Assessing and ensuring a comprehensive system of services for children with special health care needs: a public health approach

The US Department of Health and Human Services called for comprehensive systems of services for children with special health care needs in its Healthy People 2000 and 2010 health care objectives for the nation. We report on the proportion of children with special health care needs receiving care in high-quality systems of services measured by attainment of 6 essential system elements, or quality indicators, generated from a survey of 40,723 families of children with special health care needs in 2005 to 2006. Only 17.7% of children with special health care needs received services in a high-quality service system that met all 6 quality indicators in 2005-2006. Therefore, much more work lies ahead to meet the national Healthy People objective for these children.     

Evaluating prevention and quality of care in managed care plans: a public health perspective.

Public health practitioners are challenged to ensure the continued provision of necessary services in a rapidly changing delivery system. To accomplish this, new approaches to evaluating access and quality on a population basis are needed. This article presents a number of possible methods for evaluation, with particular emphasis on strategies related to managed care in Medicaid. The importance of considering cost containment in evaluating access and quality and in changing systems is discussed.     

公共卫生人才全球化视野的内涵与培养

随着中国在国际舞台上的重要性不断提高,培养具有全球化视野的公共卫生人才成为关键问题。全球化视野包括对全球政治、经济、社会发展的深入理解,对全球卫生问题的历史、现状与发展趋势的掌握,对公共卫生全球治理与公共卫生专业本身关系的理解和感悟,在多元文化环境中对多元价值的理解、适应和自我发展,以及通过外交谈判手段获得问题解决方案的能力和向全球卫生治理提供中国案例的能力。培养这些能力,既需要打造理论与实践相结合的师资队伍,选择适宜人才进行后备队伍培养和教育,也需要提供多种多样的实践与培训,如到国外留学、到国际组织或者跨国机构任职、参与中国政府对外援助项目等。     

The life course perspective: a challenge for public health research and prevention

Recently, there has been a growing awareness in public healthresearch of the long-term impact on health of various eventsand exposures earlier in life. Last year this journal introduceda section with several papers applying such a ‘life courseperspective’, which illustrated the contributions thatthis perspective is already making to the field of     

Chronic disease prevention: public health potential and research needs

This paper, arising out of an event to honour the statistical and scientific contributions of Professor Peter Armitage, is concerned with research strategies and needs for chronic disease prevention. A few highlights from recent intervention trials for the prevention of cancer, cardiovascular disease, fractures and diabetes is provided, along with a discussion of some settings where intervention trial results seem discrepant with a body of preceding observational data. This background is used to identify research strategies and infrastructure needs for moving this vitally important research area forward, for both chemoprevention and lifestyle modification interventions.     

Identifying training needs in the public health workforce: the public health prevention service as a case study.

The Public Health Prevention Service is a three-year training program committed to developing a workforce that is skilled in planning, managing, and evaluating prevention programs. In 2000, a questionnaire was administered to participants to assess their training needs. According to the resultant data, training is preferred in traditional formats (e.g., case studies and group discussion) and in short installments (one to three hours). Topics identified for future training included software application, prevention effectiveness (i.e., economic analysis), program evaluation, budgeting, and consensus building.     

Palliative care: a perspective of comprehensive care for the cancer patient

The purpose of this article is to ponder on the relevance of palliative care in assisting ill patients with neoplasias in their dwellings, since palliative care aims at giving patients and their families the best attainable quality of life. Despite the great emphasis placed upon this type of care being aimed at terminal patients, many of its principles are also applicable to initial stages of the disease, used in combination with the therapeutic measures required by the specific pathologic process. Thus, throughout this article, I outline some aspects concerning ethics, philosophy, and assistance which have guided this therapeutic modality from its start until today.     

Changing emphases in public health and medical education in health care reform

Globalisation of economies, diseases and disasters with poverty, emerging infectious diseases, ageing and chronic conditions, violence and terrorism has begun to change the face of public health and medical education. Escalating costs of care and increasing poverty have brought urgency to professional training to improve efficiency, cut costs and maintain gains in life expectancy and morbidity reduction. Technology, genetics research and designer drugs have dramatically changed medical practice. Creatively, educational institutions have adopted the use of: (1) New educational and communication technologies: internet and health informatics; (2) Problem based learning approaches; Integrated Practice and Theory Curricula; Research and Problem Solving methodologies and (3) Partnership and networking of institutions to synergise new trends (e.g. core competencies). Less desirably, changes are inadequate in key areas, e.g., Health Economics, Poverty and Health Development, Disaster Management & Bioterrorism and Ethics. Institutions have begun to adjust and develop new programs of study to meet challenges of emerging diseases, design methodologies to better understand complex social and economic determinants of disease, assess the effects of violence and address cost containment strategies in health. Besides redesigning instruction, professional schools need to conduct research to assess the impact of health reform. Such studies will serve as sentinels for the public's health, and provide key indicators for improvements in training, service provision and policy.