seeking behaviour, by showing how local concepts of illness strongly influence treatment and choice of provider. Local concepts of illness need to be considered when developing specific malaria control programmes.

Performing Compliance: The Work of Local Policy Workers during the Implementation of National Health Promotion Guidelines

Science.gov (United States)

Wimmelmann, Camila Lawaetz

2017-01-01

Guidelines are increasingly used to regulate how local authorities engage in practices. Focusing on the Danish national health promotion guidelines, this article reveals that the local policy workers did not implement the guidelines as proposed. Using a dramaturgical framework, it illustrates how the local policy workers front-staged some…

The Journey toward Voluntary Public Health Accreditation Readiness in Local Health Departments: Leadership and Followership Theories in Action.

Science.gov (United States)

Carman, Angela L

2015-01-01

Local health department directors' intent on getting their organizations ready for accreditation must embrace the blurring of leader/follower lines and create an accreditation readiness team fueled not by traditional leader or follower roles but by teamship.

The Journey toward Voluntary Public Health Accreditation Readiness in Local Health Departments: Leadership and Followership Theories in Action

OpenAIRE

Carman, Angela L.

2015-01-01

Local health department directors’ intent on getting their organizations ready for accreditation must embrace the blurring of leader/follower lines and create an accreditation readiness team fueled not by traditional leader or follower roles but by teamship.

Health Insurance Status as a Barrier to Ideal Cardiovascular Health for U.S. Adults: Data from the National Health and Nutrition Examination Survey (NHANES.

Directory of Open Access Journals (Sweden)

Michael A McClurkin

Full Text Available Little is known about the association between cardiovascular (CV health and health insurance status. We hypothesized that U.S. adults without health insurance coverage would have a lower likelihood of ideal cardiovascular health.Using National Health and Nutrition Examination Survey (NHANES data from 2007-2010, we examined the relationship between health insurance status and ideal CV health in U.S. adults aged ≥19 years and <65 (N = 3304. Ideal CV health was defined by the American Heart Association (AHA as the absence of clinically manifested CV disease and the simultaneous presence of 6-7 "ideal" CV health factors and behaviors. Logistic regression modeling was used to determine the relationship between health insurance status and the odds of ideal CV health. Of the U.S. adult population, 5.4% attained ideal CV health, and 23.5% were without health insurance coverage. Those without health insurance coverage were more likely to be young (p<0.0001, male (p<0.0001, non-white (p<0.0001, with less than a high school degree (p<0.0001, have a poverty-to-income ratio less than 1 (p<0.0001 and unemployed (p<0.0001 compared to those with coverage. Lack of health insurance coverage was associated with a lower likelihood of ideal CV health; however, this relationship was attenuated by socioeconomic status.U.S. adults without health insurance coverage are less likely to have ideal CV health. Population-based strategies and interventions directed at the community-level may be one way to improve overall CV health and reach this at-risk group.

The Impact of State Preemption of Local Smoking Restrictions on Public Health Protections and Changes in Social Norms

Directory of Open Access Journals (Sweden)

Paul D. Mowery

2012-01-01

Full Text Available Introduction. Preemption is a legislative or judicial arrangement in which a higher level of government precludes lower levels of government from exercising authority over a topic. In the area of smoke-free policy, preemption typically takes the form of a state law that prevents communities from adopting local smoking restrictions. Background. A broad consensus exists among tobacco control practitioners that preemption adversely impacts tobacco control efforts. This paper examines the effect of state provisions preempting local smoking restrictions in enclosed public places and workplaces. Methods. Multiple data sources were used to assess the impact of state preemptive laws on the proportion of indoor workers covered by smoke-free workplace policies and public support for smoke-free policies. We controlled for potential confounding variables. Results. State preemptive laws were associated with fewer local ordinances restricting smoking, a reduced level of worker protection from secondhand smoke, and reduced support for smoke-free policies among current smokers. Discussion. State preemptive laws have several effects that could impede progress in secondhand smoke protections and broader tobacco control efforts. Conclusion. Practitioners and advocates working on other public health issues should familiarize themselves with the benefits of local policy making and the potential impact of preemption.

CDC/NACCHO Accreditation Support Initiative: advancing readiness for local and tribal health department accreditation.

Science.gov (United States)

Monteiro, Erinn; Fisher, Jessica Solomon; Daub, Teresa; Zamperetti, Michelle Chuk

2014-01-01

Health departments have various unique needs that must be addressed in preparing for national accreditation. These needs require time and resources, shortages that many health departments face. The Accreditation Support Initiative's goal was to test the assumption that even small amounts of dedicated funding can help health departments make important progress in their readiness to apply for and achieve accreditation. Participating sites' scopes of work were unique to the needs of each site and based on the proposed activities outlined in their applications. Deliverables and various sources of data were collected from sites throughout the project period (December 2011-May 2012). Awardees included 1 tribal and 12 local health departments, as well as 5 organizations supporting the readiness of local and tribal health departments. Sites dedicated their funding toward staff time, accreditation fees, completion of documentation, and other accreditation readiness needs and produced a number of deliverables and example documents. All sites indicated that they made accreditation readiness gains that would not have occurred without this funding. Preliminary evaluation data from the first year of the Accreditation Support Initiative indicate that flexible funding arrangements may be an effective way to increase health departments' accreditation readiness.

A Case Study on the Implementation of Local Health Insurance Benefit Packages

Directory of Open Access Journals (Sweden)

Supriyantoro Supriyantoro

2015-06-01

Full Text Available Background: The variation of benefit packages implemented by some local social health insurance schemes (Jamkesda become an important issue in the effort to integrating them into National Health Insurance (JKN. This study aims to describe implementation of Jamkesda’s benefit packages as a basic consideration in integration to JKN. Methods: Design of this study is case study with qualitative and quantitative aproaches, conducted 2013–2014 in all of districts/cities which already have Jamkesda. Primary and secondary data was collected. Primary data has been collected by focus group discussion, interview, observation, and self administered questioner. Secondary data collected from many sources such as articles, journal, official document, statistics data, and others. Results:Of this study show there is no significant relationship between fiscal capacity group and benefit packages (continuity correction, p value = 0.065. But, districts/cities with high fiscal capacity (high and very high seem likely to have probability 1,920 bigger than lower capacity districts/cities in giving equal or more benefit than existing national social health insurance (Jamkesmas (Mantel-Haenszel, Common Odds Ratio Estimates = 1.920; Confidence Interval 95% =1.008–3.658; asymp. Sig 2 sided = 0.047. There is variation of benefit packages between each Jamkesda. Qualitative results show there are many obstacles faced in giving benefit health services, such as limited community accessibility to health facilities, the absence of health workforce, and lack of health infrastructure and equipment. Recomendation: This study recommends to set a national minimum benefit packages and equalizing percetion of local decission maker.

Health Promotion in Danish schools: local priorities, policies and practices

DEFF Research Database (Denmark)

Simovska, Venka; Nordin, Lone Lindegard; Madsen, Katrine Dahl

2016-01-01

are translated into national and local practices? What gets “lost in translation”, and what is added? The purpose of this paper is to contribute to the body of knowledge and dialogue concerning these translation processes. The study sought to identify the gaps, tensions, challenges and possibilities associated......Health and wellbeing are repeatedly identified among the greatest global challenges facing societies. As such, schools have a responsibility to support and develop children’s competences and their commitment to dealing with these challenges in socially responsible and imaginative ways. The field...... with the drive to increase the quality and effectiveness of health promotion in schools while remaining loyal to the main principles of the critical, socio-ecological paradigm of the Health Promoting Schools initiative (Green and Tones, 2010). In the following, we first present the conceptual framework, context...

eHealth Literacy and Partner Involvement in Treatment Decision Making for Men With Newly Diagnosed Localized Prostate Cancer.

Science.gov (United States)

Song, Lixin; Tatum, Kimberly; Greene, Giselle; Chen, Ronald C

2017-03-01

To examine how the eHealth literacy of partners of patients with newly diagnosed prostate cancer affects their involvement in decision making, and to identify the factors that influence their eHealth literacy.
. Cross-sectional exploratory study.
. North Carolina.
. 142 partners of men with newly diagnosed localized prostate cancer. 
. A telephone survey and descriptive and multiple linear regression analyses were used.
. The partners' eHealth literacy, involvement in treatment decision making, and demographics, and the health statuses of the patients and their partners. 
. Higher levels of eHealth literacy among partners were significantly associated with their involvement in getting a second opinion, their awareness of treatment options, and the size of the social network they relied on for additional information and support for treatment decision making for prostate cancer. The factor influencing eHealth literacy was the partners' access to the Internet for personal use, which explained some of the variance in eHealth literacy.
. This study described how partners' eHealth literacy influenced their involvement in treatment decision making for prostate cancer and highlighted the influencing factors (i.e., partners' access to the Internet for personal use).
. When helping men with prostate cancer and their partners with treatment decision making, nurses need to assess eHealth literacy levels to determine whether nonelectronically based education materials are needed and to provide clear instructions on how to use eHealth resources.

Examining Reports of Mental Health in Adults with Williams Syndrome

Science.gov (United States)

Stinton, Chris; Tomlinson, Katie; Estes, Zachary

2012-01-01

Prior research suggests that individuals with Williams syndrome (WS) have a disposition towards anxiety. Information regarding this is typically derived from parents and carers. The perspectives of the individuals with WS are rarely included in research of this nature. We examined the mental health of 19 adults with WS using explicit (psychiatric…

[Evolution of worker's health in the social security medical examination in Brazil].

Science.gov (United States)

Pinto Júnior, Afrânio Gomes; Braga, Ana Maria Cheble Bahia; Roselli-Cruz, Amadeu

2012-10-01

In order to analyze the practice of the social security medical examination starting from the introduction of the worker's health paradigms, data was gathered on the granting of social security disability benefits to assess worker illness based on notification of work-related accidents in the cement industries of Rio de Janeiro. From 2007 to 2009 there was only one notification, which involved a worker handling toxic waste instead of the energy matrix. However, the analysis revealed sources and mechanisms of illness overlooked in the social security medical examination, which is still focused on the one-cause-only logic of occupational medicine. To achieve the worker's health paradigms, changes are required to alter the way of conducting the social security medical examination, by re-establishing partnerships, training human resources, adopting epidemiological indicators, as well as setting and assessing social security goals that transcend the mere granting of disability benefits.

Examining transgender health through the International Classification of Functioning, Disability, and Health's (ICF) Contextual Factors.

Science.gov (United States)

Jacob, Melissa; Cox, Steven R

2017-12-01

For many transgender individuals, medical intervention is necessary to live as their desired gender. However, little is known about Contextual Factors (i.e., Environmental and Personal) that may act as facilitators and barriers in the health of transgender individuals. Therefore, this paper sought to examine Contextual Factors of the World Health Organization's International Classification of Functioning, Disability, and Health that may facilitate or negatively impact the physical, psychological, and social functioning of transgender individuals. A literature review was conducted to identify Environmental and Personal Factors that may influence transgender individuals' physical, psychological, and social functioning. Seven electronic databases were searched. In total, 154 records were reviewed, and 41 articles and other records met inclusion criteria. Three general themes emerged for Environmental Factors: family and social networks, education, and health care. Three general themes also emerged for Personal Factors: socioeconomic status, race, and age. Transgender individuals benefit from gender-affirming services, improved family and social support systems, and competent provider care. Educational training programs, including medical curricula or workshops, might provide the greatest benefit in improving transgender health by increasing the knowledge and cultural competency of health professionals working with this population. Given the diversity of gender expression, differences in lived experiences, and potential for enduring persistent "double discrimination" due to the intersectional relationships between socioeconomic status, race, and/or age, health professionals must approach transgender health using a holistic lens such as the World Health Organization's International Classification of Functioning, Disability, and Health.

Changes in health selection of obesity among Mexican immigrants: a binational examination.

Science.gov (United States)

Ro, Annie; Fleischer, Nancy

2014-12-01

Health selection is often measured by comparing the health of more recent immigrants to the native born of their new host country. However, this comparison fails to take into account two important factors: (1) that changes in the health profile of sending countries may impact the health of immigrants over time, and (2) that the best comparison group for health selection would be people who remain in the country of origin. Obesity represents an important health outcome that may be best understood by taking into account these two factors. Using nationally-representative datasets from Mexico and the US, we examined differences in obesity-related health selection, by gender, in 2000 and 2012. We calculated prevalence ratios from log-binomial models to compare the risk of obesity among recent immigrants to the US to Mexican nationals with varying likelihood of migration, in order to determine changes in health selection over time. Among men in 2000, we found little difference in obesity status between recent immigrants to the US and Mexican non-migrants. However, in 2012, Mexican men who were the least likely to migrate had higher obesity prevalence than recent immigrants, which may reflect emerging health selection. The trends for women, however, indicated differences in obesity status between recent Mexican immigrants and non-migrants at both time points. In both 2000 and 2012, Mexican national women had significantly higher obesity prevalence than recent immigrant women, with the biggest difference between recent immigrants and Mexican women who were least likely to migrate. There was also indication that selection increased with time for women, as the differences between Mexican nationals and recent immigrants to the US grew from 2000 to 2012. Our study is among the first to use a binational dataset to examine the impact of health selectivity, over time, on obesity. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Journey toward Voluntary Public Health Accreditation Readiness in Local Health Departments: Leadership and Followership Theories in Action

Directory of Open Access Journals (Sweden)

Angela eCarman

2015-03-01

Full Text Available Local health department directors’ intent on getting their organizations ready for accreditation must embrace the blurring of leader/follower lines and create an accreditation readiness team fueled not by traditional leader or follower roles but by teamship.

Public health agendas addressing violence against rural women - an analysis of local level health services in the State of Rio Grande do Sul, Brazil.

Science.gov (United States)

da Costa, Marta Cocco; Lopes, Marta Julia Marques; Soares, Joannie dos Santos Fachinelli

2015-05-01

This study analyses health managers' perceptions of local public health agendas addressing violence against rural women in municipalities in the southern part of the State Rio Grande do Sul in Brazil. It consists of an exploratory descriptive study utilizing a qualitative approach. Municipal health managers responsible for planning actions directed at women's health and primary health care were interviewed. The analysis sought to explore elements of programmatic vulnerability related to violence in the interviewees' narratives based on the following dimensions of programmatic vulnerability: expression of commitment, transformation of commitment into action, and planning and coordination. It was found that local health agendas directed at violence against rural women do not exist. Health managers are therefore faced with the challenge of defining lines of action in accordance with the guidelines and principles of the SUS. The repercussions of this situation are expressed in fragile comprehensive services for these women and programmatic vulnerability.

