Search

NICE has existed for 10 years. During this period, its methodological approach to developing guidance and assessing the value (cost-effectiveness) of healthcare interventions has received considerable national and international interest. At the same time, individual decisions have generated enormous controversy. This 10th anniversary provides an opportunity to look back at how the institute has responded and adapted to the various challenges and controversies. Following Lord Darzi's review of the National Health Service (UK) in 2008, the institute took on further responsibilities for setting clinical standards for the National Health Service. This article explores these developments and speculates on future trends.

ACToR (Aggregated Computational Toxicology Resource) is a database and set of software applications that bring into one central location many types and sources of data on environmental chemicals. Currently, the ACToR chemical database contains information on chemical structure, in vitro bioassays and in vivo toxicology assays derived from more than 150 sources including the U.S. Environmental Protection Agency (EPA), Centers for Disease Control (CDC), U.S. Food and Drug Administration (FDA), National Institutes of Health (NIH), state agencies, corresponding government agencies in Canada, Europe and Japan, universities, the World Health Organization (WHO) and non-governmental organizations (NGOs). At the EPA National Center for Computational Toxicology, ACToR helps manage large data sets being used in a high-throughput environmental chemical screening and prioritization program called ToxCast.

Objectives: Our goal was to gain an understanding of the extent to which environmental public health tracking (EPHT) has progressed since the release of the 2000 Pew Environmental Health Commission report examining the nation's EPHT infrastructure., Methods: As a follow-up to the Pew Commission report, we conducted a telephone survey of state practitioners in an effort to assess EPHT trends and changes in state-level capacities and activities over the past several years., Results: We found that new and enhanced federal-state partnerships; improved surveillance, data analysis, and communication capacities; and enhanced support of tracking personnel have provided a foundation for progress in the area of EPHT. Also, the Centers for Disease Control and Prevention's support of EPHT has strengthened the national environmental public health infrastructure and capacity to track environmental hazards, exposures, and health., Conclusions: Improved funding, data access, and translation of data to prevention activities are critical to sustaining progress in EPHT and developing the evidence base necessary for assessing the longer-term impacts and efficacy of EPHT and related environmental health improvements.

In the 1970s policy making in The Netherlands took place in sectoral networks, consisting of professional interest groups and like minded civil servants, advisory councils, mp's and departmental ministers. In this article the author examines whether such a sectoral policy network still exists in Dutch health care by comparing past and present data on the background of civil servants, mp's and departmental ministers. Next she describes the political fight against the health care sectoral network, which has gone on for decades. She concludes that the health care sectoral network has been severely weakened, although it remains to be seen whether this will lead to a substantial reduction of health care costs, which was one of the main reasons why politicians fought against sectoral interests in the first place.

A new information system (IS) - the software and hardware complex for controlling the state sanitary-and-epidemiological inspection (SSEI) was created. The system represents the aggregate of automated working places of RF MD chief state sanitary physician arid specialists from the department of state sanitary-and-epidemiological inspection of the Main Military Medical Headquarters. They interact through communications with working places of specialists from SSEI Main Center, chief state sanitary physicians from the Armed Forces, military districts (fleets) and RFAF CSSEI. The special software provides automation of the following technological processes: operative sanitary-and epidemiological and epidemiological monitoring; the epidemiological analysis of infectious diseases; the evaluation of quality and efficiency of sanitary-and epidemiological work. At present the complex works in the regime of experimental exploitation when the adjustment of communications and special software is performed.

