Challenges and opportunities in public health perspectives on family interventions: Introduction to the special section.

This introduction to the special section frames the idea of a public health approach to couple and family interventions as focusing upon the impact of interventions on outcomes at the population level. It notes the importance of looking at how evidence-based interventions can be used more effectively at the population level. It also stresses that the goals for population-level studies are different from randomized clinical trials. Public health interventions need evidence that the interventions can be used in widespread practice, that the interventions are cost effective when used as designed, and that monitoring and evaluation tools are available for adopting agencies. Finally, this introduction introduces the three articles of the series. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Paradigm as a methodological approach to analyzing Russia's public health system

A concept of paradigm is applied to the analysis of the national public health system. Whether it can be used as a methodological regulator in public health management is considered. Evidence is provided for the theoretical premises of constructing a paradigm of the public health system, its philosophical bases, the notional system, methodology, and the technological framework. The theoretical and practical aspects of public health paradigm, such as identification, interpretation, and rationalization are used to analyze at the conceptual and practical level, as well as search for new ways of reforming the public health system by the paradigm approach as a deeper development of the existing paradigm or its modification. This can become a foundation for the realignments of the theoretical and practical bases of the national public health system. The formation of the new paradigm of the public health system is to take place not in a revolutionary, but in a developmental mode. Priority should be given not to radical transformations and drastic changing of the key concepts, but to the fluent increasing of new knowledge and their inclusion of the theory and practice of public health. The promises of using the paradigm methodology, allowing the internal and external principles of the operation and function of the public health system to be integrated. In this context, the paradigm approach may be used as a methodological tool for analyzing person-society-state-economy-management relations within the framework of the public health system.     

Health psychology and the public health perspective: In search of the pump handle.

Health psychology and public health share many common interests and goals, but frequently define and approach problems differently. Drawing from historical and contemporary examples, this paper examines key elements of the public health approach: identification of a health problem in a population, empirically derived understanding of problems, and use of preventive interventions, often of a regulatory nature. Justification for this approach is based on explication of the public health model, described in comparison to the traditional medical model and several psychological approaches. The example of health promotion is used to explore both challenges and potential pitfalls of collaboration between health psychology and public health. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance

Decentralization has long been advocated as a desirable process for improving health systems. Nevertheless, we still lack a sufficient analytical framework for systematically studying how decentralization can achieve this objective. We do not have adequate means of analyzing the three key elements of decentralization: (1) the amount of choice that is transferred from central institutions to institutions at the periphery of health systems, (2) what choices local officials make with their increased discretion and (3) what effect these choices have on the performance of the health system. This article proposes a framework of analysis that can be used to design and evaluate the decentralization of health systems. It starts from the assumption that decentralization is not an end in itself but rather should be designed and evaluated for its ability to achieve broader objectives of health reform: equity, efficiency, quality and financial soundness. Using a "principal agent" approach as the basic framework, but incorporating insights from public administration, local public choice and social capital approaches, the article presents a decision space approach which defines decentralization in terms of the set of functions and degrees of choice that formally are transferred to local officials. The approach also evaluates the incentives that central government can offer to local decision-makers to encourage them to achieve health objectives. It evaluates the local government characteristics that also influence decision-making and implementation at the local level. Then it determines whether local officials innovate by making choices that are different from those directed by central authorities. Finally, it evaluates whether the local choices have improved the performance of the local health system in achieving the broader health objectives. Examples from Colombia are used to illustrate the approach. The framework will be used to analyze the experience of decentralization in a series of empirical studies in Latin America. The results of these studies should suggest policy recommendations for adjusting decision space and incentives so that localities make decisions that achieve the objectives of health reform.     

Public health and health psychology: Two cats of Kilkenny?

