Priorities in occupational health research: a Delphi study in The Netherlands.

OBJECTIVES: To achieve a coherent programme of topics for research in occupational health and safety, with well founded priorities and to relate them to perceived gaps and needs in The Netherlands. METHODS: In the first phase of the study 33 key informants were interviewed. In the second phase questionnaires were sent to 150 Dutch experts (including the key informants). Four groups were recruited, originating from: occupational health and safety services; scientific research institutes; governmental and other administrative bodies; and companies. Using the Delphi technique, the experts were asked to prioritize several topics, which were placed under different headings. In the third phase five workshops were organised to elaborate on the highly prioritized topics. RESULTS: The response rates were 86% for the first and 81% for the second questionnaire. In the second round consistency was reached and consensus proved to be satisfactory; so that the Delphi process was stopped. There were surprisingly few differences in opinion between the four groups. The most important heading was "design/implementation/evaluation of measures", in which the topic cost-benefit analysis of measures had the highest score. "Assessment of relations between exposure and effect" was the second most important heading. Under this heading, topics on work stress were generally judged to be more important than topics on safety and biological, chemical, and physical hazards. The headings "occupational rehabilitation/sociomedical guidance" and "occupational health care/occupational health services" had about the sam priority, closely following the heading "assessment of relations between exposure and effect". CONCLUSIONS: The general agreement on priorities should provide a sufficiently broad basis for decision makers to initiate a long term programme for occupational health research and development in The Netherlands.     

Promoción de la salud y prevención en tiempos de crisis: el rol del sector sanitario. Informe SESPAS 2014

This article reviews trends in lifestyle factors and identifies priorities in the fields of prevention and health promotion in the current economic recession. Several information sources were used, including a survey of 30 public health and primary care experts. Between 2006 and 2012, no significant changes in lifestyle factors were detected except for a decrease in habitual alcohol drinking. There was a slight decrease in the use of illegal drugs and a significant increase in the use of psychoactive drugs. Most experts believe that decision-making about new mass screening programs and changes in vaccination schedules needs to be improved by including opportunity cost analysis and increasing the transparency and independence of the professionals involved. Preventive health services are contributing to medicalization, but experts’ opinions are divided on the need for some preventive activities.Priorities in preventive services are mental health and HIV infection in vulnerable populations. Most experts trust in the potential of health promotion to mitigate the health effects of the economic crisis. Priority groups are children, unemployed people and other vulnerable groups. Priority interventions are community health activities (working in partnership with local governments and other sectors), advocacy, and mental health promotion. Effective tools for health promotion that are currently underused are legislation and mass media. There is a need to clarify the role of the healthcare sector in intersectorial activities, as well as to acknowledge that social determinants of health depend on other sectors. Experts also warn of the consequences of austerity and of policies that negatively impact on living conditions.     

Kommunale Pflegeberichterstattung für die Planung der Altenhilfe in Städten und Gemeinden

A key element in the demographic transition process is the increase in the number of very old people (80+) leading to a rising need for long-term care. For the municipalities the efficient organisation of the local support for senior citizens is an important task for legal, political and financial reasons. The local planning process must be based on systematic reporting about long-term care in the community. This report must contain fundamental facts about the demographic situation, the health care system, including the quality of care in nursing homes, by ambulatory services and families as well as the resulting costs in the local welfare budget. Comparing the problem to the methods in local health promotion it is favourable to establish an office to manage the planning process and a committee for matters of care. Committee members should be all relevant stakeholders of the local health, the care and the social sector. The first priority is to achieve the participation of patients, their relatives and the local politicians to agree on targets and measures in the planning process. Key targets are the prevention of risks for long-term care, to secure the quality of care and the preference for ambulatory services, optimisation of local cooperation and minimising the costs for the community. The whole process should be guided by these targets for the provision of care.     

Exploring decision-making for environmental health services: perspectives from four cities

Increasing resources are being allocated to environmental health monitoring, especially for developing methods and collecting data to construct environmental health indicators (EHIs). Yet, little research has focused on understanding how communities and service providers make decisions with regard to environmental health priorities and the role of indicators in this process. This paper presents insights regarding local decision-making that arose from a project to test the feasibility of using community-based EHIs to facilitate communication between the providers and the recipients of environmental services in four developing-country cities. The results of the study indicate that decision-making for environmental health services is complex and iterative rather than rational and linear. Contextual and process factors play an important role. These factors include the morale of service providers, the extent of collaboration between service agencies, the priorities of different community groups and relations between service providers and communities. Scientific information, in the form of EHIs, did not appear to be a key element of decision-making in the settings studied. As tools, EHIs are unlikely to become part of the decision-making process unless they are integrated with local agendas and backed by strong local representation.     

