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Public Health Approach (public + health_approach)
Selected AbstractsCreating Asthma-Friendly Schools: A Public Health ApproachJOURNAL OF SCHOOL HEALTH, Issue 6 2006Lisa Cicutto First page of article [source] Substance Abuse During Pregnancy: Clinical and Public Health ApproachesTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 3 2003Philip H. Jos First page of article [source] Breast Cancer from a Public Health PerspectiveTHE BREAST JOURNAL, Issue 2 2004Richard R. Love MD Abstract: , By 2010, the majority of approximately 1.5 million annual new cases of breast cancer will be diagnosed in women in countries with limited resources. Public health approaches to medical problems emphasize the importance of practical, limited toxicity and very inexpensive interventions. While clinical trials in Western countries are testing the concept of breast cancer prevention, they are not defining useful public health approaches. Early detection of breast cancer using mammography, while effective, is a high-technology, expensive approach. Adjuvant systemic and radiation therapies are increasingly expensive; careful consideration of efficacy and cost-efficacy data appear warranted. Public health perspectives thus suggest that many current "standard" approaches to breast cancer in Western countries cannot help the majority of women in the world., [source] Maternal smoking during pregnancy predicts nicotine disorder (dependence or withdrawal) in young adults , a birth cohort studyAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2009Frances V. O'Callaghan Abstract Objective: To investigate whether maternal smoking during pregnancy predicts offspring nicotine disorder (dependence or withdrawal) at 21 years. Method: Participants comprised a prospective birth cohort involving 7,223 singleton children whose mothers were enrolled between 1981 and 1983 at the first antenatal visit to the Mater Mothers' Hospital, Brisbane, Queensland. The present sub-cohort consisted of 2,571 youth who completed the Composite International Diagnostic Interview-computerised version (CIDI-Auto) that assesses nicotine dependence and withdrawal according to DSM-IV diagnostic criteria at the 21-year follow-up. Results: 12.8% of offspring met criteria for nicotine dependence and 8.5% met criteria for withdrawal. 16.6% met criteria for either dependence or withdrawal. Smoking during pregnancy resulted in offspring being more likely to have dependence or withdrawal at 21 years than offspring of mothers who never smoked (age adjusted odds ratio 1.53 (95% CI: 1.19-1.96). Conclusions: Findings emphasise the long-term adverse effects of maternal smoking during pregnancy, including nicotine dependence in young adult offspring. Implications: Public health approaches should strengthen arguments for mothers to cease smoking during pregnancy in view of the long-term health implications for offspring, and reinforce measures to help smokers among pregnant women and women of childbearing age to stop. [source] The Australian experience of deinstitutionalization: interaction of Australian culture with the development and reform of its mental health servicesACTA PSYCHIATRICA SCANDINAVICA, Issue 2006A. Rosen Objective:, To describe the Australian experience of deinstitutionalization of the Australian National Mental Health Strategy in the context of the history of mental health services in Australia, and of Australian culture. Method:, The development of Australian Mental Health Services is described with reference to developments in both psychiatric intervention research and Australian culture. The effects and achievements of national mental health reforms are described and critically examined. Results:, The relationship in Australia between the development of mental health services and the development of Australian society includes the stories of colonization, gold rushes, suppression of indigenous peoples' rights, incarceration of mentally ill people, and incompatible state service systems. Mental health services required reform to provide consistent services and support for full citizenship and rights for such individuals who are still on the margins of society. Recent national developments in service models and service system research have been driven by the Australian National Mental Health Strategy. The translation of national policy into state/territory mental health service systems has led to a ,natural' experiment between states. Differing funding and implementation strategies between states have developed services with particular strengths and limitations. Conclusion:, The effects of competition for limited resources between core mental health service delivery and the shift to a population-based public health approach (to prevention of mental illness and promotion of mental health), leaves our services vulnerable to doing neither particularly well. The recent loss of momentum of these reforms, due to failure of governments to continue to drive and fund them adequately, is