From risk-based health surveillance to health promotion: an evidence-based experience in a health care setting

In the European countries the health surveillance may be provided as a part of the national health system intervention. In Italy, the legislative Decree (626/94) makes the health surveillance compulsory for all those workers who are exposed to occupational risks. The aim of this study was to describe the introduction of preventive and protective measures, according to the new regulations, in the teaching hospital of the University of Modena. The population examined in 2000 included 1523 workers. Specific health surveillance protocols were prepared on the grounds of the risk characteristics based on the scientific evidence and on the risk perception. The intervention was oriented towards health promotion. The subjects were classified into 10 groups according to the risk characteristics. The percentage of workers ranged from 4% to 42%, depending on the exposure-related health changes. Moreover, the study explored some of the health surveillance benefits: an improvement in worker's satisfaction, an improvement in relationship between stakeholders, an early detection of health changes and a sickness absence reduction after the influenza vaccination program.     

A social model for health promotion for an aging population: Initial evidence on the experience corps model

This report evaluates whether a program for older volunteers, designed for both benerativity and health promotion, leads to short-term improvements inmultiple behavioral risk factors and positive effects on intermediary risk factors for disability and other morbidities. The Experience Corps^® places older volunteers in public elementary schools in roles designed to meet schools’ needs and increase the social, physical, and cognitive activity of the volunteers. This article reports on a pilot randomized trial in Baltimore, Maryland. The 128 volunteers were 60–86 years old; 95% were African American. At follow-up of 4–8 months, physical activity, strength, people one could turn to for help, and cognitive activity increased significantly, and walking speed decreased significantly less, in participants compared to controls. In this pilot trial, physical, cognitive, and social activity increased, suggesting the potential for the Experience Corps to improve health for an aging population and simultaneously improve educational outcomes for children.     

全球视野下青少年卫生综合性课程体系建设

面向世界培养青少年卫生创新人才是中国公共卫生教育在新时期面临的新使命.随着青少年卫生领域日新月异的发展,教学与培训模式已无法与时代同步.本文介绍世界知名高水平大学和重要国际组织有关青少年卫生教育与培训课程核心内容和成功经验,为全球化背景下我国青少年卫生人才培养提供借鉴和理论参照.     

Contracting for health services in a public health system: the New Zealand experience

This paper reports on the process and outcomes of contracting for health services in New Zealand between 1993 and 2000 when a purchaser-provider split was in place. Key factors that shaped the contracting environment were the legal framework, funding constraints, and the cultural and professional norms of contracting personnel. A lack of good information-especially on costs, volumes and quality-increased the costs of contracting and made monitoring and accountability difficult. Over time, however, the contracting process became simpler and less costly. Overall, the introduction of contracting generally improved the focus of providers on costs and volumes; led to greater clarity through specification of services; encouraged providers to focus on methods to improve quality; and enabled new styles of service provision from providers that had not traditionally received public funds for health services. Good relationships between purchasers and providers were seen as the key to successful contracting.     

An evaluation of a network for professional development in child and adolescent mental health in rural and remote communities

In 1998 a telemedicine network was established in South Australia and the Northern Territory to deliver educational material to professionals working in child and adolescent mental health in remote areas. The network involved a wide range of health professions, from psychiatrists to psychologists and social workers. The first 12 months of network activity were evaluated by quantitative and qualitative techniques. Four sources of data were used: an activity log, questionnaires, interviews and action research. A total of 36 telemedicine sessions were held, ranging in duration from 45 to 90 min (average 56 min) and involving a total of 45 different professionals, who participated an average of four times each (range 1-15). The most common types of session were case discussions (47%), followed by specialist seminars (36%) and administrative and introductory sessions (17%). The benefits of the network included: networking and peer support; improved efficiency and reduced travel costs; and improved efficiency of health services. The problems included: costs; lack of access to technical support; and the need for staff induction and training.     

Active health promotion in old age: methodology of a preventive intervention programme provided by an interdisciplinary health advisory team for independent older people

People live longer today and, therefore, have more opportunity to a quire non-fatal disabilities in old age. Disability in old age has multifactorial causes, including physiological, psychological and social risk factors. An innovative health promotion and prevention programme designed for elderly people was developed at the Albertinen-Haus Geriatrics Centre in Hamburg in 2001 and offered to residents of the city aged 60 years and over who were living in their own homes. Eligible individuals were independent, i.e. without disabilities (not in need of care or support according to the German health systems categorization), and without cognitive impairment. The programme focuses on areas of health behaviour that are interrelated and target self-efficacy and empowerment. The programme used an interdisciplinary approach in group sessions. The team of health promotion advisers (Gesundheitsberater-Team) consisted of members of four professions, i.e. physician, social worker, physiotherapist, and nutrition and home economics specialist. We decided to work in group sessions because of the potential for positive dynamic effects between group participants and for reasons of cost. We also developed a curriculum to train professional members of interdisciplinary geriatric teams to work as health promotion advisers for elderly people.

Addressing the costs of quitting' smoking: a health promotion issue for adolescent girls in Canada

While intense efforts have been implemented to address the problemof cigarette smoking, the prevalence of tobacco use among adolescents,in particular young women, remains high. Older adolescent girlsare joining their younger counterparts in taking up the smokinghabit. The literature has examined the reasons for young peoplestarting to smoke; however, little is known about the smokingcessation process in adolescents. This paper reports findingsfrom an in-depth qualitative study of 25 girls ages 18 and 19which uncovered the struggles young women experience as theyattempt to quit smoking. These struggles and losses are referredto as the ‘costs’ of quitting smoking. The ‘costs’reflect not only their ‘real’ experiences when attemptingto quit smoking, but also reflect ‘anticipated’struggles and losses. The study addressed the ‘costs’in relation to the social, emotional and physiological domainsof the adolescent girl's life. Findings from this research projectprovide theoretical direction for the development of comprehensivehealth promotion interventions. If health care professionalsare to assist in reducing cigarette smoking among young women,the ‘costs’ which girls see to quitting smokingmust be considered.     

