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2.
BMC Health Serv Res ; 19(1): 796, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690313

RESUMO

BACKGROUND: Hepatitis B virus (HBV) infection is a global public health problem. The burden of the disease is high in low and middle income countries like Ethiopia. However, for highly vulnerable groups such as health professionals, vaccination coverage is a major issue in the developing countries where health professionals are expected to pay for vaccination. Therefore, the objective of this study was to assess health professionals' acceptance and willingness to pay (WTP) and associated factors for vaccination against HBV. METHODS: Cross-sectional study was conducted from March to April, 2017 in Gondar city administration governmental health institutions among 423 health professionals. Simple random sampling method was employed to select the study participants. Data were collected using self- administered questionnaire. Tobit model was used to analyze the determinants of WTP and the maximum amount of money the individuals might pay for HBV vaccination. P-value < 0.05 was considered statistically significant. RESULT: A total of 423 health professionals (physicians, nurses, midwives, laboratory technicians/technologists, and others) participated in the study with a response rate of 100, and 62.4% of them were willing to pay for HBV vaccination. The mean amount of money the participants might pay for HBV vaccination was 325.83 ± 283.46 ETB (US$ 14.39 ± 12.52). The study indicated that the WTP for HBV vaccination of health professionals from health centers was 179.41 ETB less compared to health professionals from hospital. The WTP for HBV vaccination of the participants who had no experience of seeing previous patients with HBV was 157.87 ETB less compared to participants who had experience of seeing previous patients with HBV. As monthly income of the study participants increased by one ETB, the WTP was increased by 0.027 ETB. CONCLUSION: The study revealed that the mean amount of money the participants might pay for HBV vaccination was much less than the market price for HBV vaccination. Type of workplace and experience of seeing/observing patients with HBV, and income were the predictors of WTP for HBV vaccination. Availing the vaccine with affordable cost in governmental health institutions may increase WTP of health professionals for HBV vaccination.


Assuntos
Pessoal de Saúde/psicologia , Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/economia , Adulto , Estudos Transversais , Etiópia , Feminino , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Hepatite B/prevenção & controle , Hospitais Públicos/estatística & dados numéricos , Humanos , Governo Local , Masculino , Inquéritos e Questionários
3.
Niger Postgrad Med J ; 26(4): 199-204, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621658

RESUMO

Context: Proper use of protective eyewear (PEW) is important in the prevention of occupational eye injury. Aim: The aim of this study was to determine the ocular morbidity and utilisation of PEW among carpenters in Mushin Local Government, Lagos, with a view to promoting ocular health and safety in the workplace. Subject and Methods: This was a cross-sectional study of one hundred and fourteen (114) carpenters that were enrolled into the study. Interviewer-administered questionnaires were used to collect information on socio-demographics, work-related ocular history, awareness and utilisation of, as well as barriers to utilisation of PEW. Ophthalmic examination was done. In-depth interviews were also carried out to probe the barriers to utilisation of PEW. Quantitative responses were analysed using the IBM SPSS software, and content data analysis was performed for qualitative responses. Results: The prevalence of reported work-related eye injury and complaints were 30.7% and 32.5%, respectively. The prevalence of ocular morbidity among the respondents was 74.6%. Seventy-seven respondents (67.5%) were aware of PEW; only 21.1% owned PEW, whereas the utilisation level was 26.3%. In-depth interviews revealed ignorance, forgetfulness, and unfamiliarity as the key barriers to PEW use. The odds of using PEW were about three-fold with previous eye injury at work and history of eye complaint. Conclusions: This study demonstrates a significant prevalence of ocular morbidity and poor utilisation of PEW among carpenters in Mushin, Lagos. There was a significant relationship between previous eye injury or complaint and PEW use. Thus, there is a need to create awareness among carpenters and develop occupational safety policies to improve the use of PEW.


