Byssinosis — An historical perspective

Based on the history of the growing awareness and recognition of ailments associated with the manufacture of cotton, it is concluded that recognition of byssinosis in the United States came late. In the American south byssinosis existed in an industry and within a social framework that helped to retard the acceptance of byssinosis as an undesirable but controllable disease. As late as the 1960s, United States medical opinion declared the disease nonexistent in American textile mills. In 1970, the scientific community showed that byssinosis existed in the United States. Mobilization of public opinion, changes in social attitudes, new scientific evidence, and the Occupational Safety and Health Act led to the setting of a standard to control and eradicate byssinosis. Controversy and debate over policy have brought the impact of scientific, sociopolitical, and economic inputs into health policy decisions, the altering perceptions of hazard, and the continually changing definition of risk into focus.     

Community paediatrics moves on—an analysis of changing work patterns 1994–97

Objectives: To describe the current clinical workload of the modern community paediatrician; to outline the changes in this role over recent years and examine the reasons for these.Design and setting: The design is a retrospective analysis of data routinely collected for contracting purposes. Nottingham community paediatric service 1994–97 is the setting.Main outcome measures: These are the characteristics of patients seen, sources of referral, locations of clinical contact, referral rates by area.Results: 36 710 appointments were offered over the time period studied. The non-attendance rate was 17%. Pre-school children made up the largest group seen. Most referrals were from health visitors (23%) and school nurses (29%). There has been a small but significant increase in the numbers of children seen who have developmental problems and disability, and due to child protection issues between the time periods. There has been a shift in the proportions of children seen in a local health centre referral clinic (9.8% increase during 1994–97) rather than in a school setting. Twice as many children are referred to the community paediatrician from inner city areas than from the surrounding county areas.Conclusion: The transfer of child health surveillance to the primary health care team and the increased training of community paediatricians, has resulted in community paediatricians developing an increasingly specialised role particularly in the areas of child growth and development, disability, social and behavioural paediatrics.Public Health (2000) 114, 61–64.     

Improving health literacy in a Japanese community population—A pilot study to develop an educational programme

Objective

Although a growing number of interventional studies on health literacy have been conducted recently, the majority were designed in clinical settings, focusing mainly on functional health literacy. This study evaluated a programme designed to improve health literacy in a community population, with a scope of going beyond functional health literacy.

Methods

In collaboration with an Approved Specified Nonprofit organization (NPO), we evaluated a five‐session programme designed to provide basic knowledge on health‐care policy and systems, current issues in health care in Japan, patient roles and relationships with health‐care providers and interpersonal skills. In total, 67 of 81 programme participants agreed to participate in the study, and 54 returned the completed questionnaires at baseline and at follow‐up. Health literacy and trust in the medical profession were measured at baseline and at follow‐up. Participants’ learning through the programme was qualitatively analysed by thematic analysis.

Results

Quantitative examinations of the changes in health literacy and degree of trust in medical professionals between the baseline and follow‐up suggested that health literacy significantly improved after implementing the programme. The thematic analysis of participants’ learning throughout the programme suggested that they not only acquired knowledge and skills but also experienced a shift in their beliefs and behaviours.

Discussion

Providing individuals who are motivated to learn about health‐care systems and collaborate with health‐care providers with the necessary knowledge and skills may improve their health literacy, which could enable them to maintain and promote their health and that of their family and other people around them.     

Methodologic issues in intervention research—health care

To better understand the methodological challenges faced by intervention research in health care, workshops reviewed two intervention studies to reduce back injuries among nursing home staff and two studies on the use of precautions to prevent occupational transmission of bloodborne pathogens. These studies adapted rigorous designs to real-world settings and made good use of multiple measures to detect effects and communicate this information to policy makers. The studies grappled with issues about implementation integrity and would benefit from better theory of administrative practices associated with a safety-conscious work environment. © 1996 Wiley-Liss, Inc.     

The contingent valuation method—appraising the appraisers

Morrison & Gyldmark (MG)¹ in a recent issue of health economics reviewed the use of the contingent valuation (CV) method of measuring willingness to pay in the health area. Although it is useful to examine the appropriate role of the CV method in the health care field, the appraisal by MG has a number of limitations which are pointed out in this paper. These relate to some inaccuracies in the review of the literature, the limited nature of the criteria proposed by MG to evaluate CV studies, and finally I argue that the comparison between CV, QALYs, and HYEs is premature and confuses rather than clarifies the debate.     

Health SWAps and external aid—a case study from Tajikistan

As it moves from a relief to a development phase, the Republic of Tajikistan (RT) needs to attract more external aid and to ensure adequate alignment of this aid with health systems development priorities. A potential response to these two needs is a Sector‐Wide Approach (SWAp), a method originating from post‐colonial Africa and Asia that is increasingly being introduced in new contexts. However, little is known about whether SWAps are appropriate in the context of the former Soviet Union (FSU). This paper explores SWAps using Tajikistan as a case study. A number of lessons are identified for the Tajik health system, for other FSU countries and for health SWAps in general, covering issues of practical relevance to national and international health policy‐makers. We conclude that context‐specific SWAps may be developed to suit Tajikistan, and other FSU countries. Tajikistan currently does not yet have all the key SWAp elements in place, but this should be seen as a motive for, rather than an impediment to, developing a SWAp. Other FSU countries have a more favourable environment for implementing health SWAps. Copyright © 2010 John Wiley & Sons, Ltd.     

Protecting the public health — the role of environmental health

This article seeks to review the key concepts and issues central to environmental health in relation to the protection of public health. It will focus on the holistic framework in which environmental health operates and the major threats faced. The key issue to be addressed is the need for collaboration at the professional and organisational level as a central prerequisite for a healthy nation.     

Health promotion clinics in general practice—new or old?

The objective of this paper is to assess the variety of specialized clinics available in practice before the implementation of the 1990 Contract. An audit was carried out using information provided in the log diaries from trainees in the West of Scotland sitting the mock Membership of the Royal College of General Practitioners (MRCGP) examinations. The different types of clinics being carried out were identified from the information given. Data were obtained from 147 practices. A wide variety of clinics were being carried out, many of which were included in the list of recommended health promotion clinics and many which did not attract a fee prior to the contractual changes. Only 57% of practices employed a practice nurse and 36% of trainees had no clinic experience in a typical week. The findings indicate that principals are aware of the benefits of clinics in practice and often undertake to carry them out themselves. It is important that trainees gain more experience in carrying out these clinics. Many more clinics have been set up since the contract changes but unless more funding is available to tackle the social problems which adversely affect health we will fail to improve the health of our community.     

The discounting of lives saved in future generations—some empirical results

The aim of this note is to estimate the discount rates that individuals in the present generation in Sweden use to discount lives saved in future generations at different points in time. A binary survey question, where individuals choose between saving lives in their own generation versus saving lives in future generations, was administered in a general population sample of 850 individuals. Three time horizons of 20, 50 and 100 years were used in three different subsamples. Logistic regression analysis was used to estimate the discount rate. The estimated annual discount rate is 25% for the 20 year time horizon, 12% for the 50 year time horizon and 8% for the 100 year time horizon.