Government Health Agencies Research Articles

Multidisciplinary team puts the ‘home’ in hospital-to-home

Kim Thrasher, PharmD, BCPS, CPP, recently received a call from a care manager at Community Care of the Lower Cape Fear (CCLCF) about a medically fragile 2-year-old patient. The child had had numerous hospitalizations and was on multiple chronic medications. Most recently, the child had been discharged from the hospital after being on a ventilator and receiving narcotics for several weeks. She was discharged with a 36-hour supply of compounded methadone solution to combat withdrawal symptoms.

The Academic Health Department

The Academic Health Department (AHD) involves an arrangement between a governmental health agency and an academic institution, which provides mutual benefits in teaching, service, research, and practice. From its initial development in the mid-1980s as the public health equivalent of the relationship between a teaching hospital and a medical school, the AHD concept has evolved to include multiple levels of governmental public health agencies (local, state, and federal) as well as multiple academic institutions (public health, medicine, and primary care medical residencies). Throughout the decade of the 2000s, multiple influences have impacted both the quality and quantity of AHDs, leading to an expansion of AHDs through the Council on Linkages' AHD Learning Community. The value of the AHD--as described from prior studies as well as the AHD case examples in this current special issue--is evident in its impact on the quality of educational experiences and workforce development, agency and academic accreditation, practice-based research, and the potential to influence health reform.

Understanding the translation of scientific knowledge about arsenic risk exposure among private well water users in Nova Scotia

Arsenic is a class I human carcinogen that has been identified as the second most important global health concern in groundwater supplies after contamination by pathogenic organisms. Hydrogeological assessments have shown naturally occurring arsenic to be widespread in groundwater across the northeastern United States and eastern Canada. Knowledge of arsenic risk exposure among private well users in these arsenic endemic areas has not yet been fully explored but research on water quality perceptions indicates a consistent misalignment between public and scientific assessments of environmental risk. This paper evaluates knowledge of arsenic risk exposure among a demographic cross-section of well users residing in 5 areas of Nova Scotia assessed to be at variable risk (high-low) of arsenic occurrence in groundwater based on water sample analysis. An integrated knowledge-to-action (KTA) methodological approach is utilized to comprehensively assess the personal, social and local factors shaping perception of well water contaminant risks and the translation of knowledge into routine water testing behaviors. Analysis of well user survey data (n=420) reveals a high level of confidence in well water quality that is unrelated to the relative risk of arsenic exposure or homeowner adherence to government testing recommendations. Further analysis from the survey and in-depth well user interviews (n=32) finds that well users' assessments of risk are influenced by personal experience, local knowledge, social networks and convenience of infrastructure rather than by formal information channels, which are largely failing to reach their target audiences. Insights from interviews with stakeholders representing government health and environment agencies (n=15) are used to reflect on the institutional barriers that mediate the translation of scientific knowledge into public awareness and stewardship behaviors. The utilization of local knowledge brokers, community-based networks and regulatory incentives to improve risk knowledge and support routine testing among private well users is discussed.

What is Causing the Worldwide Rise in Body Weight?

The worldwide rise in body weight has reached epidemic proportions and this has serious public health consequences. Despite the universal recognition of this problem, its causes are still debated: some attribute it to excess caloric intake; others blame a lack of physical activity (PA); some implicate specific changes to micro- and macro-nutrients. During the past century, government health agencies have developed guidance on healthy eating. These, along with advances in agriculture and food manufacturing, have largely eliminated nutrient deficiencies and helped reduce the consumption of fat. Over the past 60 years, however, technological advances and shifts in the types of occupations prominent in industrialized as well as developing countries have resulted in well-documented decreases in energy expenditure. Energy intake must be balanced with energy expenditure in order to prevent weight gain, and there is increasing evidence that this balance must be at a relatively high level of energy flux. A program that was started in São Paulo in 1996 known as ‘Agita’ has sought to motivate populations to engage in small amounts of physical exercise daily to tackle growing obesity levels. This multi-agency initiative is one example of how to successfully increase exercise within a community and scale both within (e.g. all states in Brazil) and across many nations. Reducing caloric intake in whole populations is challenging especially at relatively low levels of energy expenditure, and evidence suggests that there is a critical energy flux threshold for regulating intake to achieve energy balance. Increasing PA, however, may be more achievable than reducing intake. Activity raises caloric expenditure and can offset excess intake. The implementation of programs to achieve greater PA is therefore vital if the worldwide rise in body weight is to be halted, while we also need to implement programs to help people eat smarter.

