National Public Health Programs Research Articles

Preventing and Controlling Emerging and Reemerging Transmissible Diseases in the Homeless

Homelessness is an increasing public health problem. Because of poor living conditions and limited access to healthcare systems, homeless persons are exposed to many communicable infections. We summarize the intervention measures reported to be efficient for the control and the prevention of common transmissible infections among homeless populations. Evidence suggests that appropriate street- or shelter-based interventions for targeted populations are the most efficient methods. Depending on the populations targeted, these interventions may include education, free condom distribution, syringe and needle prescription programs, chest radiography screening for tuberculosis, directly observed therapy for tuberculosis treatment, improvement of personal clothing and bedding hygiene, and widespread use of ivermectin for scabies and body louse infestation. Systematic vaccination against hepatitis B virus, hepatitis A virus, influenza, Streptococcus pneumoniae, and diphtheria is strongly recommended. National public health programs specific to homeless populations are required.

The state of the colorectal screening in Hungary: lessons of the pilot programs

In Hungary, colorectal cancer is the second most common malignant disease. Due to its natural history, colorectal cancer is particularly suitable for screening. At present, epidemiological evidences of the effectiveness of detection of the symptomless colorectal cancer and its precursors are only available for the demonstration of fecal occult blood, endoscopic methods are also in use. For mass screening, fecal occult blood tests are recommended. Guaiac-type chemical methods are widely criticized because of the lack of specificity. Out of the emerging technologies, immunochemical methods based on the antigenicity of blood proteins (hemoglobin) seem to be the most suitable. In the model programmes organized in the frame of the National Public Health Programme, an immunochemical method using two blood proteins (hemoglobin and albumin) have been used. The compliance was not more than 30-45%. About one-third of those with positive blood test refused colonoscopy. The programmes revealed a great number of adenomatous polyps and early cancers, and in the way, the effectiveness of the method has been proved. The model programmes are still continued. Before the continuous and gradual extension of colorectal screening, the validity of the specific method needs to be tested and proved in order to be recognized as a routine procedure for screening. There is a need to test the feasibility of total colonoscopy, however, to this effect the colonoscopic capacity in the country has to be further developed.

Social inequality in health: Dichotomy or gradient?: A comparative study of problematizations in national public health programmes

Recent public health programmes from four countries: Denmark, England, Norway, and Sweden, are studied to analyse how social inequality in health is described, explained and suggested to be tackled, i.e., the problematization or the discursive process whereby the issue is framed and made accessible to political action. Social inequality in health is defined in these programmes both as a disadvantaged minority with major health problems, in contrast to the rest of the population, i.e., as a dichotomy; and as a gradient in which health problems are seen as increasing with lower social class or educational level. The causes of health inequality are identified as behaviour, social relations and underlying social structures. Policies aimed at reducing health inequality can be characterized as either in accordance with a residual welfare state model, targeting the disadvantaged, or a universal model, addressing the whole population. All countries have policies that are mixtures of these problematizations, but with some systematic differences between the countries. In this field England resembles the Scandinavian countries, as much as they resemble each other dispelling the idea of a Nordic or Scandinavian welfare state model.

Newborn screening: A national public health programme in Brazil

The newborn screening programme started in Brazil (1976) through isolated initiatives, without governmental directions and/or policies. According to Health Ministry (2000) data the coverage was 55% and unevenly distributed. Only 17 out of 27 Brazilian states had more than 30% coverage. Public budgets covered only diagnostic examinations. There were no official data about assistance, patient follow-up or detected disorders. The creation of the National Programme (2001) has provided new perspective for newborn screening (NBS) in the public health system. It has provided important official data and established management and care units for each state: Reference Services in Newborn Screening. The programme screened about 13 million newborns from October 2001 to December 2005. The coverage increased to 80.2% (2005) and 74% of the states presented coverage of over 70%. Within 34 accredited Reference Services in 27 Brazilian states, all provide screening for PKU and CH. Ten of them provide screening for haemoglobinopathies as well, and three of them provide also for CF. The Reference Services altogether count on at least 170 health professionals, such as paediatricians, endocrinologists, nutritionists, psychologists and social workers. They are qualified to assist positive cases, within the policies established by the National Programme. There has been significant increase in NBS coverage and follow-up assuredness, including detected cases before the National Programme (10,935 positive cases) mostly in those regions where the programme did not exist. There has been significant evolution in the Newborn Screening as a Public Health Program in Brazil due to the government's commitment (federal and each component state).

Oral cancer screening: how to develop a country-wide opportunistic system in Hungary

In Hungary, oral cancer represents a very heavy public health problem. Even epidemiological evidence in support of the effectiveness of organized screening for early detection does not exist, the efforts to detect the precancerous lesions and early cancers of oral cavity must be continued. The mass screening component of the National Public Health program provides a good opportunity for that. Following the Government decision, a multidisciplinary Working Group has been brought together, and a proposal made to develop a country-wide opportunistic system to regularly examine those at high risk for oral cancer. In addition to dentists, primary care personnel as well as the occupational health service have a lot to offer to the desired effect: reduction of mortality from oral cancer.