Collaboration between practice, policy and research in local public health in the Netherlands.

Science.gov (United States)

Jansen, Maria W J; De Vries, Nanne K; Kok, Gerjo; Van Oers, Hans A M

2008-05-01

The collaboration between policy, practice, and research in local public health was studied in a multiple case study. The assumption is that collaboration will result in more solid evidence and higher quality standards in public health. First, collaboration barriers were studied by analysing the work cycles of the three domains, which are considered to operate as niches. Actors at the administrative, institutional, and individual levels were identified. Theories that describe processes of the convergence of the three niches through practical strategies were sought. Finally, the application of the practical strategies in six cases was evaluated. When administrative, institutional, and individual changes develop in a similar fashion and in parallel with each other, the likelihood of successful collaboration that goes beyond the initial period is greater. The findings suggest that organisational development (OD) strategies that address collaboration at the institutional level make a relatively strong contribution. Top level consultations just after local elections, investments in OD strategies and a new kind of accountability in public health are recommended. The assumption that successful collaboration contributes to enhanced effectiveness, efficiency, and efficacy of public health could not yet be unequivocally confirmed.

Use of Local Health Department Websites: A Study of E-Government Adoption and Diffusion

Science.gov (United States)

Aaltonen, Pamela Massie

2013-01-01

Two distinct but converging activities have the potential to alter the way local public health departments conduct business. These activities are the emergence of e-government and the addition of preparedness as a basic function of the public health system. Preparedness implies timely collaboration with government entities, community partners and…

Social capital, neighbourhood characteristics and utilisation of local public health services among domestic migrants in China: a cross-sectional study.

Science.gov (United States)

Hou, Zhiyuan; Lin, Senlin; Zhang, Donglan

2017-08-18

We examined the association between structural social capital and public health services use, and explored the modifiable effect of neighbourhood factors on this association among domestic migrants in China. Data were from a 2014 nationally representative cross-sectional sample of domestic migrants aged 15-59 years in China. Survey-weighted logistic regression models were applied to assess the association between structural social capital, measured by participation in social organisations and social activities, and use of public health services. Interaction terms between neighbourhood urban status, neighbourhood composition and social capital were further assessed in the models. Migrants who participated in social organisations were more likely to establish health records (OR 1.467, 95% CI 1.201 to 1.793) and receive health education information (OR 1.729, 95% CI 1.484 to 2.016) than those who did not. Participation in social activities was positively associated with establishing health records only in urban communities (OR 1.853, 95% CI 1.060 to 3.239), and it was positively linked to receiving health education information among those living with a higher percentage of local neighbours (OR 1.451, 95% CI 1.044 to 2.017). Structural social capital was related to an increased utilisation of local public health services among migrants. The findings of this study provided new evidence for the differential influences of social capital by neighbourhood characteristics in China, which suggested the importance to enhance social capital in rural/suburban communities and communities where the majority of the residents were migrants. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A strategic approach to workforce development for local public health.

Science.gov (United States)

Bryant, Beverley; Ward, Megan

2017-11-09

In 2009, Peel Public Health set a vision to transform the work of public health from efficient delivery of public health services as defined by provincial mandate to the robust analysis of the health status of the local population and selection and implementation of programming to achieve best health outcomes. A strategic approach to the workforce was a key enabler. PPH is a public health unit in Ontario that serves 1.4 million people. An organization-wide strategic workforce development program was instituted. It is theory-based, evidence-informed and data-driven. A first step was a conceptual framework, followed by interventions in workforce planning, human resources management, and capacity development. The program was built on evidence reviews, theory, and public health core competencies. Interventions spread across the employee work-life span. Capacity development based on the public health core competencies is a main focus, particularly analytical capacity to support decision-making. Employees gain skill and knowledge in comprehensive population health. Leadership evolves as work shifts to the analysis of health status and development of interventions. Effective human resource processes ensure appropriate job design, recruitment and orientation. Analysis of the workforce leads to vigorous employee development to ensure a strong pool of potential leadership successors. Theory, research evidence, and data provide a robust foundation for workforce development. Competencies are important inputs to job descriptions, recruitment, training, and human resource processes. A comprehensive workforce development strategy enables the development of a skilled workforce capable of responding to the needs of the population it serves.

A comparative study of 11 local health department organizational networks.

Science.gov (United States)

Merrill, Jacqueline; Keeling, Jonathan W; Carley, Kathleen M

2010-01-01

Although the nation's local health departments (LHDs) share a common mission, variability in administrative structures is a barrier to identifying common, optimal management strategies. There is a gap in understanding what unifying features LHDs share as organizations that could be leveraged systematically for achieving high performance. To explore sources of commonality and variability in a range of LHDs by comparing intraorganizational networks. We used organizational network analysis to document relationships between employees, tasks, knowledge, and resources within LHDs, which may exist regardless of formal administrative structure. A national sample of 11 LHDs from seven states that differed in size, geographic location, and governance. Relational network data were collected via an on-line survey of all employees in 11 LHDs. A total of 1062 out of 1239 employees responded (84% response rate). Network measurements were compared using coefficient of variation. Measurements were correlated with scores from the National Public Health Performance Assessment and with LHD demographics. Rankings of tasks, knowledge, and resources were correlated across pairs of LHDs. We found that 11 LHDs exhibited compound organizational structures in which centralized hierarchies were coupled with distributed networks at the point of service. Local health departments were distinguished from random networks by a pattern of high centralization and clustering. Network measurements were positively associated with performance for 3 of 10 essential services (r > 0.65). Patterns in the measurements suggest how LHDs adapt to the population served. Shared network patterns across LHDs suggest where common organizational management strategies are feasible. This evidence supports national efforts to promote uniform standards for service delivery to diverse populations.

A rural CT scanner: evaluating the effect on local health care

International Nuclear Information System (INIS)

Merkens, B.J.; Mowbray, R.D.; Creeden, L.; Engels, P.T.; Rothwell, D.M.; Chan, B.T.B.; Tu, K.

2006-01-01

The first small rural hospital in Ontario to propose a computed tomography (CT) scanner was in Walkerton, a town 160 km north of London. The Ontario Ministry of Health approved the proposal as a pilot project to evaluate the effect on local health care of a rural scanner. This evaluation study had 3 parts: a survey of physicians, a survey of patients, and an analysis of population CT scanning rates. The physicians in the area served by the scanner were asked about its impact on their care of their patients in a mailed questionnaire and in semistructured interviews. Scanner outpatients were given a questionnaire in which they rated the importance of its advantages. The analysis of scanning rates--the ratio of number of scans to estimated population--compared rates in the area with other Ontario rates before and after the scanner was introduced. The physicians reported that local CT allowed them to diagnose and treat patients sooner, closer to home, and with greater confidence. On average, 75% of the patients ranked faster and closer access as very important. Scanning rates in the area rose, although they did not match urban rates. The study confirms that the rural scanner changed the area's health care in significant ways and that it helped to narrow the gap between rural and urban service levels. We recommend that CT be expanded to other rural regions. (author)

An integrative review of information systems and terminologies used in local health departments.

Science.gov (United States)

Olsen, Jeanette; Baisch, Mary Jo

2014-02-01

The purpose of this integrative review based on the published literature was to identify information systems currently being used by local health departments and to determine the extent to which standard terminology was used to communicate data, interventions, and outcomes to improve public health informatics at the local health department (LHD) level and better inform research, policy, and programs. Whittemore and Knafl's integrative review methodology was used. Data were obtained through key word searches of three publication databases and reference lists of retrieved articles and consulting with experts to identify landmark works. The final sample included 45 articles analyzed and synthesized using the matrix method. The results indicated a wide array of information systems were used by LHDs and supported diverse functions aligned with five categories: administration; surveillance; health records; registries; and consumer resources. Detail regarding specific programs being used, location or extent of use, or effectiveness was lacking. The synthesis indicated evidence of growing interest in health information exchange groups, yet few studies described use of data standards or standard terminology in LHDs. Research to address these gaps is needed to provide current, meaningful data that inform public health informatics research, policy, and initiatives at and across the LHD level. Coordination at a state or national level is recommended to collect information efficiently about LHD information systems that will inform improvements while minimizing duplication of efforts and financial burden. Until this happens, efforts to strengthen LHD information systems and policies may be significantly challenged.

Public health agendas addressing violence against rural women - an analysis of local level health services in the State of Rio Grande do Sul, Brazil

Directory of Open Access Journals (Sweden)

Marta Cocco da Costa

2015-05-01

Full Text Available This study analyses health managers' perceptions of local public health agendas addressing violence against rural women in municipalities in the southern part of the State Rio Grande do Sul in Brazil. It consists of an exploratory descriptive study utilizing a qualitative approach. Municipal health managers responsible for planning actions directed at women's health and primary health care were interviewed. The analysis sought to explore elements of programmatic vulnerability related to violence in the interviewees' narratives based on the following dimensions of programmatic vulnerability: expression of commitment, transformation of commitment into action, and planning and coordination. It was found that local health agendas directed at violence against rural women do not exist. Health managers are therefore faced with the challenge of defining lines of action in accordance with the guidelines and principles of the SUS. The repercussions of this situation are expressed in fragile comprehensive services for these women and programmatic vulnerability.

Communities, Classrooms, and Peers: Examining How Local Contexts Shape Female Students' STEM Intentions

Science.gov (United States)

Riegle-Crumb, Catherine

2017-01-01

Despite being the focus of decades of research as well as interventions, gender inequality in representation in many STEM fields, including physics, engineering, and computer science remains. Recent research indicates that high school is a particularly important time point to investigate regarding the roots of inequality, as this is when many young women decide that they are not interested in pursuing degrees in these STEM fields. This presentation will focus on the role of local contexts, including communities, classrooms, and peers, in contributing to such decisions. Specifically, sociological theories suggest that role models and peers within young people's immediate environment can send both implicit and explicit messages that contradict larger social stereotypes, and promote perceptions and experiences of inclusion. Alternatively, adults and peers can endorse and behave in a manner consistent with stereotypes, leading to overtly exclusionary messages and actions. Utilizing data from a large urban district in the Southwest, as well as a national sample of high school students, this presentation will examine how such factors within local contexts can work in both positive and negative ways to shape girls' interests and expectations in STEM fields.

Criticism by community people and poor workplace communication as risk factors for the mental health of local welfare workers after the Great East Japan Earthquake: A cross-sectional study.

Science.gov (United States)

Ueda, Ikki; Sakuma, Atsushi; Takahashi, Yoko; Shoji, Wataru; Nagao, Ayami; Abe, Mikika; Suzuki, Yuriko; Matsuoka, Hiroo; Matsumoto, Kazunori

2017-01-01

After a large-scale natural disaster, demand for social welfare services increases, and the mental health of local social welfare workers becomes a matter of great concern because of their dual role as support providers and disaster survivors. We examined whether work-related social stressors, including criticism by community people and poor workplace communication, were associated with increased risk of post-traumatic stress disorder (PTSD), depression, or psychological distress 20-22 months after the Great East Japan Earthquake (GEJE; March 11, 2011) in local social welfare workers. Demographic characteristics, disaster-related risk factors (near-death experience, dead/missing family members, loss of housing), and work-related social risk factors (criticism, lack of communication) were obtained 20-22 months after the GEJE from 822 local workers. Questionnaires measured PTSD, depression, and psychological stress. Bivariate and multivariate regression analyses were applied. More local social welfare workers suffered from mental health problems than would be expected. Criticism by community people was significantly associated with probable PTSD and high psychological distress (adjusted odds ratio = 2.31 and 2.55, respectively). Furthermore, lack of workplace communication was associated with probable PTSD, depression, and high psychological distress (adjusted odds ratio = 3.97, 4.27, and 4.65, respectively). Almost 2 years after the disaster, local relief workers still suffered from mental health problems. Because post-disaster work-related social stressors constitute risk factors for these mental health problems, measures to improve working conditions and prevent and treat mental disorders should be a priority.

Examining the Impact of Maternal Health, Race, and Socioeconomic Status on Daughter's Self-Rated Health Over Three Decades.

Science.gov (United States)

Shippee, Tetyana P; Rowan, Kathleen; Sivagnanam, Kamesh; Oakes, J Michael

2015-09-01

This study examines the role of mother's health and socioeconomic status on daughter's self-rated health using data spanning three decades from the National Longitudinal Surveys of Mature Women and Young Women (N = 1,848 matched mother-daughter pairs; 1,201 White and 647 African American). Using nested growth curve models, we investigated whether mother's self-rated health affected the daughter's self-rated health and whether socioeconomic status mediated this relationship. Mother's health significantly influenced daughters' self-rated health, but the findings were mediated by mother's socioeconomic status. African American daughters reported lower self-rated health and experienced more decline over time compared with White daughters, accounting for mother's and daughter's covariates. Our findings reveal maternal health and resources as a significant predictor of daughters' self-rated health and confirm the role of socioeconomic status and racial disparities over time. © The Author(s) 2015.

Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities

Science.gov (United States)

Hager, Erin R.; Rubio, Diana S.; Eidel, G. Stewart; Penniston, Erin S.; Lopes, Megan; Saksvig, Brit I.; Fox, Renee E.; Black, Maureen M.

2016-01-01

Background: Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and…

The Use of Information by Policymakers at the Local Community Level.

Science.gov (United States)

Florio, Evelyn; DeMartini, Joseph R.

1993-01-01

Discussion of decision making focuses on a study that was conducted to examine how policymakers at the local community level use social science information in making decisions. The use of social science information and other information sources in two communities examining health care issues is described. (Contains 18 references.) (LRW)

The many faces of manhood: examining masculine norms and health behaviors of young fathers across race.

