AIDS: A public health and psychological emergency.

Reviews the current status and knowledge of acquired immune deficiency syndrome (AIDS), focusing on the demographic characteristics of high-risk groups (e.g., homosexual and bisexual men), assumptions and findings that have guided research to date, and problems that have hampered this research. Because most AIDS research has dealt with gay and bisexual men, misperceptions about this group and their health, lifestyles, and sexual activity, which are common, have fostered flawed research designs. Confidentiality is another sensitive issue in AIDS detection and research. The psychological ramifications of AIDs involve the social stigmas attached to the lifestyles of high-risk groups and the fear of contracting AIDS held by the general public. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The statistical basis of public policy: a paradigm shift is overdue

The recent controversy over the increased risk of venous thrombosis with third generation oral contraceptives illustrates the public policy dilemma that can be created by relying on conventional statistical tests and estimates: case-control studies showed a significant increase in risk and forced a decision either to warn or not to warn. Conventional statistical tests are an improper basis for such decisions because they dichotomise results according to whether they are or are not significant and do not allow decision makers to take explicit account of additional evidence--for example, of biological plausibility or of biases in the studies. A Bayesian approach overcomes both these problems. A Bayesian analysis starts with a "prior" probability distribution for the value of interest (for example, a true relative risk)--based on previous knowledge--and adds the new evidence (via a model) to produce a "posterior" probability distribution. Because different experts will have different prior beliefs sensitivity analyses are important to assess the effects on the posterior distributions of these differences. Sensitivity analyses should also examine the effects of different assumptions about biases and about the model which links the data with the value of interest. One advantage of this method is that it allows such assumptions to be handled openly and explicitly. Data presented as a series of posterior probability distributions would be a much better guide to policy, reflecting the reality that degrees of belief are often continuous, not dichotomous, and often vary from one person to another in the face of inconclusive evidence.     

Ethical dilemmas in AIDS research: Individual privacy and public health.

Research on the acquired immune deficiency syndrome (AIDS) presents a stark example of the dilemmas involved in balancing individual rights and social welfare in conducting psychosocial research. These dilemmas are pronounced in research on public health. Unfortunately, significant legal threats to confidentiality are matched inadequately by legal means of protecting privacy. Researchers are advised to request certificates of confidentiality from the Public Health Service. A privilege statute is needed to protect the privacy of participants in research on AIDS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction and validation in the public health modelling of HIV/AIDS

Mathematical models are an integral part of long-range scientific research and are broadly equivalent to the hypotheses to be tested. Validation consists: (1) in checking whether theoretical expectations are sufficiently close to observed values; and (2) in showing that theoretical constructions that pass the first test can also make verifiable predictions of future events. When modelling is used in operational situations to assist practical decision-making, as in the public health surveillance, prediction and control of infectious diseases, especially HIV/AIDS, it is easy to use the first criterion, but not so simple to implement the second. The paper discusses various methods of improving the validation of a specific classical compartmental model of HIV/AIDS geared to good serial public health data on AIDS incidence. These methods include model fitting to existing data, cross-checking findings with independent research results, general circumstantial support, and the possibility in special situations of the quasi-prediction of present or recent data using models fitted only to sufficiently distant past data.     

Social capital and health: implications for public health and epidemiology

Public health and its "basic science", epidemiology, have become colonised by the individualistic ethic of medicine and economics. Despite a history in public health dating back to John Snow that underlined the importance of social systems for health, an imbalance has developed in the attention given to generating "social capital" compared to such things as modification of individual's risk factors. In an illustrative analysis comparing the potential of six progressively less individualised and more community-focused interventions to prevent deaths from heart disease, social support and measures to increase social cohesion faired well against more individual medical care approaches. In the face of such evidence public health professionals and epidemiologists have an ethical and strategic decision concerning the relative effort they give to increasing social cohesion in communities vs expanding access for individuals to traditional public health programs. Practitioners' relative efforts will be influenced by the kind of research that is being produced by epidemiologists and by the political climate of acceptability for voluntary individual "treatment" approaches vs universal policies to build "social capital". For epidemiologists to further our emerging understanding of the link between social capital and health they must confront issues in measurement, study design and analysis. For public health advocates to sensitise the political environment to the potential dividend from building social capital, they must confront the values that focus on individual-level causal models rather than models of social structure (dis)integration. The evolution of explanations for inequalities in health is used to illustrate the nature of the change in values.     

Meningitis: public health issues

This paper describes a case-note review of 25 cases of meningococcal disease which occurred in the six months following distribution of pre-admission antibiotic treatment packs and prophylaxis advice packs. The data showed that while these interventions had improved some aspects of public health, and management of cases and their contacts, further action was needed     

The efficacy of psychotherapy as the basis for public policy.