What is Causing the Worldwide Rise in Body Weight?

The worldwide rise in body weight has reached epidemic proportions and this has serious public health consequences. Despite the universal recognition of this problem, its causes are still debated: some attribute it to excess caloric intake; others blame a lack of physical activity (PA); some implicate specific changes to micro- and macro-nutrients. During the past century, government health agencies have developed guidance on healthy eating. These, along with advances in agriculture and food manufacturing, have largely eliminated nutrient deficiencies and helped reduce the consumption of fat. Over the past 60 years, however, technological advances and shifts in the types of occupations prominent in industrialised as well as developing countries have resulted in well-documented decreases in energy expenditure. Energy intake must be balanced with energy expenditure in order to prevent weight gain, and there is increasing evidence that this balance must be at a relatively high level of energy flux. A programme that was started in São Paulo in 1996 known as 'Agita' has sought to motivate populations to engage in small amounts of physical exercise daily to tackle growing obesity levels. This multi-agency initiative is one example of how to successfully increase exercise within a community and scale both within (e.g. all states in Brazil) and across many nations. Reducing caloric intake in whole populations is challenging especially at relatively low levels of energy expenditure, and evidence suggests that there is a critical energy flux threshold for regulating intake to achieve energy balance. Increasing PA, however, may be more achievable than reducing intake. Activity raises caloric expenditure and can offset excess intake. The implementation of programmes to achieve greater PA is therefore vital if the worldwide rise in body weight is to be halted, while we also need to implement programmes to help people eat smarter.

Work in Progress toward Adoption of an e-health Application by Healthcare Personnel: A Model Validation

Abstract Health information systems (HIS) have provided a major leap forward in communication and management of health services. In this study, a system of pharmaceutical services, which is an HIS platform that enables pharmacists to communicate with hospitals, government health agencies and suppliers, was investigated. The study aims to assess and determine factors influencing health professionals’ (pharmacists) adoption of the system. In this work in progress study, a new research model (P-TAM) was developed, and a survey was conducted with 2169 pharmacists from different regions of Turkey. Statistical analyses were performed in order to determine strength and reliability of the model. The results were promising in terms of determining factors associated with the adoption of pharmaceutical services. The findings were useful for identifying influential behavioral constructs in HIS. It is believed that this study will be a valuable asset for the literature as well as the researchers who are in the first phase of their study in assessing HIS adoption.

Knowledge of caretakers about routine immunization and reasons for partial immunization in rural areas of Jamnagar District

Background: Routine immunization (RI) is one of the most cost-effective public health interventions, first introduced in India in 1978. Yet, despite the concerted efforts of the government and other health agencies, a large proportion of vulnerable infants and children in India remain unimmunized. Objectives: Objective of this study was to know about perception of caretakers of beneficiaries about RI in terms of knowledge about vaccines and vaccine preventable diseases and reasons for missed opportunity of immunization. Materials and Methods: Community based cross-sectional study was conducted during January-June 2012 in a rural area of Jamnagar district. A total of 200 children aged 12-24 months were selected using stratified random sampling method. Results: Nearly 52% children were fully immunized. Most common reasons for partially immunization were sick child (68.9%) followed by vaccine not available (32.3%) and being outside on the day of session (31.11%). Nearly 61% Guardians knew about Polio vaccine, main source of information about RI was health worker (83.5%). There was statistical significant association between education of mother and immunization status of children. Conclusion: There is a need to strengthen Information Education Communication activities to improve knowledge regarding immunization among people, motivation of health workers to disseminate information regarding immunization. Hence, that immunization coverage should be improved.

