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Atopic eczema is a chronic skin condition affecting between 5% and 20% of children aged up to 11 years at one time or other. Research suggests that prevalence is increasing and various environmental factors have been implicated in the aetiology. While often seen to be a minor problem, research suggests that it can cause considerable disruption to the lives of children and their carers and involves significant cost for the family and health care systems. The current consensus is that the majority of cases of atopic eczema are most appropriately managed within primary care. However, management of the condition is problematic because diagnosis is often difficult. Consultations tend to focus on the physical aspects of the problems neglecting the psychosocial, while treatment remains mainly palliative and can be as diverse as the condition itself. More appropriate and effective primary care management and support for children with atopic eczema and their carers will only be developed if health professionals become more aware of the social context of the disease and the impact on the lives of those affected. Public health responses focusing on primary prevention are also needed. This paper reviews a diverse literature on the epidemiology of the condition, the way in which it affects the lives of children and their carers and the factors that shape their help seeking decisions. The aim is to contribute to a more substantial knowledge base for public health and primary care developments and to point to areas for future research

This paper provides an overview of the context, definition, and key features of the harm reduction approach, and provides several examples of current programs in various countries. Both licit and illicit drugs are included in these illustrations. Some of the critical issues, and the strategies needed to advance harm reduction, are discussed. [Translations are provided in the International Abstracts Section of this issue.]

Nutrition and food science have each enhanced the development of an abundant, nutritious, safe food supply. A healthy diet should contain all of the required nutrients and sufficient calories to balance energy expenditure and provide for growth and maintenance throughout the life cycle. Importantly, dietary factors are associated with 5 of the 10 leading causes of death, including coronary heart disease, certain types of cancer, stroke, noninsulin dependent diabetes mellitus and atherosclerosis. National health care expenditures for 1990 totaled $666 billion of which 30% are related to inappropriate diet. Identification of external factors that contribute to premature death would aid preventive efforts, improve the quality of life, and reduce health care costs. Even though genetic predisposition increases susceptible people's risk for many of these chronic diseases, these conditions may be diminished or prevented by improvements in the American diet. Each stage of the life cycle has specific nutrient needs. Throughout infancy, childhood and adolescence nutrients are required to meet the growth processes as well as cognitive function. During pregnancy nutrients are required for both mother and developing infant needs. Adult nutrition focuses on tissue maintenance, nutrient and energy needs, and disease prevention. As the population of elderly increase in number and greater age, nutritional needs must be met to minimize certain disease states and assure the quality of life. Nutrition associated health risks have been identified for coronary heart disease, cancer and diabetes mellitus. Recommendations for each includes a decrease in dietary fat, awareness of caloric intake and enhancement of nutrient density including an increase in fruit and vegetables. These recommendations also impact obesity and diminish the compounding of other disease states affected by excessive body weight. Calcium intake at early ages affects development of bone density and manifestation of osteoporosis. Current gaps in knowledge are also identified that could improve health. Numerous nutrients are being examined for their regulation of specific gene expressions and in the processes of transcription and translation. To offer food products with greater nutrient density or improved functional health ingredients, modification of existing foods is needed to assure an improved diet. Policies to improve health require integration of nutrition needs with economic growth and development, agriculture and food production, processing, marketing, health care and education, and includes changing life styles and food choices. Increased research support is required to achieve national health goals with emphasis on nutrition and food sciences. Education methods must be improved to better inform consumers, to encourage food producers and manufactures to produce healthier foods, to assure training of future professionals and to provide legislators with the basis to make informed decisions. Recommendations to CFERR are identified. Improved quality and availability of nutritious foods will result in a healthier, more productive population. A decrease in the occurrence and duration of chronic disease should diminish the cost of health care and allow these resources to further benefit the nation. International concerns about undernutrition include 780 million people who are malnourished, lacking sufficient food to meet their basic nutritional needs for protein and energy, and 2 billion people who subsist on diets lacking essential nutrients needed for growth, development and physiological maintenance. National concerns about undernutrition exist based on incomplete data identified by indices of hunger and characterized by an increased demand for food assistance for women, children and the elderly. Major health problems in the US impacted by diet and nutrition include coronary heart disease, atherosclerosis, some types of cancer, non-insulin dependent diabetes mellitus, hypert

Education and Training: Working Paper Ten (WP10) (Department of Health 1989a) was published in October 1989. It was an integral part of Working for Patients (Department of Health 1989b) and as such was alleged to embrace the same fundamental principles. WP10 may result in the most significant change to nurse education in the UK since the 1949 Nurses Act, with variations in its funding, structure and organisation. Surprisingly, there has been relatively little discussion about this important development within the nursing press. The aim, therefore, of this paper is to evaluate WP10 within the context of the ideology which has underpinned social policy in the last 14 years. Firstly, Conservative Party policy will be explored, the WP10 itself will then be examined in order to assess how far such principles have been applied to nurse education through its implementation. It is intended that by this process of analysis further understanding will be gained about this policy and its potential consequences for the future of nursing.

