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PubMed2004

An assessment of abortion services in public health facilities in Mozambique: women's and providers' perspectives.

Complications of unsafe abortion contribute to high maternal mortality and morbidity in Mozambique. In 2002, the Ministry of Health conducted an assessment of abortion services in the public health sector to inform efforts to make abortion safer. This paper reports on interviews with 461 women receiving treatment for abortion-related complications in 37 public hospitals and four health centres in the ten provinces of Mozambique. One head of both uterine evacuation and contraceptive services at each facility was also interviewed, and 128 providers were interviewed on abortion training and attitudes. Women reported lengthy waiting times from arrival to treatment, far longer than heads of uterine evacuation services reported. Similarly, fewer women reported being offered pain medication than head staff members thought was usual. Less than half the women said they received follow-up care information, and only 27% of women wanting to avoid pregnancy said they had received a contraceptive method. Clinical procedures such as universal precautions to prevent infection were less than adequate, in-service training was less than comprehensive in most cases, and few facilities reviewed major complications or deaths. Use of dilatation and curettage was far more common than medical or aspiration abortion methods. Current efforts by the Ministry to improve abortion care services have focused on training of providers in all these matters and integration of contraceptive provision into post-abortion care.

Adolescent↗
PubMed2005

Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs.

BACKGROUND: In resource-poor countries, there remains an alarming treatment gap for people with schizophrenia, particularly those living in rural areas. Decentralization of mental health services, including community-based outreach programmes, represents one obvious strategy for bringing appropriate care to these communities. This study set out to assess the costs and effects of such a programme in rural Karnataka in India. METHOD: Eight rural communities were visited by an outreach team, who identified cases of drug-naive or currently untreated schizophrenia. Recruited cases were provided with appropriate psychotropic medication and psychosocial support, and after obtaining informed consent were assessed every 3 months over one and a half years on symptomatology, disability, family burden, resource use and costs. A repeated-measures analysis was carried out to test for significant change in these outcome measures over this period. RESULTS: A total of 100 cases of untreated schizophrenia were recruited, of whom 28% had never received antipsychotic medication and the remaining 72% had not been on medication for the past 6 months. Summary scores for psychotic symptoms, disability and family burden were all reduced significantly, with particular improvement observed at the first follow-up assessment. Increases in treatment and community outreach costs over the follow-up period were accompanied by reductions in the costs of informal-care sector visits and family care-giving time. CONCLUSIONS: Efforts to organize community-based care such as outreach services for people with schizophrenia living in more remote areas of resource-constrained countries can bring substantial benefits to patients and families alike.

Adult↗
PubMed2003

The use of formal and informal curative services in the management of paediatric fevers in four districts in Kenya.

OBJECTIVE: To assess the sources, costs, timing and types of treatment for fevers among children under 5 years of age in four ecologically distinct districts of Kenya. METHODS: Structured questionnaires were administered to caretakers of one randomly selected child aged <5 years per homestead to establish whether the child had had a fever within the last 14 days and the types, sources, costs, and timing of treatment. Drug charts of common proprietary anti-malarial and antipyretic drugs in Kenya were used as visual aids. RESULTS: A total of 2655 fevers were reported among 6287 (42.2%) children with significant differences between the four districts (P<0.01). A substantial number of fevers remained untreated (28.1%) across all districts and more fevers were treated in Greater Kisii than any other district (P<0.01). The median delay to any treatment was 2 days [inter-quartile range (IQR): 2, 4]. The informal retail sector had no transport costs associated with it and charged less for drugs than all the other sectors. Most antimalarial treated fevers occurred in the formal public sector (52.6%). Only 2.3% of fevers were treated within 24 h of onset with a sulphur-pyrimethamine drug, the nationally recommended first-line drug for the management of uncomplicated malaria. CONCLUSIONS: The Abuja target of ensuring that 60% of childhood fevers are treated with appropriate antimalarial drugs within 24 h of onset by 2010 is largely unmet and a major investment in improving prompt access to antimalarial drugs will be required to achieve this.

Analgesics, Non-Narcotic↗
PubMed2001

Measuring the socialization of graduate and diplomate nurses using the Corwin Role Orientation Scale.