Assuntos
Traumatismos Oculares/prevenção & controle , Dispositivos de Proteção dos Olhos/estatística & dados numéricos , Traumatismos Ocupacionais/prevenção & controle , Adolescente , Adulto , Idoso , Estudos Transversais , Traumatismos Oculares/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Governo Local , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Inquéritos e Questionários , Adulto Jovem
4.
Environ Monit Assess ; 191(10): 623, 2019 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-31494724

RESUMO

The aim of this study was to analyze the effect of using public resources and training for the sustainable development of Brazilian municipalities. To reach this objective, the data from 5569 municipalities in 2017 were analyzed. The data were collected in the IBGE (Brazilian Institute of Geography and Statistics) census and analyzed using structural equation modeling with PLS (Partial Least Squares). PLS is a structural equation modeling method that enables you to work with complex models on more than one level of latent variables. The results show that municipal resources have a positive impact on sustainable development. This means that the municipalities whose permanent employees socially participate in forums and workplace environment committees, which have specific financial resources for sustainability, present better economic and social performance. Such social participation also has positive effects on environmental performance in these municipalities. The study also showed that the training of government employees is fundamental for the implementation of environmental management programs and for improving the social performance of Brazilian municipalities.


Assuntos
Desenvolvimento Sustentável , Brasil , Cidades , Monitoramento Ambiental , Humanos , Governo Local
5.
Artigo em Inglês | MEDLINE | ID: mdl-31405176

RESUMO

Since the initiation of the New Rural Cooperative Medical Scheme (NCMS) in 2003 in China, medical reimbursement plays an increasingly important role in reducing the familial burden of critical illness healthcare in rural China. However, the current medical reimbursement system is operated based on prefecture-level administrative boundaries, which may prevent some residents from accessing higher-quality medical resources. Using a reliable and high-accuracy geographic information system (GIS) dataset, this study investigates whether this reimbursement system restricts rural residents from freely seeking out medical services in the Hubei Province by employing a two-step floating catchment area (2SFCA). Results show that there are spatial differences between the catchment area of different graded medical centers and prefecture-level administrative boundaries. Spatial reimbursement boundaries should be readjusted so that most rural residents receive equitable coverage by the system and reimburse their medical expenses in a more convenient way. Therefore, we argue that the local government should delineate the spatial region of the medical reimbursement for rural residents according to an assessment of their spatial accessibility to different graded medical centers beyond prefecture-level boundaries. We also discuss potential methods for designing reimbursement boundaries and reimbursement management strategies that the Chinese central government could adopt.


Assuntos
Mecanismo de Reembolso , China , Feminino , Sistemas de Informação Geográfica , Acesso aos Serviços de Saúde , Humanos , Seguro Saúde , Governo Local , Masculino , População Rural
6.
Artigo em Inglês | MEDLINE | ID: mdl-31405224

RESUMO

Previous studies show that the environmental quality is significantly influenced by corruption and the hidden economy separately. However, what is the impact of their interaction effect on environmental quality? Based on Multiple Indicators Multiple Causes (MIMIC) model, this study calculates the scale of hidden economy in Chinese provinces firstly. Then, we apply the method of spatial econometrics to analyze the interaction effect of corruption and the hidden economy on environmental pollution with China's provincial panel data from 1998 to 2017. The results indicate that the interaction effect between corruption and hidden economy significantly increases pollutant discharge, suggesting that both anti-corruption and control of the hidden economy may improve environmental quality directly and indirectly.


Assuntos
Poluição Ambiental/ética , Algoritmos , China , Poluição Ambiental/economia , Governo Local , Análise Espacial
7.
Artigo em Inglês | MEDLINE | ID: mdl-31454977

RESUMO

To promote sustainable development, the Chinese government launched a new municipal solid waste (MSW) classification strategy in 2017. Shanghai was selected as one of the first pilot cities for MSW classification. The Shanghai municipal government first established the new MSW classification policy in 2017. The Shanghai Municipal Solid Waste Management Regulation was published in 2019 and came into effect on 1 July 2019. This short communication reports on Shanghai's new MSW classification policy and its implementation. The main content and measures adopted by Shanghai's government to ensure the effective implementation of the new MSW classification policy are introduced. Besides, a SWOT (i.e., strengths, weaknesses, opportunities, and threats) analysis on the present policy and measures is conducted, and based on the results, some discussions and suggestions regarding the implementation of MSW classification in Shanghai and the whole of China are presented.