On Robust Methodologies for Managing Public Health Care Systems

Authors focus on ontology-based multidimensional data warehousing and mining methodologies, addressing various issues on organizing, reporting and documenting diabetic cases and their associated ailments, including causalities. Map and other diagnostic data views, depicting similarity and comparison of attributes, extracted from warehouses, are used for understanding the ailments, based on gender, age, geography, food-habits and other hereditary event attributes. In addition to rigor on data mining and visualization, an added focus is on values of interpretation of data views, from processed full-bodied diagnosis, subsequent prescription and appropriate medications. The proposed methodology, is a robust back-end application, for web-based patient-doctor consultations and e-Health care management systems through which, billions of dollars spent on medical services, can be saved, in addition to improving quality of life and average life span of a person. Government health departments and agencies, private and government medical practitioners including social welfare organizations are typical users of these systems.

E-Health Approach- Evidence Based Need for Cohesive Implementation from Consumers’ Perspective

Developing countries are facing a dire health crisis with major threats to public health because of the increased need for health care which has not been matched with a commensurate increase in resource, and the imbalance is still growing. India is a developing country and to make provisions for basic health care to all the people is a difficult task for administrators because of its large and diverse geographical terrain, size of the population and its ethnic and cultural variations. From the consumer perspective, expressed demand for health services has been measured by utilization of available services, particularly when the service system has the capacity to meet the expressed demand. If a health care agency provides that care, it gradually establishes a relationship of trust with the community. Innovative data based e-Health methods and technologies seems to have the ability to answer interesting and challenging research questions and explore new avenues for solving health problems. Further, implementation of a holistic national health programme would require an assessment of the available health syatem. A cross sectional survey in geographical areas of Chandigarh, India was conducted in the urban, rural, slum, and rehabilitated communities. Though the use of private health care agencies was significantly higher in all socio-economic groups in the study sectors as compared to government health agencies, the use of indigenous health agencies was significantly higher in low socio-economic study sectors and in sectors where education levels were also lower. Further, cost effectiveness in terms of money and time were among other significant reasons for the utilization of these agencies. Along with eliminating geographical barriers, identification of the consumer segments for their perception and utilization and adopting and applying evidence based information integrated from field data, are liable to affect decisions making process in a particular context to benefit an end user in mind.

How health professionals perceive and experience treating people on social assistance: a qualitative study among dentists in Montreal, Canada.

BackgroundIn Canada, the prevalence of oral diseases is very high among people on social assistance. Despite great need for dental treatment, many are reluctant to consult dental professionals, arguing that dentists do not welcome or value poor patients. The objective of this research was thus to better understand how dentists perceived and experienced treating people on social assistance.MethodsThis descriptive qualitative research was based on in-depth semi-structured interviews with 33 dentists practicing in Montreal, Canada. Generally organized in dentists’ offices, the interviews lasted 60 to 120 minutes; they were digitally recorded and later transcribed verbatim. The interview transcripts were coded with NVivo software, and data was displayed in analytic matrices. Three members of the research team interpreted the data displayed and wrote the results of this study.ResultsDentists express high levels of frustration with people on social assistance as a consequence of negative experiences that fall into 3 categories: 1) Organizational issues (people on social assistance ostensibly make the organization of appointments and scheduling difficult); 2) Biomedical issues (dentists feel unable to provide them with adequate treatment and fail to improve their oral health); 3) Financial issues (they are not lucrative patients). To explain their stance, dentists blame people on social assistance for neglecting themselves, and the health care system for not providing adequate coverage and fees. Despite dentists’ willingness to treat all members of society, an accumulation of frustration leads to feelings of powerlessness and discouragement.ConclusionsThe current situation is unacceptable; we urge public health planners and governmental health agencies to ally themselves with the dental profession in order to implement concrete solutions.

