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Kinds of Health Department Selected AbstractsUrban Service Partnerships, ,Street-Level Bureaucrats' and Environmental Sanitation in Kumasi and Accra, Ghana: Coping with Organisational Change in the Public BureaucracyDEVELOPMENT POLICY REVIEW, Issue 1 2006Richard Crook This is an empirical case study of ,street-level' officials in a classic ,regulatory' public agency: the Environmental Health Department in Kumasi and Accra, Ghana, where privatisation and contracting-out of sanitary services have imposed new ways of working on Environmental Health Officers. Both internal and external organisational relationships are analysed to explain the extent to which these officers have adapted to more ,client-oriented' ways of working. Their positive organizational culture is credited with much of the positive results achieved, but was not sufficient to cope with the negative impact of politically protected privatisations on the officials' ability to enforce standards. Nor could it entirely overcome the deficiencies in training and incentive structures which should have accompanied the changes in service delivery. [source] Key issues relating to decentralization at the provincial level of health management in CambodiaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2005Bunnan Men Abstract The following study was conducted as part of a review of management systems at a Provincial Health Department (Kampong Cham Province) and a National Health Programme (National Immunization Program) in 2002,2003 in Cambodia. The aim of this paper is to identify, analyse and recommend those management system factors that are critical to the success of health management performance, with a particular focus on provincial management. The review has identified critical success factors associated with health management performance at the sub-national level that include a stronger role for effective human resource management in health sector reform, elevation of the status of planning in senior level management, and the development of a more comprehensive and transparent finance system. These success factors will position the provincial level of health management to respond more effectively to the reform challenges of administrative de-concentration and political decentralization that are currently underway across a range of government sectors in Cambodia. Copyright © 2005 John Wiley & Sons, Ltd. [source] Building a Partnership to Evaluate School-Linked Health Services: The Cincinnati School Health Demonstration ProjectJOURNAL OF SCHOOL HEALTH, Issue 10 2005Barbara L. Rose Partners from the Cincinnati Health Department, Cincinnati Public Schools, Cincinnati Children's Hospital Medical Center, and The Health Foundation of Greater Cincinnati wanted to determine if levels of school-linked care made a difference in student quality of life, school connectedness, attendance, emergency department use, and volume of referrals to health care specialists. School nurses, principals and school staff, parents and students, upper-level managers, and health service researchers worked together over a 2.5-year period to learn about and use new technology to collect information on student health, well-being, and outcome measures. Varying levels of school health care intervention models were instituted and evaluated. A standard model of care was compared with 2 models of enhanced care and service. The information collected from students, parents, nurses, and the school system provided a rich database on the health of urban children. School facilities, staffing, and computer technology, relationship building among stakeholders, extensive communication, and high student mobility were factors that influenced success and findings of the project. Funding for district-wide computerization and addition of school health staff was not secured by the end of the demonstration project; however, relationships among the partners endured and paved the way for future collaborations designed to better serve urban school children in Cincinnati. (J Sch Health. 2005;75(10):363-369) [source] Cluster of presumed organic dust toxic syndrome cases among urban landscape workers,Colorado, 2007,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 7 2009Tegan K. Boehmer PhD Abstract Background Organic dust toxic syndrome (ODTS) is an influenza-like illness typically affecting agricultural workers exposed to organic dusts. In July 2007, Tri-County Health Department investigated a cluster of acute respiratory illnesses among urban landscape workers with known mulch exposure. Methods An epidemiologic study of landscape workers was conducted. Employees were interviewed regarding illness and occupational exposures. Medical records were reviewed. Mulch samples were tested for fungi and endotoxins. Results Five (12%) of 43 employees experienced respiratory illness compatible with ODTS. Illness was associated with prolonged mulch exposure (,6 vs. <6 hr/day; relative risk,=,24.7; 95% confidence interval,=,3.3,184.9). Mulch samples contained high levels of Aspergillus spores and endotoxin. Conclusions Contaminated mulch was implicated as the source of presumed ODTS among landscape workers, highlighting that ODTS is not limited to rural agricultural settings. Education of employers, safety officers, and clinicians is necessary to improve recognition and prevention of ODTS within urban