In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines [...]

Objectives: The Finnish dental care market operates as a dual system, divided between a regulated, affordable public sector and a less regulated, more expensive private sector that receives public subsidies. In 2015 and 2016, two policy interventions were introduced to reduce these subsidies for private dental services. The aim of this study was to evaluate the impact of these policy changes on the dental care market., Methods: This study was a realist evaluation. Context-Intervention-Mechanism-Outcome-configurations were applied to elicit an initial program theory (IPT) for the policy interventions. The IPT allowed a complicated system to be reduced to the main components, allowing for better understanding of the underlying mechanisms and the chain of events started by the interventions. The resulting hypotheses about the chain of events and outcomes were tested against a dataset collected from the Social Insurance Institution of Finland (SII) registries on public and private dental visits in the cities of Espoo, Helsinki and Oulu during the years 2010-2016. The used dataset consisted of N = 17 111 625 dental procedures or N = 8 139 990 individual visits (which can include several procedures) at a public (n = 9 097 407 procedures, n = 4 083 475 visits) or a private (n = 8 014 218 procedures or n = 4 056 515 visits) dental clinic. The system was studied during three time periods related to the two interventions in 2015 and in 2016. Changes were evaluated by statistically analysing changes in several key metrics: mean subsidy, mean out-of-pocket price, mean (non-subsidized) price, number of patients treated, number of professionals, procedures per professional, Case-Mix adjusted procedures per professional, patient-to-professional ratio, total procedures., Results: The 2015 and 2016 reductions to the subsidization of private dental care reduced the average subsidies paid to the private dental sector by 49% [-49.1, -38.8]. A 26% [25.2, 26.7] increase in the out-of-pocket price paid in the private sector was observed. Over the 2 years, 12.2% of patients left the private sector and an increase of 13% was observed in the number of patients treated in the public sector. The public sector increased its number of dental care professionals by 2.3% and the patient-to-professional ratio increased by 9.9% over the 2 years, while the private sector lost 4.6% of its dental care professionals and increased its prices by 4.0% [3.5, 4.5]., Conclusions: The policy changes had tangible effects on both the private and public sectors of the Finnish dental care market. By reducing subsidies, the private sector became more expensive for patients, causing many to transition to the public sector for their dental needs. While the public sector increased its capacity to accommodate the rise in patients, the demand still outpaced the growth in professionals, hinting at capacity or resource constraints in the public sector. The results also show initial evidence that contrary to the objectives, the policy changes increased the cost to the public sector as subsidized patient cared for in the private sector costs less to the government than treating that same patient in the public sector., (© 2023 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Despite efforts in recent years, including in policy and research, to address health disparities in the United States, many of those disparities continue to fester in marginalized racial/ethnic populations. Understanding sleep health disparities is critical in understanding the health and wellness of these groups. Using obstructive sleep apnea (OSA) in Black populations as a focus, this paper presents the role of race and ethnicity in the clinical understanding of sleep health-related issues by medical practitioners and the implications of the lack of clear policies or best practices to guide medical practitioners' attempts to meet sleep-related needs of marginalized racial/ethnic populations. Furthermore, the knowledge gap may be further complicated by the poor understanding and integration of existing evidence with the many, complex, sleep-associated co-morbidities. Policymaking in this area ought to be based on the ethical implications of disparate sleep-related health outcomes by race and ethnicity. So, we conclude by offering recommendations for developing ethically sound policies for addressing sleep problems in marginalized racial and ethnic populations., (© 2023. W. Montague Cobb-NMA Health Institute.)

A growing body of evidence demonstrates potential adverse mental health outcomes associated with exposure to occupational trauma among first responders. In response, policymakers nationwide are eager to work on these issues as evidenced by the number of states covering or considering laws for mental health conditions for first responders. Yet, little information exists to facilitate understanding of the impact of mental health-related policies in the United States on this important population. This study aims to identify and synthesize relevant state-level policies and related research on first responder mental health in the United States. Using a scoping review framework, authors searched the empirical and policy literature. State level policies were identified and grouped into two categories: (1) Workers' Compensation-related policies and (2) non-Workers' Compensation (WC) related policies. While benefits levels and other specifics vary greatly by state, 28 states cover certain first responder mental health claims under WC statutes. In addition, at the time of this study, 28 states have policies governing first responder mental health outside of WC. Policies include requiring mental health assessments, provisions for counseling and critical incident management, requiring education and training, providing funding to localities for program development, bolstering peer support initiatives and confidentiality measures, and establishing statewide offices of responder wellness, among others. Authors found a dearth of outcomes research on the impact of state level policies on first responder mental health. Consequently, more research is needed to learn about the direct impact of legislation and establish best practice guidelines for implementing state policy on first responder mental health. By conducting systematic evaluations, researchers can lay the foundation for an evidence-based approach to develop more integrated systems that effectively deliver and finance mental health care for first responders who experience work-related trauma. Such evaluations are crucial for building an understanding of the impact of policies and facilitating improvements in the support provided to first responders in managing mental health challenges arising from their work., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