Assuntos
Política Ambiental , Eliminação de Resíduos/legislação & jurisprudência , Resíduos Sólidos/classificação , Gerenciamento de Resíduos/legislação & jurisprudência , China , Cidades , Governo Local , Estudos de Casos Organizacionais , Projetos Piloto
8.
Artigo em Inglês | MEDLINE | ID: mdl-31430942

RESUMO

Village resettlement communities (VRCs) are a special type of urban community that the government has promoted considerably during China's rapid urbanization. This study uses the theory of the production of space as a basis to explore the processes and mechanisms of the physical and social space evolution of VRCs through a case study of Qunyi Community, one of the largest VRCs in Kunshan. Questionnaires and semi-structured interviews were employed in this study. Results indicate that the coupling relationship between local government power and diversified capital is the fundamental reason that promotes the production of macrophysical space. Moreover, the economic and social relationships among residents promote the reproduction of microsocial space. Landless farmers are the most important spatial producers in the microsocial space. The individual needs and cultural differences of immigrant workers also have significant effects on microspatial production. Furthermore, the production and reproduction of the physical and social spaces, respectively, of VRCs deduce the adjustment relationship among the urbanization processes of land, population, and individuals. Results also indicate that the urbanization of individuals appears to lag behind the previous two processes. This study can provide a theoretical basis for the spatial renovation and management optimization of VRCs, as well as the promotion of a new type of "people-centered" urbanization.


Assuntos
Planejamento de Cidades , Emigração e Imigração , Planejamento Ambiental , Meio Social , Urbanização , China , Países em Desenvolvimento , Emprego , Humanos , Governo Local , Capital Social , Classe Social , Inquéritos e Questionários
9.
Niger Postgrad Med J ; 26(3): 182-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441457

RESUMO

Background: Despite women's adequate knowledge and the obvious unmet need for family planning (FP), contraceptive prevalence in Nigeria is low. A greater understanding of the barriers to FP that informs service utilisation and preferences is needed to improve service delivery. Aim: This study was aimed at assessing the use and preferences of FP services among women. Subjects and Methods: A community-based, descriptive, cross-sectional survey was carried out among 367 women (15-49 years of age) residing in Ikosi-Isheri, Kosofe local government area, who were selected by multistage sampling method. Data were collected using a pre-tested, semi-structured, interviewer-administered questionnaire and were analysed using SPSS software version 20. Frequency distributions and cross tabulations were generated. The Chi-square and Fisher's exact tests were used to determine associations, and the level of significance was set at P ≤ 0.05. Results: Although 64.0% were aware of FP, only 26.4% had ever used FP services. The contraceptive prevalence was 17.9%. Traditional or religious restrictions were given as the reasons for not using FP (40.9%). The preferred FP services were those offered at primary healthcare centres (45.2%) and teaching hospitals (33.9%) because of proximity (38.7%), privacy (14.5%) and health workers being female (22.6%). Age, level of education and marital status were associated with the utilisation of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). Conclusion: Although awareness was high, uptake was low. Government health facilities were preferred. Primary healthcare should be strengthened, and FP services should be scaled up to make FP more accessible. Services should be closer to where people live while providing the privacy they desire.


Assuntos
Comportamento Contraceptivo , Anticoncepção/psicologia , Serviços de Planejamento Familiar/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Preferência do Paciente , Adolescente , Adulto , Atitude do Pessoal de Saúde , Comportamento de Escolha , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Escolaridade , Feminino , Humanos , Governo Local , Estado Civil , Pessoa de Meia-Idade , Nigéria , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Inquéritos e Questionários , Adulto Jovem
10.
J Environ Manage ; 247: 840-848, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31336349

RESUMO

Small and medium-sized enterprises (SMEs) play an important and growing role in the economy, but they also contribute to negative environmental effects. It is often argued that local governments (LGs) would be better able than the central government to address these environmental effects. LGs can generate locally specific solutions and mobilize other local stakeholders. This article examines (1) how Thai SMEs respond to complaints about their industrial water pollution and (2) to what extent LGs have been able to address such environmental degradation. Thirty cases of industrial water pollution were investigated, and stakeholders (entrepreneurs, LGs, affected communities and NGOs) were interviewed about their actions and responses. We conclude that none of the stakeholders on their own make a significant contribution to the environmental outcomes. We present two cases detailing how enterprises, LGs and communities interacted with each other over time and how this interaction shaped the environmental outcomes. The responses of polluting entrepreneurs were driven by interaction between various stakeholders. This finding suggests that LGs alone cannot address water pollution, even if they have the authority and capacity. LGs need to interact with other stakeholders to pursue this task.