occupational groups. Am. J. Ind. Med. 52:534,538, 2009. © 2009 Wiley-Liss, Inc. [source] An Active Learning Experience in Health Policy for Baccalaureate Nursing StudentsPUBLIC HEALTH NURSING, Issue 5 2004Mary E. Byrd R.N., Ph.D. Abstract Nurses have the potential to promote the public's health through active involvement in shaping health and social policy. Preparing nursing students to influence public policy is a major component of the curriculum in public/community health nursing. A series of learning experiences was designed to engage students in this process. First, students participate in information sessions at the State Health Department and the State House. This provides them with opportunities to engage in dialogue with public health leaders as well as advocates from both professional organizations and community groups. Next, students identify the legislators who represent them in the community and write a narrative that describes the legislators' interest and commitment to health-related legislation. Lastly, students work in clinical groups to analyze a public health problem that can be addressed through public policy interventions. This has led to the students testifying at legislative hearings and working with community groups involved with the issue. The students present their findings to their peers and to the wider college community. Through these learning experiences, students gain practical experience in understanding the political process that leads to important policy change. This in turn prepares them for their roles as professional nurses and involved citizens. [source] Emergency Department Chlamydia Screening Through Partnership with the Public Health DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2009Charlene Babcock Irvin MD Abstract Background:, The emergency department (ED) serves a population that may benefit from numerous screening initiatives but screening in the ED is challenging due to crowding as well as resource and time constraints. One option may be to collect specimens in the ED and then partner with the public health department (PHD) to analyze the specimens off-site and arrange follow-up treatment. Objectives:, The objective was to explore the feasibility of chlamydia screening in females using a partnership model in which the ED is responsible for urine collection and the PHD is responsible for chlamydia testing, notification, and treatment. Methods:, A collaborative partnership-based chlamydia screening project was initiated at a large (90,000 visits/yr), urban, teaching ED from April 2007 to April 2008. Study information sheets were handed out to a convenience sample of eligible female patients and visitors (15,24 yr of age). Those wishing to participate provided a urine sample and follow-up contact information. The information sheet also asked if they had either lower abdominal pain or vaginal discharge (affirmative answer for either was considered symptomatic). Specimens collected in the ED were retrieved by PHD staff for off-site testing. The PHD contacted those participants testing positive using the patient provided contact information and arranged for treatment. Results:, Of the 633 women offered screening, 296 (47%) agreed to testing and provided samples. Of the 296 tested, 38 (12.8%) were positive for chlamydia infection, and 25 (66%) received follow-up and treatment; 13 could not be contacted through information they provided. A higher percentage of symptomatic subjects (23 of 115, or 20%) tested positive for chlamydia than asymptomatic subjects (15 of 181, or 8.3%; p < 0.01). Conclusions:, This study demonstrates the feasibility of an ED,PHD partnership for chlamydia screening in young women. This model can potentially be applied to other initiatives and may improve public health screening without creating significant additional burdens for crowded EDs. [source] Aboriginal deaths in Western Australia: 1985,89 and 1990,94AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2000Michael Gracey Objective: To examine death data for Aboriginal and non-Aboriginal persons in Western Australia (WA) in 1985,89 and 1990,94. Methods: Population estimates were provided by the Health Information Centre of the WA Health Department based on data from the Australian Bureau of Statistics (ABS). Death data came from the WA Registrar-General's Office. Standard methods were used to obtain rates and levels of significance. Results: Main causes of deaths among Aboriginal males in 1990,94 were circulatory conditions, respiratory, injury and poisoning, neoplasms and endocrine diseases; in Aboriginal females they were circulatory, neoplasms, endocrine diseases, respiratory diseases, and injury and poisoning. From 1985,89 to 1990,94, the Aboriginal male all-cause age-standardised death rates fell 3% (ns) while the non-Aboriginal male rate fell 11% (p<0.05). The Aboriginal female all-cause death rate rose 11% (ns) while the non-Aboriginal rate fell 5% (p<0.05). The allcause death rate ratio (Aboriginahnon-Aboriginal) changed from 2.4 to 2.6 (males) and 2.5 to 2.9 (females). There was a major increase in deaths from endocrine diseases among Aborigines and non-Aborigines. This increase was proportionally much greater among Aborigines. In non-Aborigines there was a significant decrease in deaths from circulatory diseases (mainly ischaemic heart disease); this did not occur among Aborigines. Conclusions: Over the study