Public Health Service System Research Articles

Health technology assessment of the diagnosis of colorectal cancer in a public health service system

Health technology assessment of the diagnosis of colorectal cancer in a public health service system

New duties of the medical child health surveillance teams: the "Hamburg Concept"

In Hamburg the physical 'entrance to school examination' performed by doctors/paediatricians of the public health service system (KJGD) was rescinded in 1997. A new school law (HmbSG) is now regulating school health services as well as the developmental psychological tests and examinations of handicapped schoolchildren and thus also the field of activity of the child health surveillance teams. In 1999 a fundamental agreement was achieved according to which school health services will be part of a health promotion programme for school age children and adolescents. During the realization of the new tasks established social pediatric and population - based strategies of public health services were abandoned. The organizational, conceptional, and professional ideas are clearly divergent between the different professional groups at the moment. The KJGD needs to develop its skills as service-seller and is challenged to establish itself as an individual service for each school location. The necessary change of roles requises active support. Advanced training and development of organisation(al structures) are imperative.

Criminal behavior and emotional disorder: comparing youth served by the mental health and juvenile justice systems.

This study explored whether youth involved in joint service systems differed from single-agency users in terms of types of crimes committed and clinical functioning. Data from 4,924 youth involved in one county's public mental health and juvenile justice service systems were examined. Twenty percent of those youth receiving mental health services had recent arrest records, and 30% of youth arrested received mental health services. Of all youth arrested in the county, mental health service users had more arrests than non-mental health service users. A subsample of 94 mental health service users with arrests was matched on demographics with 94 mental health service users without arrests. Youth with arrests had a higher frequency of conduct disorder, higher Child Behavior Checklist Externalizing and Total Problem Scale scores, and more functional impairment on the Child and Adolescent Functional Assessment Scale as compared to youth without arrests. Implications for behavioral health service delivery were discussed.

Noncontact Er:YAG Laser Ablation: Clinical Evaluation

The aim of this study is to evaluate the quality of laser ablation in comparison with the classical drilling preparation. For the experiment, the Er:YAG laser drilling machine was used. The system had a laser head, water cooler, and power supply with automatic control. Spot size of 300-350 microns was used for the preparation. Repetition rate of 1-4 Hz, and pulse energies of 100-400 mJ with water spray were chosen. Cavity shape in comparison with classical drill, time of preparation, and influence of cavity shape on filling materials retention in accordance with the U.S. Public Health Service System were used. The evaluation criteria for noncontact Er:YAG ablation were done. The cavity shape is irregular, but spot surface has larger area and microretentive appearance. Caries of enamel and dentin were treated with a noncontact preparation. It was possible to remove the old insufficient fillings, except for amalgam or metal alloys. The average number of pulses was 111.22 (SE 67.57). Vibrations of microexplosions during preparation were felt by patients on 14 cavities; however, nobody felt unpleasant pain. The qualities of filling materials in laser cavities were very stable; however, cavo surface margin discoloration of 82-86% of Alfa rating could be a problem. Changes of the color and anatomic form of the tooth were observed in 4-8%. In comparison with the classical treatment, it could be said that the retention and quality of filling materials is the same or very similar.

The Rehabilitation-Recovery Paradigm: A Statement of Philosophy for a Public Mental Health System

Abstract The purpose of this statement is to provide an overview of the rehabilitative-recovery philosophy of mental health services. It is an extension of an earlier document that the author was asked to prepare for discussion within the Illinois Office of Mental Health. The use of a recovery philosophy as a general guide for service planning and delivery necessitates a process of interpreting its meaning and exploring its concrete implications for a particular system of services, a process for which this article is only the first step. It is intended to address some common questions regarding (a) the meaning of recovery, (b) the premises for adopting such a philosophy, (c) this philosophy's relationship to various service models, and (d) its implications for policy and program development with examples drawn from the Illinois public mental health services system.

