Family planning services in Sub-Saharan Africa.
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Abortion, Illegal↗
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Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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Universal coverage in the United States: lessons from experience of the 20th century.
Both the rising numbers of uninsured Americans and the recent presidential election have put the issue of universal health insurance coverage back on the national agenda. Lack of health insurance is a major barrier to care for 44 million Americans, and lack of high-quality, comprehensive insurance is a barrier to millions more. Universal coverage is one of the best ways to ensure that all Americans have equitable access to quality care, and it also contributes to the financial stability of health care providers, especially those in the urban safety net. A wide variety of ideas to expand health care coverage were proposed, and in some cases enacted, during the last century. At the beginning of the 21st century, the American health care system is made up of varied elements, ranging from employer-sponsored health insurance for the majority of working-age adults to the public Medicare program for the elderly. While this patchwork system leaves many Americans without health insurance, it also creates many different ways to expand coverage, including various options in both the private and public sectors. By understanding how the current health care system developed, how the various proposals for universal health coverage gained and lost political and public support, and the pros and cons of the various alternatives available to expand coverage, we create a solid base from which to solve the problem of the uninsured in the 21st century.
Health Benefit Plans, Employee↗
Changes in insurance coverage: 1994-2000 and beyond.
The number of uninsured Americans fell in 2000 for the second consecutive year. The reduction has been attributed to the continued expansion of employer-sponsored insurance. However, the increase in employer coverage among adults was offset by declines of other types of coverage. For children, increases in public coverage plus the growth in employer-sponsored insurance led to the reduction in the number of uninsured children. Over the longer period (1994-2000), one of great economic growth, the uninsurance rate was essentially the same at the end as at the beginning. The rate of employer-sponsored insurance increased sharply, so that more people had employer coverage. However, these increases were offset by reductions in other forms of coverage, particularly Medicaid and state-sponsored insurance and private nongroup coverage, so the overall rate of uninsurance did not change.
Adult↗
Use of sealants: societal and professional factors.
At present, sealant use continues at a low level in private practice by dentists and hygienists, and is moderate in community programs although there is high interest in their use in public health settings. Widespread delegation of sealant application to hygienists has not occurred even though the majority of state dental practice acts allow it, and even though practicing hygienists are highly interested in applying sealants. Use in federally sponsored programs is minimal or nonexistent. Information about sealants and adequate clinical experience in their application appear minimal in dental training institutions, and few opportunities have existed for continuing education. Generally, knowledge about sealants among dentists is low; many hold doubtful opinions. Insurance carriers, including commercial, provider, and governmental programs, appear reluctant to reimburse for sealants without purchaser demand and organized dentistry's blessings. Although society emphasizes patient rights to informed consent, few opportunities exist for the public, including group insurance purchasers and union negotiators, to learn about sealant use in conjunction with appropriate fluoride use. Public educational materials are sparse. Manufacturer marketing efforts at present, aimed at providers alone, are at best minimal, with a few exceptions; those targeting the public are nonexistent. Organized dentistry's Council statements may have contributed to a constriction, to date, in the flow of public information about sealants from industry. Lack of communication, or miscommunication, between practitioners and dental scientists has resulted in much misinformation and confusion about the value of sealants and their use. And, the contemporary status of dental manpower and the economy of dental practice in the private sector appear to have provided an infertile environment for acceptance of sealants as a primary preventive technology. In the public sector, interest in sealants is high but two primary constraints are inadequate manpower and lack of financial resources. Clearly there has been a time-lag in the adoption of new sealant products, and it is apparent that no one factor can explain this lag; rather, many complex factors must be taken into account simultaneously. Extent of need does not appear to have influenced use, to date. Often, social change is slow, and all things considered, the lag observed for sealants may not be totally unreasonable.(ABSTRACT TRUNCATED AT 250 WORDS)
American Dental Association↗
On a national drug policy for Bangladesh.
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Bangladesh↗
Family planning strategy for the 1990s in Tunisia.
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Africa↗
A patchwork of funding sources for Norplant users in the U.S.
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Adolescent↗
Acute respiratory infections in Pakistan: have we made any progress?