period, Aboriginal health standards, as reflected by death rates, apparently worsened relative to non-Aboriginal standards. Implications: Better health promotion, disease prevention and disease care are required to help achieve acceptable health standards among Aboriginal peoples. [source] Ascertaining the prevalence of childhood disabilityCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2005T. Hutchison Abstract Objectives, To reapply 1985 Office of Population Census and Surveys (OPCS) disability survey methods, modified as necessary, to a sample of children to ascertain presence of disability. To compare OPCS-based prevalence with prevalence based on carer's views and medical records. Design, Analytical study. Setting, Community Child Health Department in UK. Participants, Principal carers of 100 children aged 5,15, selected from a district special needs register. Main outcome measures, Comparable information about disability from three sources and diagnosis from carers and medical records. Results, Medical records of 46% contained a diagnosis. Carers were always aware of this, although a single question did not always elicit their knowledge. OPCS-derived threshold disability criteria in categories of Hand function, Personal care, Consciousness and Continence gave prevalence results similar to medical records and carers. OPCS criteria yielded higher prevalence of disability in the areas of Locomotion (8%), Communication (14%) and Hearing (18%). Carers, OPCS and medical records disagreed markedly about prevalence of disabilities of Vision, probably because of the use of differing definitions. OPCS learning criteria were judged unsuitable and standard attainment targets (SATs) were substituted. These provided similar prevalence figures to carers and medical records. OPCS behaviour criteria were also unsuitable and were replaced by the General Health and Behaviour Questionnaire (GHBQ). This found an increased prevalence of problems compared with carers and doctors. Conclusions, Diagnostic labels have limited use when collecting data about disabled children. Doubt is cast on the validity of some of the 1985 OPCS threshold criteria, and reassessment is suggested before their future use. Further work is needed on the use of SATs and GHBQ in the benchmarking of disability. To collect population data it would be easier and at least equally effective (with caution in the case of Vision) to ask carers directly rather than applying descriptive thresholds and external judgements. Similar information could be obtained from medical records, however, they are likely to be out of date. [source] The voice of detainees in a high security setting on services for people with personality disorderCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2002Sue Ryan Background British government Home and Health Departments have been consulting widely about service development for people with ,dangerous severe personality disorder' (DSPD). There has, however, been no consultation with service users, nor is there any user view literature in this area. Methods All people detained in one high security hospital under the legal classification of psychopathic disorder were eligible but those on the admission or intensive care wards were not approached. Views of service were elicited using a purpose designed semi-structured interview. The principal researcher was independent of all clinical teams. Confidentiality about patients' views was assured. Aims To establish views on services from one subgroup of people nominated by the government department as having ,DSPD'. Results Sixty-one of 89 agreed to interview. With security a given, about half expressed a preference for a high security hospital setting, 20% prison and 25% elsewhere, generally medium secure hospitals. Participants most valued caring, understanding and ,experience' among staff. An ideal service was considered to be one within small, domestic living units, providing group and individual therapies. Some found living with people with mental illness difficult, but some specified not wanting segregated units. Views were affected by gender and comorbidity. Conclusions As the sample were all in hospital, the emphasis on treatment may reflect a placement bias. All but five participants, however, had had experience of both health and criminal justice services, so were well placed to talk with authority about preferences. Copyright © 2002 Whurr Publishers Ltd. [source] Public Health Emergency Preparedness at the Local Level: Results of a National SurveyHEALTH SERVICES RESEARCH, Issue 5p2 2009Elena Savoia Objective. To study the relationship between elements of public health infrastructure and local public health emergency preparedness (PHEP). Data Sources/Study Setting. National Association of County and City Health Officials 2005 National Profile of Local Health Departments (LHDs). Study Design. Cross-sectional. Principal Findings. LHDs serving larger populations are more likely to have staff, capacities, and activities in place for an emergency. Adjusting for population size, the presence of a local board of health and the LHDs' experience in organizing PHEP coalitions were associated with better outcomes. Conclusions. The results of this study suggest that more research should be conducted to investigate the benefit of merging small health departments into coalitions to overcome the inverse relationship between