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At least 235 records · Page 13Linked to original sources
PubMed2004

Community capacity for environmental health promotion: determinants and implications for practice.

The human response to an environmental hazard can either reduce or exacerbate its impact on health. This article reviews determinants of community-level responses to environmental health hazards. The aim is to identify factors that can enhance a community's capacity to protect itself and to suggest public health strategies that can increase such capacity. Four case histories of community environmental health action are presented to test a theoretical model for understanding the determinants of community capacity to promote environmental health. Specific actions public health professionals can take to strengthen community capacity include increasing access to accurate science, building strong relationships between communities and local health departments, and supporting political reforms that level the playing field for communities that seek to challenge corporate or government practices.

Community Health Planning↗
PubMed1997

The ethics of informed consent: a critical variable in the self-determination of health and mental health clients.

Informed consent is a critical variable in the self-determination of consumers receiving health and mental health services. Consent has become a more stringent requirement in recent years. However, providers emphasize legal requirements rather than the true participation of consumers--the "spirit" of informed consent. This article discusses the elements of informed consent, the issues that reflect the "spirit" of consent, and recommendations for actions that foster self-determination in practice.

Ethics, Medical↗
PubMed1998

The determinants of health expenditure in the OECD countries: a pooled data analysis.

This paper uses international health expenditure and the latest OECD data to investigate the determinants of aggregate health expenditure. The study differs from most previous studies in two principal ways. First, it uses a somewhat larger sample for estimation, with pooled time-series, cross-section data for 22 OECD countries for a 20-year period. Most previous work has used a purely cross-section approach: in this case, the small sample size reduced the statistical reliability of results and limited the number of hypotheses that can be tested simultaneously. Second, and following from this, a more extensive range of hypotheses is tested, with particular emphasis on those relating to the contractual relations between payers, providers and patients. The findings show, for example, that the use of primary care "gatekeepers" seems to result in lower health expenditure and also that the way of remunerating physicians in the ambulatory care sector appears to influence health expenditure; capitation systems tend to lead to lower expenditure than fee-for-service systems.

Cross-Cultural Comparison↗
PubMed2005

Determinants of health insurance ownership among South African women.

BACKGROUND: Studies conducted in developed countries using economic models show that individual- and household- level variables are important determinants of health insurance ownership. There is however a dearth of such studies in sub-Saharan Africa. The objective of this study was to examine the relationship between health insurance ownership and the demographic, economic and educational characteristics of South African women. METHODS: The analysis was based on data from a cross-sectional national household sample derived from the South African Health Inequalities Survey (SANHIS). The study subjects consisted of 3,489 women, aged between 16 and 64 years. It was a non-interventional, qualitative response econometric study. The outcome measure was the probability of a respondent's ownership of a health insurance policy. RESULTS: The chi2 test for goodness of fit indicated satisfactory prediction of the estimated logit model. The coefficients of the covariates for area of residence, income, education, environment rating, age, smoking and marital status were positive, and all statistically significant at p < or = 0.05. Women who had standard 10 education and above (secondary), high incomes and lived in affluent provinces and permanent accommodations, had a higher likelihood of being insured. CONCLUSION: Poverty reduction programmes aimed at increasing women's incomes in poor provinces; improving living environment (e.g. potable water supplies, sanitation, electricity and housing) for women in urban informal settlements; enhancing women's access to education; reducing unemployment among women; and increasing effective coverage of family planning services, will empower South African women to reach a higher standard of living and in doing so increase their economic access to health insurance policies and the associated health services.

Adolescent↗
PubMed2002

Medical advancements determine health-system capacity requirements.

As the rate of advancements in medical technology accelerates, healthcare executives need to anticipate the impact that these advancements will have on health-system demand and capacity requirements. Determining these requirements is critical but difficult. Many hospitals today are operating at capacity, particularly in such areas as the emergency department, operating room, and critical care unit. Key market forces are transforming the way health care is organized, delivered, and financed. One such market force is the escalating pace of medical advancement. The healthcare industry lacks a centralized resource that tracks such developments and assesses the impact on hospital service-line demand and capacity requirements. By following an approach designed to help determine these requirements, Yale-New Haven Hospital, New Haven, Connecticut, was able to forecast its future capacity requirements.

Biomedical Technology↗
PubMed1991

What have we learnt about the cultural, social and behavioural determinants of health? From selected readings to the first Health Transition Workshop.