Acute respiratory infections (ARI) are the leading cause of death in young children in Pakistan, responsible for 20-30% of all child deaths under age 5 years. This paper summarizes the research and technical development efforts over the last 15 years which have contributed to improving the effectiveness of the case management strategy to reduce mortality from pneumonia in children in Pakistan. Community intervention is viable, effective and practical. Rising antimicrobial resistance among commonly used and low-cost oral agents is of significant concern. Appropriate monitoring and evaluation of the impact of the ARI control programme is lacking. Lack of funding for programmatic activities, lack of coordination with other child survival programs, inadequate training for community health workers and general practitioners in the private sector, lack of public awareness about seeking timely and appropriate care, and insufficient planning and support for ARI programmatic activities at provincial and district levels are major hindrances in decreasing the burden of ARI in the country. The recent introduction of the community-based Lady Health Worker (LHW) Programme and WHO and UNICEF-sponsored integrated management of childhood illness initiative present ideal opportunities for re-emphasizing early case detection and appropriate case management of ARI. Ultimately, focusing on preventive strategies such as improving nutrition, reducing indoor pollution, improving mass vaccination, as well as introduction of new vaccines effective against important respiratory pathogens will likely have the most impact on reducing severe ARI and deaths from severe disease.
Acute Disease↗
Agency-Community Partnership in Landcare: Lessons for State-Sponsored Citizen Resource Management
/ With over 2500 Australian Landcare groups, 65,000 volunteer members, and considerable evidence of program impact, Landcare is an important example of state-sponsored rural development in a developed nation. The agency-community partnership is a fundamental element of Landcare and getting the partnership right is vital to long-term program success. After reviewing the emergence of Landcare in the state of Victoria, the author reports research from a 1995 survey of Victorian Landcare groups. Survey information highlighted the extent of agency-group contact, the important roles agency staff played in many Landcare groups, and the positive impact of agency contact and government funding upon group activity. Large majorities of groups reported they were satisfied with their relationship with agency staff. However, a majority of groups reported money or materials provided to manage land and water degradation was inadequate. Recently proposed changes to the Landcare program will provide government funding of work on private property and may address this concern. A majority of groups also reported support for leadership and management training was inadequate and respondents emphasized the need to revise program guidelines that limit funding for group coordinators. This information highlighted the importance of articulating a practical model of community participation in Australia and adopting a systematic approach to providing agency support for Landcare groups. Reflecting upon the Landcare experience, the author suggests some of the key elements of a practical model of state-sponsored citizen resource management contributing to rural development.KEY WORDS: Landcare; Australia; Community participation; Rural development; Citizen resource management; Sustainable agriculture
Journal Article↗
Elective introduction to oncology.
Since 1974, the St. George Medical Society, a component of the American Cancer Society's Philadelphia Division's Professional Education Program, has sponsored paid summer clinical and research fellowships for Philadelphia medical students completing their first year. Six lectures at the student level are presented throughout the year. Students run a single society, elect officers, and select site and speakers under the guidance of the St. George Medical Society Subcommittee. Faculty from six medical schools and individual faculty preceptors donate time to provide a one-on-one summer experience in medical oncology, surgical oncology, gynecologic oncology, radiation oncology, pathology, and cancer-related research in university hospitals, community hospitals, and private offices. Financial support is provided by directed donations. Currently 50 clinical fellowships are offered. Since its inception, over 750 "fellowships" have been awarded, and over 3,000 students have attended the lectures. The program successfully provides a voluntary one-on-one introduction to clinical oncology in a reproducible format.
American Cancer Society↗
Efficiency, new equity capital enable systems to compete.
Because of limited cash, sponsors of some community and religious hospitals have sought to sell or lease their institutions to a not-for-profit (NFP) system or to a for-profit system. A number of national alliances address the capital formation problem of NFP institutions. Until now they have been almost exclusively concerned with acquiring less costly debt. Without new equity capital, market influence is difficult to obtain. Even well-managed voluntary systems face a serious threat from well-capitalized investor-owned systems. Increased competition among hospitals and physicians will force future advantages to those who have capital. It will also restrict funding of certain programs and services by voluntary enterprises. In anticipation of this, various forms of partnerships have developed with investor-owned systems. To regain the initiative as the premier sponsors of health care, religious and other voluntary systems must go beyond merely competing in their markets to acquiring weaker institutions. They also must revitalize private giving and excel in efficiency to offset threats from ambulatory, day-care operations and from high-technology hospitals. Structural changes in the industry can be predicted, including the following: The trend toward integration for production, financing, and marketing will continue. Public market equity capital will be increasingly used to finance medical practice. Hospitals that sell their equity values will establish service foundations. National alliances will continue, but strictly local systems will maintain operation. Investor-owned systems will move increasingly into high-technology tertiary care.