preparedness and population size of the jurisdiction served by the LHD. [source] Surveillance of Infectious Disease Occurrences in the Community: An Analysis of Symptom Presentation in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 7 2003Joe Suyama MD Objectives: To determine the effectiveness of a simulated emergency department (ED)-based surveillance system to detect infectious disease (ID) occurrences in the community. Methods: Medical records of patients presenting to an urban ED between January 1, 1999, and December 31, 2000, were retrospectively reviewed for ICD-9 codes related to ID symptomatology. ICD-9 codes, categorized into viral, gastrointestinal, skin, fever, central nervous system (CNS), or pulmonary symptom clusters, were correlated with reportable infectious diseases identified by the local health department (HD). These reportable infectious diseases are designated class A diseases (CADs) by the Ohio Department of Health. Cross-correlation functions (CCFs) tested the temporal relationship between ED symptom presentation and HD identification of CADs. The 95% confidence interval for lack of trend correlation was 0.0 ± 0.074; thus CCFs > 0.074 were considered significant for trend correlation. Further cross-correlation analysis was performed after chronic and non-community-acquirable infectious diseases were removed from the HD database as a model for bioterrorism surveillance. Results: Fifteen thousand five hundred sixty-nine ED patients and 6,489 HD patients were identified. Six thousand two hundred eight occurrences of true CADs were identified. Only 87 (1.33%) HD cases were processed on weekends. During the study period, increased ED symptom presentation preceded increased HD identification of respective CADs by 24 hours for all symptom clusters combined (CCF = 0.112), gastrointestinal symptoms (CCF = 0.084), pulmonary symptoms (CCF = 0.110), and CNS symptoms (CCF = 0.125). The bioterrorism surveillance model revealed increased ED symptom presentation continued to precede increased HD identification of the respective CADs by 24 hours for all symptom clusters combined (CCF = 0.080), pulmonary symptoms (CCF = 0.100), and CNS symptoms (CCF = 0.120). Conclusions: Surveillance of ED symptom presentation has the potential to identify clinically important ID occurrences in the community 24 hours prior to HD identification. Lack of weekend HD data collection suggests that the ED is a more appropriate setting for real-time ID surveillance. [source] Racism in organizations: The case of a county public health departmentJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 3 2007Derek M. Griffith Racism is part of the foundation of U.S. society and institutions, yet few studies in community psychology or organizational studies have examined how racism affects organizations. This paper proposes a conceptual framework of institutional racism, which describes how, in spite of professional standards and ethics, racism functions within organizations to adversely affect the quality of services, the organizational climate, and staff job satisfaction and morale. Grounded in systems theory and organizational empowerment, the framework is based on data that describe how racism was made manifest in a county public health department. The findings highlight the importance of understanding how organizations are influenced by external forces and can negatively affect clients, communities, and their own staff members. © 2007 Wiley Periodicals, Inc. [source] Men And Family Planning: What Is Their Future Role?JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2001FP-C, Lorraine Neeley Fortunati MSN Purpose To describe men's desired involvement in family planning and to determine the services desired by potential male clients. Data Sources Using a self-administered questionnaire, this study surveyed male partners of family planning clients and men attending sexually transmitted disease (STD) clinics at an urban health department. Perceived health concerns, contraceptive attitudes and practices, and desired involvement in family planning currently and in the future were targeted. Conclusions Respondents reported desiring involvement in family planning decisions, although reported behaviors often conflicted with this desire. Routine physical examinations and receipt of health information were perceived to be important, while "male only" clinics were not. Respondents were willing to attend partners' family planning appointments if asked and were willing to help pay for the chosen contraceptive. Provision of vasectomy services was perceived as important. Prevention of cancer, STDs, and impotence were the three highest health concerns reported. Implications for Practice Men want to be partners in family planning and will access services if available. Current political and social policies are demanding more personal responsibility for the outcome of unintended pregnancies. In response to political and social demands, Title X family planning clinics are refocusing services to include men. [source] Profile of the Australian dietetic workforce: 1991,2005NUTRITION & DIETETICS, Issue 3 2006Leanne BROWN Abstract Objective:, The present study aims to review current available data that describe the dietetics workforce in Australia. Design:, A literature search was conducted using CIHNAL and hand searches. Following this, a review of the current available dietetics