Providing Patient Care in Community Pharmacies: Practice and Research in Finland

To describe the provision of patient care in community pharmacies in Finland. The network of 799 community pharmacies across Finland dispensed 42.1 million prescriptions in 2005. Medication counseling has been mandated by law since 1983 and only pharmacists are permitted to provide therapeutic advice in pharmacies. Measurable improvements in the rates of pharmacists' medication counseling have been observed since 2000. Long-term national pharmacy practice initiatives commenced with the World Health Organization EuroPharm Forum's Questions to Ask About Your Medicines campaign from 1993 to 1996. This was followed by the larger Customized Information for the Benefit of Community Pharmacy Patients project. Since the late 1990s, Finnish pharmacies have actively participated in ongoing national public health programs, initially in the areas of asthma and diabetes, and more recently in the treatment and prevention of heart disease. Automated dose dispensing and electronic prescribing are in the process of wider uptake and implementation. A nationwide multidisciplinary project to improve the use of drugs in older people has recently been announced and research in this area is underway. Research has focused on improving the quality of patient care as a strategic priority in community pharmacies. The development of community pharmacy services in Finland has been characterized by strong collaboration among the professional associations, university departments of social pharmacy, continuing education centers, and practicing pharmacists. Implementation of new patient care services has required long-term, systematic, and well coordinated actions at the local and national levels. Future services will seek to promote the quality use of medications and to ensure that rising costs do not limit uniform access to drugs by all Finnish residents.

The state of the organised mammography screening in Hungary in 2006

Breast cancer represents a serious public health concern in Hungary. The most promising way of mortality reduction is organised screening which applies personal invitation, recall and follow-up. Screening women between 50-65 years of age by mammography combined with clinical breast examination is a method of proved effectiveness. The effectiveness has not yet been proved in premenopausal women, however, as a result of the public and professional pressure on decision-makers, perimenopausal women (above 45 years of age) are not excluded. In Hungary, the National Public Health Programme has established the managerial, administrative, legal and financial frame for an organised screening, therefore, since 2002, the programme has been in operation. Screening is provided in every other year. In the first two screening cycles, approximately 40% of invitees attended the screening test. According to the National Health Insurance Fund (OEP), under the influence of personal call-and-recall programme, the annual numbers of diagnostic mammography examinations have substantially increased, indicating that many invited women are looking for screening facility outside the programme. The detection rate and the small cancer detection rate are in line with the international standard values. To establish the number of "interval cancers", establishment of a pathological database ("patho-bank") is in progress, in close cooperation with the screening registry. According to the health economical analysis, the organised breast screening program is "affordable" for the financing agency.

Why invest in a national public health program for stroke?: An example using Australian data to estimate the potential benefits and cost implications

Objectives Stroke is the world's second leading cause of death in people aged over 60 years. Approximately 50,000 strokes occur annually in Australia with numbers predicted to increase by about one third over 10-years. Our objectives were to assess the economic implications of a public health program for stroke by: (1) predicting what potential health-gains and cost-offsets could be achieved; and (2) determining the net level of annual investment that would offer value-for-money. Methods Lifetime costs and outcomes were calculated for additional cases that would benefit if ‘current practice’ was feasibly improved, estimated for one indicative year using: (i) local epidemiological data, coverage rates and costs; and (ii) pooled effect sizes from systematic reviews. Interventions: blood pressure lowering; warfarin for atrial fibrillation; increased access to stroke units; intravenous thrombolysis and aspirin for ischemic events; and carotid endarterectomy. Value-for-money threshold: AUD$30,000/DALY recovered. Results Improved, prevention and management could prevent about 27,000 (38%) strokes in 2015. In present terms (2004), about 85,000 DALYs and AUD$1.06 billion in lifetime cost-offsets could be recovered. The net level of annual warranted investment was AUD$3.63 billion. Conclusions Primary prevention, in particular blood pressure lowering, was most effective. A public health program for stroke is warranted.