Health promotion activities in annual reports of local governments: 'Health for All' targets as a tool for content analysis

BACKGROUND: This article presents an instrument to study the annual reporting of health promotion activities in local governments within the three intervention municipalities of the Stockholm Diabetes Prevention Program (SDPP). The content of health promotion activities are described and the strengths, weaknesses and relevance of the method to health promotion discussed. METHOD: A content analysis of local governmental reports from 1995-2000 in three Swedish municipalities. A matrix with WHO's 38 'Health for All' (HFA) targets from 1991 was used when coding the local health promotion activities. RESULTS: There are many public health initiatives within the local governmental structure even if they are not always addressed as health promotion. The main focuses in the local governmental reports were environmental issues, unemployment, social care and welfare. CONCLUSIONS: Local governmental reports were found to be a useful source of information that could provide knowledge about the priorities and organizational capacities for health promotion within local authorities. Additionally the HFA targets were an effective tool to identify and categorize systematically local health promotion activities in the annual reports of local governments. Identifying local health promotion initiatives by local authorities may ease the development of a health perspective and joint actions within the existing political and administrative structure. This paper provides a complementary method of attaining and structuring information about the local community for developments in health promotion.     

What remains for the future: strengthening community actions to become an integral part of health promotion practice

To mark the 25th anniversary of the Ottawa Charter, this paper will discuss what remains to be achieved in strengthening community actions as an integral part of health promotion practice. To do this, the paper discusses four key elements for the future of health promotion programmes: (1) engage communities to share priorities; (2) build community capacity; (3) mechanisms for flexible and transparent funding; and (4) being creative in order to expand or replicate successful local initiatives. The paper uses a number of international case study examples of how these key elements can be achieved in health promotion programmes. A major challenge for the future is how health promotion agencies can develop and maintain the trust of communities, especially socially marginalized communities in society. The paper concludes by identifying a number of short and longer term challenges to achieve these goals and offers a way forward for a brighter future direction of health promotion practice.     

The mental health needs of Mexican-American agricultural workers

We used three measurement procedures to produce a comprehensive profile of the mental health needs of Mexican-American farmworkers and to determine what kinds of mental health services were required to meet those needs. These measurement procedures were a field survey, a key informant survey, and a nominal group process. The results of the field survey indicated that rural Mexican Americans are not being served by mental health providers, despite their having higher symptom levels than would be expected in the general population and their substantial use of rural primary health clinics and private physicians. The key informant survey included mental health providers, health providers, and community agency personnel. According to these informants, the mental health sector is unable to provide services for the farmworkers; and the ability of other providers to reach them depends on a number of factors, including the nature of the services offered and the socioeconomic characteristics of the farmworkers themselves. Key informants identified the environmental conditions implicated in the farmworkers' psychosocial problems and recommended types of services, sites, and key personnel. Key informants concurred that general health settings and multiservice agencies were the most appropriate for reaching Mexican Americans, and that mental health services must include bilingual and bicultural staff members. Key informants disagreed, however, about the relative value of certain kinds of mental health services. The nominal group process identified 32 design criteria that could be used to improve mental health services for farmworkers.(ABSTRACT TRUNCATED AT 250 WORDS)     

Health education perspectives in Latin America

While health education and health promotion are acknowledgedas vital by Latin American health leaders, few systematic effortshave been made to promote these fields and few human resourceshave been allocated to them. This article provides a frameworkfor a collaborative effort to design health education strategiesfor health promotion in Latin America. The framework is basedon the theoretical work of leading Latin American public healthscholars, on selected data on the health status of people inLatin American countries, and on the results of a needs assessmentstudy done in five Latin American countries over the last twoyears. First is a review of the concepts of epidemiologicaltransition and the stages of development in public health inLatin America. Current health data are then presented to illustratethe state of Latin American epidemiological transition. Theconcept of epidemiological transition characterizes a set ofcircumstances in which various stages of development in healthstatus coexist within countries, regions or population groups.These circumstances have significant implications for healtheducation. Finally there is an analysis of the public healthand health education priorities for Latin America identifiedby a sample of 130 key health experts from 5 Latin Americancountries. The experts' recommendations for strategies are designedto help overcome the wide regional gaps in health educationcharacteristic of an epidemiological transition and to furtherdevelop this area of public health. The recommendations emphasizethe need for the establishment of networks of mutual collaborationfor training, research, and the exchange of information, publicationsand experts.     