workforce data was conducted. Dietitians Association of Australia (DAA) membership data were analysed. Subjects and setting:, Sources of workforce data included: the Australian Bureau of Statistics Census data, DAA membership database, state health department and national workforce reports, reports by allied health organisations and independent research. Main outcome measures:, Descriptive data profiling the Australian dietetic workforce and employment trends. Statistical analysis:, A descriptive analysis of DAA membership data was undertaken. The DAA membership data were mapped by postcode with the Australian Standard Geographical Classification for remoteness. Counts and proportions were used to summarise and compare available data. Results:, There has been a growth and diversity of the dietetics profession in Australia in recent years, despite a lower proportion of qualified dietitians working as dietitians. The dietetic workforce is relatively young, predominantly female and unevenly distributed across the country. The available data are complex and difficult to interpret. Conclusions:, The present review of currently available dietetic workforce data provides a profile of the dietetics profession in Australia. Further workforce data are required in order to adequately describe the dietetics workforce in Australia and to determine future needs for the profession. National monitoring and systematic workforce data collection are urgently required. [source] How the psychiatrists of a mental health department managed their patients before an attempted suicidePSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 6 2009Paolo Scocco md Aims:, The aim of this survey was to describe patients in care at a large mental health department in northern Italy who attempted suicide, and the clinical management adopted by their psychiatrists before the event. Methods:, Data collection was based on a questionnaire administered to the reference psychiatrists. Results:, Over a period of 12 months, 166 catchment area residents attempted suicide. Sixty-six (40%) had contacted the mental health department in the previous two years and completed data were obtained on 63. Twenty-nine (46%) suffered from mood, 26 (41%) from personality and 11 (18%) from schizophrenic disorders. Thirty-four attempts occurred within one year of psychiatric ward discharge, mostly in the first quarter. The reference psychiatrists reported that, at the last evaluation, 38 of 63 patients (60%) presented no change in clinical conditions, and 41 of 63 (68%) were considered at no immediate risk of suicide. Most of the attempted suicides in question (45, 72%) were judged to be unpreventable. In the two logistic regression analyses carried out, no independent variables were able to statistically significantly explain the variance in judged suicidal risk or the preventability of the index attempted suicide. Conclusions:, According to the psychiatrists' descriptions of their last contact with the patients, most attempted suicides have not been preceded by a change in clinical conditions. Moreover, psychiatrists, irrespective of their age and gender, and of patient diagnosis, frequently judged the attempts to have been unpreventable. [source] Finding Ways to Create Connections Among Communities: Partial Results of an Ethnography of Urban Public Health NursesPUBLIC HEALTH NURSING, Issue 1 2000Judeen Schulte Ph.D. The purpose of this ethnographic study was to describe the culture of public health nurses (PHNs) in a large, Midwestern urban health department. Data collection methods, data management, and analyses followed ethnographic procedures and resulted in the development of categories, domains, and cultural themes. The general study participants were PHNs, clients, supervisors, and administrators. The primary cultural theme that emerged was that public health nursing is finding ways to create connections among communities. Three interacting communities were identified: the local communities, communities created by individuals and families, and communities of resources. This article describes one of the three subthemes that emerged, processes used to help clients create connections, and describes how caring is shown uniquely in public health nursing. As a result of the study, implications for nursing practice, education, and research were developed. The results of the study supported a position that public health nursing is a unique nursing specialty. It reinforced also the applicability of an ethnographic design and methodology to nursing research. [source] Emergency Department Chlamydia Screening Through Partnership with the Public Health DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2009Charlene Babcock Irvin MD Abstract Background:, The emergency department (ED) serves a population that may benefit from numerous screening initiatives but screening in the ED is challenging due to crowding as well as resource and time constraints. One option may be to collect specimens in the ED and then partner with the public health department (PHD) to analyze the specimens off-site and arrange follow-up treatment. Objectives:, The objective was to explore the feasibility of chlamydia screening in females using a partnership model in which the ED is responsible for urine collection and the PHD is responsible for chlamydia testing, notification, and treatment. Methods:, A collaborative partnership-based