The Transformation of Teacher Education and Special Education

As public schools implement the national reform agenda and as educational philosophy and practice reflect the changes in culture and science, teacher educators are finding themselves needing to make more extensive changes in their programs and in themselves. what follows is a discussion of the changes in one department of special education that restructured all aspects of its program in order to respond to educational reforms in institutions of higher education and to the reforms relative to services integration. addressing the broad reform agendas that cut across and integrate fields of education, social welfare, public health, and other service systems has resulted in changes both within the university of south florida and between the university and the community. a major focus of this article is on our attempt to address the changing needs of teachers and schools. a discussion of the national and local contexts of our work, and the philosophy guiding our research and program development, is followed by a description of specific changes in our approach to teacher education and our work in the community.

Why Do States Privatize Mental Health Services? Six State Experiences

State governments fund more than one-half of public mental health service system costs through mental health departments, other state agencies, and the Medicaid program. They use some of these resources to finance community-based mental health services through purchase-of-service contracts. I explored the reasons why states privatize mental health services and focused on political, economic, and organizational theories as possible frameworks for contracting. I gathered data during site visits to Massachusetts, Michigan, New York, Oregon, Tennessee, and Texas, where I interviewed more than one hundred individual stakeholders about mental health purchase-of-service contracting. I also examined relevant documents about contracting practices for mental health services in each state. My results suggest that state policy makers can use mental health contracting to effect multiple goals. Contracting helps states achieve political, economic, and organizational objectives, such as avoiding the influence of interest groups and leveraging state resources, while avoiding conflict. With contracting, state policy makers can also continue the ongoing mental health policy paradigm shift begun during deinstitutionalization, in which persons with serious and persistent mental illnesses receive services from community-based providers rather than in state hospitals. Finally, my results suggest that contracting will continue to be an important state policy tool in further development of state-supported mental health systems.

Integrating psychology and public health: Challenges and opportunities.

Psychology has made significant strides in developing applications relevant to public health. However, improvements are still needed to integrate psychology into the public health infrastructure. The challenge .(or public health is to recognize psychology's special contributions to poli~T and practice, especially to prevention of disease and injuo'. The challenge.for psychology is to assure coherent integration of relevant theories, knowledge bases, and public health practice. Recommendations to address these challenges include (a) demonstrating how psychology incrementally improves public health service systems; (b) developing middle range and small theories of public health problems and practice (Lipsey, 1993, Merton, 1968); (c) developing intervention models in partnership with nonpsychologists so that the effects can become widespread, and (d) ongoing scrutiny of the intervention models to assure that theory has been operationalized well. Psychology's unique role in public health is to act as the steward of a correct application of behavioral knowledge and theory.

The Integration of Public Health and Medicine

President Clinton's American Health Security Act proposes to reform and integrate the medical care and public health service delivery systems. Historically, there have been examples of efforts to integrate public health and medical activities. Yet, while many have acknowledged the inherent value of such an integrated approach to improving health, the fact is that these efforts have had only limited success. The "new deal" President Clinton has proposed for these health institutions is examined in this context. If the notion of integration is taken seriously--that is to mean the extent to which each system's diverse activities complement each other, fitting together to form an integrated whole--then it will not be easy to achieve. Review of the "visions" of public health and medicine and of examples of efforts to integrate public health and medicine in this country suggest five conditions that must be met if successful integration is to be achieved. While the resources necessary to integrate public health and medicine are great, of equal importance is the acceptance of a shared vision of an integrated health care system, and of the respective roles and responsibilities of public health and medical care in that system. The benefits to our nation's health of proceeding in this way, however, are enormous. As we move into the twenty-first century, an integrated system of public health and medical care services is our nation's best hope for not only improving the health of all our citizens, but for closing the "health gap" between socioeconomically disadvantaged groups and the rest of the population.