Health services, health promotion, and health literacy: report from the State of the Science in Aging with Developmental Disabilities Conference

BackgroundThis article summarizes the proceedings of the Health Services, Health Promotion, and Health Literacy work group that was part of the “State of the Science in Aging with Developmental Disabilities: Charting Lifespan Trajectories and Supportive Environments for Healthy Living.” Participants aimed to identify unmet needs related to health and health care and to determine training, research, and policy needs addressing the demands for increasing health care services and resources, end-of-life and palliative care, and health literacy.MethodsKey issues addressed included (1) major health-related disparities for adults with intellectual and developmental disabilities (I/DD); (2) the impact of internal and external factors on health care services and resources, end-of-life and palliative care, and health literacy for adults with I/DD; and (3) frameworks that can be used for understanding and promoting health care services and resources, end-of-life and palliative care, and health literacy.ResultsGroup participants identified research and practice needs related to primary care, health promotion, disease prevention, illness care, end-of-life issues, and palliative care.ConclusionsHealth care services for adults with I/DD may occur in a variety of settings including community-based programs, private practices, and community-based agencies supporting persons with disabilities. Major gaps relate to health disparities due to underdiagnosis, misdiagnosis, less chance of receiving prompt treatment, limited access to providers, lack of research information, transportation barriers, and lack of accessible medical equipment. Models of care including variables related to translation, sustainability, accessibility (e.g., affordability, availability), acceptability (e.g., culturally relevant, satisfaction), and equity need to be developed.     

Child health care centres: an academic model for comprehensive child health care in the community

The challenge of the discipline of paediatrics in the 21st century is to promote health and development of children in a way that will enable them to maximize their biological and social potential. The community child health centre (CHC) in Israel is a model of community health care service built to provide comprehensive health care to children and adolescents, as well as an academic setting for under- and postgraduate paediatric training. Today there are 34 CHCs in Israel, serving a population of 220 000 children from birth to 18 years of age. The CHC combines the advantages of group practice with those of an academic medical centre and enables flexibility and mutual learning. Further expansion and development are required to realize the CHC's mission of a true comprehensive academic centre for paediatric community health.     

Geographic analysis of pertussis infection in an urban area: a tool for health services planning.

OBJECTIVE: This study examined whether incident cases of pertussis cluster in urban census tracts and identified community characteristics that predict high-incidence areas. METHODS: An ecological study design was used. The study population included all persons diagnosed with pertussis from January 1, 1986, through December 31, 1994. Maps of rates were constructed via a geographic information system and clustering was statistically confirmed. Associations between pertussis rates and community characteristics were tested. RESULTS: Mapping and statistical analysis revealed spatial clustering of pertussis. Higher age-adjusted rates of pertussis infection were associated with higher proportions of residents below poverty level. CONCLUSIONS: In urban areas pertussis infection clusters in areas of poverty.     

Mothers'' attitudes to and experience of pre-school child health services: a comparative study in two districts in the West Midlands

A postal questionnaire survey was undertaken amongst a ten percent random sample of mothers in Walsall and South Warwickshire in order to determine their views concerning health services available for their three year old children. A response rate of 59% and 75% respectively was obtained. Despite differences in demographic profile between the two districts, the overall views of mothers were remarkably similar. The majority of mothers were happy with services provided but mothers whose first language was other than English were less likely to be satisfied. Criticisms included dissatisfaction with waiting times, inappropriate timing of clinics, insufficient advice given as well as inconsistencies in advice offered. Health visitors in particular were perceived to be helpful and requests for further input from them were made. Specific health needs of children from ethnic minority backgrounds were discovered which should form the basis of further, more detailed local research. The survey also highlighted the high prevalence of accidents and asthma among pre-school children.     

Migration-specific expertising in the spheres of tension between medicine,law, psychology and politics -- report on an interdisciplinary meeting of experts

The 4th conference of transcultural medical appraisal was organized once again by the ethno-medical center in Hannover on 2nd and 3rd of November, 2001. For the first time, medical estimators and decision-makers from the spheres of medicine, psychology, law and administration got together thematically and interdisciplinary. As to the public health authorities, the intensive discussion and working session on the topic of deportation, transportability and asylum was of high relevance. The specific working group included judges, clinical and public health physicians, psychologists, migration authority officials and representatives of migrant organisations. In full agreement finally it was pointed out that medical or psychological estimation concerning asylum and deportation should remain in the hands of the public health authorities because of their expert knowledge, experience and full independence in the sphere of medical and psychological appraisal.     

Performance of a general location model with an ignorable missing-data assumption in a multivariate mental health services study.

In a study of the impact of case management teams in a publicly funded mental health programme, mental health patients were interviewed about a variety of outcomes suggestive of successful community adaptation, such as support from family and friends and avoidance of legal problems. Because outcome data were missing for a number of patients, a follow-up study was carried out to obtain this information form previous non-responders whenever possible. Because the data of interest were multivariate and included both continuous and categorical variables, a candidate approach for handling incomplete data in the absence of follow-up data would have been to fit a general location model, presumably with log-linear constraints on cell probabilities to avoid overfitting of the data. Here, we use available follow-up data to investigate the performance of a series of general location models with ignorable non-response. We note some problems with this approach and embed the discussion of this example in a broader consideration of the role of ignorable and non-ignorable models in applied research.