chlamydia screening project was initiated at a large (90,000 visits/yr), urban, teaching ED from April 2007 to April 2008. Study information sheets were handed out to a convenience sample of eligible female patients and visitors (15,24 yr of age). Those wishing to participate provided a urine sample and follow-up contact information. The information sheet also asked if they had either lower abdominal pain or vaginal discharge (affirmative answer for either was considered symptomatic). Specimens collected in the ED were retrieved by PHD staff for off-site testing. The PHD contacted those participants testing positive using the patient provided contact information and arranged for treatment. Results:, Of the 633 women offered screening, 296 (47%) agreed to testing and provided samples. Of the 296 tested, 38 (12.8%) were positive for chlamydia infection, and 25 (66%) received follow-up and treatment; 13 could not be contacted through information they provided. A higher percentage of symptomatic subjects (23 of 115, or 20%) tested positive for chlamydia than asymptomatic subjects (15 of 181, or 8.3%; p < 0.01). Conclusions:, This study demonstrates the feasibility of an ED,PHD partnership for chlamydia screening in young women. This model can potentially be applied to other initiatives and may improve public health screening without creating significant additional burdens for crowded EDs. [source] Exposure to opioid maintenance treatment reduces long-term mortalityADDICTION, Issue 3 2008Amy Gibson ABSTRACT Aims To (i) examine the predictors of mortality in a randomized study of methadone versus buprenorphine maintenance treatment; (ii) compare the survival experience of the randomized subject groups; and (iii) describe the causes of death. Design Ten-year longitudinal follow-up of mortality among participants in a randomized trial of methadone versus buprenorphine maintenance treatment. Setting Recruitment through three clinics for a randomized trial of buprenorphine versus methadone maintenance. Participants A total of 405 heroin-dependent (DSM-IV) participants aged 18 years and above who consented to participate in original study. Measurements Baseline data from original randomized study; dates and causes of death through data linkage with Births, Deaths and Marriages registries; and longitudinal treatment exposure via State health departments. Predictors of mortality examined through survival analysis. Findings There was an overall mortality rate of 8.84 deaths per 1000 person-years of follow-up and causes of death were comparable with the literature. Increased exposure to episodes of opioid treatment longer than 7 days reduced the risk of mortality; there was no differential mortality among methadone versus buprenorphine participants. More dependent, heavier users of heroin at baseline had a lower risk of death, and also higher exposure to opioid treatment. Older participants randomized to buprenorphine treatment had significantly improved survival. Aboriginal or Torres Strait Islander participants had a higher risk of death. Conclusions Increased exposure to opioid maintenance treatment reduces the risk of death in opioid-dependent people. There was no differential reduction between buprenorphine and methadone. Previous studies suggesting differential effects may have been affected by biases in patient selection. [source] Effects of a sustained heroin shortage in three Australian StatesADDICTION, Issue 7 2005Louisa Degenhardt ABSTRACT Background In early 2001 in Australia there was a sudden and dramatic decrease in heroin availability that occurred throughout the country that was evidenced by marked increases in heroin price and decreases in its purity. Aim This study examines the impact of this change in heroin supply on the following indicators of heroin use: fatal and non-fatal drug overdoses; treatment seeking for heroin dependence; injecting drug use; drug-specific offences; and general property offences. The study was conducted using data from three Australian States [New South Wales (NSW), Victoria (VIC) and South Australia (SA)]. Methods Data were obtained on fatal and non-fatal overdoses from hospital emergency departments (EDs), ambulance services and coronial systems; treatment entries for heroin dependence compiled by State health departments; numbers of needles and syringes distributed to drug users; and data on arrests for heroin-related incidents and property-related crime incidents compiled by State Police Services. Time-series analyses were conducted where possible to examine changes before and after the onset of the heroin shortage. These were supplemented with information drawn from studies involving interviews with injecting drug users. Results After the reduction in heroin supply, fatal and non-fatal heroin overdoses decreased by between 40% and 85%. Despite some evidence of increased cocaine, methamphetamine and benzodiazepine use and reports of increases in harms related to their use, there were no increases recorded in the number of either non-fatal overdoses or deaths related to these drugs. There was a sustained decline in injecting drug use in NSW and VIC, as indicated by a substantial drop in the number of needles and syringes distributed (to 1999 levels in Victoria). There was a short-lived increase in property crime in NSW followed by a sustained reduction in such offences. SA and VIC did not show any marked change