Science.gov (United States)

Gordon, Derrick M; Hawes, Samuel W; Reid, Allecia E; Callands, Tamora A; Magriples, Urania; Divney, Anna; Niccolai, Linda M; Kershaw, Trace

2013-09-01

This study examined the relationship between the traditional masculine norms ("status," "toughness" and "antifemininity") of 296 ethnically and racially diverse, young men transitioning to fatherhood and substance use (smoking, alcohol, marijuana, hard drugs) and health behaviors (diet, exercise). Participants were recruited from urban obstetric clinics in the Northeast United States. Logistic and multiple regression equations were constructed to examine the relationship between masculine norms and health behaviors. Moderator effects were also examined. Masculine norm "status" was most endorsed and "antifemininity" was least endorsed. African American young men had higher masculine norm scores than Latino and Whites. Different masculine norms were associated with health-promoting and health-undermining behaviors. Different racial groups who had higher scores on some masculine norms were more likely to engage in either health-promoting or health-undermining behaviors when compared with other ethnic groups in this study. These results observed different relationships between the traditional masculine norms measured and the substance use and health behaviors of diverse, young men transitioning to fatherhood. This may have implications for intervention strategies and future research.

Periodic health examination, 1995 update: 1. Screening for human papillomavirus infection in asymptomatic women. Canadian Task Force on the Periodic Health Examination.

Science.gov (United States)

Johnson, K

1995-02-15

To develop recommendations for practising physicians on the advisability of screening for human papillomavirus (HPV) infection in asymptomatic women. Visual inspection, Papanicolaou testing, colposcopy or cervicography, use of HPV group-specific antigen, DNA hybridization, dot blot technique, Southern blot technique or polymerase chain reaction followed by physical or chemical therapeutic intervention. Evidence for a link between HPV infection and cervical cancer, sensitivity and specificity of HPV screening techniques, effectiveness of treatments for HPV infection, and the social and economic costs incurred by screening. MEDLINE was searched for articles published between January 1966 to June 1993 with the use of the key words "papillomavirus," "cervix neoplasms," "mass screening," "prospective studies," "prevalence," "sensitivity," "specificity," "human" and "female." Proven cost-effective screening techniques that could lead to decreased morbidity or mortality were given a high value. The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination were used. Potential benefits are to prevent cervical cancer and eliminate HPV infection. Potential harmful effects include the creation of an unnecessary burden on the health care system and the labelling of otherwise healthy people as patients with a sexually transmitted disease for which therapy is generally ineffective. Potential costs would include expense of testing, increased use of colposcopy and treatment. There is fair evidence to exclude HPV screening (beyond Papanicolaou testing for cervical cancer) in asymptomatic women (grade D recommendation). The report was reviewed by members of the task force and three external reviewers who were selected to represent different areas of expertise. These guidelines were developed and endorsed by the task force, which is funded by Health Canada and the National Health Research and Development Program. The principal author (K.J.) was

Structural Health Monitoring of Wind Turbine Blades: Acoustic Source Localization Using Wireless Sensor Networks

Directory of Open Access Journals (Sweden)

Omar Mabrok Bouzid

2015-01-01

Full Text Available Structural health monitoring (SHM is important for reducing the maintenance and operation cost of safety-critical components and systems in offshore wind turbines. This paper proposes an in situ wireless SHM system based on an acoustic emission (AE technique. By using this technique a number of challenges are introduced due to high sampling rate requirements, limitations in the communication bandwidth, memory space, and power resources. To overcome these challenges, this paper focused on two elements: (1 the use of an in situ wireless SHM technique in conjunction with the utilization of low sampling rates; (2 localization of acoustic sources which could emulate impact damage or audible cracks caused by different objects, such as tools, bird strikes, or strong hail, all of which represent abrupt AE events and could affect the structural health of a monitored wind turbine blade. The localization process is performed using features extracted from aliased AE signals based on a developed constraint localization model. To validate the performance of these elements, the proposed system was tested by testing the localization of the emulated AE sources acquired in the field.

Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities.

Science.gov (United States)

Hager, Erin R; Rubio, Diana S; Eidel, G Stewart; Penniston, Erin S; Lopes, Megan; Saksvig, Brit I; Fox, Renee E; Black, Maureen M

2016-10-01

Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students). Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression. Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (≥75%) African-American/Hispanic students, and 25.5% majority (≥75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05). Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities. © 2016, American School Health Association.

Examining Mental Health Differences between Transfer and Nontransfer University Students Seeking Counseling Services

Science.gov (United States)

Mehr, Kristin E.; Daltry, Rachel

2016-01-01

This article sought to examine the differences between transfer and nontransfer students on mental health factors, social involvement, and academic success. It was found that transfer students had significantly higher scores on several mental health factors as compared to nontransfer students. It was also found that transfer students were less…

Introduction of new technologies and decision making processes: a framework to adapt a Local Health Technology Decision Support Program for other local settings

Directory of Open Access Journals (Sweden)

Poulin P

2013-11-01

Full Text Available Paule Poulin,1 Lea Austen,1 Catherine M Scott,2 Michelle Poulin,1 Nadine Gall,2 Judy Seidel,3 René Lafrenière1 1Department of Surgery, 2Knowledge Management, 3Public Health Innovation and Decision Support, Alberta Health Services, Calgary, AB, Canada Purpose: Introducing new health technologies, including medical devices, into a local setting in a safe, effective, and transparent manner is a complex process, involving many disciplines and players within an organization. Decision making should be systematic, consistent, and transparent. It should involve translating and integrating scientific evidence, such as health technology assessment (HTA reports, with context-sensitive evidence to develop recommendations on whether and under what conditions a new technology will be introduced. However, the development of a program to support such decision making can require considerable time and resources. An alternative is to adapt a preexisting program to the new setting. Materials and methods: We describe a framework for adapting the Local HTA Decision Support Program, originally developed by the Department of Surgery and Surgical Services (Calgary, AB, Canada, for use by other departments. The framework consists of six steps: 1 development of a program review and adaptation manual, 2 education and readiness assessment of interested departments, 3 evaluation of the program by individual departments, 4 joint evaluation via retreats, 5 synthesis of feedback and program revision, and 6 evaluation of the adaptation process. Results: Nine departments revised the Local HTA Decision Support Program and expressed strong satisfaction with the adaptation process. Key elements for success were identified. Conclusion: Adaptation of a preexisting program may reduce duplication of effort, save resources, raise the health care providers' awareness of HTA, and foster constructive stakeholder engagement, which enhances the legitimacy of evidence

Assessing Injury and Violence Prevention in North Carolina's Local Health Departments.

Science.gov (United States)

Mouw, Mary S; Counts, Jennifer; Fordham, Corinne; Francis, Molly Merrill; Bach, Laura E; Maman, Suzanne; Proescholdbell, Scott K

2016-01-01

Injury and violence-related morbidity and mortality present a major public health problem in North Carolina. However, the extent to which local health departments (LHDs) engage in injury and violence prevention (IVP) has not been well described. One objective of the current study is to provide a baseline assessment of IVP in the state's LHDs, describing capacity, priorities, challenges, and the degree to which programs are data-driven and evidence-based. The study will also describe a replicable, cost-effective method for systematic assessment of regional IVP. This is an observational, cross-sectional study that was conducted through a survey of North Carolina's 85 LHDs. Representatives from 77 LHDs (91%) responded. Nearly one-third (n = 23; 30%) reported that no staff members were familiar with evidence-based interventions in IVP, and over one-third (n = 29; 38%) reported that their LHD did not train staff in IVP. Almost one-half (n = 37; 48%) had no dedicated funding for IVP. On average, respondents said that about half of their programs were evidence-based; however, there was marked variation (mean, 52%; standard deviation = 41). Many collaborated with diverse partners including law enforcement, hospitals, and community-based organizations. There was discordance between injury and violence burden and programming. Overall, 53% of issues listed as top local problems were not targeted in their LHDs' programs. Despite funding constraints, North Carolina's LHDs engaged in a broad range of IVP activities. However, programming did not uniformly address state injury and violence priorities, nor local injury and violence burden. Staff members need training in evidence-based strategies that target priority areas. Multisector partnerships were common and increased LHDs' capacity. These findings are actionable at the state and local level. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Learning from games: Stakeholders’ experiences involved in local health policy

DEFF Research Database (Denmark)

Spitters, Hilde; van de Goor, Ien; Juel Lau, Cathrine

2018-01-01

Since public health problems are complex and the related policies need to address a wide range of sectors, cross-sectoral collaboration is beneficial. One intervention focusing on stimulating collaboration is a ‘policy game’. The focus on specific problems facilitates relationships between...... the stakeholders and stimulates cross-sectoral policymaking. The present study explores stakeholders’ learning experiences with respect to the collaboration process in public health policymaking. This was achieved via their game participation, carried out in real-life stakeholder networks in the Netherlands...... the collaboration processes in local policymaking. Specific learning experiences were related to: (i) the stakeholder network, (ii) interaction and (iii) relationships. The game also increased participant’s understanding of group dynamics and need for a coordinator in policymaking. This exploratory study shows...

Neighbourhood green space, social environment and mental health: an examination in four European cities.

Science.gov (United States)

Ruijsbroek, Annemarie; Mohnen, Sigrid M; Droomers, Mariël; Kruize, Hanneke; Gidlow, Christopher; Gražulevičiene, Regina; Andrusaityte, Sandra; Maas, Jolanda; Nieuwenhuijsen, Mark J; Triguero-Mas, Margarita; Masterson, Daniel; Ellis, Naomi; van Kempen, Elise; Hardyns, Wim; Stronks, Karien; Groenewegen, Peter P

2017-07-01

This study examines the relationship between neighbourhood green space, the neighbourhood social environment (social cohesion, neighbourhood attachment, social contacts), and mental health in four European cities. The PHENOTYPE study was carried out in 2013 in Barcelona (Spain), Stoke-on-Trent (United Kingdom), Doetinchem (The Netherlands), and Kaunas (Lithuania). 3771 adults living in 124 neighbourhoods answered questions on mental health, neighbourhood social environment, and amount and quality of green space. Additionally, audit data on neighbourhood green space were collected. Multilevel regression analyses examined the relation between neighbourhood green space and individual mental health and the influence of neighbourhood social environment. Mental health was only related to green (audit) in Barcelona. The amount and quality of neighbourhood green space (audit and perceived) were related to social cohesion in Doetinchem and Stoke-on-Trent and to neighbourhood attachment in Doetinchem. In all four cities, mental health was associated with social contacts. Neighbourhood green was related to mental health only in Barcelona. Though neighbourhood green was related to social cohesion and attachment, the neighbourhood social environment seems not the underlying mechanism for this relationship.

Examining the importance of incorporating emergency preparedness and disaster training core competencies into allied health curricula.

Science.gov (United States)

Curtis, Tammy

2015-01-01

Preparation for responding to emergency events that does not warrant outside help beyond the local community resources or responding to disaster events that is beyond the capabilities of the local community both require first responders and healthcare professionals to have interdisciplinary skills needed to function as a team for saving lives. To date, there is no core emergency preparedness and disaster planning competencies that have been standardized at all levels across the various allied health curricula disciplines. To identify if emergency preparedness and disaster training content are currently being taught in allied health program courses, to identify possible gaps within allied health curricula, and to explore the perceptions of allied health college educators for implementing emergency preparedness and disaster training core competencies into their existing curricula, if not already included. A quantitative Internet-based survey was conducted in 2013. Convenient sample. Fifty-one allied health college educators completed the survey. Descriptive statistics indicated that the majority of allied health college instructors do not currently teach emergency preparedness and disaster training core competency content within their current allied health discipline; however, their perceived level of importance for inclusion of the competencies was high. The results of this study supported the need for developing and establishing a basic national set of standardized core emergency preparedness and disaster planning competencies at all levels across various allied health curricula disciplines to ensure victims receive the best patient care and have the best possible chance of survival.

Mental disorder and victimisation in prison: Examining the role of mental health treatment.

Science.gov (United States)

Daquin, Jane C; Daigle, Leah E

2018-04-01

There is evidence that people with mental disorders are at increased risk of victimisation in prison. It is unclear whether this risk of victimisation varies across types of disorders or symptoms and what role mental health treatment has on victimisation risk in this context. To examine the relationship between specific mental disorders, psychiatric symptoms, and victimisation in prison and the effect of treatment for the disorders on victimisation risk. Using a nationally-representative sample of prisoners, path analyses were conducted to examine the relationship between mental disorder and victimisation. The analyses also examined whether receiving mental health treatment in prison affected any such relationship. Victimisation risk varied with the type of mental disorder or symptoms. Depression, personality disorder, hopelessness, paranoia, and hallucinations were associated with increased victimisation risk. Psychotic illnesses were otherwise negatively associated with victimisation. Receiving mental health treatment in prison was associated with greater risk of victimisation there. Receiving treatment appeared to mediate the relationship between mental disorders, symptoms, and victimisation. The findings suggest that not all inmates with mental disorders are at an increased risk of victimisation. Further, mental health treatment in prison also appears to be a risk factor of victimisation. More research is needed to further elucidate the relationship between mental disorders, treatment, and victimisation. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

78 FR 60283 - Guidance for Temporary Reassignment of State and Local Personnel During a Public Health Emergency

Science.gov (United States)

2013-10-01

... Personnel During a Public Health Emergency AGENCY: Department of Health and Human Services, Office of the... and Local Personnel during a Public Health Emergency.'' Section 201 of the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (PAHPRA), Public Law 113-5, amends section 319 of the Public Health...

