A turbulent decade: lessons from the 'health reforms'.
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Biomedical subjects
Publications and source records attributed to A Hornblow.
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AIMS: To obtain estimates of the costs of the main options of care for the long term mentally ill and to compare different approaches to costing. METHOD: Resources used by samples of residents in extended hospital care (EC, n = 43), community staffed houses (SH, n = 30), boarding houses (BH, n = 43) and group homes (GH, n = 100) were identified and costed using both the expenditure and total resource concepts of cost estimation. RESULTS: Using the expenditure concept of cost SH was the most expensive at $773 per person per week, compared to $700 for EC, $189 for BH and $155 for GH. Using the resource cost approach, valuing all resources used, SH and EC were similar at $790, compared to $184 and $169 for BH and GH care. Nursing was the most costly input with striking differences between nursing costs in the four modes of care. CONCLUSIONS: The results indicate a gap in the spectrum of residential care options, between high and low cost care. Future funding arrangements will require improved linkage between needs assessment and resource provision.
AIM: To evaluate the planned movement of long stay patients with chronic mental disorders from Sunnyside Hospital into staffed residential accommodation in the community. METHOD: Sixty-nine long stay psychiatric patients were followed up over 18 months to assess their social functioning, psychiatric symptomatology, resource use, relapse rate, satisfaction with their care, and impact on the community. RESULTS: Social functioning and psychiatric symptomatology scores on the social behaviour schedule remained stable overall. Relapse rates were low, and rehospitalisation rare. Use of community and area health board resources tended to decrease. Over 90% of patient responses indicated satisfaction with their new living arrangements. Over 50% reported no contact with outside friends, though over the follow up period about 70% maintained at least monthly contact with relatives. CONCLUSION: Careful community placement of the long term mentally ill, with ongoing supervision, can have a successful outcome from clinical, patient and community perspectives.
We have studied a normal adult caucasian population (462 females, 264 males age range 20-84) using dual photon absorptiometry to establish patterns of bone reduction at the spine and hip. Subjects were either randomly selected from the electoral roll or volunteers. Bone mineral density reduction at the lumbar spine in females appeared to increase at 40 years and was sustained until 60 years. In males bone mineral density at the spine was preserved. The density at the hip in females decreased throughout adult life beginning before the menopause. In males bone density was preserved at the femoral neck and trochanteric region but not at Wards triangle where reduction occurred throughout life. When compared with other normal populations there was higher bone mineral density at the spine in postmenopausal New Zealand females but no significant difference at the hip.
Medical students' levels of anxiety under different conditions of stress were investigated, as well as the stability of anxiety ratings from one examination to another. After completing an end-of-term psychiatry examination, fourth-year medical students at Monash University were asked to score the Visual Analogue Scale for Anxiety (VASA) for three situational cues; usual day-to-day anxiety, highest anxiety associated with major exams the previous year and anxiety experienced in the end-of-term examination just completed. Twenty-eight weeks later students rated their anxiety in a subsequent end-of-term psychiatry examination. Most students rated themselves toward the lower end of the VASA for day-to-day anxiety and as having significantly, though not markedly higher anxiety in the end-of-term psychiatry examinations. The previous year's examinations, marking the end of pre-clinical training, provoked extremely high anxiety for most students, who achieved academically despite this. Comparison of anxiety ratings for the two end-of-term examinations indicated that VASA ratings shifted substantially for half the class. This variation suggests that students' levels of anxiety are not stable and predictable from one examination to another. Examination anxiety should not be seen necessarily as a consistent response to a specific and recurring situation. It is postulated that a range of situational factors and personal pressures, operating at the time, may determine how much anxiety is experienced as a reaction to the examination.