causing the erosion of their considerable achievements. [source] Perinatal illicit drug use and fetal exposure: consequences and management with a public health approachDRUG TESTING AND ANALYSIS, Issue 2 2009Resmiye Oral [source] Vested Interests in Addiction Research and Policy Alcohol policies out of context: drinks industry supplanting government role in alcohol policies in sub-Saharan AfricaADDICTION, Issue 1 2010Øystein Bakke ABSTRACT Background In this paper, we describe an analysis of alcohol policy initiatives sponsored by alcohol producer SABMiller and the International Center on Alcohol Policies, an alcohol industry-funded organization. In a number of sub-Saharan countries these bodies have promoted a ,partnership' role with governments to design national alcohol policies. Methodology A comparison was conducted of four draft National Alcohol Policy documents from Lesotho, Malawi, Uganda and Botswana using case study methods. Findings The comparison indicated that the four drafts are almost identical in wording and structure and that they are likely to originate from the same source. Conclusions The processes and the draft policy documents reviewed provide insights into the methods, as well as the strategic and political objectives of the multi-national drinks industry. This initiative reflects the industry's preferred version of a national alcohol policy. The industry policy vision ignores, or chooses selectively from, the international evidence base on alcohol prevention developed by independent alcohol researchers and disregards or minimizes a public health approach to alcohol problems. The policies reviewed maintain a narrow focus on the economic benefits from the trade in alcohol. In terms of alcohol problems (and their remediation) the documents focus upon individual drinkers, ignoring effective environmental interventions. The proposed policies serve the industry's interests at the expense of public health by attempting to enshrine ,active participation of all levels of the beverage alcohol industry as a key partner in the policy formulation and implementation process'. [source] A question of balance: prioritizing public health responses to harm from gamblingADDICTION, Issue 5 2009Peter J. Adams ABSTRACT Aim To provide an overview on the nature and importance of public health approaches to the global expansion of commercial gambling. Method Three key areas of public health activity are examined: harm minimization, health promotion and the political determinants for change. Findings The rapid proliferation of gambling experienced in many countries is driven by the commercial development of new products orientated around continuous and rapid mass consumption. This is particularly the case with ongoing refinements to electronic gambling machines and the development of new gambling technologies using the internet and mobile telephones. So far responses to negative impacts have, on the whole, focused upon individualized treatment interventions. A public health approach to gambling offers a broad range of strategies to tackle the wider implications of gambling expansion: harm reduction provides evidence-based strategies for managing identifiable harm; health promotion focuses upon communities building their capacity, knowledge and resilience with regard to the attractions of gambling, and action on the political determinants sets out to increase the accountability and reduce the conflicts of interest that influence government resolve in managing their gambling environments. Conclusion In this new environment of mass consumption, efforts in developing treatment responses to problem gambling need to be balanced with, at least, equal efforts in developing public health responses. With the expansion of commercial gambling occurring globally, international agencies could play a critical role in supporting public health initiatives. [source] The role of alcohol and drugs in homicides in England and WalesADDICTION, Issue 8 2006Jenny Shaw SUMMARY Background The annual number of homicide convictions in England and Wales is increasing. Previous studies have highlighted the aetiological role of alcohol and drugs in homicide. Aims To examine rates of alcohol and drug misuse and dependence in people convicted of homicide; the role of alcohol and drugs in the offence; the social and clinical characteristics of alcohol- and drug-related homicides; and the social and clinical characteristics of patients with dual diagnosis who commit homicide. Methods A national clinical survey based on a 3-year (1996,9) consecutive sample of people convicted of homicide in England and Wales. Information on rates of alcohol and drug misuse/dependence, the role of alcohol and drugs in the offence and social and clinical characteristics of perpetrators were collected from psychiatric reports prepared for the court in homicide convictions. Detailed clinical information was gathered from questionnaires completed by mental health teams for those in contact with mental health services. Results