Health equity issues at the local level: Socio-geography, access, and health outcomes in the service area of the Hôpital Albert Schweitzer-Haiti

Directory of Open Access Journals (Sweden)

Aftab Asma S

2007-08-01

Full Text Available Abstract Background Although health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked. Here, we describe here a comprehensive equity assessment carried out by the Hôpital Albert Schweitzer-Haiti (HAS in 2003. HAS has been operating health and development programs in the Artibonite Valley of Haiti for 50 years. Methods We reviewed all available information arising from a comprehensive evaluation of the programs of HAS carried out in 1999 and 2000. As part of this evaluation, two demographic and health surveys were carried out. We carried out exit interviews with clients receiving primary health care, observations within health facilities, interviews with households related to quality of care, and focus group discussions with community-based health workers. A special study was carried out in 2003 to assess factors determining the use of prenatal care services. Finally, selected findings were obtained from the HAS information system. Results We found markedly reduced access to health services in the peripheral mountainous areas compared to the central plains. The quality of services was more deficient and the coverage of key services was lower in the mountains. Finally, health status, as measured by under-five mortality rates and levels of childhood malnutrition, was also worse in the mountains. Conclusion These findings indicate that local health programs need to give attention to monitoring the health status as well as the quality and coverage of basic services among marginalized groups within the program service area. Health inequities will not be overcome until such monitoring occurs and leaders of health programs ensure that inequities identified are addressed in the local programming of activities. It is quite likely that, within relatively small geographic areas in resource-poor settings around the world, similar, if not

Health equity issues at the local level: socio-geography, access, and health outcomes in the service area of the Hôpital Albert Schweitzer-Haiti.

Science.gov (United States)

Perry, Henry B; King-Schultz, Leslie W; Aftab, Asma S; Bryant, John H

2007-08-01

Although health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked. Here, we describe here a comprehensive equity assessment carried out by the Hôpital Albert Schweitzer-Haiti (HAS) in 2003. HAS has been operating health and development programs in the Artibonite Valley of Haiti for 50 years. We reviewed all available information arising from a comprehensive evaluation of the programs of HAS carried out in 1999 and 2000. As part of this evaluation, two demographic and health surveys were carried out. We carried out exit interviews with clients receiving primary health care, observations within health facilities, interviews with households related to quality of care, and focus group discussions with community-based health workers. A special study was carried out in 2003 to assess factors determining the use of prenatal care services. Finally, selected findings were obtained from the HAS information system. We found markedly reduced access to health services in the peripheral mountainous areas compared to the central plains. The quality of services was more deficient and the coverage of key services was lower in the mountains. Finally, health status, as measured by under-five mortality rates and levels of childhood malnutrition, was also worse in the mountains. These findings indicate that local health programs need to give attention to monitoring the health status as well as the quality and coverage of basic services among marginalized groups within the program service area. Health inequities will not be overcome until such monitoring occurs and leaders of health programs ensure that inequities identified are addressed in the local programming of activities. It is quite likely that, within relatively small geographic areas in resource-poor settings around the world, similar, if not even greater, levels of health inequities exist. These inequities

Do Local Social Hierarchies Matter for Mental Health? A Study of Neighborhood Social Status and Depressive Symptoms in Older Adults.

Science.gov (United States)

Kelley-Moore, Jessica A; Cagney, Kathleen A; Skarupski, Kimberly A; Everson-Rose, Susan A; Mendes de Leon, Carlos F

2016-03-01

Despite a well-established association between relative social position and health, stratification at smaller levels of social organization has received scant attention. Neighborhood is a localized context that has increasing relevance for adults as they age, thus one's relative position within this type of mesolevel group may have an effect on mental health, independent of absolute level of social and economic resources. We examine the relationship between an older adult's relative rank within their neighborhoods on two criteria and depressive symptoms. Using data from the Chicago Health and Aging Project, neighborhood relative social position was ascertained for two social domains: income and social reputation (number of neighbors one knows well enough to visit). Using multilevel models, we estimated the effect of relative position within the neighborhood on depressive symptoms, net of absolute level for each domain and average neighborhood level. Higher neighborhood relative rankings on both income and visiting neighbors were associated with fewer depressive symptoms. Although both were modest in effect, the gradient in depressive symptoms was three times steeper for the relative rank of visiting neighbors than for income. Men had steeper gradients than women in both domains, but no race differences were observed. These findings suggest that an older adult's relative position in a local social hierarchy is associated with his/her mental health, net of absolute position. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Exploration of barriers and facilitators to publishing local public health findings: A mixed methods protocol

OpenAIRE

Smith, Selina A.; Webb, Nancy C.; Blumenthal, Daniel S.; Willcox, Bobbie; Ballance, Darra; Kinard, Faith; Gates, Madison L.

2016-01-01

Background Worldwide, the US accounts for a large proportion of journals related to public health. Although the American Public Health Association (APHA) includes 54 affiliated regional and state associations, little is known about their capacity to support public health scholarship. The aim of this study is to assess barriers and facilitators to operation of state journals for the dissemination of local public health research and practices. Methods A mixed methods approach will be used to co...

Sexual and gender minority's social media user characteristics: Examining preferred health information.

Science.gov (United States)

Park, Hyojung; Rodgers, Shelly; McElroy, Jane A; Everett, Kevin

2018-01-01

The authors examined the influence of social media involvement on health issues in sexual and gender minorities (SGMs). Demographic and technological characteristics of social media users and nonusers were identified, and the influence of social media involvement on these factors was assessed for its potential to influence health information needs and preferences. A survey of 2,274 SGM individuals revealed that age, sexual orientation, number of Internet access points, and use of smartphones predicted levels of social media involvement. Results suggest that a broader range of traditional and nontraditional communication channels is needed to meet a diversity of health information needs in SGMs.

Introduction of new technologies and decision making processes: a framework to adapt a Local Health Technology Decision Support Program for other local settings.

Science.gov (United States)

Poulin, Paule; Austen, Lea; Scott, Catherine M; Poulin, Michelle; Gall, Nadine; Seidel, Judy; Lafrenière, René

2013-01-01

Introducing new health technologies, including medical devices, into a local setting in a safe, effective, and transparent manner is a complex process, involving many disciplines and players within an organization. Decision making should be systematic, consistent, and transparent. It should involve translating and integrating scientific evidence, such as health technology assessment (HTA) reports, with context-sensitive evidence to develop recommendations on whether and under what conditions a new technology will be introduced. However, the development of a program to support such decision making can require considerable time and resources. An alternative is to adapt a preexisting program to the new setting. We describe a framework for adapting the Local HTA Decision Support Program, originally developed by the Department of Surgery and Surgical Services (Calgary, AB, Canada), for use by other departments. The framework consists of six steps: 1) development of a program review and adaptation manual, 2) education and readiness assessment of interested departments, 3) evaluation of the program by individual departments, 4) joint evaluation via retreats, 5) synthesis of feedback and program revision, and 6) evaluation of the adaptation process. Nine departments revised the Local HTA Decision Support Program and expressed strong satisfaction with the adaptation process. Key elements for success were identified. Adaptation of a preexisting program may reduce duplication of effort, save resources, raise the health care providers' awareness of HTA, and foster constructive stakeholder engagement, which enhances the legitimacy of evidence-informed recommendations for introducing new health technologies. We encourage others to use this framework for program adaptation and to report their experiences.

Cost, energy, global warming, eutrophication and local human health impacts of community water and sanitation service options.

Science.gov (United States)

Schoen, Mary E; Xue, Xiaobo; Wood, Alison; Hawkins, Troy R; Garland, Jay; Ashbolt, Nicholas J

2017-02-01

We compared water and sanitation system options for a coastal community across selected sustainability metrics, including environmental impact (i.e., life cycle eutrophication potential, energy consumption, and global warming potential), equivalent annual cost, and local human health impact. We computed normalized metric scores, which we used to discuss the options' strengths and weaknesses, and conducted sensitivity analysis of the scores to changes in variable and uncertain input parameters. The alternative systems, which combined centralized drinking water with sanitation services based on the concepts of energy and nutrient recovery as well as on-site water reuse, had reduced environmental and local human health impacts and costs than the conventional, centralized option. Of the selected sustainability metrics, the greatest advantages of the alternative community water systems (compared to the conventional system) were in terms of local human health impact and eutrophication potential, despite large, outstanding uncertainties. Of the alternative options, the systems with on-site water reuse and energy recovery technologies had the least local human health impact; however, the cost of these options was highly variable and the energy consumption was comparable to on-site alternatives without water reuse or energy recovery, due to on-site reuse treatment. Future work should aim to reduce the uncertainty in the energy recovery process and explore the health risks associated with less costly, on-site water treatment options. Copyright © 2016 Elsevier Ltd. All rights reserved.

School Mental Health: The Impact of State and Local Capacity-Building Training

Science.gov (United States)

Stephan, Sharon; Paternite, Carl; Grimm, Lindsey; Hurwitz, Laura

2014-01-01

Despite a growing number of collaborative partnerships between schools and community-based organizations to expand school mental health (SMH) service capacity in the United States, there have been relatively few systematic initiatives focused on key strategies for large-scale SMH capacity building with state and local education systems. Based on a…

Three Hundred Sixty Degree Feedback: program implementation in a local health department.

Science.gov (United States)

Swain, Geoffrey R; Schubot, David B; Thomas, Virginia; Baker, Bevan K; Foldy, Seth L; Greaves, William W; Monteagudo, Maria

2004-01-01

Three Hundred Sixty Degree Feedback systems, while popular in business, have been less commonly implemented in local public health agencies. At the same time, they are effective methods of improving employee morale, work performance, organizational culture, and attainment of desired organizational outcomes. These systems can be purchased "off-the-shelf," or custom applications can be developed for a better fit with unique organizational needs. We describe the City of Milwaukee Health Department's successful experience customizing and implementing a 360-degree feedback system in the context of its ongoing total quality improvement efforts.

Adoption and Use of Internet Technologies in Health Communication: Examining Disparities in Diffusion Patterns, Health Information Sources, and Patient-Provider Encounters

Science.gov (United States)

Massey, Philip Minter

2013-01-01

This dissertation examines the impact of internet technologies on the field of health communication. Access and use of health communication technologies has and will continue to become increasingly important to manage and treat chronic conditions and other ailments, particularly in the context of health care reform that promotes improved quality…

Health Aspects of Climate Change in Cities with Mediterranean Climate, and Local Adaptation Plans.

Science.gov (United States)

Paz, Shlomit; Negev, Maya; Clermont, Alexandra; Green, Manfred S

2016-04-21

Cities with a Mediterranean-type climate (Med-cities) are particularly susceptible to health risks from climate change since they are located in biogeographical hot-spots that experience some of the strongest effects of the changing climate. The study aims to highlight health impacts of climate change in Med-cities, analyze local climate adaptation plans and make adaptation policy recommendations for the Med-city level. We identified five Med-cities with a climate change adaptation plan: Adelaide, Barcelona, Cape Town, Los Angeles and Santiago. Beyond their similar Med-climate features (although Santiago's are slightly different), the cities have different socio-economic characteristics in various aspects. We analyzed each plan according to how it addresses climate change-related drivers of health impacts among city dwellers. For each driver, we identified the types of policy adaptation tools that address it in the urban climate adaptation plans. The surveyed cities address most of the fundamental climate change-related drivers of risks to human health, including rising temperatures, flooding and drought, but the policy measures to reduce negative impacts vary across cities. We suggest recommendations for Med-cities in various aspects, depending on their local needs and vulnerability challenges: assessment of health risks, extreme events management and long-term adaptation, among others.

The development and pilot testing of a rapid assessment tool to improve local public health system capacity in Australia

Directory of Open Access Journals (Sweden)

Lin Vivian

2009-11-01

Full Text Available Abstract Background To operate effectively the public health system requires infrastructure and the capacity to act. Public health's ability to attract funding for infrastructure and capacity development would be enhanced if it was able to demonstrate what level of capacity was required to ensure a high performing system. Australia's public health activities are undertaken within a complex organizational framework that involves three levels of government and a diverse range of other organizations. The question of appropriate levels of infrastructure and capacity is critical at each level. Comparatively little is known about infrastructure and capacity at the local level. Methods In-depth interviews were conducted with senior managers in two Australian states with different frameworks for health administration. They were asked to reflect on the critical components of infrastructure and capacity required at the local level. The interviews were analyzed to identify the major themes. Workshops with public health experts explored this data further. The information generated was used to develop a tool, designed to be used by groups of organizations within discrete geographical locations to assess local public health capacity. Results Local actors in these two different systems pointed to similar areas for inclusion for the development of an instrument to map public health capacity at the local level. The tool asks respondents to consider resources, programs and the cultural environment within their organization. It also asks about the policy environment - recognizing that the broader environment within which organizations operate impacts on their capacity to act. Pilot testing of the tool pointed to some of the challenges involved in such an exercise, particularly if the tool were to be adopted as policy. Conclusion This research indicates that it is possible to develop a tool for the systematic assessment of public health capacity at the local level

The development and pilot testing of a rapid assessment tool to improve local public health system capacity in Australia.

Science.gov (United States)

Bagley, Prue; Lin, Vivian

2009-11-15

To operate effectively the public health system requires infrastructure and the capacity to act. Public health's ability to attract funding for infrastructure and capacity development would be enhanced if it was able to demonstrate what level of capacity was required to ensure a high performing system. Australia's public health activities are undertaken within a complex organizational framework that involves three levels of government and a diverse range of other organizations. The question of appropriate levels of infrastructure and capacity is critical at each level. Comparatively little is known about infrastructure and capacity at the local level. In-depth interviews were conducted with senior managers in two Australian states with different frameworks for health administration. They were asked to reflect on the critical components of infrastructure and capacity required at the local level. The interviews were analyzed to identify the major themes. Workshops with public health experts explored this data further. The information generated was used to develop a tool, designed to be used by groups of organizations within discrete geographical locations to assess local public health capacity. Local actors in these two different systems pointed to similar areas for inclusion for the development of an instrument to map public health capacity at the local level. The tool asks respondents to consider resources, programs and the cultural environment within their organization. It also asks about the policy environment - recognizing that the broader environment within which organizations operate impacts on their capacity to act. Pilot testing of the tool pointed to some of the challenges involved in such an exercise, particularly if the tool were to be adopted as policy. This research indicates that it is possible to develop a tool for the systematic assessment of public health capacity at the local level. Piloting the tool revealed some concerns amongst participants

Achieving excellence in community health centers: implications for health reform.

Science.gov (United States)

Gurewich, Deborah; Capitman, John; Sirkin, Jenna; Traje, Diana

2012-02-01

Existing studies tell us little about care quality variation within the community health center (CHC) delivery system. They also tell us little about the organizational conditions associated with CHCs that deliver especially high quality care. The purpose of this study was to examine the operational practices associated with a sample of high performing CHCs. Qualitative case studies of eight CHCs identified as delivering high-quality care relative to other CHCs were used to examine operational practices, including systems to facilitate care access, manage patient care, and monitor performance. Four common themes emerged that may contribute to high performance. At the same time, important differences across health centers were observed, reflecting differences in local environments and CHC capacity. In the development of effective, community-based models of care, adapting care standards to meet the needs of local conditions may be important.