The state of the organized screening in Hungary in 2006

Hungary carries a heavy burden of cancer. At present, the organized screening of symptomless people seems to be the most promising strategy. According to the state-of-the art, those are the mammography-based breast screening, the cytology screening of cervix uteri, and the colorectal screening using immunochemical detection of the fecal occult blood satisfy the criteria of organized screening. The screening for cancers of the oral cavity, and the methods suitable for early detection of prostate cancer are not based on epidemiological evidence, therefore can only be applied opportunistically, as part of the medical practice. For the time belong, there are no suitable methods for detection of early lung cancer. The organized screening which applies personal call-and-recall has been incorporated in the National Public Health Programme. The concepts underlying the organized screening are fully in accordance with the recommendations by the European Union. The Chief Medical Officers' Office (OTH) is being charged with the organization, coordination and evaluation of organized screening programmes for the above screening modalities. In the past few years, an appropriate system for administration and information (including a country-wide screening registry) has been established, in addition to a regional coordination system based on the institutes of National Public Health and Medical Officers' Service (ANTSZ) and a nation-wide network of mammography and cytological laboratories, capable of meeting the requirements. This publication is to summarize the problems yet to be solved and the results expected from the organized screening programmes.

Prioritising violence prevention in national public health programmes: Experiences from Jamaica

No Abstract. African Safety Promotion: A Journal of Injury and Violence Prevention Vol. 4 (2) 2006: 137-145

TRIPS and the international public health controversies: issues and challenges

The aim of this article is to contribute to an evaluation of the meaning and practical effects of the Trade-Related Intellectual Property Rights (TRIPS) agreement on public health issues. Section 2 presents the situation that prevailed for intellectual property (IP) protection in the pharmaceutical industry before the signing of the TRIPS, in both developed countries and developing countries (DCs). Section 3 is devoted to a presentation of the key changes that have taken place at the legal level with the signing of the TRIPS, providing an opportunity to highlight the way in which TRIPS has disrupted the existing situation by generating a series of serious tensions, notably in the relations between North and South countries. Section 4 is devoted to the new challenges posed by the post-2005 scenario, 2005 being the end of the transition period granted DCs to comply with the TRIPS requirements. Section 5, focusing on the Brazilian anti-AIDS program, tries to illustrate how the post-2005 scene has narrowed the margins for efficient action against the AIDS pandemics and put the Brazilian national public health program under strain.

Zsuzsanna Jakab—Director of the European Centre for Disease Prevention and Control

Zsuzsanna Jakab was the former Secretary of State in Hungary's Ministry of Health. As the most senior civil servant at the ministry she was responsible for overseeing Hungary's implementation of European Union (EU) policies and laws in her area, administering the spending of EU financial assistance, and managing Hungary's national public-health programme. She worked as a Director in the WHO Regional Office for Europe (WHO Euro) for 11 years before being invited to join the Ministry of Health by the Hungarian government in 2002.

A report on the current status of European research on the use of human papillomavirus testing for primary cervical cancer screening

Cervical cancer remains a significant public health concern, both at a global and a European level. A number of new technologies such as diagnostic tests for human papillomavirus (HPV) have a potential to assist with the reduction of this disease. However, both the efficacy and the cost-effectiveness of these new technologies must be established in properly designed trials before they can be implemented within national public health programs. Our study reviews the randomized controlled trials that are currently being conducted in Europe to establish the performance of HPV testing as a primary cervical cancer screening test.

Prise en charge du VIH en Afrique

Africa is the continent hardest hit by the HIV pandemic with, according to the WHO for 2004, more than 25 million people infected. Although the mortality and socioeconomic consequences of HIV infection have been visible and predictable, only since 2000 has the catastrophic situation in Africa and other developing areas mobilized international political and medical attention, in view of the impressive results from antiretroviral treatments where they are accessible. The intolerable lack of access to medical care and effective treatments has engendered a fusion of energy and will - political and scientific, local and international - to make HIV treatment available in Africa. Access to treatment must be accompanied by creation of national public health programs and establishment of infrastructures and trained teams. Necessary steps including anticipation and prevention of pitfalls in the large-scale use of antiretrovirals, long-term planning, organization of supplies and distribution, ensuring the permanence of financial support, and making appropriate strategic choices. These steps are required to guarantee the future and to prevent an epidemic rebound due to drug-resistant HIV strains. The conditions of international economic and medical aid have been clarified and are now better adapted to real needs. Nonetheless large disparities still exist according to country and region. The initial results of cohorts of treated patients show results similar to those in the industrialized countries and provide encouragement about the future. Results in countries such as Uganda and Senegal show that local political involvement is primordial for long-term success. Access to antiretroviral drugs is an urgent and essential marker of comprehensive management, but the conditions of their use must be taken into account in assessing future projects if we want to change the course of HIV in Africa.

Improving the oral health of older people: the approach of the WHO Global Oral Health Programme.

