To provide regional, state, and local public health officials a conceptual framework and checklist for assessing regional public health emergency preparedness, specifically in regard to cross-border public health preparedness needs.
The project had four phases that are as follows: defining the scope, conducting a literature review, soliciting expert opinion, and creating the assessment framework and checklist. A conceptual framework was developed to define the scope of the project on the basis of the kinds of resources likely to be shared across borders in a public health response (eg, data, supplies, staff), in support of the public health functions likely to be important in a health emergency (eg, epidemiology, laboratory). A literature review was then conducted to identify key articles and tools addressing regional preparedness. Key informant interviews (n = 23) were conducted with public health and emergency management professionals in the Pacific Northwest to identify a set of systems, agreements, and protocols that should be systematically considered in assessing regional public health preparedness. Using the literature review and themes from interviews, a checklist was developed.
A checklist was developed for use by public health leaders, which recommends 24 specific agreements, protocols, systems, and management structures that should be considered to foster cross-border public health preparedness.
Regional public health preparedness represents not only the sum of state-level preparedness of the states in a region but also the capacity of those states to collaborate across state and international borders during a public health emergency. This checklist provides a tool to systematically consider cross-border preparedness issues.
This paper describes the unusual problems encountered in making medical services available to a remote Eskimo community and the pattern of utilization of these services by the people of the community. The findings may be of some assistance to other persons concerned with the health needs of a population living under similar adverse circumstances.
Alaska Medical Library - From: Fortuine, Robert et al. 1993. The Health of the Inuit of North America: A Bibliography from the Earliest Times through 1990. University of Alaska Anchorage. Citation number 1474.
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Screening for breast cancer has been evaluated by 9 randomized trials over 5 decades and recommended by major guideline groups for more than 3 decades. Successes and lessons for cancer screening from this history include development of scientific methods to evaluate screening, by the Canadian Task Force on the Periodic Health Examination and the U.S. Preventive Services Task Force; the importance of randomized trials in the past, and the increasing need to develop new methods to evaluate cancer screening in the future; the challenge of assessing new technologies that are replacing originally evaluated screening tests; the need to measure false-positive screening test results and the difficulty in reducing their frequency; the unexpected emergence of overdiagnosis due to cancer screening; the difficulty in stratifying individuals according to breast cancer risk; women's fear of breast cancer and the public outrage over changing guidelines for breast cancer screening; the need for population scientists to better communicate with the public if evidence-based recommendations are to be heeded by clinicians, patients, and insurers; new developments in the primary prevention of cancers; and the interaction between improved treatment and screening, which, over time, and together with primary prevention, may decrease the need for cancer screening.
In response to the high rates of injury morbidity and mortality among Native Americans, the Indian Health Service initiated community injury control programs in 1982 mainly aimed at educating the populations served. Substantial declines in hospitalization rates per population for falls, motor vehicle injuries, and assaults were observed through 1984. Regression analyses of changes in hospitalization rates for particular types of injury in relation to rates of persons served in 54 service units suggests some favorable effect of certain activities and possible adverse effect of a few. Increased targeting of effort based on detailed surveillance of serious injuries is planned.
Cites: Public Health Rep. 1970 Oct;85(10):881-84990244
Both the United States and Canada have a federal form of government, but approaches used in the two countries to ensure the safety of drinking water supplies differ. The Environmental Protection Agency currently enforces regulations for 10 organic chemicals (including 6 pesticides) under the Safe Drinking Water Act and provides advice on others through its health advisory program. Canada, however, does not have similar legislation, but rather provides health-related guidelines for 21 organic chemicals (including 16 pesticides) which are used by the provincial agencies responsible for drinking water supplies. Both countries are in the process of revising their standards and will include a variety of additional synthetic organic chemicals. Where possible, standards are set using a calculated acceptable daily intake usually derived from animal feeding experiments. Procedures for setting standards for carcinogens involve a blend of risk estimation coupled with consideration of the feasibility of reducing the risk in light of socio-economic factors. Most drinking water treatment plans in North America utilize 'conventional' treatment. Some now employ modifications in order to minimize trihalomethane formation. A few use aeration or granular activated carbon to remove synthetic organic chemicals.
Early in 1970, analyses of fish caught in Lake St. Clair revealed levels of mercury in excess of the Food and Drug Administration's guidelines of 0.5 ppm. Confirmation and extension of these surprising findings came quickly, and triggered a flurry of meetings, studies, reports, and government hearings that culminated in the unprecedented recommendation by the FDA that consumers no longer eat swordfish because of their consistently high mercury content.