Of the 1594 homicide perpetrators, more than one-third (42%) occurred in people with a history of alcohol misuse or dependence and 40% in people with a history of drug misuse or dependence. Alcohol or drug misuse played a contributory role in two-fifths of homicides. Alcohol played a major role in 52 (6%) and a minor role in 364 (39%) homicides. Drugs played a major role in six (1%) and a minor role in 138 (14%) homicides. Forty-two homicides (17%) were committed by patients with severe mental illness and substance misuse. Alcohol- and drug-related homicides were generally associated with male perpetrators who had a history of violence, personality disorders, mental health service contact and with stranger victims. Conclusions Substance misuse contributes to the majority of homicides in England and Wales. A public health approach to homicide would highlight alcohol and drugs before severe mental illness. [source] Sleeping with baby: an internet-based sampling of parental experiences, choices, perceptions, and interpretations in a western industrialized contextINFANT AND CHILD DEVELOPMENT, Issue 4 2007J. J. McKenna Abstract Mothers and infants sleeping within proximity to each other (co-sleeping) represents normal, healthy, and expectable human behaviour, especially if mothers breastfeed. Yet, western health officials generally recommend against particularly one form of co-sleeping known as bedsharing. This study explores these issues and especially highlights parental accounts of their sleep practices, interpretations, and reflections based on detailed narratives or ,ethnohistories.' The sample involves a self-selected sub-group of over 200 mostly middle-class mothers from Canada, the United States, Australia, and Great Britain. Mothers report how and why they adopted co-sleeping practices, how satisfied they are (or were) with their decisions, and what benefits they think they or their infants derived from their co-sleeping practices. Also included in the reports are a surprisingly high number of parents who think they may have saved their infant's life by bedsharing, data heretofore never reported in the literature. The formulation of medical policies, we suggest, ultimately must be informed by a full understanding of how parents actually think about and subsequently structure their infant's sleep, what their goals and expectations are, and by an awareness of the emotional factors motivating parents to choose certain sleeping arrangements over others. The results reveal that many factors coalesce, often in unique ways, under unique circumstances, family by family, to determine where babies sleep and why. We conclude that sleeping arrangements are not solely determined by medically based recommendations, but also by the method of feeding, the particular needs of a particular infant, and the needs of mothers and fathers to get more sleep. While baby sleep locations and sleep patterns change in the first year of life, nighttime sleeping arrangements almost always reflect the nature of family values and the quality of social relationships at any given time. We conclude that these factors, alongside widely known independent SIDS risk factors, must also be acknowledged and respected if we are ever to achieve an effective and inclusive public health approach to the question of creating safe sleep environments for infants and children. Copyright © 2007 John Wiley & Sons, Ltd. [source] Occurrence and management of acute respiratory illnesses in early childhoodJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2007Merci MH Kusel Aim: Acute respiratory illnesses (ARI) impose massive economic burden on health services. The growing costs, limited benefits of pharmacotherapeutic agents, and alarming rise in antibiotic resistance poses a major health challenge. Analysis of the nature and burden of ARI through well-designed epidemiologic studies will help in the development of a uniform public health approach to identify methods to reduce disease transmission and maximise prevention strategies. The aim of this study was to analyse the nature and magnitude of the burden of ARI encountered by a cohort of children in the first 5 years of life. Methods: This community-based prospective study of ARI followed a cohort of children from birth until 5 years of age. Information on all episodes of ARI encountered, and their management, was collected through daily symptom diary and fortnightly telephone calls. Results: Four episodes of ARI/year were reported in the first 2 years and 2,3 episodes/year between 2 and 5 years. The majority were upper respiratory infections. 53% had at least one lower respiratory infection in the first year. For the majority, symptoms lasted 1,2 weeks. 