in the categories of property crime examined in the study. Conclusions Substantial reductions in heroin availability have not occurred often, but in this Australian case a reduction had an aggregate positive impact in that it was associated with: reduced fatal and non-fatal heroin overdoses; reduced the apparent extent of injecting drug use in VIC and NSW; and may have contributed to reduced crime in NSW. All these changes provide substantial benefits to the community and some to heroin users. Documented shifts to other forms of drug use did not appear sufficient to produce increases in deaths, non-fatal overdoses or treatment seeking related to those drugs. [source] Public Health Emergency Preparedness at the Local Level: Results of a National SurveyHEALTH SERVICES RESEARCH, Issue 5p2 2009Elena Savoia Objective. To study the relationship between elements of public health infrastructure and local public health emergency preparedness (PHEP). Data Sources/Study Setting. National Association of County and City Health Officials 2005 National Profile of Local Health Departments (LHDs). Study Design. Cross-sectional. Principal Findings. LHDs serving larger populations are more likely to have staff, capacities, and activities in place for an emergency. Adjusting for population size, the presence of a local board of health and the LHDs' experience in organizing PHEP coalitions were associated with better outcomes. Conclusions. The results of this study suggest that more research should be conducted to investigate the benefit of merging small health departments into coalitions to overcome the inverse relationship between preparedness and population size of the jurisdiction served by the LHD. [source] Travel-Associated Dengue Infections in the United States, 1996 to 2005JOURNAL OF TRAVEL MEDICINE, Issue 1 2010Hamish P. Mohammed PhD Background. As the incidence of dengue increases globally, US travelers to endemic areas may be at an increased risk of travel-associated dengue. Methods. Data from the US Centers for Disease Control and Prevention's laboratory-based Passive Dengue Surveillance System (PDSS) were used to describe trends in travel-associated dengue reported from January 1, 1996 to December 31, 2005. The PDSS relies on provider-initiated requests for diagnostic testing of serum samples via state health departments. A case of travel-associated dengue was defined as a laboratory-positive dengue infection in a resident of the 50 US states and the District of Columbia who had been in a dengue-endemic area within 14 days before symptom onset. Dengue infection was confirmed by serologic and virologic techniques. Results. One thousand one hundred and ninety-six suspected travel-associated dengue cases were reported,334 (28%) were laboratory-positive, 597 (50%) were laboratory-negative, and 265 (22%) were laboratory-indeterminate. The incidence of laboratory-positive cases varied from 1996 to 2005, but had an overall increase with no significant trend (53.5 to 121.3 per 108 US travelers, p = 0.36). The most commonly visited regions were the Caribbean, Mexico and Central America, and Asia. The median age of laboratory-positive cases was 37 years (range: <1 to 75 y) and 166 (50%) were male. Of the 334 laboratory-positive cases, 41 (12%) were hospitalized, and 2 (1%) died. Conclusions. Residents of the US traveling to dengue-endemic regions are at risk of dengue infection and need to be instructed on appropriate prevention measures prior to travel. Especially in light of the potential transmissibility of dengue virus via blood transfusion, consistent reporting of travel-associated dengue infections is essential. [source] Retrospective Analysis of the Cholera Cases Imported to France From 1973 to 2005JOURNAL OF TRAVEL MEDICINE, Issue 4 2007Arnaud Tarantola MD Background The manners of traveling and travelers' vulnerability to infection are changing: increasing numbers of travelers, travels at the extreme ages of life, "backpacker" tourism in close contact with local populations. What is the epidemiologic situation and what are the trends of imported cholera to Metropolitan France? Method A descriptive retrospective study was undertaken on all the confirmed cases of cholera imported to France, and notified from January 1, 1973, to December 31, 2005, using compulsory notification data from local health departments and information from the National Reference Centre. Results A total of 129 imported cases of cholera were notified between 1973 and 2005 (3.9 cases/y on average). The geographical sources of infection have changed with time: in the 1980s, 94% of the patients were infected in Maghreb (Morocco and Algeria) but none were in 2000. On the other hand, Asia and West Africa progressively emerged and now predominate. In spite of certain poorly informed data and possible underdetection, the number of cases of importation appears to be low and falling. Conclusions The patient profile seems to have evolved and increasingly concerns people at the extreme ages of life, living elsewhere than the principal basins of immigration in France, and diagnosis is increasingly made in nonteaching hospitals. The lessons likely to help clinicians will be discussed. [source] Travel Agents and the Prevention of Health Problems among Travelers in QuébecJOURNAL OF TRAVEL MEDICINE, Issue 1 2002Sylvie Provost Background: Among the factors influencing travelers to seek preventive