Parental Cancer Beliefs and Trust in Health Information From Medical Authorities as Predictors of HPV Vaccine Acceptability

This research examines parental cancer beliefs and trust in health information from medical authorities as predictors of HPV vaccine acceptability. Specifically, the authors investigated how parents' perceived susceptibility to and severity of cancer, fatalistic beliefs about cancer prevention, and trust in health information from doctors/health professionals and government health agencies are related to willingness to vaccinate their daughters ages 11–12 years against HPV. The authors analyzed data from the 2007 Health Information National Trends Survey. The authors found that parents were more likely to accept the vaccine if they perceived a higher risk of getting cancer themselves and if they had a higher level of trust in health information from medical authorities. Perceived severity of cancer and fatalistic beliefs about cancer prevention did not predict vaccine acceptance.

Intolerance of uncertainty, appraisals, coping, and anxiety: The case of the 2009 H1N1 pandemic

Although ambiguous and uncertain situations, such as those dealing with the threat of widespread viral illness, may have pronounced psychological ramifications, there have been few studies that examined the factors that contributed to such outcomes. The purpose of the present investigation was to examine emotional reactions to a health threat. A structural equation model examined the interplay between anxiety and intolerance of uncertainty, as sequentially mediated by appraisals and coping strategies. Adult participants over the age of 18 (N = 1,027) completed online self-report measures during the H1N1 pandemic in 2009. Greater intolerance of uncertainty was related to lower appraisals of self- and other control, which predicted low levels of problem-focused coping and greater reports of H1N1-related anxiety. Additionally, individuals with a high intolerance of uncertainty were more likely to perceive the pandemic as threatening and also were more apt to use emotion-focused coping strategies, and both of these factors predicted elevated levels of anxiety. Together, these data indicate that threats, such as those related to a potential pandemic, not only have implications for physical health, but also for psychological distress, and that such outcomes vary with a constellation of appraisal and coping factors. What is already known on this subject? It has been established that the public is often confused by the threat that a potential pandemic virus poses and that they are unsure of what information related to the disease they can trust. Government health agencies often walk the line of minimizing the threat to prevent panic, but simultaneously emphasize the importance of action (vaccination) to prevent a worldwide pandemic. What does this study add? Beyond the physical threat of a pandemic, a significant psychological toll may occur for certain individuals. Anxiety regarding H1N1 is heightened amongst those who cannot tolerate uncertainty. Appraisals of threat, control, and the use of emotion-focused coping mediate the above relationship.

Use of diffusion‐ordered NMR spectroscopy and HPLC–UV–SPE–NMR to identify undeclared synthetic drugs in medicines illegally sold as phytotherapies

The informal (and/or illegal) e-commerce of pharmaceutical formulations causes problems that governmental health agencies find hard to control, one of which concerns formulas sold as natural products. The purpose of this work was to explore the advantages and limitations of DOSY and HPLC-UV-SPE-NMR. These techniques were used to identify the components of a formula illegally marketed in Brazil as an herbal medicine possessing anti-inflammatory and analgesic properties. DOSY was able to detect the major components present at higher concentrations. Complete characterization was achieved using HPLC-UV-SPE-NMR, and 1D and 2D NMR analyses enabled the identification of known synthetic drugs. These were ranitidine and a mixture of orphenadrine citrate, piroxicam, and dexamethasone, which are co-formulated in a remedy called Rheumazim that is used to relieve severe pain, but it is prohibited in Brazil because of a lack of sufficient pharmacokinetic and pharmacodynamic information.

Knowledge of Hypertension Among Adults in Owerri Senatorial Zone of Imo State, Nigeria

The study was conducted to ascertain knowledge of hypertension among adults in Owerri senatorial zone of Imo state, Nigeria. Three specific objectives were formulated with three corresponding research questions. The only null-hypothesis was also postulated to guide the study. Descriptive survey research design was used and the sample consisted of 432 adults. Questionnaire was the instrument for data collection. Percentages and ANOVA were used to analyze the data. The results of the study showed that adults had high level of knowledge of the concept and risk factors of hypertension. There was significant difference in the level of knowledge of hypertension among adults according to level of education. The study therefore recommends that government and voluntary health agencies should sponsor intensive enlightenment campaign through print and electronic media in order to sustain the knowledge level of adults on hypertension. DOI: 10.5901/mjss.2013.v4n5p69