The United States Environmental Protection Agency (USEPA) and other U.S. and international agencies have focused extensive efforts on the evaluation of the potential health risks of exposures to chlorinated dioxins (PCDDs), furans (PCDFs), and related dioxin-like polychlorinated biphenyls (PCBs). Extensive regulatory efforts over the past 20 years have also been made to control emissions of these compounds and thus to reduce exposures in the general population. This paper reviews the available information on temporal trends in emissions, environmental levels, intake levels through foods, and human body burdens of dioxins. This paper also provides an overview and comparison of recent hazard assessments for dioxins from U.S. and international agencies. Available data on emissions, environmental and food levels, and human body burdens of dioxins in the general population indicate a several-fold reduction in exposures and body burdens in the general population over the three decades from 1970 to 2000. U.S. and international hazard assessments concur on certain aspects, but disagree on fundamental issues including the likelihood of a threshold for carcinogenic dose-response and the degree of safety factors needed in deriving a protective exposure limit. These disagreements have significant consequences for interpreting the potential health risks of current background dioxin exposure levels. However, whatever the degree of health risk that may be associated with current background exposures, the general population is experiencing several-fold lower exposures, and, therefore, lower health risks, currently compared to 30 years ago. In light of the dramatic declines in exposure already observed, further efforts to reduce exposures through attempts to control emissions or food levels should be carefully evaluated to understand the likely efficacy of the efforts and the relative costs and benefits.

A look at some of the developments of 2002 from the regulator's perspective.

Public employers provide health insurance coverage to nearly 16 percent of all U.S. workers. Their reactions to rapidly rising premiums can have an important effect on local markets for health insurance because of their size, their visibility, and their reflection of public policy. However, public employers are constrained in their responses by tight budgets set by elected officials and statutes regarding due process, public input, and public accountability. As insurance markets consolidate and premiums continue to increase, public employers face tough choices regarding employee benefits.

A personal view is presented on progress made during the last 25 years in applying the Three Rs (reduction, refinement, replacement) to animal testing in regulatory toxicology, with an emphasis on "good moments" (for example, international workshops on the principles and practical application of the validation process and on regulatory acceptance) and "not-so-good moments" (for example, the time taken to accept alternatives to the LD50 test and to accept in vitro tests for skin absorption as OECD Test Guidelines). The importance of dialogue and cooperation between international coordinating centres and scientific activities at the national level is stressed, as exemplified by the work of ECVAM during its first decade.

Background: Continuing controversy surrounds screening mammography, particularly for women 40 to 49 years of age. Newspapers are potentially important sources of information on this topic, but it is not known whether they provide well-founded and objective information and recommendations., Objective: To examine how screening mammography is reported in newspapers., Design: Cross-sectional descriptive study., Setting: 6 top-circulation U.S. newspapers, 1990 to 1997., Measurements: Number of articles about screening mammography, issues covered by the articles, information sources, content and sources of quotes, recommendations cited in articles, and presentation of risks and benefits., Results: The most common theme of newspaper articles about mammography was screening for women 40 to 49 years of age. Thirty-one percent of the articles presented information without citing a source or justification. Quotes and recommendations in the articles were approximately twice as likely to support as to express reservations about mammography for women aged 40 to 49 years. Recommendations changed little over time and rarely reflected changes in recommendations of national organizations. Of the 102 articles describing the benefits of mammography, 95% expressed them in relative terms and 11% expressed them in absolute terms., Conclusions: Newspapers tended to overrepresent support for screening mammography for women aged 40 to 49 years. Reports would have been improved by identification of all sources for information cited, less reliance on relatively few sources, and discussion of benefits in absolute as well as relative terms. Medical journalism may benefit from identification of standards similar to those used for reporting medical research.

Zimbabwe's agricultural biotechnology research capacity is located at universities, government research institutions and parastatal (state funded) organizations. Projects range from those using traditional biotechnology to a few that are experimenting with genetically modified organisms (GMOs).

The authors investigated exposure to high-level occupations in relation to the well-known survival advantage of women compared with men of the same age. Women in the federal workforce in positions of General Schedule 14 and above in 1979--1993 (n = 4,727) were each matched with three men (n = 14,181) by age, General Schedule level, and supervisory role. Fifteen-year mortality rates were compared between men and women and against expected 15-year mortality from the US general population. Despite similar job demands, women experienced markedly lower 15-year mortality than did men. However, men in these positions had nearly 50% lower mortality compared with age-matched men in the general population; the comparable reduction for women was 38%. The simultaneous substantial, but unequal by gender, improvement in mortality resulted in a reduced male/female mortality ratio, from 1.67 in the general population to 1.40. The reduced male/female mortality ratio was especially prominent for cancer and was not evident for heart disease mortality. Survival was nominally higher in non-White than in White participants. In summary, high-level employment is associated with substantially reduced mortality in both men and women. The relative improvement in survival is greater in men despite a comparable reduction in risk of heart disease mortality by gender.