The nature of United Kingdom (UK) nursing education has changed significantly as the responsibility has been transferred from hospitals to the University sector. More information is needed on the outcome of the Project 2000 diploma and degree courses given the rapidly changing health care context. This paper focuses on the role socialization of graduate and diploma nurses. As part of a larger study, this research investigated the role orientations of 52 nursing graduates and 28 diplomates from two different universities at three time points; on graduation and at 6 and 12 months postgraduation. The Corwin Role Orientation Scale was selected and modified for the study. It comprised of three separate scales measuring professional, bureaucratic and service orientation. The data from the two groups of nurses were examined to identify nurses' ideal role orientations and role discrepancies over the transitionary period from graduate to qualified nurse. Although the results showed observed differences between the groups over time, none of these differences were statistically significant. The findings raise a number of questions about the value of the instrument as a measure in the contemporary nursing context. Furthermore, each of the Corwin subscales had a low internal reliability. A possible explanation may be that the instrument, which was developed in the United States of America (USA) in the 1960s, and modified, for this study, has little relevance for contemporary UK nursing. The study findings are also limited by the small size of the sample. In spite of these limitations, the study suggests there are few differences between the role orientations and socialization experiences of UK nursing graduates and diplomates. Indeed, both programmes commonly take place in university settings and students receive the same amount of clinical experience. Further instrument development and exploratory research is recommended to identify the role socialization and orientations of UK nurses through larger national studies.

Education, Nursing, Baccalaureate↗
PubMed2000

The management of osteoarthritis in the third millennium.

Osteoarthritis (OA) is already the most common disorder of joints, and is likely to go on increasing in prevalence. Primary prevention, although theoretically possible, is unlikely to occur because it would need major behavioural changes within society as a whole. Similarly, disease control through drugs seems unlikely to be achieved for a disorder that is an age-associated, mechanically driven "disorder of evolution". Current treatment is not very effective (with the exception of joint replacement), is dominated by drug therapy, and by the interests of those in the secondary care sector. The information revolution, combined with increasing understanding of the nature of OA, is likely to lead to major changes in management strategies in the future. There may be little of no place for the rheumatologist within future management of OA.

Forecasting↗
PubMed1998

Formal determinants of informal arrangements: housing and undocumented immigrants in Rotterdam.

"Using data on undocumented immigrants in the city of Rotterdam, it is argued that peculiarities of the Dutch housing market, especially the large degree of decommodification of the housing stock, lead to a specific housing situation and housing career of illegal immigrants.... The housing situation of undocumented immigrants in Rotterdam clearly shows how formal arrangements create conditions for informal practices.... A comparison between Dutch and U.S. data shows that differences in formal arrangements have substantial effects on the potential of ethnic solidarity within immigrant communities."

Americas↗
PubMed1998

Immigrant involvement in the informal economy: the Portuguese case.

"This article demonstrates how Portugal, despite appearing to be a country which would be [an] unattractive country to immigrants, is rapidly becoming a country of immigration. The existence and extent of opportunities for immigrants in Portugal is assessed with this objective in mind. On the basis of an analysis of the country's labour market, the immigrants' economic profiles and the Portuguese informal economy--and the interaction of these factors--it is concluded that the Portuguese economy is currently generating labour demands which the immigrants are satisfying. In some cases they complement and in others they substitute for the domestic labour force."

Demography↗
PubMed1992

Informal caring networks among Chinese elderly with disabilities in Hong Kong.

Community care has been a major guiding policy in developing services for the elderly in Hong Kong. It has been assumed that Chinese families tend to have a large caring network to render care in the community. However, in a survey conducted in early 1991, it was found that such caring networks for disabled elderly people were very small and inconsequential. Quite a high proportion of Chinese disabled elderly are living alone in the community, and have a small network for emotional support. Effective measures to promote family care of disabled elderly people are discussed. Two pathways for integrating the formal and informal care sectors are examined in relation to promoting effective practice for the frail elderly living in the community.

Activities of Daily Living↗
PubMed2000

Recent declines in reported syphilis rates in eastern Europe and central Asia: are the epidemics over?