Discusses the tremendous growth that has occurred in the number of mental health providers, the rate of use of mental health services, and public and private reimbursement for mental health care. Governmental policymakers and leading insurance officials continue to seek information regarding the appropriateness and efficacy of specific psychotherapeutic techniques with various types of presenting problems. The efforts during the Carter administration to stimulate additional efficacy research and knowledge synthesis regarding the efficacy of psychotherapy are described. A public policy proposal is forwarded that no form of health intervention—physical or mental—should be supported through 3rd-party reimbursement and publicly supported training programs unless it has been demonstrated to be safe and effective. It is argued that randomized controlled clinical trials should be viewed as the most valid, though not exclusive, source of evidence. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The importance of public health for twenty-first-century health care: lessons from tuberculosis

Once epidemic, tuberculosis has re-emerged, often in newly drug-resistant forms. This public health threat calls for strong public action as well as improved private care. Action has been hampered by failures in public health infrastructure and legal-philosophical support for government intervention. Josephine Gittler's accompanying article usefully suggests rebuilding public-health agencies and adapting traditional authority and controls from the age of epidemics to take account of today's circumstances and sensibilities.     

AIDS and public policy: A legislative view.

Discusses public policy concerning acquired immune deficiency syndrome (AIDS) research, prevention, patient care, and treatment. Government research has been understaffed and underfunded, and improvements are needed in equipment, instrumentation, and oversight of federal agencies. Prevention efforts have been hindered by restrictions on explicitness about sexual behaviors and drug use. Priority should be given to changing public attitudes, counseling and testing of high-risk groups, and community-based programs with access to such groups. Treatment efforts should focus on services for those in the early stages of infection, psychosocial and specialized programs, and financing of AIDS-related health care. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Asbestos in the air of public buildings: a public health risk?

The Environmental Health and Safety Council of the American Health Foundation has examined current estimates of cancer risks associated with the presence of asbestos-containing materials (ACM) in public buildings. The Council finds that even complete removal of asbestos from all of these buildings will provide no measurable benefit to public health. The removal of nonfriable ACM only can be postulated to protect the public against a small hypothetical risk that cannot be measured epidemiologically. Moreover, examination of the assumptions used in the risk assessment calculations leads to the conclusion that these small calculated risks are likely to represent overestimates. In recent surveys, the measured asbestos levels in indoor air cast some doubt on whether occupant exposure to asbestos levels are contributed to significantly by ACM even when some of the material is friable or in bad condition. Furthermore, the models used for cancer risk estimates assume no threshold level for cancer and conclude that any exposure is carcinogenic. This may be unjustified in light of information on the mechanisms for some asbestos-caused disease. Based on the best available data, it is very unlikely that cancer will result from indoor asbestos exposure, especially where ACM is well maintained.     

Catastrophe and public health: reasons for an impasse]

ANOTHER PUBLIC HEALTH CRISIS: Coming into public view after the AIDS transfusion and the mad cow crises, asbestos-related health risks have provoked an atmosphere of panic incompatible with calmly planned public health prevention programs. The avalanche of passionate reactions has led to an inextricable dead-end situation. SCAPEGOATS: Faultfinders have accused a long list of scapegoats--scientists, physicians, experts, public health officials, industrial leaders and the media--but court actions do not favor rigorous analysis of health safety dispositions. What is needed is a pondered examination of the sinister chain of events which has made such a wasteful situation possible. MEETING PUBLIC DEMANDS: Prohibiting asbestos cannot solve the problem once and for all. Asbestos removal programs must be conducted in terms of a solid risk/benefit analysis and more generally, management of environment-related health risks must be based on specific and credible measures. Without a real rehabilitation of environmental medicine, there is a genuine risk of seeing crisis situations override public health decision making.     

The social psychological basis for public acceptance of the social security system: The role for social research in public policy formation.

Examined the issue of carrying out research that meets traditional standards of quality while bearing upon significant public issues. Measures of orientation toward socal security were studied, using an opinion questionnaire administered in 615 home interviews in 3 cities. Results indicate that people are committed to social security because it is work-connected through the payroll tax. There is no dissatisfaction with the system by persons who appear to bear the brunt of its inequities. Factors related to willingness to pay into the system are noted. The question of why there has been no previous social psychological research on the social security program is considered, and ways of coping with this lack are suggested. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The feasibility and desirability of public health credentialing: a survey of public health leaders

OBJECTIVES: The goal of this study was to provide insight concerning the potential of credentialing public health workers through an exploratory examination of public health leaders' perceptions. METHODS: Qualitative and quantitative procedures were used. Credentialing issues were identified through the literature and through open-ended interviews with leaders and experts. A 74-item Likert-type survey was used to quantify perceptions. Key informants and survey participants were identified through pertinent organizations. RESULTS: The public health leaders leaned toward consensus on some benefits of and concerns about credentialing. There was no consensus related to a specific form of desired credentialing, although national certification was supported by a plurality. State licensing and an emphasis on the master's in public health (MPH) degree were opposed by large margins. Public health leadership survey results were similar to results of a survey of credentialing experts. CONCLUSIONS: The lack of consensus and the vehemence of some opposing positions indicate that movements toward credentialing should proceed cautiously. However, many of the response patterns indicate that the issue merits further exploration.