The proportion of older people continues to grow worldwide, especially in developing countries. Non-communicable diseases are fast becoming the leading causes of disability and mortality, and in coming decades health and social policy-makers will face tremendous challenges posed by the rapidly changing burden of chronic diseases in old age. Chronic disease and most oral diseases share common risk factors. Globally, poor oral health amongst older people has been particularly evident in high levels of tooth loss, dental caries experience, and the prevalence rates of periodontal disease, xerostomia and oral precancer/cancer. The negative impact of poor oral conditions on the quality of life of older adults is an important public health issue, which must be addressed by policy-makers. The means for strengthening oral health programme implementation are available; the major challenge is therefore to translate knowledge into action programmes for the oral health of older people. The World Health Organization recommends that countries adopt certain strategies for improving the oral health of the elderly. National health authorities should develop policies and measurable goals and targets for oral health. National public health programmes should incorporate oral health promotion and disease prevention based on the common risk factors approach. Control of oral disease and illness in older adults should be strengthened through organization of affordable oral health services, which meet their needs. The needs for care are highest among disadvantaged, vulnerable groups in both developed and developing countries. In developing countries the challenges to provision of primary oral health care are particularly high because of a shortage of dental manpower. In developed countries reorientation of oral health services towards prevention should consider oral care needs of older people. Education and continuous training must ensure that oral health care providers have skills in and a profound understanding of the biomedical and psychosocial aspects of care for older people. Research for better oral health should not just focus on the biomedical and clinical aspects of oral health care; public health research needs to be strengthened particularly in developing countries. Operational research and efforts to translate science into practice are to be encouraged. WHO supports national capacity building in the oral health of older people through intercountry and interregional exchange of experiences.

The Complexities of Multi-level Governance in Public Health

This article reviews some of the challenges to developing national public health programs, focussing on the distribution of constitutional authority for public health and governance challenges that arise from this. Constitutional authority for public health resides primarily with the provinces. The federal government has obtained the authority to legislate in this area primarily through its power over criminal law. Challenges facing the establishment of national public health programs include the ambiguity over constitutional responsibility, challenges in managing externalities and spillovers, and issues related to funding and data ownership. Policy-making is also complicated by the importance of municipal and supranational governments in public health. National programs need to be structured in a way that balances the advantages of regional approaches to public health challenges with the benefits of a coordinated central response. To do so, policy-makers need to address unique challenges to public health governance.

Public health in Quebec at the dawn of the 21st century

This paper summarises the status of public health in Quebec at the dawn of the 21st century. After introducing the current definition, the author lays out five basic functions of public health in Quebec: knowledge and surveillance of populations health and wellbeing, health protection; prevention of disease, trauma and social problems that influence health; health and wellbeing promotion; and service organization and evaluation. The organization of public health services is then described at the local level (CLSC), regional level (Public health units) and national level (Ministry, Public health directorate and National Institute of Public Health). Finally, the trends and priorities elaborated over the last ten years, as well as the National Public Health Program to be implemented over the next ten years are described.

Public health nurses in Quebec: an essential contribution that remains to be known

Public health nurses in Quebec are essential although little is known about their role. Generally trained at the undergraduate level, with additional qualifications in community health, they essentially work in CLSCs in maternal and child health programs, youth clinics or occupational health. In regional public health departments, they also work in the field of infectious disease prevention or other programs. Like their colleagues, they are confronted to the profession's challenges, the most notable being current and future shortage of nurses. However, they can now count on a new. As nurses further develop their practice and orient it even more towards primary prevention and health promotion, they will significantly contribute to the National Public Health Program and to the improvement of population health and wellbeing.

An international collaboration that connects academic researches and health program practices

This paper summarized several research results, which were conducted under collaboration with organizations in Mongolia and Japan, and how these findings were applied to strengthen the national health program on elimination of iodine deficiency disorders (IDD) in Mongolia, from 1996 to 2003. Implemented researches were in four categories: (1) assessment and monitoring of nation's IDD status, (2) salt intake estimation with the aim of determining appropriate iodine content in salt, and (3) effectiveness of iodized salt on normalizing goiter. Those research findings regarding IDD status and program were utilized for strengthening the program. It must be pointed out that collaboration among academic and governmental organizations is a prospective activity to contribute to improve community health. To the national public health program, academic researches can provide scientific evidences to its programming process from the viewpoints of clinical, social, economic, and people's perceptional aspects. Meanwhile, practical activities in fields always also bring the inspiration of new assumptions to researchers.

Ensuring quality preventive care: the Texas Department of Health's Put Prevention into Practice initiative.

In the current public health arena, assurance of quality clinical preventive services to all populations will be possible only if collaborations are nurtured between public health and the private sector health care delivery systems. This article explores key preventive health programs that serve as the historical context for the evolution of the Texas Department of Health-Put Prevention Into Practice (TDH-PPIP) initiative, outlines documented barriers to implementation of preventive services in primary care, and reviews national public health programs launched to reduce these barriers. Lastly, a discussion regarding the joint responsibilities of the public health and the private sector professionals in assuring quality preventive services to all populations is initiated. Collaborative efforts, such as the TDH-PPIP, initiative improve the availability and quality of clinical preventive services and, thus, result in significant advances in the public health goal of ensuring conditions in which people can be healthy.