BACKGROUND: Since the early 1990s, major syphilis epidemics have occurred in the Newly Independent States (NIS) of the former Soviet Union. The new and rapidly changing societal and economic conditions in these countries challenge their traditional approaches to the control of sexually transmitted infections (STI). Nevertheless, following a steady increase until 1997, reported syphilis incidence has declined during the past 3 years in most parts of the region. We examine these trends against a background of ongoing changes in service delivery, care seeking behaviour, and case finding practices. METHODS: National syphilis surveillance data reported to the WHO Regional Office for Europe were compiled and analysed, and supplemented with information presented at recent expert meetings and with results from ongoing research. RESULTS: Since 1997, reported syphilis incidence either stabilised or declined in many locations in the NIS, but further increased in others, especially in rural areas. Congenital syphilis continued to increase in all countries, except Latvia. The proportion of self presenting cases versus cases detected through screening declined, and so did notifications of early compared with late forms of syphilis. Patients increasingly seek care in the private formal and informal healthcare sectors which hardly participate in case reporting. CONCLUSIONS: Recent declines in syphilis notifications in the NIS are at least partially a reflection of a reduced intensity of active case finding and of changes in reporting completeness because of a shift in service utilisation from the public to the private/informal sectors. Syphilis rates are still high, indicating that both public and private sectors have to respond more efficiently to the needs of many people at risk of STI. The collection of serial STI prevalence data is recommended to be able to validate trends in notifications.

Adolescent↗
PubMedDate not supplied

[Singularization processes: a proposal for continuity between clinical activity and health policy objectives].

BACKGROUNDS AND OBJECTIVES: In 1996 the Gipuzkoa Territorial Health Agency (Basque Country, Spain) created the Health Plan Service. The aim was to transform the health objectives prioritized by the Health Department into intervention strategies to be incorporated into the local contract services. PROCESS AND RESULTS: One of the procedures the service uses for this purpose, known as < >, involves selecting a process linked to a prioritized health problem, and analyzing and reconstructing it so that the related activity, expected results, financial costs and its impact on the population's health can be identified. After this process the service provides the Territorial Health Agency, which is responsible for service purchase for the public and private sectors, with information about contract conditions for the process reviewed. Annual assessment of contract services monitors the extent to which the agreements made have been carried out and their consequences on the population's health. The present article deals with the process through which this < > is carried out.

Contracts↗
PubMed1993

Vietnamese refugees and blocked mobility.

"This paper examines data from published sources and ethnographic studies conducted by the authors in Oakland, California and Philadelphia [Pennsylvania] to assess the economic situation of Vietnamese refugees in the United States. Evidence suggests that in strong contrast to being a 'success story,' the economic status of many recently arrived Vietnamese refugees is characterized by unstable, minimum-wage employment, welfare dependency and participation in the informal economy. The paper suggests that the group's economic opportunities have been limited by the configuration of circumstances that have surrounded their entry and settlement into the United States as refugees, as well as by the demographic structure of the group."

Americas↗
PubMed2005

Confidentiality with respect to third parties: a psychoanalytic view.

It is assumed that confidentiality is not one singular ethical entity but a conglomerate of quite different issues depending upon clinical context and the sector of information sharing at stake. The focus here is on how to think psychoanalytically about requests for information from third parties (payers, courts, public security). Defining confidentiality as a promise to 'never tell anything' outside of the relationship omits evaluation of the impact of the third's listening on the combined freedom of thought and freedom of speech in analyst and analysand. Circulation of information outside the dyad need not be toxic, need not disrupt the analytic couple's openness to new meaning. Key to contamination and inhibition of analytic work is whether or not disclosure serves an analytic end. Current defense of confidentiality relies heavily on the models of protection of privacy and professional secrecy, which, though useful and relevant, fail to encompass the transitional, intersubjective space engendered by the analytic process. Suggestions are made for alternate sources of paradigms better suited to represent the latter. Offered for discussion is a draft of a confidentiality policy with respect to third parties that is informed by psychoanalytic theory and clinical practice rather than by local legal jurisdiction or original disciplines' ethics codes.

Confidentiality↗
PubMed2006

[Environmental surveillance in health in Brazil's Unified Health System].

The incorporation of environmental surveillance in the field of public health policies is a relatively recent demand in Brazil. One of the major challenges in environmental health surveillance is defining its object and the specificity of its practice. The expanded concept of exposure, treated as a set of complex relations between a society and the environment, and not as a personal attribute, is central to the definition of indicators and should guide the practice of environmental surveillance in the health sector. Among the difficulties encountered in applying this concept within the Brazilian Health System, is the need to restructure health surveillance activities and to form multidisciplinary teams capable of dialoguing with other sectors. Furthermore, information systems capable of aiding in health situation analysis and decision making must be constructed. Taking this into consideration, a review of the object and concepts of environmental health surveillance was undertaken and the challenges with respect to its implementation in the Brazilian Health System were identified.

Brazil↗