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Biomedical subjects

N Fulop

Publications and source records attributed to N Fulop.

15 recordsLinked to original sources
PubMed2000

Determinants of unsafe sex in women.

We aimed to identify determinants of condom usage and unsafe sex in women having sex with a new partner. One hundred women attending either a genitourinary medicine (GUM) clinic or a family planning clinic participated in the study. Respondents were interviewed about last 3 new male partners, from the beginning of the sexual relationship through its development, if any. Data analysis was primarily qualitative, quantitative analysis was conducted where appropriate. Alternative contraceptive use was the most commonly reported determinant of condom usage overall. The most commonly reported determinant of condom use for prophylaxis was the woman's perception of her partner and the risks he presented. Models of risky sexual behaviour have focused on the individual's generalized estimation of risks of acquiring STDs. Existing models are poor predictors of risky sexual behaviour. We propose that it is the perceived risk presented by a particular individual partner, not global risk, which influences behaviour. An individual risk model is put forward.

Adolescent↗
PubMed1999

Drink, illicit drugs and unsafe sex in women.

AIMS: To establish the extent and nature of linkages between illicit drug and alcohol use and sexual behaviour in women. PARTICIPANTS AND SETTING: One hundred women attending either a Genitourinary Medicine Clinic or a Family Planning Clinic. DESIGN: Respondents were interviewed using a semi-structured interview schedule covering the effect of drink/illicit drug use on the incidence of sex, on condom use, and on specific sexual activities, and deliberate use of drink/illicit drugs to affect sex. Interviews focused on the last three new male partners, from the beginning of the sexual relationship through its development. Data analysis was primarily qualitative, quantitative analysis was conducted where appropriate. RESULTS: There were few cases in which women reported that consumption of drink/illicit drugs caused them to engage in sexual behaviour which they would not have engaged in if they had not had drink/drugs. Associations between drink and illicit drugs and sexual behaviour were, mainly, either because encounters took place in social situations where drugs or drink were being consumed or because the woman used drink or drugs instrumentally to engage in desired behaviours. There was some evidence to suggest that greater use of drugs and alcohol might be part of a wider pattern of social behaviour including more sexual partners. CONCLUSIONS: The women's self-reported behaviour suggested that illicit drug and alcohol use in itself did not usually result in unsafe or undesired sexual behaviour.

Acquired Immunodeficiency Syndrome↗
PubMed1999

The influence of health needs assessment on health care decision-making in London health authorities.

OBJECTIVES: Health needs assessment gained prominence under the model of health care purchasing developed to support the 1991 reforms of the UK National Health Service (NHS). The objectives of this paper are to determine how needs assessment has been used in the NHS, to assess the influence it has had on decision-making, and to relate the observed uses of needs assessment to competing theoretical models of health care policy-making. METHODS: A survey of needs assessment activity in 14 London health authorities identified 217 needs assessments conducted between 1993 and 1996. Semi-structured interviews were conducted with public health and commissioning staff in each authority. RESULTS: The survey indicated that needs assessment directly supported decision-making and action in two-thirds of the studies identified, but up to 20% of needs assessments had no impact on service provision. Four key functions of health needs assessment were observed: identifying a problem; planning detailed changes to services; providing post hoc justification for earlier decisions; and using participation in needs assessment to build 'ownership' of subsequent decisions. CONCLUSIONS: The survey suggests that needs assessment is, in practice, consistent with a 'mixed scanning' model of decision-making. Needs assessment is used to help select issues for detailed investigation and to direct analytical and decision-making resources. However, certain key areas are not amenable to technical analysis and solution, and are resolved through bargaining.

Data Collection↗
PubMed1996

Assessing the impact of delayed discharge on acute care.

This study examined the incidence of delayed discharge in three acute treatment wards. Of 118 admissions during the eight-week study period, 13.5 per cent (n = 16) were categorised as 'inappropriately located' by the study tool. The staff cited lack of rehabilitative facilities or care of the elderly facilities as reasons for patients' inappropriate stay in the acute ward. The authors recommend that healthcare professionals and social services departments liaise more closely to reduce the incidence of delayed discharge and allow these patients to return to the community whenever feasible.

Acute Disease↗
PubMed1996

What impact do annual public health reports have?