53% were treated with antitussives or cough mixtures, 44% with paracetamol and 23% with antibiotics. A total of 46% of the episodes presented to a family physician, with younger children and those with lower respiratory infection more likely to seek attention. Conclusion: ARI are common in childhood and although symptoms may last for 4 weeks, the majority resolve spontaneously. Use of medication does not appear to significantly alter the course or duration of symptoms of ARI. [source] Sociocultural influences on infant feeding decisions among HIV-infected women in rural Kwa-Zulu Natal, South AfricaMATERNAL & CHILD NUTRITION, Issue 1 2005Lucy N. Thairu msc Abstract The promotion of exclusive breastfeeding for 6 months, followed by rapid transition to alternative food sources may be an important public health approach to the reduction of mother-to-child transmission of HIV through breastmilk. The basic ethical principle of ,informed choice' requires that HIV positive women are provided with adequate information about their options. However, information is only one factor that affects their decisions. The objective of this ethnographic study was to identify sociocultural influences on infant feeding decisions in the context of a large cohort study designed to assess the impact of a breastfeeding counselling and support strategy to promote exclusive breastfeeding on postnatal transmission of HIV in African women. Following an initial period of exploratory interviewing, ethnographic techniques were used to interview 22 HIV positive women about their views on infant feeding and health. Interviews were tape-recorded, transcribed and analysed with a text analysis program. Five themes of influences on feeding decisions emerged: (1) social stigma of HIV infection; (2) maternal age and family influences on feeding practices; (3) economic circumstances; (4) beliefs about HIV transmission through breastmilk; and (5) beliefs about the quality of breastmilk compared to formula. The study highlights the role of cultural, social, economic and psychological factors that affect HIV positive women's infant feeding decisions and behaviour. [source] Obesity and type 2 diabetesNUTRITION BULLETIN, Issue 2 2006C. Waine Summary, The rise in obesity , and specifically abdominal obesity , is driving the global increase in type 2 diabetes. Excess visceral fat, the causative factor behind abdominal obesity, is closely linked with ,-cell dysfunction and insulin resistance, two of the key components of type 2 diabetes pathogenesis. Attempts to curb the current abdominal obesity and type 2 diabetes epidemics will require a government-led public health approach, in tandem with a personal approach aimed at helping abdominally obese individuals reduce their cardiovascular and metabolic (cardiometabolic) risk profile. [source] Authors' response to letter regarding a public health approach to child abuse and neglectAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2009Melissa O'Donnell No abstract is available for this article. [source] ,EVEN IF YOU'RE POSITIVE, YOU STILL HAVE RIGHTS BECAUSE YOU ARE A PERSON': HUMAN RIGHTS AND THE REPRODUCTIVE CHOICE OF HIV-POSITIVE PERSONSDEVELOPING WORLD BIOETHICS, Issue 1 2008LESLIE LONDON ABSTRACT Global debates in approaches to HIV/AIDS control have recently moved away from a uniformly strong human rights-based focus. Public health utilitarianism has become increasingly important in shaping national and international policies. However, potentially contradictory imperatives may require reconciliation of individual reproductive and other human rights with public health objectives. Current reproductive health guidelines remain largely nonprescriptive on the advisability of pregnancy amongst HIV-positive couples, mainly relying on effective counselling to enable autonomous decision-making by clients. Yet, health care provider values and attitudes may substantially impact on the effectiveness of nonprescriptive guidelines, particularly where social norms and stereotypes regarding childbearing are powerful, and where providers are subjected to dual loyalty pressures, with potentially adverse impacts on rights of service users. Data from a study of user experiences and perceptions of reproductive and HIV/AIDS services are used to illustrate a rights analysis of how reproductive health policy should integrate a rights perspective into the way services engage with HIV-positive persons and their reproductive choices. The analysis draws on recognised tools developed to evaluate health policies for their human rights impacts and on a model developed for health equity research in South Africa to argue for greater recognition of agency on the part of persons affected by HIV/AIDS in the development and content of policies on reproductive choices. We conclude by proposing strategies that are based upon a synergy between human rights and public health approaches to policy on reproductive health choices for persons with HIV/AIDS. [source] A question of balance: prioritizing public health responses to harm from gamblingADDICTION, Issue 5 2009Peter J. Adams ABSTRACT Aim To provide an overview on the nature and importance of public health approaches to the global expansion of commercial gambling. Method Three key areas of public health activity are examined: harm minimization, health promotion