The strategic network position: a feasible model for implementing a decentralized psychiatry

The Norwegian psychiatric health system is sectorized, decentralizedand mainly in the public domain. This paper examines the theoreticaland empirical foundation for community psychiatry with the responsibilityfor dealing with all mental disorders within the confines ofa community, both current and potential cases. Some resultsfrom a comprehensive epidemiological research project in a catchmentarea—Lofoten in Northern Norway—are presented. Thepaper describes a model— the strategic network position—andits application in the same area. A main requirement for themodel is a small catchment area (25—35 000 inhabitants)with geographical and personal proximity of psychiatric specialists,primary health services and other resources for mental healthin a community. The model aims at reaching in an optimal waythe people and the networks which influence the present andfuture mental health of the given communities. The model alsofocuses on various preventive and mental health promoting approacheswhich are feasible in the Norwegian social system. The recognizedstrategic networks consist of the most demanding patients, peoplewith explicit responsibility for treatment and care of definedpsychiatric patients, persons often in contact with people ina position to influence attitudes or with possibilities forobserving a great number of people, persons setting the frameworkand priorities for health and social services and people withspecial influence on the social function of the local communities.The attention and collaboration take place in the normal dayto day working situation, in offering support in crisis situationsand in establishing priorities when there is a need of psychiatrichelp. The model, so far, contributes in a promising way, bothto psychiatric treatment and implementation of mental healthpromotion in the community.     

Developing a community health promotion agenda for a managed care organization

Coordination and collaboration between organizations interested in promoting the health of the populations they serve can potentially help to ensure that key services are provided as well as augment the efforts beyond that which could be accomplished by each organization alone. Understanding the perspectives of each organization can facilitate development of health promotion initiatives that will be of mutual benefit. In Maryland, when a Medicaid managed care program was initiated, Memoranda of Understanding were signed between each managed care organization (MCO) and each of the 24 local health departments; many stipulated that the parties will coordinate on community health issues. This report describes a telephone survey of the health departments that was performed by one MCO to better understand the interests and expectations of the health departments and discusses a process for developing a community health promotion agenda for an MCO.     

Ambulatory turning point and family home care: a gamble in public health

CONTEXT: Family caregivers are now considered an at-risk population in Canada. As hospital stays have been gradually reduced, family caregivers of the elderly are burdened with complex responsibilities. This change in care delivery was implemented with little consideration for services offered to this specific population. INTERVENTION AND DISCUSSION: The purpose of this study was to explore the perceptions of four groups of stakeholders towards services as determinants of health: family caregivers, professionals, community organizations and health care administrators. Focus groups (FG) were conducted (n=11 with 49 participants), followed by semi-structured interviews with key informants (n=29), in urban and rural areas. Results of content analysis were categorized according to the Donabedian model. Congruent perceptions between groups pinpointed the following: A limited accessibility of services, a lack of flexibility and coordination of services, a disregard for health promotion of caregivers and a lack of preventive services. Transportation problems and geographical distance to access services were specific to rural area. CONCLUSION: Results provide evidence-based data for public health. They suggest insights for the development of preventive interventions and services for this increasing at-risk population of family caregivers in Canada.     

Women's views of their main health problems.

Though there has been increased emphasis on women's health and on community participation in the development of health policy, 'ordinary women' have seldom been asked about their major health concerns. This paper reports on a survey of a stratified random sample of 356 women in Hamilton. Among their main worries regarding health were various cancers and heart disease. The health problems they had experienced in the previous six months which had bothered them most were stress, arthritis, being overweight, migraines/chronic headaches and tiredness. On the basis of these and similar data presented here, it is argued that such community surveys provide an important source of data. They identify somewhat different priorities than approaches which rely on the opinions of experts and other key informants.     

Partnerships to promote mental health of NSW farmers: the New South Wales Farmers Blueprint for Mental Health

Objective: To describe the process and outcome of development of a framework for planning and implementation of a range of interventions aimed at improving the mental health and wellbeing of farmers and farm families in New South Wales (NSW). Design: In response to a major drought in New South Wales (NSW), key agencies were invited to participate in a longer-term collaborative program aimed at improving the mental health and well-being of the people on NSW farms. These agencies became the NSW Farmers Mental Health Network. Setting: The Australian National Action Plan for Promotion, Prevention & Early Intervention for Mental Health 2000 proposed a population health approach base encompassing the range of risk and protective factors that determine mental health at the individual, family and community and society levels. It incorporated three traditional areas of health activity into programs aimed at achieving improved mental health for the Australian population – mental health promotion, prevention activities and early intervention. Although the farming population was not identified as a priority population, research has identified this population to be at high risk of suicide, and of having difficulty in coping with the range of pressures associated with life and work in this industry. Participants: Participants were agencies providing services across rural NSW in the fields of farmer and country women's organisations, financial counselling services, government departments of primary industries and health, mental health advisory and support services, charitable organisations and others. Results: The NSW Farmers Blueprint for Mental Health ( http://www.aghealth.org.au/blueprint ) was developed to be ‘a simplified summary of key issues that need to be addressed, and the major actions that we can be confident will be effective in achieving our purpose’. It has identified ‘steps’ along ‘pathways to breakdown’ from the range of known mental health and suicide risk factors that are relevant to the NSW farming population, and 23 areas of current and potential action that would contribute to improving mental health, as key steps along ‘pathways to health’. For each of the areas of action there is described the rationale and basis for action, and the lead agency or individual who has accepted responsibility for coordinating and reporting further activity to the Network. Conclusion: It is suggested that the NSW Farm Blueprint and the activities being implemented by the NSW Farmers Mental Health Network partners represent a model for implementation of a mental health promotion in identified at-risk Australian populations.     