Job characteristics in relation to the prevalence of myocardial infarction in the US Health Examination Survey (HES) and the Health and Nutrition Examination Survey (HANES).

Science.gov (United States)

Karasek, R A; Theorell, T; Schwartz, J E; Schnall, P L; Pieper, C F; Michela, J L

1988-08-01

Associations between psychosocial job characteristics and past myocardial infarction (MI) prevalence for employed males were tested with the Health Examination Survey (HES) 1960-61, N = 2,409, and the Health and Nutrition Examination Survey (HANES) 1971-75, N = 2,424. A new estimation method is used which imputes to census occupation codes, job characteristic information from national surveys of job characteristics (US Department of Labor, Quality of Employment Surveys). Controlling for age, we find that employed males with jobs which are simultaneously low in decision latitude and high in psychological work load (a multiplicative product term isolating 20 per cent of the population) have a higher prevalence of myocardial infarction in both data bases. In a logistic regression analysis, using job measures adjusted for demographic factors and controlling for age, race, education, systolic blood pressure, serum cholesterol, smoking (HANES only), and physical exertion, we find a low decision latitude/high psychological demand multiplicative product term associated with MI in both data bases. Additional multiple logistic regressions show that low decision latitude is associated with increased prevalence of MI in both the HES and the HANES. Psychological workload and physical exertion are significant only in the HANES.

Multiple physical healthcare needs among outpatients with schizophrenia: findings from a health examination study.

Science.gov (United States)

Eskelinen, Saana; Sailas, Eila; Joutsenniemi, Kaisla; Holi, Matti; Koskela, Tuomas H; Suvisaari, Jaana

2017-08-01

Despite the abundant literature on physical comorbidity, the full range of the concurrent somatic healthcare needs among individuals with schizophrenia has rarely been studied. This observational study aimed to assess the distressing somatic symptoms and needs for physical health interventions in outpatients with schizophrenia, and factors predicting those needs. A structured, comprehensive health examination was carried out, including a visit to a nurse and a general practitioner on 275 outpatients with schizophrenia. The required interventions were classified by type of disease. Logistic regression was used to assess the influence of sociodemographic factors, lifestyle, functional limitations, factors related to psychiatric disorder, and healthcare use on the need for interventions. In total, 44.9% of the patients (mean age 44.9 years) reported somatic symptoms affecting daily life; 87.6% needed specific interventions for a disease or condition, most commonly for cardiovascular, dermatological, dental, ophthalmological, and gastrointestinal conditions, and for altered glucose homeostasis. Smoking and obesity predicted significantly a need of any intervention, but the predictors varied in each disease category. Strikingly, use of general practitioner services during the previous year did not reduce the need for interventions. Health examinations for outpatients with schizophrenia revealed numerous physical healthcare needs. The health examinations for patients with schizophrenia should contain a medical history taking and a physical examination, in addition to basic measurements and laboratory tests. Prevention and treatment of obesity and smoking should be given priority in order to diminish somatic comorbidities in schizophrenia.

A Profile of Puerto Rican Health in the United States: Data from the Hispanic Health and Nutrition Examination Survey 1982-84.

Science.gov (United States)

Munoz, Eric; And Others

The health conditions and health status of Hispanic Americans will assume increased importance as their population increases. The goal of this book of charts is to present data from the Hispanic Health and Nutrition Examination Survey (HHANES) on Puerto Ricans. The Puerto Rican HHANES sampling procedure is a multi-stage probability sample of…

Financing alternative energy projects: An examination of challenges and opportunities for local government

International Nuclear Information System (INIS)

Cheung, Grace; Davies, Peter J.; Trück, Stefan

2016-01-01

Local government in Australia has a strong collective capacity to reduce GHG emissions through policies, funding allocation to renewable energy projects and the delivery of programs and services. This study examines the institutional capacity of councils in Sydney and how this impacts on decisions to invest in alternative energy projects. We find greenhouse gas emission targets of councils are strongly aligned to national targets but do not reflect the local council's institutional capacity, political leadership or strategic priorities. Energy reduction projects are often identified and undertaken by environmental staff without support from financial staff or financial-evaluation tools. An absence of national guidelines to provide consistency in tracking and reporting limits cross-sector benchmarking. Street lighting contributes to a significant proportion of council's total electricity expenditure and GHG emission profile. Being highly regulated, existing contracts and the current practice of street lighting services limits the councils’ ability to reduce emissions. Based on our analysis we recommend a number of measures to overcome these constraints including the use of financial evaluation tools for small-scale renewable energy projects, a standardised national tracking and reporting platform to facilitate progress-reporting and meaningful comparative analysis between councils and policy reform to the regulation of street lighting. - Highlights: • Australian local government sector can influence up to 50% of GHG emissions. • Institutional capacity, finance, leadership and staff, influence GHG performance. • Monitoring GHG emissions is limited by a lack of national guidelines or protocols. • Environmental officers lack tools and support to assess GHG reduction projects. • Reducing GHG emissions from street lighting is a contested legal and policy area.

Bisphenol-A and Sleep Adequacy among Adults in the National Health and Nutrition Examination Surveys

Science.gov (United States)

Beydoun, Hind A.; Beydoun, May A.; Jeng, Hueiwang Anna; Zonderman, Alan B.; Eid, Shaker M.

2016-01-01

Study Objectives: To evaluate bisphenol-A (BPA) level and its relationship to sleep adequacy in a nationally representative sample of U.S. adults. Methods: A population-based cross-sectional study was conducted using 2005–2010 National Health and Nutrition Examination Survey whereby data were collected using in-person interviews, physical examination and laboratory testing. BPA level was measured in urine samples and analyzed as loge-transformed variable and in quartiles ( 8 h); (Bisphenol-A and sleep adequacy among adults in the National Health and Nutrition Examination Surveys. SLEEP 2016;39(2):467–476. PMID:26446109

Local health workers' perceptions of substandard care in the management of obstetric hemorrhage in rural Malawi

NARCIS (Netherlands)

Beltman, Jogchum Jan; van den Akker, Thomas; Bwirire, Dieudonne; Korevaar, Anneke; Chidakwani, Richard; van Lonkhuijzen, Luc; van Roosmalen, Jos

2013-01-01

Background: To identify factors contributing to the high incidence of facility-based obstetric hemorrhage in Thyolo District, Malawi, according to local health workers. Methods: Three focus group discussions among 29 health workers, including nurse-midwives and non-physician clinicians ('medical

Local health workers' perceptions of substandard care in the management of obstetric hemorrhage in rural Malawi

NARCIS (Netherlands)

Beltman, J.J.; van den Akker, T.; Bwirire, D.; Korevaar, A.; Chidakwani, R.; van Lonkhuijzen, L.; van Roosmalen, J.

2013-01-01

Background: To identify factors contributing to the high incidence of facility-based obstetric hemorrhage in Thyolo District, Malawi, according to local health workers.Methods: Three focus group discussions among 29 health workers, including nurse-midwives and non-physician clinicians ('medical

76 FR 11187 - Examinations of Work Areas in Underground Coal Mines for Violations of Mandatory Health or Safety...

Science.gov (United States)

2011-03-01

... DEPARTMENT OF LABOR Mine Safety and Health Administration 30 CFR Part 75 RIN 1219-AB75 Examinations of Work Areas in Underground Coal Mines for Violations of Mandatory Health or Safety Standards... rule addressing Examinations of Work Areas in Underground Coal Mines for Violations of Mandatory Health...

Criticism by community people and poor workplace communication as risk factors for the mental health of local welfare workers after the Great East Japan Earthquake: A cross-sectional study.

Directory of Open Access Journals (Sweden)

Ikki Ueda

Full Text Available After a large-scale natural disaster, demand for social welfare services increases, and the mental health of local social welfare workers becomes a matter of great concern because of their dual role as support providers and disaster survivors. We examined whether work-related social stressors, including criticism by community people and poor workplace communication, were associated with increased risk of post-traumatic stress disorder (PTSD, depression, or psychological distress 20-22 months after the Great East Japan Earthquake (GEJE; March 11, 2011 in local social welfare workers. Demographic characteristics, disaster-related risk factors (near-death experience, dead/missing family members, loss of housing, and work-related social risk factors (criticism, lack of communication were obtained 20-22 months after the GEJE from 822 local workers. Questionnaires measured PTSD, depression, and psychological stress. Bivariate and multivariate regression analyses were applied. More local social welfare workers suffered from mental health problems than would be expected. Criticism by community people was significantly associated with probable PTSD and high psychological distress (adjusted odds ratio = 2.31 and 2.55, respectively. Furthermore, lack of workplace communication was associated with probable PTSD, depression, and high psychological distress (adjusted odds ratio = 3.97, 4.27, and 4.65, respectively. Almost 2 years after the disaster, local relief workers still suffered from mental health problems. Because post-disaster work-related social stressors constitute risk factors for these mental health problems, measures to improve working conditions and prevent and treat mental disorders should be a priority.

The impact of local immigration enforcement policies on the health of immigrant hispanics/latinos in the United States.

Science.gov (United States)

Rhodes, Scott D; Mann, Lilli; Simán, Florence M; Song, Eunyoung; Alonzo, Jorge; Downs, Mario; Lawlor, Emma; Martinez, Omar; Sun, Christina J; O'Brien, Mary Claire; Reboussin, Beth A; Hall, Mark A

2015-02-01

We sought to understand how local immigration enforcement policies affect the utilization of health services among immigrant Hispanics/Latinos in North Carolina. In 2012, we analyzed vital records data to determine whether local implementation of section 287(g) of the Immigration and Nationality Act and the Secure Communities program, which authorizes local law enforcement agencies to enforce federal immigration laws, affected the prenatal care utilization of Hispanics/Latinas. We also conducted 6 focus groups and 17 interviews with Hispanic/Latino persons across North Carolina to explore the impact of immigration policies on their utilization of health services. We found no significant differences in utilization of prenatal care before and after implementation of section 287(g), but we did find that, in individual-level analysis, Hispanic/Latina mothers sought prenatal care later and had inadequate care when compared with non-Hispanic/Latina mothers. Participants reported profound mistrust of health services, avoiding health services, and sacrificing their health and the health of their family members. Fear of immigration enforcement policies is generalized across counties. Interventions are needed to increase immigrant Hispanics/Latinos' understanding of their rights and eligibility to utilize health services. Policy-level initiatives are also needed (e.g., driver's licenses) to help undocumented persons access and utilize these services.

ABCC-JNIH Adult Health Study. Report 3. 1958-1960 cycle of examinations, Hiroshima

Energy Technology Data Exchange (ETDEWEB)

Finch, S C; Anderson, Jr, P S

1963-10-29

Results of 10,368 examinations of participants in the ABCC-JNIH Adult Health Study, Hiroshima, were tabulated and discussed. About 82% of the entire sample was examined at least once during the 1958-60 cycle. Physical and laboratory findings as well as major diagnoses were considered by comparison group, age, and sex. 8 references, 7 figures, 13 tables.

Differences in uptake of immunisations and health examinations among refugee children compared to Danish-born children

DEFF Research Database (Denmark)

Moller, Sanne Pagh; Hjern, Anders; Andersen, Anne-Marie Nybo

2016-01-01

diphtheria, tetanus, pertussis and polio (HR = 0.50; 95 % confidence interval (CI) 0.48–0.51). Participation in child health examinations was also lower among refugee children with the lowest at the last child health examination at age 5 (HR = 0.48; 95 % CI 0.47–0.50). Adjusting the analysis for parental...

Information management and technology strategy in healthcare: local timescales and national requirements

Directory of Open Access Journals (Sweden)

Les Smith

2000-01-01

Full Text Available The UK National Health Service’s strategic switch-back is well documented and each centrally originated change results in various attempts to record the repercussions and predict the outcomes. The most recent shift is embodied in the Department of Health’s information strategy, Information for health published in September 1998. This document provides the context for an examination of the issue of developing an Information Management and Technology (IM&T strategy at the local level within the changing national requirements for NHS information management. The particular pressures on an individual unit and the need to react to them alongside the requirements of the national strategy are the subjects of this article. The case detailed is that of Clatterbridge Centre for Oncology (CCO on Merseyside, the second largest centre of its type in the UK. Its initial investigation of information needs preceded the publication of the national strategy and its implementation straddled the timescale devised by the NHS Information Authority. The inevitable incompatibility between timescales for the local and the national developments is examined within the case. The work of the new NHS Information Authority and its supporting guidance in its Circular, Information for Health: Initial Local Implementation Strategies, is evaluated as a tool in aligning local and national strategy. Information Managers in other centrally governed organisations within the public sector and large corporations are often alert to similar issues.

Understanding the Mental Health Needs of Primary School Children in an Inner-City Local Authority

Science.gov (United States)

Hackett, Latha; Theodosiou, Louise; Bond, Caroline; Blackburn, Clare; Spicer, Freya; Lever, Rachel

2010-01-01

There is growing awareness of mental health problems among children, and schools are increasingly being encouraged to take a wider role in preventing mental health difficulties. Local population studies are needed to inform delivery of universal through to targeted services. In the current study, parents and teachers of 2% of primary school…

State Public Health Enabling Authorities: Results of a Fundamental Activities Assessment Examining Core and Essential Services

Science.gov (United States)

Hoss, Aila; Menon, Akshara; Corso, Liza

2016-01-01

Context Public health enabling authorities establish the legal foundation for financing, organizing, and delivering public health services. State laws vary in terms of the content, depth, and breadth of these fundamental public health activities. Given this variance, the Institute of Medicine has identified state public health laws as an area that requires further examination. To respond to this call for further examination, the Centers for Disease Control and Prevention’s Public Health Law Program conducted a fundamental activities legal assessment on state public health laws. Objective The goal of the legal assessment was to examine state laws referencing frameworks representing public health department fundamental activities (ie, core and essential services) in an effort to identify, catalog, and describe enabling authorities of state governmental public health systems. Design In 2013, Public Health Law Program staff compiled a list of state statutes and regulations referencing different commonly-recognized public health frameworks of fundamental activities. The legal assessment included state fundamental activities laws available on WestlawNext as of July 2013. The results related to the 10 essential public health services and the 3 core public health functions were confirmed and updated in June 2016. Results Eighteen states reference commonly-recognized frameworks of fundamental activities in their laws. Thirteen states have listed the 10 essential public health services in their laws. Eight of these states have also referenced the 3 core public health functions in their laws. Five states reference only the core public health functions. Conclusions Several states reference fundamental activities in their state laws, particularly through use of the essential services framework. Further work is needed to capture the public health laws and practices of states that may be performing fundamental activities but without reference to a common framework. PMID

State Public Health Enabling Authorities: Results of a Fundamental Activities Assessment Examining Core and Essential Services.