Assuntos
Governo Local , Poluição da Água , Poluição Ambiental , Indústrias , Tailândia
11.
Public Health ; 174: 11-17, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31265975

RESUMO

OBJECTIVES: In England, in 2013, responsibility for some public health (PH) functions transferred from the National Health Service (NHS) to local government. This moved PH from a health-focussed into a broader and more politically oriented context. This article reports on the perceptions of those involved in this transition about how the PH function was changing as it transited to local government. STUDY DESIGN: This is a cross-sectional interview study. METHODS: The study included semi-structured interviews with 31 local government councillors, directors and deputy directors of PH, PH team members and members of clinical commissioning groups. Interviews and data analysis were informed by a theoretical framework, COM-B and an inductive and deductive approach was taken to identify relevant themes. RESULTS: There was a mixed picture of perceived gains and losses for PH. The transition from NHS to local government was seen by some as a 'homecoming', providing the opportunity for PH to have further reach through influence and collaboration with departments like housing, transport and planning. The opportunity to promote evidence-based practice across local government was also seen as a positive aspect of the transition. However, professional roles of PH and individual PH practitioners were perceived to have less influence and autonomy than in the NHS, with some uncertainty about roles within local government. PH practitioners perceived the need to develop other skills to fulfil their roles in local government. Shorter timescales for action and pressure for faster responses were reported to be the reason for less emphasis on using PH evidence to inform policy and decision-making than hitherto in the NHS. CONCLUSION: This study illustrates a variety of consequences of transitioning from NHS to local government. There were perceived benefits afforded by proximity to related local government departments but at the costs of reduction in status for PH practitioners and working to a timescale which in some cases reduced drawing on scientific evidence.


Assuntos
Governo Local , Administração em Saúde Pública , Medicina Estatal/organização & administração , Estudos Transversais , Inglaterra , Humanos , Pesquisa Qualitativa
12.
Artigo em Inglês | MEDLINE | ID: mdl-31208141

RESUMO

:The aim of this paper is to examine the impact of local government competition and environmental regulation intensity on regional innovation performance and its regional heterogeneity. Based on the theoretical mechanism of the aforementioned variables, this study uses the Chinese provincial panel data from 2001 to 2016. We use the super-efficiency data envelopment analysis (SE-DEA) to evaluate regional innovation performance. To systematically examine the impact of local government competition and environmental regulation intensity on regional innovation performance, we build a panel date model using the feasible generalized least squares (FGLS) method. The results indicate that: the regional innovation performance can be significantly improved through technological spillover; local governments compete for foreign direct investment (FDI) to participate in regional innovative production. Moreover, improvements in environmental regulation intensity enhance regional innovation performance through the innovation compensation effect. Our results show that the local governments tend to choose lower environmental regulation intensity to compete for more FDI, which has an inhibitory effect on regional innovation performance. Furthermore, due to regional differences in factor endowments, economic reforms and economic development levels in Chinese provinces, there exists a significant regional consistency in the impact of local government competition and environmental regulation intensity on regional innovation performance. Therefore, institutional arrangements and incentive constraints must be adopted to enhance regional innovation performance as well as to guide and foster the mechanism of green innovation competition among local governments. At the same time, considering the regional heterogeneity of local government competition and environmental regulation intensity affecting regional innovation performance, policy makers should avoid the "one-size-fits-all" strategy of institutional arrangements.


Assuntos
Difusão de Inovações , Meio Ambiente , Regulamentação Governamental , Governo Local , Modelos Teóricos , Grupo com Ancestrais do Continente Asiático , China , Desenvolvimento Econômico , Eficiência , Humanos , Internacionalidade , Investimentos em Saúde , Controle Social Formal
13.
Int J Med Inform ; 128: 1-6, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160006