and the political determinants for change. Findings The rapid proliferation of gambling experienced in many countries is driven by the commercial development of new products orientated around continuous and rapid mass consumption. This is particularly the case with ongoing refinements to electronic gambling machines and the development of new gambling technologies using the internet and mobile telephones. So far responses to negative impacts have, on the whole, focused upon individualized treatment interventions. A public health approach to gambling offers a broad range of strategies to tackle the wider implications of gambling expansion: harm reduction provides evidence-based strategies for managing identifiable harm; health promotion focuses upon communities building their capacity, knowledge and resilience with regard to the attractions of gambling, and action on the political determinants sets out to increase the accountability and reduce the conflicts of interest that influence government resolve in managing their gambling environments. Conclusion In this new environment of mass consumption, efforts in developing treatment responses to problem gambling need to be balanced with, at least, equal efforts in developing public health responses. With the expansion of commercial gambling occurring globally, international agencies could play a critical role in supporting public health initiatives. [source] Evidence From Data Searches and Life-Table Analyses for Gender-Related Differences in Absolute Risk of Hip Fracture After Colles' or Spine Fracture: Colles' Fracture as an Early and Sensitive Marker of Skeletal Fragility in White Men,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 12 2004Patrick Haentjens Abstract Based on data searches and life-table analyses, we determined the long-term (remaining lifetime) and short-term (10- and 5-year) absolute risks of hip fracture after sustaining a Colles' or spine fracture and searched for potential gender-related differences. In aging men, Colles' fractures carry a higher absolute risk for hip fracture than spinal fractures in contrast to women. These findings support the concept that forearm fracture is an early and sensitive marker of male skeletal fragility. Introduction: Colles' fracture occurrence has been largely ignored in public health approaches to identify target populations at risk for hip fracture. The aim of this study was to estimate the long-term and short-term absolute risks of hip fracture after sustaining a Colles' or spine fracture and to search for potential gender-related differences in the relationship between fracture history and future fracture risk. Materials and Methods: To determine the long-term (remaining lifetime) and short-term (10- and 5-year) absolute risks of hip fracture, we applied life-table methods using U.S. age- and sex-specific hip fracture incidence rates, U.S. age-specific mortality rates for white women and men, pooled hazard ratios for mortality after Colles' and spine fracture, and pooled relative risks for hip fracture after Colles' and spine fracture, estimated from cohort studies by standard meta-analytic methods. Results: Our results indicate that the estimated remaining lifetime risks are dependent on age in both genders. In women, remaining lifetime risks increase until the age of 80 years, when they start to decline because of the competing probabilities of fracture and death. The same pattern is found in men until the age of 85 years, the increment in lifetime risk being even more pronounced. As expected, the risk of sustaining a hip fracture was found to be higher in postmenopausal women with a previous spine fracture compared with those with a history of Colles' fracture. In men, on the other hand, the prospective association between fracture history and subsequent hip fracture risk seemed to be strongest for Colles' fracture. At the age of 50, for example, the remaining lifetime risk was 13% in women with a previous Colles' fracture compared with 15% in the context of a previous spine fracture and 9% among women of the general population. In men at the age of 50 years, the corresponding risk estimates were 8%, 6%, and 3%, respectively. Similar trends were observed when calculating 5- and 10-year risks. Conclusions: In aging men, Colles' fractures carry a higher absolute risk for hip fracture than spinal fractures in contrast to women. These findings support the concept that forearm fracture is an early and sensitive marker of male skeletal fragility. The gender-related differences reported in this analysis should be taken into account when designing screening and treatment strategies for prevention of hip fracture in men. [source] Public health in the undergraduate medical curriculum , can we achieve integration?JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2000David H. Stone MD, FFPHM, FRCP (Glasg) Abstract Public health is widely regarded by medical students as peripheral or even irrelevant to the acquisition of clinical knowledge and skills. This paper