In this article I describe the opposition of concepts underlying the public health and health psychology disciplines. The considerations of active versus passive and individual versus population approaches to prevention currently divide the two disciplines. Some writers for the public health model vigorously advocate the passive, structural intervention as the most important strategy while deprecating the fundamental tenets of health psychology and behavioral health. This attitude is discussed in terms of finding the most comprehensive, effective, acceptable, and implementable strategy to achieve preventive health benefits through a multifaceted approach targeted at numerous levels of intervention involving both active and passive and both individual and population approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roaming through methodology. V. The prevention paradox: few with a high risk versus many with a moderate risk

With a good primary prevention programme a number of healthy individuals will never know that they had a narrow escape from disease and maybe even death. Large numbers of individuals participate in such a programme, while only a few of those would have fallen ill without it. Nevertheless such a population approach often will yield a larger health benefit (on a population level) than an intervention that only aims at the high risk group in the population. That has been called the prevention paradox. The choice between a population or a high risk approach has prompted lengthy debates in the Netherlands. Epidemiology offers a methodology to estimate the effects of different approaches. The health impact will be determined by the distribution of exposure in the population and the risk function of exposure. In the final decision on a prevention strategy other considerations such as cost-effectiveness of interventions, negative side effects, possibilities of identification of high risk groups and ethical issues can play a part.     

Research utilization: evaluation of initiatives in a public health nursing division

The need to incorporate research findings into public health nursing has never been greater. This paper describes briefly, the initiatives to promote research in a public health nursing division and the results of the evaluation questionnaire. Results indicated that public health nurses valued research and felt comfortable with the concepts and phases of the research utilization model. They would engage in research activities if conducted at team meetings and when time was allotted. They identified administrative support and the supportive environment as being positive facilitators to research utilization. Despite these findings, the majority (67.5%) were not changing their practice as a result of the initiatives. They identified having difficulty formulating a research question and needing assistance with article critique. Time was cited as the greatest deterrent. They felt they did not have time to read research or engage in the steps of the research utilization model. Recommendations from the evaluation include the need to designate time for research utilization at team meetings. Once the nurses comfort level and value placed on research utilization increases, they may be motivated to initiate research activities on their own.     

Prospective study of tobacco smoking and substance dependencies among samples of ADHD and non-ADHD participants

In this paper, the determinants of growth of aggregate health expenditures are investigated. The study departs from previous literature in that it looks at differences across countries in growth (and not levels) of health care expenditures. Estimation is made for 24 OECD countries. Health system characteristics usually believed to influence health expenditures growth, like population ageing, the type of health system (public reimbursement, public contract or integrate) and existence of gatekeepers, are found to be non-significant. Nevertheless, there is evidence that health expenditures experienced a clear slower growth in the last decade. The explanation for this slowdown could not be found in the proposed model and should stimulate further research.     

Interleukin-1beta expression after inhibition of protein phosphatases in endotoxin-tolerant cells

BACKGROUND: There are cogent reasons why public health specialists should take an active interest in and measure the psychological health and well-being of populations. The literature was searched and reviewed with the aim of evaluating survey instruments that would enable public health specialists to measure the psychological health and well-being of populations. METHODS: The search and review were restricted to instruments that were applicable to adults of working age, and that did not focus on psychotic disorder or organic brain disorder. An attempt was also made to identify instruments that were designed to measure some form of positive well-being and could be applied in population-based surveys. Detailed evaluation was then carried out of two or three instruments that appeared representative of a particular field or approach. RESULTS: The literature search revealed three major fields of research, 'Psychiatric Epidemiology', 'Stress Studies' and 'Subjective Well-being'. Accordingly, the results of the review are presented under these three headings. Results pertaining to commonly used survey instruments in the field of 'Psychiatric Epidemiology' are presented. (Those on 'Stress Studies' and 'Subjective Well-being' are presented in Part 2 of this study.) CONCLUSIONS: Although some questionnaires in the field of 'Psychiatric Epidemiology', such as the General Health Questionnaire and the HAD Scale, offer a valid and convenient means of measuring degrees of neurotic disorder in a population, they do not measure any form of positive well-being. In Part 2, methods of measurement from the other two fields are reviewed and overall conclusions are drawn about the options available to public health specialists.     

