Local Public Health Services Research Articles

Action vital to protect children from public health services cuts

Cuts to local authority public health services seem inevitable after the government announced it is to slash budgets from this year, with councils considering a range of options to reconfigure some services and reduce others

Concurrent control of blood glucose, pressure, lipids, and body mass in patients with type 2 diabetes and comparison with the 2013 Chinese guidelines: a cross-sectional study

BackgroundDiabetes has rapidly become an epidemic in recent decades, and in 2008, the prevalence of type 2 diabetes was reported to be 9·7% in China. According to the China National Basic Public Health Services implemented in 2009, local public health services should take charge of management of patients with chronic diseases, including diabetes. The 2013 Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes has set comprehensive goals for control of the disease. The aim of this study was to assess concurrent control of blood glucose, pressure, lipid, and body mass in patients with diabetes in comparison with the 2013 Chinese Guidelines. MethodsA cross-sectional study with stratified cluster sampling was conducted in Changshu county and Huai'an City of Jiangsu Province. According to criteria by America Diabetes Association, 39 564 patients diagnosed with type 2 diabetes have registered and received management of the National Basic Public Health Services in 2012. 23 240 patients with type 2 diabetes in 44 public health service centers within 65 townships were sampled, and 20 340 individuals agreed to participant in the survey, which consisted of a structured epidemiological questionnaire and physical examination between December, 2013, and January, 2014. Fasting blood samples were collected to measure glycated haemoglobin A1c (HbA1c), fasting blood glucose, and lipid profiles. Blood pressure, weight, height, and body-mass index (BMI) were also measured and calculated. This study was approved by the ethic committe of Jiangsu Provincial Center for Disease Control and Prevention (2013026), and informed consent was obtained from each participant. Findings20 053 patients with type 2 diabetes were included in the study. The mean age of the participants was 62·8 years (SD 9·9), and 12190 (60·8%) patients were female. 8370 (42%) patients had controlled HbA1c concentration below 7·0%, and 6291 (31%) patients had fasting blood glucose concentration below 7·0 mmol/L. 15 406 (77%) patients had hypertension, and 4876 (24%) patients had controlled blood pressure (systolic blood pressure <140 mm Hg and diastolic blood pressure <80 mm Hg). The prevalence of dyslipidemia was 48% (9715 of 20 053 patients); 11 119 (55%) patients had controlled triglyceride concentrations (<1·7 mmol/L), 4774 (24%) patients had controlled total cholesterol (<4·5 mmol/L), 4439 (22%) patients had controlled LDL-cholesterol concentration (<1·8 mmol/L with cornary heart disease and <2·6 mmol/L without the disease), and 15 115 (75%) patients had controlled HDL-cholesterol concentration (>1·0 mmol/L in men and >1·3 mmol/L in women). 7186 (36%) participants had BMI less than 24·0 kg/m2. InterpretationThe glycaemic control is quite low in the present study, and even fewer patients had gained control of blood pressure and body mass. Nearly half of the participants had dyslipidemia. More intensive management of diabetes and comorbidities is warranted in the Chinese population. FundingJiangsu Provincial Health Department (K201105).

Viral haemorrhagic fevers in South Africa.

Viral haemorrhagic fevers (VHFs) include a diverse array of diseases caused by a broad range of viruses transmitted from various animal hosts and originating from almost all the continents in the world. These are potentially fatal and highly transmissible diseases without specific treatments or prophylactic vaccines. As has been demonstrated during the Ebola virus disease outbreak in West Africa, the consequences of VHFs are not limited to specific countries - they may become epidemic, and may have considerable economic impact and disrupt local public health and social service structures. Intensive public health intervention is necessary to contain these diseases. Here we provide a concise overview of the VHFs that are of current public health importance to South Africa.

Comparison of findings using ultrasonography and cystoscopy in urogenital schistosomiasis in a public health centre in rural Angola.

Schistosomiasis is a chronic disease caused by infection with parasitic worms of the genus Schistosoma. In sub-Saharan Africa, infections with S. haematobium are most common. Cystoscopic examination (CE) has been accepted as the goldstandard test for detecting the late manifestations of schistosomiasis, including urothelial cancer of the bladder. However, this procedure is invasive and 10-40% of tumours may remain undetected. A non-invasive examination and a new generation of biomarkers are needed for better monitoring of the disease. To assess the usefulness of ultrasound (US) scans for monitoring of structural urinary tract disease by local public health services in areas of Angola in which urogenital schistosomiasis is endemic. A cohort of 80 S. haematobium-infected patients was selected in order to compare changes in the bladder wall detected by US with those observed on CE. There was a notable correlation between the findings observed on CE and US. Patients with lesions of the bladder mucosa such as neoplasms, ulcers or granulomas detected by CE also had changes in bladder wall thickness on US. The results support increased use of portable US machines for non-invasive examination of the bladder by local general practitioners. US examination should be an integral part of the investigation of haematuria and used in all S. haematobium control programmes. General practitioners may find it useful for more accurate diagnosis of haematuria and to identify bladder wall alterations in both adults and children in schistosomiasis-endemic regions.

