From service provision to function based performance - perspectives on public health systems from the USA and Israel.

If public health agencies are to fulfill their overall mission, they need to have defined measurable targets and should structure services to reach these targets, rather than offer a combination of ill-targeted programs. In order to do this, it is essential that there be a clear definition of what public health should do- a definition that does not ebb and flow based upon the prevailing political winds, but rather is based upon professional standards and measurements.The establishment of the Essential Public Health Services framework in the U.S.A. was a major move in that direction, and the model, or revisions of the model, have been adopted beyond the borders of the U.S.This article reviews the U.S. public health system, the needs and processes which brought about the development of the 10 Essential Public Health Services (EPHS), and historical and contemporary applications of the model. It highlights the value of establishing a common delineation of public health activities such as those contained in the EPHS, and explores the validity of using the same process in other countries through a discussion of the development in Israel of a similar model, the 10 Public Health Essential Functions (PHEF), that describes the activities of Israel's public health system. The use of the same process and framework to develop similar yet distinct frameworks suggests that the process has wide applicability, and may be beneficial to any public health system.Once a model is developed, it can be used to measure public health performance and improve the quality of services delivered through the development of standards and measures based upon the model, which could, ultimately, improve the health of the communities that depend upon public health agencies to protect their well-being.

Factors affecting Varicella vaccine uptake among children 1-17 years old in the Haifa District in 2007.

The Israeli National Vaccination Program (INVP) is aimed mainly at the pediatric age group. Till 2008 the program did not include routine administration of vaccine against Varicella (chickenpox). For the past 7 years, however, vaccine against Varicella has been available to the public and subsidized through the health maintenance organizations (HMOs). On the eve of probable introduction of the Varicella Zoster Vaccine (VZ-V) into the INVP a study was conducted to examine factors postulated to be of importance in vaccination uptake. These factors can be assessed while the vaccine is only administered through active choice, as opposed to administration by default as part of INVP. The study group comprised the communities in the District of Haifa. The aim of the study was to assess vaccination rates and contributing factors in the decision to vaccinate or not vaccinate against VZ. The study showed that uptake of VZ-V was in correlation with: 1. Population group (i.e. religious denomination)--Jews were more likely to vaccinate (OR=3.88). 2. Level of education--parents with higher level of education were more likely to vaccinate. (OR=1.91). 3. Level of religious observance--non-observant parents were more likely to vaccinate (OR=2.7) 4. Complementary insurance (reimbursement of cost)--parents with complementary insurance were more likely to vaccinate (OR=3.41). 5. A physician's recommendation to vaccinate--when a physician recommendation was given for vaccination the likelihood of vaccination was increased (OR=2.94).

Describing the social environment of elderly persons at the time of death.

OBJECTIVES: To describe the social environment of elderly persons at the time of their death and its correlates. DESIGN: Telephone interviews with the next-of-kin of deceased elderly persons. PARTICIPANTS: Potential participants were the next-of-kin of all Jewish elderly individuals who died during the course of one year in a major city in the northern part of Israel. The final sample included 139 participants (58% response rate; 70% cooperation rate). MEASUREMENTS: Information was collected regarding the decedents' social environment three days before their death and at the time of death. Eight types of informal sources of support and four sources of formal support were examined. The correlates examined included the decedents' demographic, health, social, and death characteristics. RESULTS: The majority of the decedents died while surrounded by at least one family member. Having a larger social network was associated with a larger number of persons present at the time of death. Being informed about the impending death was associated with a larger number of persons from the formal and informal networks present at the time of death. CONCLUSIONS: The common fear of dying alone and isolated was not confirmed by this study. Increased efforts should be invested in helping professionals to deal with the difficulties inherent to the process of diagnosing an upcoming death.

Oral anticoagulants in the elderly.

Over a 1-year period, 34,998 prothrombin time tests were performed on 2,379 patients aged 40-89 years with a recommended target International Normalized Ratio (INR) value of 2.5. At least one INR value of >/= 5 was found in 507/2,379 patients (21.3%). The elderly demonstrated higher maximum and lower minimum INR values, lower warfarin doses, and an increased number of tests performed. After adjustment for these factors, the risk of INR values >/= 5 increased with age by 15% every 10 years (95% CI 4-28%). We conclude that age is a risk factor for more unstable prothrombin time results.