One of the missions of the American Academy of Nursing is to formulate strategies for health policy. To arrive at these strategies, Academy members share their thoughts, knowledge, and imagination in working groups at Academy meetings. The Expert Panel on Older Adults, one of these working groups, asked for interested members to formulate a policy paper on wellness and health promotion of the elderly for presentation at the AAN meeting in Los Angeles last October. This was done, and AAN members at that meeting shared their views on the paper. Now, this draft is being published here to invite all Nursing Outlook readers to review and comment on the policy recommendations that have been formulated. We encourage feedback so your ideas can be considered in the development of the paper. The paper will be submitted for approval to the AAN Committee on Health Policy Reform.

The health of the nation white paper has been widely welcomed as a clear shift in NHS policy towards health promotion. But will the strategy achieve real improvements in the health of those who need help most? What part can health visitors and school nurses expect to play?

Medical education should provide the essential basis for a comprehensive health service. Postgraduate training in the hospital sphere is manifestly inadequate, particularly in the early postqualification years. It is in sharp contrast to the excellence of vocational training for general practice. The White Paper presents a challenge and a window of opportunity to redress this imbalance and calls for a clear educational strategy crossing all administrative, professional and political boundaries.

Poverty Reduction Strategy Papers (PRSPs) represent the World Bank and the International Monetary Fund’s (IMF) most recent initiative for reducing the plight of the poor. This paper examines whether the PRSPs for Liberia, Afghanistan and Haiti follow World Bank guidance on health. The health data, analysis and strategy content of the three PRSPs are assessed with respect to the ‘Health, Nutrition and Population’ chapter of the World Bank’s PRSP Sourcebook. This guidance states that PRSPs should include: health data on the poor and a clear analysis showing the determinants of ill health and pro-poor health strategies. Unfortunately, none of the PRSPs analysed comply with the guidance and, consequently, do not adequately portray the health situation within their countries. Thus health is not given a high priority in the PRSP process and is seemingly low on the agenda of both poor country governments and the International Financial Institutions (IFIs). If the situation for the world’s poorest people is to improve, health and the right to health need to be promoted within PRSPs.

Introduction In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of [...]

Coronavirus disease 2019 (COVID-19) has accelerated the adoption of telemedicine globally. The current consortium critically examines the telemedicine frameworks, identifies gaps in its implementation and investigates the changes in telemedicine framework/s during COVID-19 across the globe. Streamlining of global public health preparedness framework that is interoperable and allow for collaboration and sharing of resources, in which telemedicine is an integral part of the public health response during outbreaks such as COVID-19, should be pursued. With adequate reinforcement, telemedicine has the potential to act as the “safety-net” of our public health response to an outbreak. Our focus on telemedicine must shift to the developing and under-developing nations, which carry a disproportionate burden of vulnerable communities who are at risk due to COVID-19.

Purpose: Norway, like other welfare states, seeks to leverage data to transform its pressured public healthcare system. While managers will be central to doing so, we lack knowledge about how specifically they would do so and what constraints and expectations they operate under. Public sources, like the Norwegian policy documents investigated here, provide important backdrops against which such managerial work emerges. This article therefore aims to analyze how key Norwegian policy documents construe data use in health management., Design/methodology/approach: We analyzed five notable policy documents using a "practice-oriented" framework, considering these as arenas for "organizing visions" (OVs) about managerial use of data in healthcare organizations. This framework considers documents as not just texts that comment on a topic but as discursive tools that formulate, negotiate and shape issues of national importance, such as expectations about data use in health management., Findings: The OVs we identify anticipate a bold future for health management, where data use is supported through interconnected information systems that provide relevant information on demand. These OVs are similar to discourse on "evidence-based management," but differ in important ways. Managers are consistently framed as key stakeholders that can benefit from using secondary data, but this requires better data integration across the health system. Despite forward-looking OVs, we find considerable ambiguity regarding the practical, social and epistemic dimensions of data use in health management. Our analysis calls for a reframing, by moving away from the hype of "data-driven" health management toward an empirically-oriented, "data-centric" approach that recognizes the situated and relational nature of managerial work on secondary data., Originality/value: By exploring OVs in the Norwegian health policy landscape, this study adds to our growing understanding of expectations towards healthcare managers' use of data. Given Norway's highly digitized health system, our analysis has relevance for health services in other countries., (© Emerald Publishing Limited.)