Silicone breast implant materials

This opinion article has been written on request because of the recent public controversy over silicone breast implants produced by a now-defunct company, Poly Implant Prosthese (PIP) in France. More than 300,000 PIP devices have been implanted. The purposes of my article are to (1.) provide a general overview of silicone breast implant materials, (2.) to describe the general safety of these materials as reported to date, and (3.) to summarise current publicly available information about these aspects of the PIP prostheses. The materials covered are the silicone rubber from which the implant shells are made and the silicone gel used to fill the shell. The materials safety issues are biocompatibility (especially of the gel) and biodurability of the shell. The literature reviewed indicates that biocompatibility is not an issue with other current generation implants. However, biodurability is. A rough estimate of implant shell rupture rate is ~10+% at 10 years. Information is still emerging about the PIP implants. Initial regulatory disclosures suggest the PIP implants may have both biocompatibility and biodurability problems. They also suggest that PIP implants may have been produced using silicone materials not certified as medical grade. Governmental health and regulatory agencies are just now in the process of deciding what actions should be taken to protect patients.

How the Most Trusted Venues for Health-Related Information Influence Physician Referrals to Smoking Cessation Services.

Public health programs seek to educate physicians by using a variety of venues. Therefore, it is important to understand which health information sources physicians are using and how these sources affect referrals. We explored how venues for health-related information affect physicians’ referral practices to smoking cessation services. The 2008 DocStyles survey asked physicians to rank a list of their most trusted sources of health-related information. The analysis was restricted to 1,617 physicians who responded to all variables of interest. In this sample, the most trusted sources of health-related information cited by physicians were medical journals (95.9%), government health agencies (82.2%), other physicians (76.4%), professional medical societies (75.2%), and medical Web sites or podcasts (65.9%). Medical providers were more likely to refer tobacco users to cessation services if they used professional medical societies as a source to obtain patient health-related information, compared with medical providers not using this source (multivariate odds ratio = 1.31; 95% confidence interval = 1.03–1.66). Physicians use many health information sources. Therefore, to reach physicians effectively, a broad dissemination of guidelines and best practices in tobacco control is needed and should include information for medical societies.

Mortality and ST resolution in patients admitted with STEMI: the MOMI survey of emergency service experience in a complex urban area.

Since 2001, the urban area of Milan has been operating a network among 23 cardiac care units, the 118 dispatch centre (national free number for medical emergencies), and the county government health agency called Group for Prehospital Cardiac Emergency. In order to monitor the network activity, time to treatment, and clinical outcome, a periodic survey, called MOMI(2), was repeated two or three times a year. Each survey lasted 30 days and was repeated in comparable periods. Data were stratified for hospital admission mode. We collected data concerning 708 consecutive ST-elevation myocardial infarction (STEMI) patients (male 72.6%; mean age 64.4 years). In these six surveys, we observed a high rate of primary percutaneous coronary intervention (73.2%) and a mortality rate of 6.3%. Using advanced statistical models, we identified age, Killip class, and the symptom onset-to-balloon time as most relevant prognostic factors. Nonparametric test showed that the modality of hospital admittance was the most critical determinant of door-to-balloon time. 12-lead ECG tele-transmission and activation of a fast track directly to the catheterization laboratory are easy action to reduce time to treatment. The experience of the Milan network for cardiac emergency shows how a network coordinating the community, rescue units, and hospitals in a complex urban area and making use of medical technology contributes to the health care of patients with STEMI.

Bringing it All Together: Effective Maternal and Child Health Practice as a Means to Improve Public Health