Understanding and Controlling Violence

Understanding and Controlling Violence

Who Is Served by Programs for the Homeless? Admission to a Domiciliary Care Program for Homeless Veterans

Demographic and clinical data are presented on 4,138 veterans assessed in the 20-site Department of Veterans Affairs (VA) Domiciliary Care for Homeless Veterans program during its first year of operation. More than two-thirds of the veterans who were screened had been hospitalized in VA medical centers during the year before assessment, and 34 percent were hospitalized at the time of assessment. Compared with veterans who were not admitted for residential treatment, veterans who were admitted were more likely to be previously involved in mental health treatment, literally homeless rather than at risk for homelessness, and without public financial support. Specialized service programs for the homeless such as the VA domiciliary care program may also be called on to play a broader role in the discharge and rehabilitative efforts of public mental health service systems.

"The Future of Public Health": The Institute of Medicine's 1988 Report

A long list of enduring and emerging public health issues have raised questions about the capacity of the public health service system to address these concerns. A two-year Institute of Medicine study revealed a system in disarray. It is inappropriately politicized, and public health responsibilities have become so fragmented that deliberate action is often difficult. The Institute of Medicine's committee emphasized that these issues are complex and affect our society broadly. It called for comprehensive action to bring about necessary changes including a clear delineation of the mission of the public health service system and improvement in technical, political, managerial and programmatic skills of public health practitioners.

Epidemiologic aspects of cataract surgery. II: Regional variation in frequencies.

A large data source was examined to determine age and sex specific cataract extraction rates in different counties and urbanization areas in Denmark. Significant regional variation in surgical rates could be demonstrated in spite of a comprehensive Public Health Service System. When comparing rates in different urbanization areas and in towns with and without ophthalmologists, we found the lowest surgical rates in areas or towns short of ophthalmic service. However, a direct correlation could not be found between standard operation ratio and ophthalmic surgeon/ophthalmic bed supply on county level. The reason might be that cataract extraction rates are influenced by a number of other factors, as cataract extraction has become an elective surgical procedure.

Graduate training in community psychology.

The results of a 1975 survey of graduate training programs in community psychology and community mental health are presented. For 62 programs offering master's or doctoral training, formal curriculum components in each of five content areas (community systems and behavior, prevention or promotion of effectiveness, practice of community mental health, research and evaluation, and administration) are reported. Availability of training in six sites (community mental health centers, state hospitals, schools, legal, public health, and social service systems) is also indicated for each program. The number of faculty primarily involved in community psychology or community mental health training and principal sources of financial support for graduate students are described. A list of the 62 programs is provided.

Medical system engineering

Medical system engineering is a theoretical discipline which unifies the methods of analysis and synthesis of complex medical systems, medical technology, and public health services in general. The work of medical institutions typically involves an abundance of medical and economic information, basically in statistical form. Mathematical models of medical institutions establish regularities in the mass of empirical information and remove distortions in the statistical data, thereby aiding the work of planning organizations. Considering medical institutions as complex queueing systems involving cost estimates of the institutions themselves and implicit losses connected with delay times, gives a theoretical basis for choosing the parameters of the medical institutions to be economically optimal. To determine these parameters we must solve problems of nonlinear programming. Some particular problems of public health services are studied: i.e., determining the optimal number of beds in a hospital and the optimal number of ambulances, and determining periodicities in conducting prophylactic examinations. The study of the systems of several medical institutions and their influence on the flow of patients leads to the use of the method of statistical simulation. A simulation using the Markov process, changing the random waiting times of individual cases to their mean values, thereby decreasing the variance of the statistical estimates, is considered. A numerical example is given, illustrating one heuristic approach to estimating the accuracy of the results of this type of simulation. The contradiction between the level of scientific achievements of medicine and the possibilities of their wide practical realization is discussed in the framework of the present system of public health services where individual forms of labor prevail, hampering the effective use of medical technology. The importance of computer automation in processing medical information is pointed out.