Science.gov (United States)

Hoss, Aila; Menon, Akshara; Corso, Liza

2016-01-01

Public health enabling authorities establish the legal foundation for financing, organizing, and delivering public health services. State laws vary in terms of the content, depth, and breadth of these fundamental public health activities. Given this variance, the Institute of Medicine has identified state public health laws as an area that requires further examination. To respond to this call for further examination, the Centers for Disease Control and Prevention's Public Health Law Program conducted a fundamental activities legal assessment on state public health laws. The goal of the legal assessment was to examine state laws referencing frameworks representing public health department fundamental activities (ie, core and essential services) in an effort to identify, catalog, and describe enabling authorities of state governmental public health systems. In 2013, Public Health Law Program staff compiled a list of state statutes and regulations referencing different commonly-recognized public health frameworks of fundamental activities. The legal assessment included state fundamental activities laws available on WestlawNext as of July 2013. The results related to the 10 essential public health services and the 3 core public health functions were confirmed and updated in June 2016. Eighteen states reference commonly-recognized frameworks of fundamental activities in their laws. Thirteen states have listed the 10 essential public health services in their laws. Eight of these states have also referenced the 3 core public health functions in their laws. Five states reference only the core public health functions. Several states reference fundamental activities in their state laws, particularly through use of the essential services framework. Further work is needed to capture the public health laws and practices of states that may be performing fundamental activities but without reference to a common framework.

Assessing Injury and Violence Prevention in North Carolina’s Local Health Departments

Science.gov (United States)

Mouw, Mary S.; Counts, Jennifer; Fordham, Corinne; Francis, Molly Merrill; Bach, Laura E.; Maman, Suzanne; Proescholdbell, Scott K.

2016-01-01

Context Injury and violence-related morbidity and mortality present a major public health problem in North Carolina. However, the extent to which local health departments (LHDs) engage in injury and violence prevention (IVP) is not well described. Objectives 1) Provide a baseline assessment of IVP in the state’s LHDs, describing capacity, priorities, challenges, and the degree to which programs are data-driven and evidence-based. 2) Describe a replicable, cost-effective method for systematic assessment of regional IVP. Design An observational, cross-sectional study, through a survey of NC’s 85 LHDs. Results Representatives from 77 LHDs (91%) responded. Nearly a third (n=23, 30%) reported no staff were familiar with evidence-based interventions in IVP; over a third (n=29, 38%) reported their LHD did not train staff in IVP. Almost half (n=37, 46%) had no dedicated funding. On average, respondents said about half of their programs were evidence-based; however, there was marked variation (mean 52%, SD = 41). Many collaborated with diverse partners including law enforcement, hospitals, and community-based organizations. There was discordance between injury and violence burden and programming. Overall, 53% of issues listed as top local problems were not targeted in their LHDs’ programs. Conclusions Despite funding constraints, NC’s LHDs are engaged in a broad range of IVP activities. Programming did not uniformly address state injury and violence priorities, however, nor local injury and violence burden. Staff need training in evidence-based strategies targeting priority areas. Multi-sector partnerships were common and increased LHDs’ capacity. These findings are actionable at the state and local-level. PMID:27621337

Underutilization of Mental Health Services among College Students: An Examination of System-Related Barriers

Science.gov (United States)

Marsh, Carey N.; Wilcoxon, S. Allen

2015-01-01

Despite the documented benefits of counseling and mental health services on academic performance and degree attainment, only about 10% of psychologically distressed college students ever seek professional help. This investigation examined mental health care system-related barriers that might distinguish help seekers from nonhelp seekers among…

Google walkability: a new tool for local planning and public health research?

Science.gov (United States)

Vargo, Jason; Stone, Brian; Glanz, Karen

2012-07-01

We investigate the association of different composite walkability measures with individual walking behaviors to determine if multicomponent metrics of walkability are more useful for assessing the health impacts of the built environment than single component measures. We use a previously published composite walkability measure as well as a new measure that was designed to represent easier methods of combination and which includes 2 metrics obtained using Google data sources. Logistic regression was used to assess the relationship between walking behavior and walkability metrics. Our results suggest that composite measures of walkability are more consistent predictors of walking behavior than single component measures. Furthermore, a walkability measure developed using free, publicly available data from Google was found to be nearly as effective in predicting walking outcomes as a walkability measure derived without such publicly and nationally available measures. Our findings demonstrate the effectiveness of free and locally relevant data for assessing walkable environments. This facilitates the use of locally derived and adaptive tools for evaluating the health impacts of the built environment.

The digital divide: Examining socio-demographic factors associated with health literacy, access and use of internet to seek health information.

Science.gov (United States)

Estacio, Emee Vida; Whittle, Rebecca; Protheroe, Joanne

2017-02-01

This article aims to examine the socio-demographic characteristics associated with access and use of Internet for health-related purposes and its relationship with health literacy. Data were drawn from a health literacy survey ( N = 1046) and analysed using logistic regression. Results show a strong association between health literacy, internet access and use. Socio-demographic characteristics particularly age, education, income, perceived health and social isolation also predict internet access. Thus, in addition to widening access, the movement towards digitisation of health information and services should also consider digital skills development to enable people to utilise digital technology more effectively, especially among traditionally hard-to-reach communities.

Facilitators for the development and implementation of health promoting policy and programs – a scoping review at the local community level

Directory of Open Access Journals (Sweden)

Daniel Weiss

2016-02-01

Full Text Available Abstract Background Health promotion, with a focus on multidimensional upstream factors and an ecological, life-course approach, is establishing itself as the guiding philosophy for addressing public health. Action at the political and programmatic level on the Social Determinants of Health has proven effective for promoting and building public health at all levels but has been particularly evident at the national and international levels – due in large part to available documents and guidelines. Although research and experience establish that health promotion is most effective when settings-based, the development of health promoting policies and programs at the local level is still difficult. This study intended to investigate available knowledge on the development and implementation of health promoting policies and programs at the local level and identify factors most important for facilitating capacity building and outcome achievement. Methods We used a scoping review in order to review the current literature on local policy development and program implementation. Keywords were chosen based on results of a previous literature review. A total of 53 articles were divided into two categories: policy and implementation. Critical analysis was conducted for each article and a summary assembled. Data was charted with specific focus on the aims of the study, data acquisition, key theories/concepts/frameworks used, outcome measures, results, and conclusions. Results The articles included in this study primarily focused on discussing factors that facilitate the development of health promoting policy and the implementation of health promotion programs. Most significant facilitators included: collaborative decision-making, agreement of objectives and goals, local planning and action, effective leadership, building and maintaining trust, availability of resources, a dynamic approach, a realistic time-frame, and trained and knowledgeable staff. Within

Increasing mental health capacity in a post-conflict country through effective professional volunteer partnerships: a series of case studies with government agencies, local NGOs and the diaspora community.

Science.gov (United States)

Tribe, Rachel; Weerasinghe, Dilanthi; Parameswaran, Shanthy

2014-10-01

The focus of this paper is on working in partnership with local practitioners and communities to strengthen local capacity building in the area of mental health and well-being in Sri Lanka. This paper will examine the context, organizing concepts, organizational processes, and the development of good working relationships and partnership building behind this work. Our involvement was based on requests which came to the authors as a result of their previous work in Sri Lanka over several decades. This work had been undertaken on behalf of the UK-Sri Lanka Trauma Group (UKSLTG), a UK-based charity which was set up in 1994, and of which the authors are founding members ( www.uksrilankatrauma.org.uk ). In the first section of the paper, contextual issues will be discussed. The second section of the paper provides details of the training undertaken on mental health promotion among young people in Sri Lanka for the Directorate of Mental Health. The third section of the paper reviews work undertaken with a major psycho-social/mental health organization on issues relating to writing and implementing an ethical code for mental health practitioners and briefly discusses some of the dilemmas associated with this.

[Health promotion based on assets: how to work with this perspective in local interventions?

Science.gov (United States)

Cofiño, Rafael; Aviñó, Dory; Benedé, Carmen Belén; Botello, Blanca; Cubillo, Jara; Morgan, Antony; Paredes-Carbonell, Joan Josep; Hernán, Mariano

2016-11-01

An asset-based approach could be useful to revitalise health promotion or community health interventions combining work with multiple partnerships, positive health, community engagement, equity and orientation of health determinants. We set some recommendations about how to incorporate the assets model in programmes, projects and interventions in health promotion. Some techniques are described for assets mapping and some experiences with this methodology being developed in different regions are systematised. We propose the term "Asset-based Health Promotion/Community Health" as an operational definition to work at the local level with a community engagement and participatory approach, building alliances between different institutions at the state-regional level and trying to create a framework for action with the generation of evaluations and evidence to work on population interventions from the perspective of positive health. Copyright © 2016 SESPAS. All rights reserved.

Local food: benefits and failings due to modern agriculture

Directory of Open Access Journals (Sweden)

Fábio Cunha Coelho

Full Text Available ABSTRACT: This paper aims to examine the issue raised by the consumption of locally produced food in all its various aspects, and in particular, addresses how this practice contributes to local and global sustainability. It analyzes the different definitions of local food, the strategies used, the implications of the distance traveled in the transportation of food to the consumer's table – food miles, the relationships between local food consumption and sustainability, farming practices that reduce carbon emissions, contribution of urban agriculture to local food, local trading of food produced by rural farmers, as well as a number of relationships between the consumption of local food and human nutrition and health, local food protection and the ability to support local food production for humanitarian actions in disaster situations. The promotion of “local food” is a complex problem covering environmental issues, the economy and health. Transportation is not the only factor that determines how efficient it is to consume local food. Often, the technologies used for agricultural production are those most responsible for the degree of sustainability in the production and supply of food to the population. Local production does not always mean lower emissions of greenhouse gases. In general, the consumption of local foods, produced in ways adapted to the local environment using technologies with an ecological basis, is something beneficial and salutary for the environment, economy and society in general.

Climate change and health: global to local influences on disease risk.

Science.gov (United States)

Patz, J A; Olson, S H

2006-01-01

The World Health Organization has concluded that the climatic changes that have occurred since the mid 1970s could already be causing annually over 150,000 deaths and five million disability-adjusted life-years (DALY), mainly in developing countries. The less developed countries are, ironically, those least responsible for causing global warming. Many health outcomes and diseases are sensitive to climate, including: heat-related mortality or morbidity; air pollution-related illnesses; infectious diseases, particularly those transmitted, indirectly, via water or by insect or rodent vectors; and refugee health issues linked to forced population migration. Yet, changing landscapes can significantly affect local weather more acutely than long-term climate change. Land-cover change can influence micro-climatic conditions, including temperature, evapo-transpiration and surface run-off, that are key determinants in the emergence of many infectious diseases. To improve risk assessment and risk management of these synergistic processes (climate and land-use change), more collaborative efforts in research, training and policy-decision support, across the fields of health, environment, sociology and economics, are required.

Differences in uptake of immunisations and health examinations among refugee children compared to Danish-born children: a cohort study.

Science.gov (United States)

Moller, Sanne Pagh; Hjern, Anders; Andersen, Anne-Marie Nybo; Norredam, Marie

2016-04-01

Refugee children and their families constitute a vulnerable group regarding health and access to care. In a register-based cohort design, we examined differences in uptake of immunisations and child health examinations between refugee children and Danish-born children, including predictors of uptake among refugee children. Refugee children (n = 16,701) who, between January 1993 and December 2010, obtained residency permits in Denmark were included and matched in a 1:6 ratio on age and sex with Danish-born children (n = 100,206). Personal identification numbers were cross-linked to the National Danish Health Service Register, identifying all contacts for immunisation and child health examinations. We estimated hazard ratios (HR) of uptake. Refugee children had a lower uptake of all immunisations compared to Danish-born children. The lowest uptake was found for immunisation against diphtheria, tetanus, pertussis and polio (HR = 0.50; 95 % confidence interval (CI) 0.48-0.51). Participation in child health examinations was also lower among refugee children with the lowest at the last child health examination at age 5 (HR = 0.48; 95 % CI 0.47-0.50). Adjusting the analysis for parental income increased the HRs by 10-20 %. This Danish register-based study using nationwide data revealed a lower uptake of routine immunisations and child health examinations among refugee children compared to Danish-born children. •Uptake of immunisation and child health examination is associated with low household income, unemployment and low educational status among the parents. •Uptake may be even lower among refugee families as they constitute a vulnerable group regarding access to healthcare. What is New: •Refugee children had lower uptake of immunisations and child health examinations compared to Danish-born children. •Several predictors of uptake were identified including region of origin and duration of residence.

Adult health study Hiroshima analysis of participation in examinations, July 1958-December 1960

Energy Technology Data Exchange (ETDEWEB)

Anderson, Jr, P S

1961-07-19

The participation data for Adult Health Study examinations conducted in Hiroshima during the period July 1958 to December 31, 1960, are presented. The continuing medical examination program includes approximately 13,700 individuals who form the Adult Health Study population of ABCC in Hiroshima. The Adult Health Study population is composed of four exposure groups of equal size, matched by age and sex. Participation scores are analyzed with respect to exposure, age, sex, and socioeconomic variables as well as history of previous contact with the ABCC programs. Significant differences were demonstrated between the participation scores by age, marital status, history of prior contact with ABCC, and occupation; this latter category was significant only for males. Although differences were observed for these variables, the significance was usually attributable to one category in each of the variables, often the least populated, such as separated or divorced for marital status; and previous history unknown for prior ABCC contact. A trend was apparent with respect to exposure, with the lowest participation noted in the nonexposed and the highest participation in the exposed group with symptoms. Sex differences were not significant. Although relatively minor differences were demonstrated for some variables, the outstanding features of this program are the remarkable high participation scores. Only 9 percent of the population were in the so-called refusal category and over 80 percent of the living Adult Health Study population, including non-Hiroshima residents, were examined during the period considered by this report. 6 references, 1 figure, 9 tables.