Local government and public dental health services: an analysis of inequality in use

The aim of this study was to identify factors associated with the use of primary and specialized public dental health services and private services. A population-based household survey was conducted in two cities of Bahia State, Brazil. Key informants provided data on socioeconomic variables and use of dental health services. Organization of the local public dental health service was ranked as worse versus better. Univariate and multivariate polytomous logistic regression was performed. Of the total of 1,290 individuals, 38.76% used private services, 33.80% used public primary care, and 17.29% used both primary care and the Center for Dental Specialties. Less use of both primary care and specialized public services was associated with lower education (OR = 1.47; 95%CI: 1.03-2.10) and worse organization of services (OR = 1.74; 95%CI: 1.22-2.48), when compared to the exclusive use of primary care. The study showed inequality in the use of dental services, even when comparing more homogeneous groups, namely users of public services.

Use of Fees to Fund Local Public Health Services in Western Massachusetts

Recent budget cuts have forced many local health departments (LHDs) to cut staff and services. Setting fees that cover the cost of service provision is one option for continuing to fund certain activities. To describe the use of fees by LHDs in Western Massachusetts and determine whether fees charged cover the cost of providing selected services. A cross-sectional descriptive analysis was used to identify the types of services for which fees are charged and the fee amounts charged. A comparative cost analysis was conducted to compare fees charged with estimated costs of service provision. Fifty-nine LHDs in Western Massachusetts. Number of towns charging fees for selected types of services; minimum, maximum, and mean fee amounts; estimated cost of service provision; number of towns experiencing a surplus or deficit for each service; and average size of deficits experienced. Enormous variation exists both in the types of services for which fees are charged and fee amounts charged. Fees set by most health departments did not cover the cost of service provision. Some fees were set as much as $600 below estimated costs. These results suggest that considerations other than costs of service provision factor into the setting of fees by LHDs in Western Massachusetts. Given their limited and often uncertain funding, LHDs could benefit from examining their fee schedules to ensure that the fee amounts charged cover the costs of providing the services. Cost estimates should include at least the health agent's wage and time spent performing inspections and completing paperwork, travel expenses, and cost of necessary materials.

Building the evidence for decision-making: the relationship between local public health capacity and community mortality.

We examined associations between local health department (LHD) spending, staffing, and services and community health outcomes in North Carolina. We analyzed LHD investments and community mortality in North Carolina from 2005 through 2010. We obtained LHD spending, staffing, and services data from the National Association of City and County Health Officials 2005 and 2008 profile surveys. Five mortality rates were constructed using Centers for Disease Control and Prevention mortality files, North Carolina vital statistics data, and census data for LHD service jurisdictions: heart disease, cancer, diabetes, pneumonia and influenza, and infant mortality. Spending, staffing, and services varied widely by location and over time in the 85 North Carolina LHDs. A 1% increase in full-time-equivalent staffing (per 1000 population) was associated with decrease of 0.01 infant deaths per 1000 live births (P < .05). Provision of women and children's services was associated with a reduction of 1 to 2 infant deaths per 1000 live births (P < .05). Our findings, in the context of other studies, provide support for investment in local public health services to improve community health.

Organization and performance of public preventive health services in Italy: a national web based survey, 2012-2013

Background In Italy since 2001, the progressive devolution of healthcare policy making and responsibilities to the Regions has produced an heterogeneous picture of the regional governance. We report the results of a national survey aimed to describe organization and performances of regional and local public health services in charge of preventive health (SPH) for the years 2010-2012. Methods Main stakeholders (the Ministry of Health, the National Institute for Health, the National Agency for …

A cross sectional survey on the prevalence of active pulmonary tuberculosis in three ‘key’ elderly population