Capital Financing↗
Cost-effectiveness considerations in planning a preventive dental programme for British Columbia.
The Government of British Columbia, Canada, with organized dentistry, in 1974, sponsored research towards the introduction of a comprehensive children's dental programme. Dental care was at that time primarily provided by private practitioners on a personal fee-for-service basis, which system was working close to capacity. Educational and preventive dental programmes in school and health centres were sponsored by governments. Utilization of treatment services by children was estimated at a maximum of 60 per cent per annum. For the improvement of overall dental health, it was adjudged this should be at least 90 per cent. Approximately 45 per cent of children's treatment was related to dental caries. Four possible dental care delivery systems were costed. It was essential that the comprehensive programmed include proven anti-cariogenic measures and that they be the most effective in cost and in the utilization of professional personnel. Techniques for measurement of effectiveness were reviewed. Using a modified Davies cost-benefit ratio, four professionally applied and four self-administered topical fluoride systems were compared. The Knutson-Szwejda technique scored highest when used by community dental health programmes. In a private practice system or in large paediatric clinics the annual application of acidulated phosphate fluoride would be preferable. In British Columbia, experience has indicated problems with continuing school cooperation in mouth rinse programmes. Statistical proof of the effectiveness of "brush-in" programmes was adjudged as inconclusive but hopeful.
Adolescent↗
[Application of guidelines for the treatment of headache and cancer pain by private practitioners].
In a regional pain management network in Cologne, sponsored by the German Ministry of Health, structures of outpatient pain treatment in general practice and the adherence to pain management guidelines were examined. The 3-year project was divided into a 1-year observational period to analyze the present state of outpatient pain management followed by a 2-year period of interventions such as consultations and educational training programs in pain treatment. Eighty physicians with different specializations working in general practice took part in the network. The knowledge of and adherence to the guidelines for the treatment of headache and cancer pain were examined by questionnaire surveys and six simulated patient cases. These investigations were performed yearly from 1997 to 2000. The adherence to the guidelines for the treatment of headache and cancer pain by the physicians participating in the network was low. The levels achieved for simulated cases of headache were higher than for cancer pain. The results of simulated patient cases from the beginning and the end of the project were available for comparison for 28 physicians. Evaluation of the physicians' assessment of the simulated patient cases increased only fractionally and was not significant in headache patients (median change of 0.67) and cancer pain patients (median change of 0.17). The network interventions resulted in a slight improvement in the knowledge of and attitudes to the treatment of headache and cancer pain as judged by simulated patient cases. This improvement, however, did not reach statistical significance. The small number of physicians answering at the beginning and at the end of the project made it difficult to draw a general conclusion on whether the interventions had led to an improvement in outpatient pain management in a larger group of physicians.
Adult↗
The number of Americans without health insurance rose in 2001 and continued to rise in 2002.
Data from the Census Bureau and the Centers for Disease Control and Prevention indicate that the number of uninsured Americans rose in 2001and in the first quarter of 2002. The main reason insurance coverage fell was a drop-off in employer-sponsored insurance for workers and their dependents. This reduction was triggered by rising unemployment levels and rising health insurance premiums, which made it more difficult for employers to offer insurance or for workers to afford it. The downturn in private coverage was partially offset by increased enrollment in Medicaid and the State Children's Health Insurance Program (SCHIP). About two million mor e children and one million more adults would have been uninsured had it not been for the growth in these programs. Funding for the public programs is, however, threatened by budget shortfalls affecting most states, which administer these programs. Many states have cut their Medicaid programs and are planning further cutbacks. Increasing federal assistance to states and their Medicaid programs could help protect insurance coverage for low-income people during the current economic slowdown. Future SCHIP enrollment could drop sharply because of a shortage of federal funds, and Congress could take steps to bolster SCHIP funding.
Adolescent↗
Shining lights: studies that have most influenced the understanding of health promotion's financial impact.