Patients' Perceptions on the Performance of a Local Health System to Eliminate Leprosy, Paraná State, Brazil

Science.gov (United States)

Pieri, Flávia Meneguetti; Touso, Michelle Mosna; Rodrigues, Ludmila Barbosa Bandeira; Yamamura, Mellina; Pinto, Ione Carvalho; Dessunti, Elma Mathias; Crispim, Juliane de Almeida; Ramos, Antônio Carlos Vieira; Arroyo, Luiz Henrique; Neto, Marcelino Santos; Garcia, Maria Concebida da Cunha; Popolin, Marcela Paschoal; Silveira, Tatiane Ramos dos Santos; Arcêncio, Ricardo Alexandre

2014-01-01

Background In Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the “Pact for life” (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income. Methodology/Principal Findings A cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community. Conclusions/Significance The patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem. PMID:25412349

Addressing health inequalities in the delivery of the human papillomavirus vaccination programme: examining the role of the school nurse.

Directory of Open Access Journals (Sweden)

Tammy Boyce

Full Text Available HPV immunisation of adolescent girls is expected to have a significant impact in the reduction of cervical cancer. UK The HPV immunisation programme is primarily delivered by school nurses. We examine the role of school nurses in delivering the HPV immunisation programme and their impact on minimising health inequalities in vaccine uptake.A rapid evidence assessment (REA and semi-structured interviews with health professionals were conducted and analysed using thematic analysis. 80 health professionals from across the UK are interviewed, primarily school nurses and HPV immunisation programme coordinators. The REA identified 2,795 articles and after analysis and hand searches, 34 relevant articles were identified and analysed. Interviews revealed that health inequalities in HPV vaccination uptake were mainly related to income and other social factors in contrast to published research which emphasises potential inequalities related to ethnicity and/or religion. Most school nurses interviewed understood local health inequalities and made particular efforts to target girls who did not attend or missed doses. Interviews also revealed maintaining accurate and consistent records influenced both school nurses' understanding and efforts to target inequalities in HPV vaccination uptake.Despite high uptake in the UK, some girls remain at risk of not being vaccinated with all three doses. School nurses played a key role in reducing health inequalities in the delivery of the HPV programme. Other studies identified religious beliefs and ethnicity as potentially influencing HPV vaccination uptake but interviews for this research found this appeared not to have occurred. Instead school nurses stated girls who were more likely to be missed were those not in education. Improving understanding of the delivery processes of immunisation programmes and this impact on health inequalities can help to inform solutions to increase uptake and address health inequalities

Examining the Relationship between Teacher Organizational Commitment and School Health in Turkish Primary Schools

Science.gov (United States)

Sezgin, Ferudun

2009-01-01

The purpose of this study was to examine the relationships between teachers' perceptions of organizational commitment and school health in Turkish primary schools. The Organizational Commitment Scale and the Organizational Health Inventory were used to gather data from 323 randomly selected teachers employed in 20 primary schools in Ankara.…

The role of community health centers in assessing the social determinants of health for planning and policy: the example of frontier New Mexico.

Science.gov (United States)

Bruna, Sean; Stone, Lisa Cacari; Wilger, Susan; Cantor, Jeremy; Guzman, Carolina

2014-01-01

This article examines the experience of a frontier-based community health center when it utilized the Tool for Health and Resilience in Vulnerable Environments (THRIVE) for assessing social determinants of health with a local health consortium. Community members (N = 357) rated safety, jobs, housing, and education among the top health issues. Community leaders integrated these health priorities in a countywide strategic planning process. This example of a frontier county in New Mexico demonstrates the critical role that community health centers play when engaging with local residents to assess community health needs for strategic planning and policy development.

The relationships between work characteristics and mental health: Examining normal, reversed and reciprocal relationships in a 4-wave study

NARCIS (Netherlands)

Lange, A.H. de; Taris, T.W.; Kompier, M.A.J.; Houtman, I.L.D.; Bongers, P.M.

2004-01-01

This longitudinal study examined the causal relationships between job demands, job control and supervisor support on the one hand and mental health on the other. Whereas we assumed that work characteristics affect mental health, we also examined reversed causal relationships (mental health

Resource allocation in public health practice: a national survey of local public health officials.

Science.gov (United States)

Baum, Nancy M; DesRoches, Catherine; Campbell, Eric G; Goold, Susan Dorr

2011-01-01

The purpose of this study was to gain an empirical understanding of the types of allocation decisions local health officials (LHOs) make and the factors that influence those allocation decisions. We conducted a national survey of LHOs in the United States in 2008 to 2009. The sample was stratified by the size of the population served by the department. We merged our data with data from the 2008 National Association of County and City Health Officials Profile survey. Descriptive statistics were generated using weighted data. Our final sample size was 608 respondents, with an average of 10 years experience. The LHOs reported little shifting of resources among population groups but greater capacity to redirect staffing time. Less than half of LHOs reported using economic analyses or conducting needs assessments when setting priorities. Having sole provider status in a community strongly influenced LHOs' allocation decisions. In addition, the effectiveness of activities, previous budget allocations, and input from boards of health were influential factors in allocation decisions. Public expectations were moderately to very influential, but direct public input had a low impact on allocation decisions. Survey findings provide a clearer understanding of how LHOs fulfill their obligations as stewards of public health resources and ensure effective activities and access to needed services. It may be useful to assess the value of more structured allocation methods (eg, decision frameworks) in the allocation process. Expanding opportunities for public engagement in priority setting may also be valuable for difficult allocation decisions.

Communication with the public in the health-care system: a descriptive study of the use of social media in local health authorities and public hospitals in Italy.

Science.gov (United States)

Vanzetta, Marina; Vellone, Ercole; Dal Molin, Alberto; Rocco, Gennaro; De Marinis, Maria Grazia; Rosaria, Alvaro

2014-01-01

In 2010 the Italian Ministry of Health set out recommendations for the use of social technology and Web 2.0, inviting organisations within the Italian national health service (Servizio Sanitario Nazionale, SSN) to equip themselves with instruments. 1. to ascertain how many local health authorities (Aziende Sanitarie Locali, ASL) and public hospitals have a presence on the most widely used social media websites in Italy: Facebook, Twitter and YouTube; 2. to find out how well the Facebook, Twitter and YouTube pages of ASLs and public hospitals are known among the general population; 3. to find out how ASLs and public hospitals engage with the general public on social media sites. The websites of all ASLs and public hospitals across the country were visited to look for the icons of the social media sites under examination. The data considered were publicly available upon access. A total of 245 websites were analysed. 7.34% ASLs and hospitals had social media accounts. 8 organisations had an account on all three of the social media sites considered in the study. The results show a low presence of ASLs and hospitals on social media. Other studies are needed in this field.

Examining Residence Status as a Risk Factor for Health Risk Behaviors among College Students

Science.gov (United States)

DiBello, Angelo M.; Benz, Madeline B.; Miller, Mary Beth; Merrill, Jennifer E.; Carey, Kate B.

2018-01-01

Objective: The current study is aimed to evaluate college student residence as a unique risk factor for a range of negative health behaviors. Participants: We examined data from 63,555 students (66% females) from 157 campuses who completed the National College Health Assessment Survey in Spring 2011. Methods: Participants answered questions about…

Examination Of The Physicochemical Characteristics Of Domestic Water Sources In Ebonyi Local Government Area Of Ebonyi State Nigeria.

Directory of Open Access Journals (Sweden)

Nwidembia

2015-08-01

Full Text Available Lack of good drinking water due to contamination by chemicals has been a global menace. It is one of the most serious environmental problems that have greatly impacted human health. Basic quality parameters of domestic water sources in Ebonyi Local Government Area were studied in the months of September 2014 and October 2014. Samples were randomly collected from common water sources well stream borehole and pond across four communities in the Local Government Area. The physicochemical characteristics of the collected water samples were investigated using standard procedures. The results showed mean pH values of 7.3 7.8 6.8 and 7.0 for well stream borehole and pond water samples respectively. The colour examination showed 13 HU 11 HU 13 HU and 16 HU for well stream borehole and pond water samples respectively. The turbidity were recorded as 103 NTU well 90 NTU stream 0.8 NTU borehole and 92 NTU pond. Total dissolved solids TDS showed a record of 595 mgL 386mgL 76 mgL and 563 mgL for well stream borehole and pond respectively. Well water recorded 78 mgL stream 112 mgL borehole 42 mgL and pond 795 mgL for Total Suspended Solids respectively. Also the total hardness showed 525 mgL 779 mgL 44 mgL and 837 mgL for well stream borehole and pond water samples respectively. The results show that most of the common sources of water in the studied areas are not good for drinking since the physicochemical variables evaluated mostly exceeded WHO permissible limits. We therefore recommend that water treatment should be paramount as alternative sources of drinking water in the communities should be considered.

Examining Attachment to God and Health Risk-Taking Behaviors in College Students

NARCIS (Netherlands)

Barrett, J.; Horton, K.D.; Ellison, Ch.G.; Loukas, A.; Downey, D.L.

2012-01-01

Drawing on insights from attachment theory, this study examined whether three types of attachment to God—secure, avoidant, and anxious—were associated with health-risk behaviors, over and above the effects of religious attendance, peer support, and demographic covariates, in a sample of 328

A systematic review of economic evaluations of local authority commissioned preventative public health interventions in overweight and obesity, physical inactivity, alcohol and illicit drugs use and smoking cessation in the United Kingdom.

Science.gov (United States)

White, Pam; Skirrow, Helen; George, Abraham; Memon, Anjum

2018-02-16

Since 2013, local authorities in England have been responsible for commissioning preventative public health interventions. The aim of this systematic review was to support commissioning by collating published data on economic evaluations and modelling of local authority commissioned public health preventative interventions in the UK. Following the PRISMA protocol, we searched for economic evaluations of preventative intervention studies in four different areas: overweight and obesity, physical inactivity, alcohol and illicit drugs use and smoking cessation. The systematic review identified studies between January 1994 and February 2015, using five databases. We synthesized the studies to identify the key methods and examined results of the economic evaluations. The majority of the evaluations related to cost-effectiveness, rather than cost-benefit analyses or cost-utility analyses. These analyses found preventative interventions to be cost effective, though the context of the interventions differed between the studies. Preventative public health interventions in general are cost-effective. There is a need for further studies to support justification of continued and/or increased funding for public health interventions. There is much variation between the types of economically evaluated preventative interventions in our review. Broader studies incorporating different contexts may help support funding for local authority-sponsored public health initiatives.

Investigating the health care delivery system in Japan and reviewing the local public hospital reform

Directory of Open Access Journals (Sweden)

Zhang X

2016-03-01

Full Text Available Xing Zhang, Tatsuo Oyama National Graduate Institute for Policy Studies, Tokyo, Japan Abstract: Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. Keywords: health care system, health care resource, public hospital, multivariate regression model, financial performance

Demographic indicators of trust in federal, state and local government: implications for Australian health policy makers.

Science.gov (United States)

Meyer, Samantha B; Mamerow, Loreen; Taylor, Anne W; Henderson, Julie; Ward, Paul R; Coveney, John

2013-02-01

To provide baseline findings regarding Australians' trust in federal, state and local government. A computer-assisted telephone interviewing (CATI) survey was administrated during October to December 2009 to a random sample (n=1109) across Australia (response rate 41.2%). Binary logistic regression analyses were carried out by means of SPSS. Age, household size, household income, IRSD and ARIA were found to be significant indicators for trust in federal, state and local government. Trust in state government is lower for older respondents and respondents living in inner and outer regional areas. Trust in local council is lower in respondents living in inner regional areas, respondents living in disadvantaged areas, and respondents in the income bracket of $60001 to $100000. Trust in federal government is lower for older respondents and respondents living in disadvantaged areas. Of note is diminished trust in government among older, regional and lower income ($30001-$60000) respondents. Trust in all levels of government was found to be the lowest in population groups that are identified by empirical research and media to have the poorest access to government services. As a consequence, improved access to services for these populations may increase trust in health policy. Increased trust in health governance may in turn, ensure effective dissemination and implementation of health policies and that existing inequities are not perpetuated through distrust of health information and policy initiatives.

Cardiovascular health metrics and accelerometer-measured physical activity levels: National Health and Nutrition Examination Survey, 2003-2006.

Science.gov (United States)

Barreira, Tiago V; Harrington, Deirdre M; Katzmarzyk, Peter T

2014-01-01

To determine whether relationships exist between accelerometer-measured moderate-to-vigorous physical activity (MVPA) and other cardiovascular (CV) health metrics in a large sample. Data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES) collected from January 1, 2003, through December 31, 2006, were used. Overall, 3454 nonpregnant adults 20 years or older who fasted for 6 hours or longer, with valid accelerometer data and with CV health metrics, were included in the study. Blood pressure (BP), body mass index (BMI), smoking status, diet, fasting plasma glucose level, and total cholesterol level were defined as ideal, intermediate, and poor on the basis of American Heart Association criteria. Results were weighted to account for sampling design, oversampling, and nonresponse. Significant increasing linear trends in mean daily MVPA were observed across CV health levels for BMI, BP, and fasting plasma glucose (Pphysical activity in the overall definition of ideal CV health. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Making health system performance measurement useful to policy makers: aligning strategies, measurement and local health system accountability in ontario

NARCIS (Netherlands)

Veillard, Jeremy; Huynh, Tai; Ardal, Sten; Kadandale, Sowmya; Klazinga, Niek S.; Brown, Adalsteinn D.

2010-01-01

This study examined the experience of the Ontario Ministry of Health and Long-Term Care in enhancing its stewardship and performance management role by developing a health system strategy map and a strategy-based scorecard through a process of policy reviews and expert consultations, and linking

Local health department translation processes: potential of machine translation technologies to help meet needs.