To conduct a survey on the prevalence of active pulmonary tuberculosis among 65 year olds or above. Study subjects would include those with characteristics of TB suspicious symptoms, diabetes and close contacts. Purpose-sampling method was applied to choose 3 counties in Shandong province as the study sites, relying on the local basic public health service, for those elderly under 65 years old or above. The study team would introduce the process and contents of this study to the subjects followed by chest X-ray and sputum smears on those registered tuberculosis suspects, patients with diabetes, TB close contacts in the past 2 years, from January to September, 2013. 82 active pulmonary TB cases were identified among 9 041 cases who received the examination, with a crude prevalence rate as 9.1‰. From patients having both suspicious TB and diabetic symptoms, patients with diabetes or having suspicious symptoms of TB, the prevalence rates of active TB were 115‰, 3.4‰, 0.9‰ respectively. No active pulmonary TB case was found in the TB close contacts, patients with diabetes, or those people with suspicious TB symptoms. TB prevalence rates among all the above mentioned groups were significantly different (χ(2) = 697.478, P = 0.000). Prevalence rate of active pulmonary TB with diabetes was 18 times (RR = 17.951) higher than those non-diabetic patients, and 2 times higher than those with suspicious symptoms (RR = 3.860). Results from single factor analysis showed that diabetes were closely related to the prevalence of pulmonary tuberculosis(χ(2) = 46.637, P = 0.000), the longer duration of diabetes and the higher risk of tuberculosis(RR > 1). Our data showed that active pulmonary TB prevalence was high in elderly diabetes patients which suggesting that 'Key crowd screening program' should be introduced into case-finding strategy on TB, with special focus on TB patients with diabetes or those people having suspicious symptoms of TB.

Tax Levy Financing for Local Public Health

Local health departments (LHDs) rely on a wide variety of funding sources, and the level of financing is associated with both LHD performance in essential public health services and population health outcomes. Although it has been shown that funding sources vary across LHDs, there is no evidence regarding the relationship between fiscal allocation (local tax levy); fiscal effort (tax capacity); and fiscal capacity (community wealth). The purpose of this study is to analyze local tax levy support for LHD funding. Three research questions are addressed: (1) What are tax levy trends in LHD fiscal allocation? (2) What is the role of tax levy in overall LHD financing? and (3) How do local community fiscal capacity and fiscal effort relate to LHD tax levy fiscal allocation? This study focuses on 74 LHDs eligible for local tax levy funding in Minnesota. Funding and expenditure data for 5 years (2006 to 2010) were compiled from four governmental databases, including the Minnesota Department of Health, the State Auditor, the State Demographer, and the Metropolitan Council. Trends in various funding sources and expenditures are described for the time frame of interest. Data were analyzed in 2012. During the 2006-2010 time period, total average LHD per capita expenditures increased 13%, from $50.98 to $57.63. Although the overall tax levy increase in Minnesota was 25%, the local tax levy for public health increased 5.6% during the same period. There is a direct relationship between fiscal effort and LHD expenditures. Local funding reflects LHD community priorities and the relative importance in comparison to funding other local programs with tax dollars. In Minnesota, local tax levy support for local public health services is not keeping pace with local tax support for other local government services. These results raise important questions about the relationship between tax levy resource effort, resource allocation, and fiscal capacity as they relate to public health spending in local communities.

Morphologic abnormalities in 2-year-old children born after in vitro fertilization/intracytoplasmic sperm injection with preimplantation genetic screening: follow-up of a randomized controlled trial

To evaluate the effect of preimplantation genetic screening (PGS) on morphologic outcome in children. Follow-up of a randomized controlled trial (RCT). University hospital. Two-year-old children born to mothers who participated in an RCT on the efficacy of PGS: 50 children born after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) with PGS (intervention group; PGS+) and 72 children born after IVF/ICSI only (control group; PGS-). Sixty-six age-matched children conceived without any form of assisted reproduction were recruited separately in a local public health service center (reference group). PGS. Body surface examination and anthropometry. The evaluation of morphologic abnormalities allowed assessment of children's phenotype in detail. Morphologic abnormalities were classified as major abnormalities (abnormal development in organogenesis, deformations, disruptions, or dysplasia) and minor anomalies (deviations in phenogenesis). The percentage of children with ≥ 1 major abnormality was 28% in the PGS+ and 35% in the PGS- group [difference -7%, 95% CI -23% to 10%]. The percentage of children with ≥ 1 minor anomaly was 64% in the PGS+ and 67% in the PGS- group [difference -3%, 95% CI -15% to 20%]. In the reference group 30% of the children had ≥ 1 major abnormality [95% CI 20% to 43%] and 74% had ≥ 1 minor anomaly [95% CI 62% to 84%]. No statistically significant differences were found in minor anomalies between children conceived after IVF/ICSI with or without PGS. There is < 2.5% chance of ≥ 10% more major abnormalities in children born after PGS.

Does regionalization of local public health services influence public spending levels and allocative efficiency?