PURPOSE: To examine the literature from the past 20 years and identify those studies that support the economic merit of health promotion. DATA SOURCE: A panel of experts was used to identify the top studies supporting the purpose of this article. STUDY INCLUSION AND EXCLUSION CRITERIA: Studies were chosen based on the following criteria: the study (1) examined the relationship between health risks and financial outcomes, or health promotion programs and financial outcomes; (2) provided strong and compelling financial data supporting the worth of health promotion; (3) had a high-quality methodology; (4) answered an important question or replicated important findings with superior methodology; and (5) represented U.S.-based initiatives published since 1980. After initially nominating a group of studies for consideration, panelists rated each on a scale from 1 to 3 representing their opinion of importance. Studies rating the highest were included for this discussion. DATA EXTRACTION METHODS: Studies were analyzed by population characteristics, design, statistical tests, limitations, and results. This information was summarized for each identified article. MAJOR CONCLUSIONS: A relationship between modifiable health risk factors and health care costs is supported by research. Health promotion interventions appear to provide positive financial returns, most notably for health care costs and absenteeism reduction. Private sector initiatives seem to be driving economic-based research. Overall, health promotion shows promising results for providing financial advantages for its sponsors; however, if this discipline is to show its true worth, considerable funding is needed from government or philanthropic sources to cover the substantial costs of quality research.
Cost-Benefit Analysis↗
The AIDS pandemic: changes in the believability and use of information sources.
Over 20,000 Americans under 25 years old are infected with HIV every year. In 1994, AIDS was the number one killer of adults between the ages of 25 and 44 years old. Education concerning HIV is critical to the prevention of AIDS. Both the public and private sectors, including government agencies, cause-related organizations, medical professionals, and promotion specialists must determine the best information sources to educate young people. However, with many television shows that appeal to young adults condoning casual sex, it is increasingly difficult to generate motivation to act responsibly. This paper examines the effectiveness of information sources, sponsored by both the government and private organizations, about HIV. Given the impact of media publicity regarding the AIDS virus and the "hard-hitting" messages and public service announcements about AIDS, implications about ethical issues, public policy issues, and media strategies to educate the public about AIDS are discussed. While publicity and specific types of television programming were found to be the most believable and most often used information sources for health issues, there are many strategic implications concerning promotion strategies, targeting, and positioning for both the public and private sectors.
Acquired Immunodeficiency Syndrome↗
For the health of Smith Island.
It is not much more than thirteen miles from Ewell to the hospital in Crisfield, but for residents of the small waterfront community, twelve and a half of those miles are across the open waters of the Chesapeake Bay. So it is not surprising that a program charged with increasing health care access for rural populations uses the island to introduce future practitioners to the needs of such underserved communities. Located roughly in the middle of the Chesapeake Bay, Smith Island falls within the boundaries of Somerset County, the poorest of Maryland's Eastern Shore counties. For the Eastern Shore Area Health Education Center (ESAHEC), a state-supported but private nonprofit agency founded to foster rural health care, Smith Island offered a perfect environment to expose an interdisciplinary group of health professions students to the realities of rural health care. Through a joint venture with the Somerset County Health Department, Smith Island is a destination for ESAHEC-sponsored trips that are part of the clinical experience for selected nursing, allied health, social work, and medical students in the University of Maryland system.
Education, Nursing, Baccalaureate↗
Data requirements to measure progress on the objectives for the nation in health promotion and disease prevention.
The Reagan Administration has adopted the policy guidelines developed over the previous few years in the disease prevention and health promotion initiative of the Carter Administration. Broad national consensus had been sought in the formulation of 226 measurable objectives for the decade. We classify the prevention objectives according to their position in an implied causal chain: 1) improved programs, 2) increased public and professional awareness, 3) reduced risk factors, and 4) improved health status. Prior to 1980, the data systems and periodic surveys sponsored by federal agencies and national organizations covered only four of the 42 objectives in the public and professional awareness category, whereas at least half of the objectives in each of the other three categories were covered by available national data sources, mostly federal. Sample surveys are needed to measure the majority of the currently unmeasured objectives in all four categories. Private and state health interview surveys are needed to supplement the federal capacity, especially in the face of federal cutbacks in survey capacity.
Adolescent↗