RESUMO

OBJECTIVE: To determine the impact in the adoption of electronic health records and health information exchanges by local health departments on population health. METHODS: The study analyzed 433 local health departments population-based data across 433 counties in the United States. Controlling for high school graduation rate, percentage of adults with some post- secondary education, race, median household income, percentage rural, population size served, governance structure of local health departments and revenue, the study used multiple linear regression to analyze the impact in the adoption of health information technology by local health departments on the population health of a county. RESULTS: Electronic health records adoption was statistically significant at improving population health at the county level. Health information exchange adoption was not statistically significant. CONCLUSION: When local health departments adopt electronic health records, it improves health- related quality of life and reduces years of potential life lost. POLICY IMPLICATIONS: The value derived from the adoption of electronic health records by local health departments deserves attention because of its abilities to enhance the services provided at local health departments. It is important for local health departments to use health information technology to electronically capture patient information to improve upon the services received at community health centers.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Informática Médica/estatística & dados numéricos , Saúde da População/estatística & dados numéricos , Qualidade de Vida , Adulto , Idoso , Feminino , Humanos , Governo Local , Masculino , Pessoa de Meia-Idade , População Rural , Estados Unidos
14.
Environ Sci Pollut Res Int ; 26(20): 21059-21064, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31154638

RESUMO

Unapproved and illegal buildings have sprawled into the Northern Piedmont of the Qinling Mountains. The problem of illegal villas has aroused widespread public opinion and concern. The ecological environment of the Qinling Mountains has been seriously affected by the resurgence of illegal villas. This paper introduces the characteristics and distribution of illegal villas, analyzes the hazards caused by illegal villas, and describes control measures for illegal villas and land consolidation and ecological remediation in the Northern Piedmont of the Qinling Mountains. The results show that illegal planning and illegal development, as well as local governments' irregularities, including control, governance, punishment, demolition, and compensation for illegal buildings in the expropriation of premises, have caused the problem of illegal construction of villas in the Northern Piedmont of the Qinling Mountains. Control measures for illegal villas are demolition, land consolidation, and ecological remediation. Policy implications for protection of Qinling Mountains are provided.


Assuntos
Conservação dos Recursos Naturais , Ecossistema , China , Monitoramento Ambiental/legislação & jurisprudência , Monitoramento Ambiental/estatística & dados numéricos , Expropriação , Atividades Humanas , Humanos , Governo Local
15.
BMC Health Serv Res ; 19(1): 430, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248402

RESUMO

BACKGROUND: Maternal and child health workers (MCHWs) are often the first point of contact with pregnant women, children, and caregivers. Therefore, they can play a significant role in early detection of causes of childhood blindness, facilitate prompt referral to specialized centers and provide health education to caregivers for preventive eye care. METHODS: This is a pre-test, post-test, single group, quasi-experimental study to evaluate the outcome of training MCHWs on common blinding childhood diseases. All MCHWs in Ifo Local Government Area were selected to participate in the study. Pre-training, qualitative data was obtained from two focus group discussions while quantitative data was obtained using a self-administered questionnaire. Three months post-training, quantitative data was obtained using the same self-administered questionnaire as was used pre-training. Total and percentage scores on the pre- and post-tests were calculated for each participant. A score of ≥70% was regarded as sufficient while < 70% score was regarded as insufficient. McNemar's test was used to determine differences in proportions between pre- and post-training quantitative measurements. RESULTS: Of the 65 MCHWs in the Local Government Area, 61 participated in the study giving a response rate of 93.8%. The age range of study participants was from 28 to 57 years with a mean age of 41 ± 8.3 years. The male: female ratio was 1:7.7. During the focus group discussions, measles was the most commonly mentioned cause of childhood blindness however, participants showed more knowledge of the signs and symptoms of new-born conjunctivitis. Based on a sufficient knowledge score of ≥70%, only one participant (1.6%) demonstrated sufficient knowledge on quantitative survey pre-training. Post-training, there was a statistically significant increase (20, 32.8%) in the proportion of participants with sufficient knowledge (McNemar's test p = .000). CONCLUSIONS: This study demonstrated that the training of MCHWs on common childhood blinding diseases (such as congenital cataract and congenital glaucoma) had the potential to improve knowledge regarding prevention, prompt recognition and early referral of common treatable potentially blinding diseases.