This paper uses a panel data set of Connecticut communities to offer several empirical insights into the economics of local public health services. First, the demand characteristics associated with local public health services are explored. Tax-share, income, and aid elasticities of local public health demand and the congestability of local public health services are estimated and compared to similar estimates for local public education and municipal services. Second, local and regional demands for public health services are compared with respect to their underlying characteristics and spending levels. Third, Brueckner's test is conducted to determine if resources are efficiently allocated to local public health services in communities with an independent health department and those participating in a regional health district. Empirical evidence reveals that the demand for local public health services is inelastic with respect to tax share, unrelated to income, and relatively sensitive to intergovernmental aid. Moreover, regionalization appears to increase spending on public health services especially relative to both municipal and local education services. Finally, regional health departments serving large populations appear to overspend on local public health services.

Public Health Spending in 2008

In recent years, state and local public health department budgets have been cut, sometimes drastically. However, there is no systematic tracking of governmental public health spending that would allow researchers to assess these cuts in comparison with governmental public health spending as a whole. Furthermore, attempts to quantify the impact of public health spending are limited by the lack of good data on public health spending on state and local public health services combined. The objective of this article is to integrate self-reported state and local health department (LHD) survey data from 2 major national organizations to create state-level estimates of governmental public health spending. To create integrated estimates, we selected 1388 LHDs and 46 states that had reported requisite financial information. To account for the nonrespondent LHDs, estimates of the spending were developed by using appropriate statistical weights. Finally, funds from federal pass-through and state sources were estimated for LHDs and subtracted from the total spending by the state health agency to avoid counting these dollars in both state and local figures. On average, states spend $106 per capita on traditional public health at the state and local level, with an average of 42% of spending occurring at the local level. Considerable variation exists in state and local public health funding. The results of this analysis show a relatively low level of public health funding compared with state Medicaid spending and health care more broadly.

Determining mental health research priorities in a Queensland region: An inclusive and iterative approach with mental health service clinicians, consumers and carers

Australia has national and state mental health plans that guide service development and promote quality in its public mental health system. Interestingly though, Australia still lacks a well-managed, priority-driven program of research in the mental health sector. This lack is perhaps indicative of the historical relative lack of funding for mental health research compared with other areas of health, at a national level. As a result, approaches to research tend to be ad hoc and reactive to emergent problems. In 2009–2010, a participatory action research study using elements of the consensus oriented Delphi method was implemented in a Queensland regional public mental health service. The aims of the study were to identify and prioritise research questions of importance to the local public mental health service and its members, to compare local priorities with national and state research agendas, and to identify needs relating to research capacity. Data were collected using a modified Delphi technique, three rounds of surveys, field notes and research team reflection.The study reached consensus, with all three cohorts of participants agreed that emotional well-being was the most important research area. The second most important research area was service quality and accountability. The equal third most important research areas were family involvement in the care of their relative and personal (that is, consumer) involvement in their own care.

PIH46 The State of the Drug Provision System of Kazakhstani Population within the Scope of the Extent of the Free Guaranteed Medical Assistance

To determine the level of availability and transparency of the drug provision system of Kazakhstani populationat the expense of the governmental budget and to detect the level of their satisfaction. A total of 1236 patients filled the random anonymous questionnaire in polyclinics and hospitals in Almaty, East-Kazakhstani, Kzyl-Orda and Karaganda regions. The questionnaire consisted of 38 questions. A total of 51.6 % of the patients were provided with drugs by the reduced price with the substitution coefficient of 0,5. Almost 47% of the patients were refused to be provided with medical assistance and drugs within the scope of the extent of the free guaranteed medical assistance; furthermore, 80,3% of the asked had to use additional amount of their own money during not only at the ambulatory but also at the hospital level. At the same time, it was unaffordable for 63,8% of the asked to buy drugs. A total of 57,9% of the patients defined the drug availability provided within the scope of the guaranteed free medical assistance as poor and unsatisfactory. Moreover, 76,8 % claimed that several medicines were absent in the current and last year lists. In order to protect their rights, the patients applied to medical organizations (27,9 %), to local public health services (21,9 %), to social patients protecting services (11,1 %), to courts (4,3 %) and others (17,1 %). In 43,7% of cases doctors either had not explained their prescription or rarely -17,3 %. 42 % were dissatisfied with their doctors; moreover, 71,5 % of the patients suggested that educational brochures containing information on the disease, side effects of the prescribed medicines, etc. should be provided. Therefore, there are problems with the drug provision within the scope of the guaranteed medical assistance which mainly concern with poor availability of medicines and low compliance.