health advice before departure, the travel agent's recommendation plays an important role. The objective of our study was to document the practices and needs of travel agents in Québec (Canada) in relation to the prevention of health problems among travelers. Methods: In June 2000, a cross-sectional descriptive survey was carried out among travel agents from all travel agencies in Québec. One agent per agency was asked to answer our questions. Data were collected using a 32-item telephone questionnaire. Results: Altogether, 708 travel agents from the 948 agencies contacted answered our questionnaire (participation rate: 75%). Most respondents (81%) believed that the travel agent has a role to play in the prevention of health problems among travelers, especially to recommend that travelers consult a travel clinic before departure. Although over 80% of the agents interviewed mentioned recommending a visit to a travel clinic before an organized tour to Thailand or a backpacking trip in Mexico, less than half said they make the same recommendation for a stay in a seaside resort in Mexico. The majority of respondents were acquainted with the services offered in travel health clinics, and these clinics were the source of travel health information most often mentioned by travel agents. However, nearly 60% of the agents questioned had never personally consulted a travel clinic. When asked about the best way to receive information about travelers' health, more than 40% of respondents favoured receiving information newsletters from public health departments regularly whereas 28% preferred the Internet. Conclusion: Despite the limits of this study, our results should help the public health network better target its interventions aimed to inform travel agents on prevention of health problems among travelers. [source] Corporate Travel Medicine: Benefit Analysis of On-Site ServicesJOURNAL OF TRAVEL MEDICINE, Issue 4 2001Timothy S. Prince Background: Corporations with employees who travel internationally address their travel-related medical needs in a variety of ways. Options utilized include corporate medical departments, local health departments, and local clinics, both contracted and independent. Methods: A travel clinic at a university medical center routinely provided preventive travel medicine services for many of the local companies. Two of these companies had on-site medical clinics which routinely saw patients for occupational and personal health reasons. At these companies, the university travel clinic assisted in moving employee travel medicine services to the on-site clinic. Direct and indirect costs for new, predeparture employee travel care at each company were compared before, and after, the move on-site. Results: When measured per patient, total cost savings associated with the on-site travel clinic were greater than 15% at both companies (17%, 25%), primarily due to the value of the employees' time saved with decreased travel. Utilization increased at one company by 24% over the first 8 months and lead to higher overall cost, but this cost increase was only 4%. Informal assessments of the value of the on-site service at both companies was uniformly positive. Conclusion: For certain corporate settings, on-site clinics may be effective ways of providing travel medicine services. [source] From biological anthropology to applied public health: Epidemiological approaches to the study of infectious disease,,AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 5 2009Rachel Albalak This article describes two large, multisite infectious disease programs: the Tuberculosis Epidemiologic Studies Consortium (TBESC) and the Emerging Infections Programs (EIPs). The links between biological anthropology and applied public health are highlighted using these programs as examples. Funded by the Centers for Disease Control and Prevention (CDC), the TBESC and EIPs conduct applied public health research to strengthen infectious disease prevention and control efforts in the United States. They involve collaborations among CDC, public health departments, and academic and clinical institutions. Their unique role in national infectious disease work, including their links to anthropology, shared elements, key differences, strengths and challenges, is discussed. Am. J. Hum. Biol. 2009. Published 2009 Wiley-Liss, Inc. [source] Why planned attended homebirth should be more widely supported in AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2008Lareen A. NEWMAN This article argues that the continuing reluctance on the part of professional and bureaucratic bodies in Australia to provide for and support planned attended homebirth for low-risk women is unfounded according to the research evidence. It also suggests that such lack of support might be encouraging some planned but intentionally unattended homebirths to occur in Australia, particularly as in recent years there appears to have been an increase in popularity in freebirth (or do-it-yourself homebirth). The article calls for RANZCOG and Australian state health departments to support planned attended homebirth for low-risk women in the face of what is now a considerable amount of evidence showing its safety, when compared with unplanned homebirth and hospital birth. The article raises a number of challenging issues for obstetricians, midwives and managers or planners of maternity services. [source] | ||||||||||||||||