Science.gov (United States)

Turner, Anne M; Mandel, Hannah; Capurro, Daniel

2013-01-01

Limited English proficiency (LEP), defined as a limited ability to read, speak, write, or understand English, is associated with health disparities. Despite federal and state requirements to translate health information, the vast majority of health materials are solely available in English. This project investigates barriers to translation of health information and explores new technologies to improve access to multilingual public health materials. We surveyed all 77 local health departments (LHDs) in the Northwest about translation needs, practices, barriers and attitudes towards machine translation (MT). We received 67 responses from 45 LHDs. Translation of health materials is the principle strategy used by LHDs to reach LEP populations. Cost and access to qualified translators are principle barriers to producing multilingual materials. Thirteen LHDs have used online MT tools. Many respondents expressed concerns about the accuracy of MT. Overall, respondents were positive about its potential use, if low costs and quality could be assured.

Educational disparities in quality of diabetes care in a universal health insurance system: evidence from the 2005 Korea National Health and Nutrition Examination Survey.

Science.gov (United States)

Do, Young Kyung; Eggleston, Karen N

2011-08-01

To investigate educational disparities in the care process and health outcomes among patients with diabetes in the context of South Korea's universal health insurance system. Bivariate and multiple regression analyses of data from a cross-sectional health survey. A nationally representative and population-based survey, the 2005 Korea National Health and Nutrition Examination Survey. Respondents aged 40 or older who self-reported prior diagnosis with diabetes (n= 1418). Seven measures of the care process and health outcomes, namely (i) receiving medical treatment for diabetes, (ii) ever received diabetes education, (iii) received dilated eye examination in the past year, (iv) received microalbuminuria test in the past year, (v) having activity limitation due to diabetes, (vi) poor self-rated health and (vii) self-rated health on a visual analog scale. Except for receiving medical care for diabetes, overall process quality was low, with only 25% having ever received diabetes education, 39% having received a dilated eye examination in the past year and 51% having received a microalbuminuria test in the past year. Lower education level was associated with both poorer care processes and poorer health outcomes, whereas lower income level was only associated with poorer health outcomes. While South Korea's universal health insurance system may have succeeded in substantially reducing financial barriers related to diabetes care, the quality of diabetes care is low overall and varies by education level. System-level quality improvement efforts are required to address the weaknesses of the health system, thereby mitigating educational disparities in diabetes care quality.

Finnish experiences of health monitoring: local, regional, and national data sources for policy evaluation

Directory of Open Access Journals (Sweden)

Katri Kilpeläinen

2016-02-01

Full Text Available Background: Finland has a long tradition of gathering information about the health and welfare of the adult population. Design: Surveys and administrative registers form the basis for national and local health monitoring in Finland. Results: Different data sources are used in Finland to develop key indicators, which can be used to evaluate how the national health policy targets have been met in different parts of the country and in different population subgroups. Progress has been shown in chronic disease risk factors, such as smoking reduction. However, some health policy targets have not been met. Socioeconomic health differences, for example, have remained large compared with other European countries. Conclusion: Although data availability for key health indicators is good in Finland, there is a need for wider and more comprehensive use of this information by political decision-makers and healthcare professionals.

Examining clinicians’ experiences providing sexual health services for LGBTQ youth: considering social and structural determinants of health in clinical practice

Science.gov (United States)

Knight, R. E.; Shoveller, J. A.; Carson, A. M.; Contreras-Whitney, J. G.

2014-01-01

Although barriers related to lesbian, gay, bisexual, transgender and queer (LGBTQ) youth’s experiences accessing sexual health services have been examined in detail, research into the experiences and perceptions of clinicians providing these services has been conspicuously absent. The aim of this article is to explore the perceptions and experiences of clinicians providing sexual health services for LGBTQ youth. Drawing on in-depth, semi-structured interviews, this study examines 24 clinicians’ experiences providing sexual health services to LGBTQ youth in five communities in British Columbia, Canada. Our findings reveal how many clinicians provide services to LGBTQ youth with a lack of cultural competency—either implicitly (e.g. by describing heteronormative practices) or explicitly (e.g. by expressing frustration that they had not been sufficiently provided with appropriate training related to LGBTQ youth sexual health). Institutional norms and values were identified as the dominant barriers in the effective provision of LGBTQ-tailored services. Many clinicians find themselves unprepared to provide culturally competent sexual health services that have both the capacity to address individual-level issues (e.g. promoting condom use) while considering (and adapting services to) the broader socio-cultural and structural conditions that can render LGBTQ youth socially vulnerable. PMID:24412811

Population Health Management and the Second Golden Age of Arab Medicine: Promoting Health, Localizing Knowledge Industries, and Diversifying Economies in the GCC Countries.

Science.gov (United States)

Mattke, Soeren; Hunter, Lauren E; Magnuson, Madeline; Arifkhanova, Aziza

2015-07-15

Over the past half-century, the Gulf Cooperation Council (GCC) countries-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates-have experienced rapid economic growth and, with it, dramatic lifestyle changes. Low levels of physical activity and calorie-dense diets have led to an increase in the prevalence of chronic disease, most prominently diabetes. After having successfully controlled communicable diseases and made advanced acute care accessible locally, the GCC countries now face the challenge of orienting their health care systems toward prevention and treatment of chronic diseases. In this study, Dr. Mattke and his colleagues argue that this challenge presents GCC countries with a historic opportunity to reestablish the thought leadership role that Arab medicine had in the Islamic Golden Age. They propose that GCC countries could apply their considerable wealth to design and implement innovative health care systems based on population health management principles and sophisticated health information technology. Taking this path would not only improve prevention and management of chronic disease in the GCC countries but also contribute to the diversification of their economies and localization of knowledge industries.

Opportunity costs and local health service spending decisions: a qualitative study from Wales.

Science.gov (United States)

Karlsberg Schaffer, Sarah; Sussex, Jon; Hughes, Dyfrig; Devlin, Nancy

2016-03-25

All health care systems face the need to find the resources to meet new demands such as a new, cost-increasing health technology. In England and Wales, when a health technology is recommended by the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS) is mandated to provide the funding to accommodate it within three months of publication of the recommendation. Identifying what, in practice, is foregone when new cost-increasing technologies are introduced is important for understanding the effects of health technology assessment (HTA) decisions on the NHS or any other health care system. Our objective was to investigate how in practice local NHS commissioners in Wales accommodated financial "shocks" arising from technology appraisals (TAs) issued by NICE and from other cost pressures. Semi-structured interviews were conducted with Finance Directors and Medical Directors from all seven Local Health Boards (LHBs) in NHS Wales. These interviews covered prioritisation processes, as well as methods of financing NICE TAs and other financial shocks at each LHB. We then undertook a systematic identification of themes and topics from the information recorded. The study relates to the period October 2010 to March 2013. The financial impact of NICE TAs is generally anticipated and planned for in advance and the majority of LHBs have contingency funds available to cope with these and other financial shocks within-period. Efficiency savings (defined as reductions in costs with no assumed reductions in quality) were a source of funds for cost pressures of all kinds. Service displacements were not linkable to particular NICE TAs and there appears to be a general lack of explicit prioritisation activities. The Welsh Government has, on occasion, explicitly or implicitly acted as the funder of last resort. Services may be displaced as part of a response to the cumulative impact of all types of cost pressures, including cost-increasing health

Improving local health workers' knowledge of malaria in the elimination phase-determinants and strategies: a cross-sectional study in rural China.

Science.gov (United States)

Wang, Ruoxi; Tang, Shangfeng; Yang, Jun; Shao, Tian; Shao, Piaopiao; Liu, Chunyan; Feng, Da; Fu, Hang; Chen, Xiaoyu; Hu, Tao; Feng, Zhanchun

2017-05-19

The current stage of malaria elimination in China requires experienced local health workers with sufficient knowledge of malaria who help to keep the public health system vigilant about a possible resurgence. However, the influencing factors of local health workers' knowledge level are not fully comprehended. This study aims to explore the factors with heavy impact on local health worker's knowledge of malaria and propose corresponding suggestions. Underpinned by stratified sampling method, a cross-sectional survey was carried out between November 2014 and April 2016. Chi square test was performed to identify the factors with potential influence on health workers' knowledge level of malaria. Bivariate logistic regression was employed to explore the relationship between the predictors and local health workers' knowledge level of malaria. Layered Chi square test was used to calculate the homogeneity of the interaction between training approaches and the percentage of participants with high-level knowledge. The endemic type of county and type of organization played the most significant role in influencing local health workers' knowledge level regarding malaria in the sample population. The participants from Type 1 and Type 2 counties were 4.3 times (4.336 and 4.328, respectively) more likely to have high-level knowledge of malaria than those who work in Type 3 counties. The probability of having high-level knowledge amongst the participants from county-level facilities (county hospitals and CDCs) were more than 2.2 times higher than those who work in villages. Other socio-demographic factors, such as education and work experience, also affected one's knowledge regarding malaria. Amongst the six most-used training approaches, electronic material (OR = 2.356, 95% CI 1.112-4.989), thematic series (OR = 1.784, 95% CI 0.907-3.508) and supervision (OR = 2.788, 95% CI 1.018-7.632) were proven with significant positive impact on local health workers' knowledge of

The Geography of Diabetes in London, Canada: The Need for Local Level Policy for Prevention and Management

Science.gov (United States)

Tompkins, Jordan W.; Luginaah, Isaac N.; Booth, Gillian L.; Harris, Stewart B.

2010-01-01

Recent reports aimed at improving diabetes care in socially disadvantaged populations suggest that interventions must be tailored to meet the unique needs of the local community—specifically, the community’s geography. We have examined the spatial distribution of diabetes in the context of socioeconomic determinants of health in London (Ontario, Canada) to characterize neighbourhoods in an effort to target these neighbourhoods for local level community-based program planning and intervention. Multivariate spatial-statistical techniques and geographic information systems were used to examine diabetes rates and socioeconomic variables aggregated at the census tract level. Creation of a deprivation index facilitated investigation across multiple determinants of health. Findings from our research identified ‘at risk’ neighbourhoods in London with socioeconomic disadvantage and high diabetes. Future endeavours must continue to identify local level trends in order to support policy development, resource planning and care for improved health outcomes and improved equity in access to care across geographic regions. PMID:20623032

Implementation of a web-based national child health-care programme in a local context: A complex facilitator role.

Science.gov (United States)

Tell, Johanna; Olander, Ewy; Anderberg, Peter; Berglund, Johan Sanmartin

2018-02-01

The aim of this study was to investigate child health-care coordinators' experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide. The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed. The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme 'Being a facilitator: a complex role' was formed to express the child health-care coordinators' experiences. Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context.

Monte Carlo simulation to analyze the cost-benefit of radioactive seed localization versus wire localization for breast-conserving surgery in fee-for-service health care systems compared with accountable care organizations.

Science.gov (United States)

Loving, Vilert A; Edwards, David B; Roche, Kevin T; Steele, Joseph R; Sapareto, Stephen A; Byrum, Stephanie C; Schomer, Donald F

2014-06-01

In breast-conserving surgery for nonpalpable breast cancers, surgical reexcision rates are lower with radioactive seed localization (RSL) than wire localization. We evaluated the cost-benefit of switching from wire localization to RSL in two competing payment systems: a fee-for-service (FFS) system and a bundled payment system, which is typical for accountable care organizations. A Monte Carlo simulation was developed to compare the cost-benefit of RSL and wire localization. Equipment utilization, procedural workflows, and regulatory overhead differentiate the cost between RSL and wire localization. To define a distribution of possible cost scenarios, the simulation randomly varied cost drivers within fixed ranges determined by hospital data, published literature, and expert input. Each scenario was replicated 1000 times using the pseudorandom number generator within Microsoft Excel, and results were analyzed for convergence. In a bundled payment system, RSL reduced total health care cost per patient relative to wire localization by an average of $115, translating into increased facility margin. In an FFS system, RSL reduced total health care cost per patient relative to wire localization by an average of $595 but resulted in decreased facility margin because of fewer surgeries. In a bundled payment system, RSL results in a modest reduction of cost per patient over wire localization and slightly increased margin. A fee-for-service system suffers moderate loss of revenue per patient with RSL, largely due to lower reexcision rates. The fee-for-service system creates a significant financial disincentive for providers to use RSL, although it improves clinical outcomes and reduces total health care costs.

Global Health Diplomacy, "San Francisco Values," and HIV/AIDS: From the Local to the Global.

Science.gov (United States)

Kevany, Sebastian

2015-01-01

San Francisco has a distinguished history as a cosmopolitan, progressive, and international city, including extensive associations with global health. These circumstances have contributed to new, interdisciplinary scholarship in the field of global health diplomacy (GHD). In the present review, we describe the evolution and history of GHD at the practical and theoretical levels within the San Francisco medical community, trace related associations between the local and the global, and propose a range of potential opportunities for further development of this dynamic field. We provide a historical overview of the development of the "San Francisco Model" of collaborative, community-owned HIV/AIDS treatment and care programs as pioneered under the "Ward 86" paradigm of the 1980s. We traced the expansion and evolution of this model to the national level under the Ryan White Care Act, and internationally via the President's Emergency Plan for AIDS Relief. In parallel, we describe the evolution of global health diplomacy practices, from the local to the global, including the integration of GHD principles into intervention design to ensure social, political, and cultural acceptability and sensitivity. Global health programs, as informed by lessons learned from the San Francisco Model, are increasingly aligned with diplomatic principles and practices. This awareness has aided implementation, allowed policymakers to pursue related and progressive social and humanitarian issues in conjunction with medical responses, and elevated global health to the realm of "high politics." In the 21st century, the integration between diplomatic, medical, and global health practices will continue under "smart global health" and GHD paradigms. These approaches will enhance intervention cost-effectiveness by addressing and optimizing, in tandem with each other, a wide range of (health and non-health) foreign policy, diplomatic, security, and economic priorities in a synergistic manner

Melhores práticas em sistemas locais de saúde: sob foco, a saúde bucal do idoso Best practices in local health systems: focusing on the elderly's oral health

Directory of Open Access Journals (Sweden)

Ana Lúcia Schaefer Ferreira de Mello

2010-01-01