Effective maternal and child health (MCH) practice requires skillfully combining a number of theoretical models and frameworks to support systems addressing the health needs of women, children, and families. This paper describes three perspectives relevant to current MCH practice: the federal Maternal & Child Health Bureau's Pyramid of MCH Health Services [1], Frieden's Health Impact Pyramid [Frieden in Am J Public Health 100(4):590-595, (2010)], and life course theory [Halfon in Milbank Quart, 80:433-79, (2002); Kotelchuck in Matern Child Health J, 7:5-11, (2003); Pies (2009)], an emerging conceptual framework that addresses a number of pressing maternal and child health issues including health disparities and the social determinants of health. While developed independently, a synthesis of these three frameworks provides an important analytical perspective to assess the adequacy and comprehensiveness of current public health programs and systems supporting maternal and child health improvement. Synthesizing these frameworks from the specific vantage point of MCH practice provides public health practitioners with important and dynamic opportunities to promote improvements in health, especially for state and local governmental health agencies with the statutory authority and public accountability for improving the health of women, children, and families in their jurisdictions. A crucial finding of this synthesis is that significant improvements in MCH outcomes at the state and local levels are the result of collaborative, integrated, and synergistic implementation of many different interventions, programs and policies that are carried out by a number of stakeholders, and administered in many different settings. MCH programs have a long history of coordinating disparate sectors of the health care and public health enterprise to create systems of services that improve maternal and child health. Future improvements in MCH build on this legacy but will come from a "paradigm shift" in MCH practice that blends (1) evidence-based interventions and best practices that improve the health of individuals, communities, and populations, and crosscuts health service settings with (2) public policies that promote and improve maternal and child health needs at the local, state, and national levels, and (3) supports MCH leadership to implement such changes in MCH systems nationwide. As such, the challenge presented by this synthesis is not merely technical, i.e. having the scientific and organizational capacity to address identified MCH needs. Instead, a more pressing challenge is providing effective leadership in the coordination and integration of these frameworks and using them in practice to develop a vision that guides programs and policies to improve maternal and child health nationwide.

Public health implications of differences in US and European Union regulatory policies for breast implants

The recall of tens of thousands of defective breast implants in Europe in 2011–12 as well as new data on risks have raised questions about regulatory standards for these and other medical implants in the United States (US) and European Union (EU). In the US, breast implants are regulated as high-risk medical devices that must be proven reasonably safe and effective in clinical trials and subject to government inspection before they can be sold. In contrast, clinical trials and inspections have not been required for breast implants or other implanted devices in the EU; approval is based on other information. As a result of these differing standards, the PIP breast implants that were recalled across Europe had been removed from the market years earlier in the US than in the EU, a decision US government health agencies can point to with pride. Nevertheless, the FDA track record on post-marketing breast implant research indicates poorly implemented studies and little meaningful enforcement to ensure that studies have been conducted correctly or findings reported accurately or acted upon. In sum, neither the EU nor the US has used their regulatory authority to ensure the long-term safety of breast implants. However, in 2012 the EU announced regulatory changes that could improve that situation.

THE “NAKED FACE” OF SECULAR EXCLUSION: BILL 94 AND THE PRIVATIZATION OF BELIEF

This article will consider the case study of Québec’s Bill 94 (An Act to establish guidelines governing accommodation requests within the Administration and certain institutions), introduced in March 2010, one of many recent bans imposed on the wearing of the niqab in the West. Citing the importance of “the right to gender equality and the principle of religious neutrality of the State,” Bill 94 emphasizes the necessity of “un visage découvert” or “naked face” when giving or receiving a broad range of public services in Québec, including all government services, childcare centres, hospitals, and health and social service agencies. According to section 6 of the Act, “If an accommodation involves an adaptation of that practice and reasons of security, communication or identification warrant it, the accommodation must be denied.” While quasi-neutral, this bill clearly has a disproportionate impact on religious women who wear the niqab. In fact, as a direct result of the legislation, Muslim women will likely disappear from the public sphere and be restricted to the private home where they might effectively be dependent on male family members to navigate the “market place” on their behalf. Borrowing from Charles Taylor’s A Secular Age, this paper will consider the distributive consequences of the niqab ban, a critical juncture of “religion-state relations” in which belief is more and more relegated to the private sphere in Quebec. The article will use Bill 94 to explore this peculiar manifestation of “secularism” with the concurrent existence of “governance feminism”— how the privatization of belief goes hand in hand and is perversely reinforced by a colonial discourse on gender equality, leaving some already marginalized women out of the public gaze. Is this legislated demand for a “naked face” truly the logical outcome of a successful feminist movement (as some have asserted) or isthis erasure of religious women in fact the latest veil of patriarchy?