attempts to set out some of the reasons for this, to encourage innovative approaches to integrating public health with clinical teaching and to offer a theoretical framework of integrated public health education for curriculum development and evaluation. The points of convergence between public health and clinical practice should not be regarded as self-evident. A practical demonstration of the application of public health principles to clinical problem solving may be the most effective means of overcoming resistance. Almost anywhere that clinical services are provided is suitable for this purpose. Community clinics, health centres or general practices have obvious appeal but acute hospitals have important advantages arising from students' preoccupation with clinical medicine. The main aim of integrated public health teaching is to facilitate the students' acquisition of knowledge, skills and attitudes that promote the effective application of public health approaches to clinical practice. The interrelationships between clinical practice and public health may be represented in the form of a grid. The vertical headings are the clinical skills that relate to the different stages of the natural history of disease , from the pre-disease state through diagnosis, treatment and follow up. The horizontal headings describe four key public health dimensions: epidemiology, behaviour/lifestyle, environment and health policy. The text in the boxes suggests appropriate topics for discussion. The grid is also potentially useful for course documentation and content evaluation. [source] Breast Cancer from a Public Health PerspectiveTHE BREAST JOURNAL, Issue 2 2004Richard R. Love MD Abstract: , By 2010, the majority of approximately 1.5 million annual new cases of breast cancer will be diagnosed in women in countries with limited resources. Public health approaches to medical problems emphasize the importance of practical, limited toxicity and very inexpensive interventions. While clinical trials in Western countries are testing the concept of breast cancer prevention, they are not defining useful public health approaches. Early detection of breast cancer using mammography, while effective, is a high-technology, expensive approach. Adjuvant systemic and radiation therapies are increasingly expensive; careful consideration of efficacy and cost-efficacy data appear warranted. Public health perspectives thus suggest that many current "standard" approaches to breast cancer in Western countries cannot help the majority of women in the world., [source] Tracking Diabetes: New York City's A1C RegistryTHE MILBANK QUARTERLY, Issue 3 2009SHADI CHAMANY Context: In December 2005, in characterizing diabetes as an epidemic, the New York City Board of Health mandated the laboratory reporting of hemoglobin A1C laboratory test results. This mandate established the United States' first population-based registry to track the level of blood sugar control in people with diabetes. But mandatory A1C reporting has provoked debate regarding the role of public health agencies in the control of noncommunicable diseases and, more specifically, both privacy and the doctor-patient relationship. Methods: This article reviews the rationale for adopting the rule requiring the reporting of A1C test results, experience with its implementation, and criticisms raised in the context of the history of public health practice. Findings: For many decades, public health agencies have used identifiable information collected through mandatory laboratory reporting to monitor the population's health and develop programs for the control of communicable and noncommunicable diseases. The registry program sends quarterly patient rosters stratified by A1C level to more than one thousand medical providers, and it also sends letters, on the provider's letterhead whenever possible, to patients at risk of diabetes complications (A1C level >9 percent), advising medical follow-up. The activities of the registry program are similar to those of programs for other reportable conditions and constitute a joint effort between a governmental public health agency and medical providers to improve patients' health outcomes. Conclusions: Mandatory reporting has proven successful in helping combat other major epidemics. New York City's A1C Registry activities combine both traditional and novel public health approaches to reduce the burden of an epidemic chronic disease, diabetes. Despite criticism that mandatory reporting compromises individuals' right to privacy without clear benefit, the early feedback has been positive and suggests that the benefits will outweigh the potential harms. Further evaluation will provide additional information that other local health jurisdictions may use in designing their strategies to address chronic disease. [source] Special issue 2011 public health approaches to safeguarding childrenCHILD ABUSE REVIEW, Issue 3 2010Article first published online: 4 MAY 2010 No abstract is available for this article. [source] | ||||||||||||||||