Each district health authority is required to produce an annual report on the health of their population. Although they consume considerable resources, there is little evidence as to their impact on their intended audiences. We describe the results of a postal survey of how these reports are viewed by health authority and local government managers in one region. Eighty-nine out of 139 responded (64%). Over half of the managers had read the reports in their entirety. Most were discussed by health authorities but few by relevant local government committees. There was some disagreement between directors of public health and other health authority managers about the impact of the reports on commissioning. The paper discusses the difficulties in evaluating the impact of annual public health reports. The survey reveals a fundamental disagreement about whether the intended audience should be health care purchasers or the public. This reflects an underlying tension about the role of public health and the debate about its independence.

Administrative Personnel↗
PubMed1996

Preventing sudden infant deaths--the slow diffusion of an idea.

The sudden infant death syndrome (SIDS) is among the leading causes of post-neonatal mortality in industrialised countries. Research has highlighted that many of these deaths are avoidable by adopting a few simple precautions. These include sleeping in the supine position, avoiding exposure to tobacco smoke, breast feeding where possible, and avoiding over heating. The paper traces the development of understanding of the role of sleeping position in the aetiology of SIDS and the diffusion of this knowledge among and within industrialised countries. In retrospect, evidence began to become available in the early 1980s but it was several years before it was acted upon, initially in The Netherlands and subsequently in New Zealand, the United Kingdom and Scandinavia. Several countries have mounted major national preventive campaigns, of various kinds, each of which has been associated with a reduction in deaths from SIDS, but others have not. The reasons for these differences are explored. The evidence for a causal link between sleeping position and SIDS is now very strong and the costs of implementing a policy to change behaviour is small, compared with other health care interventions. This information is now widely available in the international literature. The example of SIDS provides information on the barriers to adoption of knowledge as well as the factors that promote it.

Developed Countries↗
PubMed1996

Changing life expectancy in central Europe: is there a single reason?

BACKGROUND: During the 1980s, at a time that life expectancy at birth in western Europe has increased by 2.5 years, it has stagnated or, for some groups, declined in the former socialist countries of central and eastern Europe. METHODS: A study was carried out to ascertain the contribution of deaths at different age groups and from different causes to changes in life expectancy at birth in Czechoslovakia, Hungary and Poland between 1979 and 1990. RESULTS: Improvements in infant mortality have been counteracted by deteriorating death rates among young and middle-aged people, with the deterioration commencing as young as late childhood in Hungary but in the thirties or forties in Czechoslovakia and Poland. The leading contributors to this deterioration are cancer and circulatory disease but, in Hungary, cirrhosis and accidents have also been of great importance. CONCLUSIONS: The patterns observed in each country differ in the age groups affected and the causes of death. Further work is required to explain these differences.

Adolescent↗
PubMed1996

Does hospital-at-home make economic sense? Early discharge versus standard care for orthopaedic patients.

Hospital-at-home has been promoted as a potentially effective means of replacing costly inpatient care with cheaper domiciliary care. We studied three hospital-at-home schemes in West London providing intensive home care for early discharge orthopaedic patients, comparing their costs with those of standard inpatient care. Although costs per day of hospital-at-home care were lower than those of inpatient care, the schemes appeared to increase the total duration of orthopaedic episodes, so that the costs of standard care, per episode, were lower than those of hospital-at-home. While hospital-at-home may offer considerable future potential, substitution of home care for inpatient care will not necessarily save resources.

Cost-Benefit Analysis↗
PubMed1993

The inappropriate use of acute hospital beds in an inner London District Health Authority.

The requirement for District Health Authorities to assess the health care needs of their population implies that they must consider how well acute hospital care meets these identified needs. This study, which was conducted in an inner London health district, identified that 123 (14.6%) patients were perceived by medical and/or nursing staff to be inappropriately located in an acute bed. This group was dominated by patients aged 65 years or above, those in general and geriatric medicine, those with a length of stay of 30 days or more, and those with high levels of physical and mental dependency. The main reasons for patients being labelled as 'inappropriate' were the need for non-acute health services (eg rehabilitation, terminal care etc), a need for nursing home places or because of social or housing problems. Five months after identification, the notes of 100 of the 123 inappropriate patients were traced. Retrospective classification of these notes using the more 'objective' Oxford Bed Study Instrument showed that 97 patients were still defined as inappropriate. Details of the length of inappropriate stay were available for 74 patients who accrued 7,519 inappropriate bed days at a cost of 836,547 pounds. These patients are an illustration of the potential failings of current health and social care systems and highlight the need for imaginative care solutions which bridge this divide.

Adult↗