Monitoring the quality of drinking water is a cardinal task of German Public Health Offices and of the relevant Ministries of Health of the German Federal states ("Länder"). Today this can be tackled on a large scale and economically only with computer assistance. A system has been developed in North Rhine Westphalia on behalf of the Ministry of Health, for data assessment and communication which is suitable for practical work and user friendly. It aims at supporting the Public Health Offices in their daily work and at improving and simplifying the monitoring of drinking water supply systems and of drinking water quality control.

The right of the Israeli public to get information from state authorities has been based until recently only on Israeli Supreme Court rulings. In 1998, a Law of Freedom of Information was enacted. The new Law tries to follow the rulings of the Israeli Supreme Court regarding freedom of information, in establishing substantive statutory arrangements.

The end of the Cold War has called into question the activities of the national laboratories and, more generally, the level of support now given to federal intramural research in the United States. This paper seeks to analyze the potential role of the laboratories, with particular attention to the possibility, on the one hand, of integrating private technology development into the laboratory's menu of activities and, on the other hand, of outsourcing traditional mission activities. We review the economic efficiency arguments for intramural research and the political conditions that are likely to constrain the activities of the laboratories, and analyze the early history of programs intended to promote new technology via cooperative agreements between the laboratories and private industry. Our analysis suggests that the laboratories are likely to shrink considerably in size, and that the federal government faces a significant problem in deciding how to organize a downsizing of the federal research establishment.

We surveyed the present status and future roles of Tuberculosis (TB) Advisory Committees to study the ideal concept of the Committees using questionnaires. After the introduction of the new TB Control Law (which allowed the integration of the Committees), about half of the local governments (prefectures, special cities and special wards in Tokyo) have decreased their committees numbers by a third to two-thirds of the original number of health centers. In order to improve the quality of the Committees, there were additional educational activities suggested by the respondents in the questionnaire. However there were several problems highlighted in the questionnaire, for example a decrease in TB specialists, the aging of Committee members and some Committees with extremely low numbers in reported cases of TB. For the improvement of the Committees both in quality and the range in activities, it is not enough to integrate the Committees. It is recommended that the Committees should be improved in training and education for doctors and staff of the health centers and that they contribute more in comprehensive counter measures against TB in each region. In future the Committees roles should be enlarged and improved in quality, for example, to carry out extra periodic mass screening for TB, and to examine the chest x-rays in mass screenings for lung cancer.

Based on cardinal problems of medical prevention, the author formulates priority lines of action for the country's health structures in the field of community health, emphasizing areas for interaction between the National Center of Hygiene and Hygiene-and-Epidemiology Inspectorates across the country. According to the author, priority problems necessitating collaborative efforts between the National Center of Hygiene and HEIs throughout the country should be focused on the following areas: updating sanitary legislation; environmental monitoring, including community and territorial planning; health risk assessment; development of an efficient health-information system concerning environment and health; manpower training; and ecologic education of the public. Collaboration also needs to cover joint implementation of projects at international collaboration level along the lines of the World Health Organization, the PHARE programs, etc. The priorities referred to also reflect the conception of medical prevention functions in the area of community health.

This study presents a historical retrospective of research activities in nursing in Brazil, with emphasis on systematization, tendencies and diffusion of these studies, especially for the support of these by the National Council of Scientific and Technological Development. The origins and actual structure of this agency is also presented. In discussing the insertion of nursing in this agency of financial support, the contradictory situation between the official proposal for the training of a nurse and the orientation offered by the National Council of Scientific and Technological Development is reported. This study also offers reflection about the importance of the definition of research lines for nursing, in view of the actual demands of the process of knowledge production.