Development and test of an extendable endoprosthesis for bone reconstruction in the leg

Chemical contamination in the environment is affecting public health in increasing numbers of communities across the country. Although historically and theoretically well within the realm of nursing, methods for assessing and diagnosing threats to community environmental health are not being included in community health nurses' training. A community's environmental health is assessed by retrieving information from federal, state, and local sources. Developing the diagnosis involves four steps: identifying a community aggregate at highest risk of exposure, determining the potential or actual health response, citing related host and environmental factors, and correlating any existing epidemiologic data that may substantiate the nursing diagnosis. To illustrate these concepts, a systematic environmental health assessment was conducted for Douglas, Arizona. The results indicated elevated lead levels in residential soils and led to the community diagnosis, potential for injury: children in Douglas are at risk of developing adverse neurobehavioral health effects, and pregnant women in Douglas are at risk of developing adverse reproductive health effects related to several environmental and host factors, as evidenced by average blood lead level, in children exceeding the Centers for Disease Control recommended level of 10 micrograms/dl.     

Human onchocerciasis in Africa

In the United States, the traditional public utilities, power and telecommunications, along with health care, are being deregulated and becoming increasingly competitive, especially on price. Regulation of the public utilities has occurred for the past century not simply because they have been monopolies, but, more importantly, because they are "industries affected with the public interest," that is industries which: 1. provide an essential service, 2. benefit from public prequisites, and 3. would cause great public harm if mismanaged. Consequently, the presence of competition in these industries does not negate the need for regulation. Regulation of these industries is best understood as being along the three sides of a "triangle of public interests"--quality, public accountability, and universal service. Examples are provided of these types of regulation in power and telecommunications, even in current "deregulatory" legislation. Health care reform activists in the United States have lately paid attention mostly to the first two legs of the triangle; they are encouraged to focus creatively on the third leg--universal health care.     

Effect of dietary fish oil supplementation on peroxidation of serum lipids in patients with non-insulin dependent diabetes mellitus

Target 17 of the Health Policy for Europe calls for the health-damaging consumption of dependence-producing substances such as alcohol, tobacco and psychoactive substances to be significantly reduced in all Member States between the year 1980 and the year 2000. With regard to alcohol, it is suggested that alcohol consumption be reduced by 25%, with particular attention to reducing harmful use. A question posed by a number of Member States is what is the level of per capita alcohol consumption of lowest risk to physical, psychological and social harm. A working group was convened to consider population levels of alcohol consumption with particular reference to the Member States of the European Region of WHO. A basis for understanding population problem experience can be established through the interaction between individual risk and distribution of consumption levels within the population. The working group concluded that public health policy within the European Region should continue to advise decreases of per capita consumption. Even when taking into account coronary heart disease, it can be concluded at the population level, across all ranges of alcohol consumption found in almost all countries of Europe, that a reduction in consumption is linked to better health. However, public health policy concerning alcohol should not be based solely on mortality. All outcomes of drinking, that is mortality, morbidity, social and criminal consequences, as well as quality of life, should be considered. The existing data relating alcohol consumption to health originates from countries primarily with a cultural experience of consuming alcohol. In those countries, where there is a cultural or religious tradition of not consuming alcohol, there can be no public health grounds for recommending alcohol consumption.     

Social and economic factors as obstacles to blood pressure control

Further improvement in blood pressure control at the population level will result from dealing with hard-to-solve problems, such as access to care, long-term management of a chronic disease, and societal influences on lifestyle. Additional knowledge and experimental data are needed, reinforced by clear public health choices in this direction.     

The public health approach to youth violence and child maltreatment prevention at the Centers for Disease Control and Prevention.