Activating communities for health promotion: a process evaluation method.

OBJECTIVES. To date, evaluations of community-based prevention programs have focused on assessing outcomes, not the process of organizing communities for health promotion. An approach was developed to analyze community organization efforts aimed at advancing community health objectives. These organizational processes are referred to as community activation. METHODS. Information was gathered from 762 informants through a key informant survey conducted in 28 western communities. The data collected included informant ratings of community activation and information about interorganizational activities analyzed through network analytic techniques. RESULTS. Activation levels, as measured by informant ratings, varied across communities. Program coordination, as measured by network analysis, occurred, on average, approximately 30% of the time. Higher income communities tended to be more activated than lower income communities. CONCLUSIONS. There is a widely recognized need for improved information about health-related community organization activities. It appears possible to gather such information through key informant surveys and to develop measures of community organization status that can be used in the evaluation of community health promotion programs.     

Health behaviours of young, rural residents: A case study

Objective:  To analyse self-reported health behaviours of young people from a rural community and the factors influencing their behaviours.
Methods:  Interviews were conducted with 19 young people, 11 parents and 10 key informants from a small rural Victorian community, asking about teenage health behaviours and the factors influencing these behaviours.
Results:  Young people ate both healthy and unhealthy foods, most participated in physical activity, few smoked and most drank alcohol. The study found that community level factors, including community norms, peers, access issues and geographic isolation, were particularly powerful in shaping health behaviours, especially alcohol consumption. Smoking was influenced by social participation in the community and national media health campaigns. Diet and exercise behaviour were influenced by access and availability, convenience, family, peers and local and non-local cultural influences.
Conclusion and implications:  The rural context, including less access to and choice of facilities and services, lower incomes, lack of transport and local social patterns (including community norms and acceptance), impact significantly on young people's health behaviours. Although national health promotion campaigns are useful aspects of behaviour modification, much greater focus on the role and importance of the local contexts in shaping health decisions of young rural people is required.     

Problems and proposals for improvement in the health care of economic immigrants

Objectives: To analyse existing problems in health care to economic immigrants from the point of view of health and social professionals, health authorities and economic immigrants and to know which will be their proposals and priorities to improve economic immigrants's health assistance.Methods: Qualitative approach study made in Majorca island. (Spain). Three focus groups and three nominal groups with health and social workers from primary health care and hospital services were carried out as well as two partially structured interviews to health authorities, one Autonomic Authority and one Governmental Authority, and twelve partially structured interviews to economic immigrants identified trough key informants.Results: Health and social workers perceive the increase in the number of economic immigrants as a massive arrival. The main problems identified are: access restrictions to public helath services for economic immigrants, the follow-up of these patients and diagnostic difficulties because lack of training in tropical medicine. Health and social workers's first proposal for improving this situation is their own training in tropical medicine. Autonomic Authority priorities are to garantiee access to public health services for all immigrants and to look actively for health problems in these population. Governmental Authority, instead, holds the legalization for all. In fact, economic immigrants are not concerned on health care because legalization and houssing problems.Conclusions: The main barriers identified by health and social workers in health care to economic immigrants are: access restrictions, follow-up and lack of training in tropical medicine. Health and social first proposal to improve this situation is their own training in tropical medicine while Autonomic and Central Authorities's priorities are not the same. For economic inmigrants, health assistance is not their biggest concern.     

两城市社区居民口腔健康知识行为及需求定性调查

目的了解三亚市和银川市社区居民口腔健康知识、基本口腔卫生习惯以及对口腔卫生保健的需求情况,为开展口腔健康教育工作提供参考。方法以典型抽样方法选择银川市和三亚市,分别随机抽取社区并组织居民121人开展小组访谈。结果城市社区居民均能做到每人一把牙刷、并定期更换,但口腔卫生习惯存在较大的地区差异,32位三亚市民晚上从不刷牙;开展过口腔健康教育的地区居民健康知识明显高于未开展过的地区;但对口腔健康的重视程度远远不够,预防性口腔卫生服务的利用水平很低,无一人定期进行口腔健康检查,过去一年的口腔卫生服务利用均为治疗行为。结论应加强全民口腔健康教育,完善口腔医疗保障机制,提高公众的口腔健康水平。