Assuntos
Cuidadores/educação , Oftalmopatias/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde Materno-Infantil/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Criança , Diagnóstico Precoce , Oftalmopatias/epidemiologia , Oftalmopatias/prevenção & controle , Feminino , Grupos Focais , Humanos , Governo Local , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Gravidez , Pesquisa Qualitativa
16.
Health Res Policy Syst ; 17(1): 61, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31248422

RESUMO

BACKGROUND: Local public health service delivery and policy-setting in England was overhauled in 2013, with local government now responsible for the complex tasks involved in protecting and improving population health and addressing health inequalities. Since 2013, public health funding per person has declined, adding to the challenge of public health decision-making. In a climate of austerity, research evidence could help to guide the more effective use of resources, although there are concerns that the reorganisation of public health decision-making structures has disrupted traditional evidence use patterns. This study aimed to explore local public health evidence use and needs in this new decision-making climate. METHODS: Semi-structured interviews with Public Health Practitioners across three Local Authorities were conducted, with sites purposefully selected to represent urban, suburban and county Local Authorities, and to reflect a range of public health issues that might be encountered. A topic guide was developed that allowed participants to reflect on their experience and involvement in providing evidence for, or making a decision around, commissioning a public health service. Data were transcribed and template analysis was employed to understand the findings, which involved developing a coding template based on an initial transcript and applying this to subsequent transcripts. RESULTS: Increased political involvement in local public health decision-making, while welcomed by some participants as a form of democratising public health, has influenced evidence preferences in a number of ways. Political and individual ideologies of locally elected officials meant that certain forms of evidence could be overlooked in favour of evidence that corresponded to decision-makers' preferences. Political involvement at the local level has increased the appetite for local knowledge and evidence. Research evidence needs to demonstrate its local salience if it is to contribute to decision-making alongside competing sources, particularly anecdotal information. CONCLUSION: To better meet decision-making needs of politicians and practitioners, a shift in the scope of public health evidence is required. At a systematic review level, this could involve moving away from producing evidence that reflects broad global generalisations about narrow and simple questions, and instead towards producing forms of evidence that have local applicability and can support complex policy-focussed decisions.


Assuntos
Tomada de Decisões , Governo Local , Política , Administração em Saúde Pública , Medicina Estatal/organização & administração , Inglaterra , Prática Clínica Baseada em Evidências , Disparidades nos Níveis de Saúde , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa
17.
Am J Public Health ; 109(8): 1107-1110, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31219716

RESUMO

Objectives. To learn about local health policymakers' experiences and responses to preemption-the ability of a higher level of government to limit policy activity at a lower level. Methods. Between March and June 2018, we conducted an anonymous Web-based survey of mayors and health officials in US cities with populations of 150 000 or more. We used descriptive statistics to analyze multiple-choice responses. We analyzed open text responses qualitatively. Results. Survey response rates were 28% (mayors) and 32% (health officials). Nearly all respondents found preemption to be an obstacle to local policymaking. When faced with preemption, 72% of health officials and 60% of mayors abandoned or delayed local policymaking efforts. Conclusions. Preemption is viewed as an impediment across a range of public health issues and may stifle local policy activity (i.e., have a chilling effect). Those working at the local level should consider the potential for preemption whenever seeking to address public health concerns in their communities. Public Health Implications. Local governments should engage with advocates, practitioners, and public health lawyers to learn about successful and failed efforts to meet public health objectives when faced with preemption.


Assuntos
Política de Saúde/legislação & jurisprudência , Formulação de Políticas , Saúde Pública/legislação & jurisprudência , Política Pública/legislação & jurisprudência , Humanos , Governo Local , Política , Governo Estadual , Inquéritos e Questionários , Estados Unidos
18.
Am J Public Health ; 109(8): 1084-1091, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31219718

RESUMO

Objectives. To examine associations of county-level demographic, socioeconomic, and labor market characteristics on overall drug mortality rates and specific classes of opioid mortality. Methods. We used National Vital Statistics System mortality data (2002-2004 and 2014-2016) and county-level US Census data. We examined associations between several census variables and drug deaths for 2014 to 2016. We then identified specific classes of counties characterized by different levels and rates of growth in mortality from specific opioid types between 2002 to 2004 and 2014 to 2016. We ran multivariate and multivariable regression models to predict probabilities of membership in each "opioid mortality class" on the basis of county-level census measures. Results. Drug mortality rates overall are higher in counties characterized by more economic disadvantage, more blue-collar and service employment, and higher opioid-prescribing rates. High rates of prescription opioid overdoses and overdoses involving both prescription and synthetic opioids cluster in more economically disadvantaged counties with larger concentrations of service industry workers. High heroin and "syndemic" opioid mortality counties (high rates across all major opioid types) are more urban, have larger concentrations of professional workers, and are less economically disadvantaged. Syndemic opioid counties also have greater concentrations of blue-collar workers. Conclusions. Census data are essential tools for understanding the importance of place-level characteristics on opioid mortality. Public Health Implications. National opioid policy strategies cannot be assumed universally applicable. In addition to national policies to combat the opioid and larger drug crises, emphasis should be on developing locally and regionally tailored interventions, with attention to place-based structural economic and social characteristics.