Millions of people in the United States suffer the consequences of violence, including physical injuries, psychological trauma, and death. Solutions to violence have traditionally been reactive. Through the lens of the public health perspective, the Centers for Disease Control and Prevention (CDC) views violence as predictable based on various contributing factors, and thus as preventable. Within CDC, the Division of Violence Prevention (DVP) leads efforts to prevent injury, death, and disability, and to reduce the suffering and medical costs caused by violence. DVP employs a multidisciplinary, public health approach to identify factors associated with violence, and to develop, evaluate, and disseminate preventive interventions. Psychology is one discipline that has contributed to our approach. The authors present a series of violence prevention initiatives funded by the CDC that are framed within a public health perspective, with attention to the contributions of psychology to youth violence and child maltreatment prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multicomponent intervention to prevent partner violence within an existing service intervention.

Intimate partner violence (IPV) is an enormous public health problem that results in injury, health problems, and substantial cost to society. Despite having a grasp of the scope of IPV, public health officials and workers know little about how to prevent it. The few empirically established primary prevention programs consist of school-based curricula targeting high school students. Additional venues for IPV prevention are needed, especially for women at elevated risk. This article describes a preventive intervention for IPV consisting of three components: (a) a structured assessment for IPV; (b) a brochure-driven intervention for women experiencing IPV, including safety planning, referrals, and advocacy; and (c) a skills-based curriculum delivered to all participants that focuses on improving relationship decisions and outcomes. While this intervention could potentially be delivered in a multitude of clinical settings, this article focuses on its delivery within a home visitation program for young, disadvantaged new mothers, a population known to be at increased risk for IPV. If found to be effective, this intervention could be incorporated into many service delivery systems, with broad-based clinical implications for IPV prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A causal analysis of factors affecting adjustment to spinal cord injury.

A study with 85 spinal-cord-injured male inpatients (mean age at time of injury 33.2 yrs; mean time since injury 10 yrs) evaluated the relative contributions of physical vs psychological variables to Ss' long-term perceptions of themselves after injury and illustrated the usefulness of a multivariate analytic approach to research questions about these effects. LISREL examinations of predictors (e.g., education, physical activities) and outcomes were conducted. Although some variables (e.g., level of injury) have long been assumed to exert powerful effects on all areas of adjustment to injury, causal analyses in the present study indicated that Ss' long-term perceptions of physical/externally observed features were best predicted by the same sort of predictor; a similar correspondence was seen for psychological/internally observed perceptions and their predictors. For example, level of injury was a relatively strong predictor of Ss' perceptions of health and physical activity, while perceptions of pain, which are acknowledged to have a large psychological component, were best predicted by more psychological predictors (e.g., S's role in sustaining the injury, S's level of education). The present authors assert that their assessment of the location and degree of correspondence between predictors and outcomes along a physical-psychological dimension of experience in the present study would not have been possible without causal analysis. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public health crises of cities in developing countries

During the decade and a half after Alma Ata hundreds of projects were started in developing countries to implement the principles of PHC and start community based health care programs in the rural areas of developing countries. Until the past five years urban health was not seen as a special health problem. Population pressure in the rural areas has created shortages of land, food and employment opportunities. These forces have generated major population movements to the urban centres. The population movements have encouraged unprecedented expansion of urban centres. This sudden concentration of large populations in small geographical areas has resulted in the urban health crises of the developing world. The poor who live in the slum areas have no access to adequate health services, they experience frequent epidemics of communicable diseases like cholera, they live within a heavily polluted environment, and their children have very poor health because they are not immunized and are malnourished. The paper agrees with approaches which have been championed by development agencies to address the urban health crises. These approaches propose the reorientation of urban health systems to include adoption of PHC for urban health programs, intersectoral collaboration and extra budgetary support. The paper argues for further strengthening of the reorientation approach by adjusting the development planning model. It is proposed that the urban plan be integrated into the national development plan so that emerging urban health crises can receive special attention in resource allocation.