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Public Health Programmes (public + health_programme)
Selected AbstractsProvision and financial burden of TB services in a financially decentralized system: a case study from Shandong, ChinaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2004Qingyue Meng Abstract Both challenges and opportunities have been created by health sector reforms for TB control programmes in developing countries. China has initiated radical economic and health reforms since the late 1970s and is among the highest TB endemic countries in the world. This paper examines the operation of TB control programmes in a decentralized financial system. A case study was conducted in four counties of Shandong Province and data were collected from document reviews, and key informant and TB patient interviews. The main findings include: direct government support to TB control weakened in poorer counties after its decentralization to township and county governments; DOTS programmes in poorer counties was not implemented as well as in more affluent ones; and TB patients, especially the low-income patients, suffered heavy financial burdens. Financial decentralization negatively affects the public health programmes and may have contributed to the more rapid increase in the number of TB cases seen over the past decade in the poorer areas of China compared with the richer ones. Establishing a financial transfer system at central and provincial levels, correcting financial incentives for health providers, and initiating pro-poor projects for the TB patients, are recommended. Copyright © 2004 John Wiley & Sons, Ltd. [source] Accessing rural populations: role of the community pharmacist in a breast and cervical cancer screening programmeJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007Timothy R. McGuire Pharm.D. FCCP Abstract Rationale, Community pharmacists are one of the most frequently visited health care providers in the USA. The article describes a demonstration project which used community pharmacists to educate and enrol low to moderate income and medically under-served women into a statewide breast and cervical cancer screening programme. Methods, The Nebraska Department of Health programme entitled, ,Every Woman Matters', funded through the Centers of Disease Control and Prevention, provided no cost or low cost mammography and pap smears to eligible women. Patient enrolment packets were distributed to 91 pharmacies expressing an initial interest in participating. These were reduced to 28 pharmacies based on their commitment level during the initial 3 months of the study. Results, One hundred and fourteen patient referrals were generated from the 28 network pharmacies; two from pharmacies in urban areas, and 112 referrals from rural sites. All referrals were from the 22 independently owned pharmacies in the study. Conclusions, Results suggest that the use of independent community pharmacies in the rural setting can be an effective method of recruiting women into public health programmes. [source] The rationale of value-laden medicineJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2002Michael H. Kottow MA(Soc) MD Abstract Medicine is becoming increasingly confident that scientific advances, especially in the area of genetics, will allow a major improvement in the control and eradication of disease. This development seems to go hand in hand with health-enhancement strategies, erasing the distinction between the states of health and disease, and blurring the specific goals of medical services. Medicine tends to become an increasingly technocentric practice that relies heavily on expert knowledge and on epidemiological evidence, neglecting the lived-body experience of being ill, and tending to transform costly medical services into commodities only affordable by the affluent. This paper argues that disease is not merely a functional description, but rather a definitely value-laden organismic state that is experienced by the patient, needs to be explored and treated by medical practitioners, and requires the assessment and participation of social institutions concerned with the delivery and support of medical services. Each of these perspectives introduces its own set of values, both in the clinical encounter and in public health programmes. Bioethics seems to be the appropriate discipline to discuss all these values involved, and help assign them properly in order to rescue the caring concern of medicine for the sick, as well as uphold a principle of fairness in publicly funded medical services. [source] MASS-VACCINATION PROGRAMMES AND THE VALUE OF RESPECT FOR AUTONOMYBIOETHICS, Issue 5 2008LOTTE ASVELD ABSTRACT Respect for autonomy is problematic in relation to public health programmes such as vaccination, as the success of such programmes depends on widespread compliance. European countries have different policies for dealing with objectors to vaccination programmes. In some countries compliance is compulsory, while in others objectors are exempted or allowed to enter the programme under specific conditions. In this paper I argue that the objectors should not be treated as a homogenous group as is done in the above-mentioned policies. Objectors have different arguments for not participating in vaccination programmes. Considering the value of respect for autonomy, some but not all of these arguments need to be accommodated by authorities. The concept of ,narrative autonomy' provides criteria to distinguish between tenable and untenable claims to the right to refuse vaccination. Narrative autonomy understands autonomy as essentially linked to identity, as this provides the moral framework with which we assess our first-order preferences. The above-mentioned concept of autonomy is derived from the concept of narrative identity as described by Marya Schechtman. She suggests that the application of the Articulation Constraint and the Reality Constraint enables us to establish the validity of personal narratives. Additionally, form and content features of identity, as proposed by Anthony Laden, will be used as criteria to establish the compatibility of the defectors' arguments with shared scientific and political values. Such compatibility is essential to accommodate respect for autonomy in the context of public health. [source] PERINATAL AND CHILDHOOD PRECURSORS OF ADULT CARDIOVASCULAR DISEASECLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 2007Lawrence Beilin SUMMARY 1Longitudinal studies from the US, Australia and Europe have demonstrated tracking of childhood risk factors for cardiovascular disease from adolescence into adult life. These factors include obesity, blood cholesterol levels, blood pressure and measures of insulin resistance. Worldwide increases in childhood obesity and overweight are already resulting in increases in adolescent diabetes and are likely to translate into earlier onset hypertension and cardiovascular disease in adults. 2Low birth weight has also been associated with increased risk of adult cardiovascular disease, diabetes and high blood pressure, but there is considerable debate as to the relative importance of pre- and postnatal influences. 3These issues are discussed in the context of results of a longitudinal cohort study of cardiovascular and metabolic risk factors in Western Australia, the ,Raine' childhood cohort, which showed that in a well-nourished Australian population at age 8 there was a U-shaped relationship between birth weight and a cluster of factors predisposing to adult cardiovascular disease, with postnatal weight gain being the dominant factor. 4Future public health programmes should focus on both pre- and early postnatal factors predisposing to obesity, hypertension and diabetes. 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