Assuntos
Censos , Overdose de Drogas/mortalidade , Mortalidade , Transtornos Relacionados ao Uso de Opioides/mortalidade , Saúde Pública/estatística & dados numéricos , Overdose de Drogas/epidemiologia , Humanos , Governo Local , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia
19.
Rev Esp Salud Publica ; 932019 May 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31038127

RESUMO

OBJECTIVE: The health system in Spain rests mostly in the Autonomous Communities (similar to the states in the US). The public health activities of many local governments are little studied. The objective of this work was to bring knowledge about the public health activities of the municipalities, providing information obtained from a recent survey in Catalonia. METHODS: Descriptive study based on a survey to public health officers in the 119 municipalities above 10,000 population in Catalonia, excluding the city of Barcelona. The survey was conducted between May and October 2016, with 103 municipalities (86.6%) reporting on their services in 2015, prior to the survey. Data were collected and descriptive analyses performed. RESULTS: A consolidation of both political and professional public health structures of the municipalities was observed. Most frequent activities in health protection were related to legionella control, the control of urban pests and the management of complaints and requests by citizens. Most frequent activities in the field of health promotion were related to physical activity and health, prevention in tobacco and alcohol, food and nutrition. There were relatively few changes reported in public health structures and their officers, as well as in human resources. CONCLUSIONS: In Catalonia, municipalities above 10,000 population have a remarkable level of activity in public health. Both the areas of health protection (with mandatory minimum services for local governments) and of health promotion show high levels of activity. The system seems stable regarding political changes and budget constraints. There are opportunities for improvement in the training of professionals and service accreditation. It would be desirable to find ways to improve coordination among these services.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Governo Local , Administração em Saúde Pública/estatística & dados numéricos , Prática de Saúde Pública/estatística & dados numéricos , Serviços Urbanos de Saúde/provisão & distribução , Pesquisas sobre Serviços de Saúde , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Humanos , Espanha , Serviços Urbanos de Saúde/organização & administração
20.
Environ Manage ; 64(1): 97-106, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076828

RESUMO

Pharmaceutical consumption continues to grow constantly. Unused/expired pharmaceuticals are disposed of to the municipal sewage system or waste disposal. Consequently, many countries have implemented a system of collecting pharmaceutical waste, with pharmacies playing an important role. It is important to educate consumers on rational consumption and the appropriate disposal of unused/expired pharmaceuticals and to identify the level of public awareness. Two studies were conducted in Poland to estimate the problem of collection and disposal of expired/unused pharmaceuticals. The purpose of the Survey I was to identify the scale of pharmaceutical consumption and the way pharmaceuticals are disposed of by various social groups. The Survey II was aimed to identify patients' attitudes regarding expired/unused pharmaceuticals at home. Of the respondents who participated in in Survey I, almost 74% indicated that analgesics were among the over-the-counter drugs they purchased. Group of pharmaceuticals 65% of the respondents purchased were medicines for treating flu symptoms. Almost 68% of the respondents said they usually disposed of expired pharmaceuticals in their household waste or by flushing them down the toilet. In Survey II more than 35% reported that they disposed of pharmaceuticals in the same ways. Of all respondents, ~30% returned their expired pharmaceuticals to pharmacies. Most respondents (over 65%) who participated Survey I indicated that they were aware that pharmaceutical waste can be returned to pharmacies. It should be noted that local governments are currently not obliged by law to work with or compensate pharmacies in the collection and proper disposal of unused pharmaceuticals.


Assuntos
Preparações Farmacêuticas , Eliminação de Resíduos , Atitude , Humanos , Governo Local , Polônia , Inquéritos e Questionários
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