'McDonalds and KFC, it's never going to happen': the challenges of working with food outlets to tackle the obesogenic environment

Food outlets may make an important contribution to an obesogenic environment. This study investigated barriers and facilitators to public health work with food outlets in disadvantaged areas. In-depth qualitative interviews with 36 directors, managers and public health service delivery staff in a coterminous primary care trust and local authority in northwest England. Data were analysed using the constant comparative method. Three interventions were available to engage with businesses; awards for premises that welcomed breastfeeding mothers or offered healthy menu options and local authority planning powers. Sensitivity to the potential conflict between activities that generate profit and those that promote health, led to compromises, such as awards for cafés that offer only one healthy option on an otherwise unhealthy menu. An absence of existing relationships with businesses and limited time were powerful disincentives to action, leading to greater engagement with public rather than private sector organizations. Hiring staff with commercial experience and incentives for businesses were identified as useful strategies, but seldom used. Encouraging food outlets to contribute to tackling the obesogenic environment is a major challenge for local public health teams that requires supportive national policies. Commitment to engage with the local public health service should be part of any national voluntary agreements with industry.

Determining mental health research priorities in a Queensland region: An inclusive and iterative approach with mental health service clinicians, consumers and carers

Australia has national and state mental health plans that guide service development and promote quality in its public mental health system. Interestingly though, Australia still lacks a well-managed, priority-driven program of research in the mental health sector. This lack is perhaps indicative of the historical relative lack of funding for mental health research compared with other areas of health, at a national level. As a result, approaches to research tend to be ad hoc and reactive to emergent problems. In 2009–2010, a participatory action research study using elements of the consensus oriented Delphi method was implemented in a Queensland regional public mental health service. The aims of the study were to identify and prioritise research questions of importance to the local public mental health service and its members, to compare local priorities with national and state research agendas, and to identify needs relating to research capacity. Data were collected using a modified Delphi technique, three rounds of surveys, field notes and research team reflection.The study reached consensus, with all three cohorts of participants agreed that emotional well-being was the most important research area. The second most important research area was service quality and accountability. The equal third most important research areas were family involvement in the care of their relative and personal (that is, consumer) involvement in their own care.

Petroleum Scarcity and Public Health: Considerations for Local Health Departments

Recognition of petroleum as a finite global resource has spurred increasing interest in the intersection between petroleum scarcity and public health. Local health departments represent a critical yet highly vulnerable component of the public health infrastructure. These frontline agencies currently face daunting resource constraints and rely heavily on petroleum for vital population-based health services. Against this backdrop, petroleum scarcity may necessitate reconfiguring local public health service approaches. We describe the anticipated impacts of petroleum scarcity on local health departments, recommend the use of the 10 Essential Public Health Services as a framework for examining attendant operational challenges and potential responses to them, and describe approaches that local health departments and their stakeholders could consider as part of timely planning efforts.

Petroleum Scarcity and Public Health: Considerations for Local Health Departments

Recognition of petroleum as a finite global resource has spurred increasing interest in the intersection between petroleum scarcity and public health. Local health departments represent a critical yet highly vulnerable component of the public health infrastructure. These frontline agencies currently face daunting resource constraints and rely heavily on petroleum for vital population-based health services. Against this backdrop, petroleum scarcity may necessitate reconfiguring local public health service approaches. We describe the anticipated impacts of petroleum scarcity on local health departments, recommend the use of the 10 Essential Public Health Services as a framework for examining attendant operational challenges and potential responses to them, and describe approaches that local health departments and their stakeholders could consider as part of timely planning efforts.

Changes in public health awareness of traditional Chinese medicine in Shanghai in the late Qing Dynasty

Public health awareness existed in the practice of traditional Chinese medicine (TCM) long ago. In the process of Shanghai's modernization and in competition with Western medicine, TCM in Shanghai has gradually accepted the modern public health awareness, fostering its strengths, circumventing its weaknesses and playing an important role in the local public health service. To study the vicissitude of TCM public health awareness at this time will be helpful to further understand the modern history of TCM and also provide useful reference for further participation of TCM in modern public health enterprise. In this paper, the authors used literature analysis and historical research to analyze the medical practice and writings of representative TCM practitioners, medical groups and journals. The results showed that the public health awareness of TCM in Shanghai has evolved from its traditional pattern to the modern pattern seen today; the traditional pattern was characterized by individual health care and some degree of medical collaboration, whereas the modern pattern is characterized by public health education. This process was propelled forward throughout by intense national spirit. TCM has made significant contributions to the local public health service in Shanghai in the late Qing Dynasty, which promoted the modernization of public health awareness of TCM in the People's Republic of China. The authors also found that one of the ways of modernizing TCM is to diversify the ways of publicizing TCM and make it easily understood, which can shed a new light on promoting the development of TCM.