The article explores the issue of whether the holding of an international workshop in Canberra in 1989, and the preparation of papers for it, increased our knowledge of the cultural, social and behavioural determinants of health and whether the publication of the proceedings placed new knowledge in the public domain. The approach adopted is to compare those proceedings with a collection of selected readings on the subject made shortly before as part of the same program and also with certain other publications. The conclusions reached are that, in addition to having stimulated interest in the field, the workshop and its proceedings furthered knowledge in at least five important areas: (1) the existence of mortality-prone households; (2) the impact of differing cultural situations of women in terms of individualism on their children's survival; (3) the mechanisms whereby maternal education is translated into child survival; (4) the impact of culture and ethnicity on mortality; and (5) indirect indices of the impact of care. The workshop failed to contribute to substantial advances (or draw attention to the lack of advance) in the following areas: (1) the measurement of Third World morbidity or health; (2) adult health transition; (3) the impact of radicalism or egalitarianism in communities other than Kerala and Sri Lanka on mortality; (4) the impact of lifestyle diseases on Third World mortality; (5) the identification of economically optimum mixes of social change and the provision of health services in reducing mortality and improving health; and (6) the employment of health transition knowledge in the reduction of mortality and the improvement of health.

Adult↗
PubMed1999

The social determinants of health: a contribution to the analysis of gender differences in health and illness.

While it is established that socioeconomic status and social integration influence the distribution of health and illness among men and women, little attention has been paid to the different ways in which women and men experience socioeconomic opportunities and social attachments to others. Drawing on evidence from the literature, the position developed in this article is that gender mediates the influence of both socioeconomic status and social integration on health, and for women, these are intricately linked. Women's relationship to the labour market establishes and perpetuates their socioeconomic inequality relative to men, and may produce contradictory influences on women's health. Furthermore, for women, the marital relationship is paradoxical: marriage may at once improve economic and social support opportunities, while diminishing control over paid and unpaid work--potentially increasing as well as compromising the health status of women. The article is intended to contribute to the growing body of literature on gender and the determinants of health.

Female↗
PubMed2000

Social determinants of health: from observation to policy.

Differences in the health of individuals reflect inherent features of the societies in which they live. The way a society organizes itself and delivers wellbeing to its members are major determinants of health. Social, economic and political factors have an important influence on health and longevity. Social position and lifestyle only partially explain ill health. Psychosocial factors, such as a sense of isolation, deprivation or loss of control, are also important. Governments can reduce health inequalities by ensuring that all policies are assessed for their potential impact on the health of all sectors of society.

Attitude to Health↗
PubMed1986

Word familiarity and cardiovascular health as determinants of age-related recall differences.

This study investigated surprise free recall in two generations of adults following a semantic processing task. The study was designed to determine the effect of word familiarity and cardiovascular health status on the age-related decrement typically demonstrated in that task. Two lists were used. One list contained words familiar to young adults, whereas the other contained words familiar to older adults. Cardiovascular health status of older adults was assessed by determining whether the person was taking medication prescribed for cardiovascular problems. Participants rated half the words on a pleasantness scale and half on a size scale and were then given a surprise free-recall test. The results indicated that word familiarity and cardiovascular health status both have significant effects on the age-related decrement in free recall following a semantic processing task.

Adult↗
PubMed2002

Parameters and techniques to determine intestinal health of poultry as constituted by immunity, integrity, and functionality.

The intestinal microflora lives in intimate contact with its surrounding intestinal wall and the bacteria can exert beneficial or deleterious effects on the host, depending on whether they are classified as probiotics or as pathogens. The interaction is determined on one hand by characteristics of the microorganisms, and on the other hand by characteristics of the intestinal wall. Together they determine the health status of the intestine. This review describes parameters and techniques (with advantages and disadvantages) available for poultry to identify the characteristics of the intestinal health, as constituted by three components: immunity, integrity, and functionality. To investigate intestinal immunity, in situ detection of various cell populations of the immune system with specific monoclonal antibodies using immunocytochemical staining is a reliable, semi-quantitative method. In vitro assays to measure functional aspects of T lymphocytes, B lymphocytes, plasma cells, natural killer cells, macrophages, and phagocytes are applicable to intestinal wall tissue. For investigation of intestinal integrity, in situ detection of villous height and crypt depth and their ratio, and villus arrangement is still an easy, routine histological method. In addition, expression levels of specific molecules, such as E-cadherin, different growth factors, and trefoil factor, seem promising parameters. To investigate functionality of the intestine, the permeability can be measured as the rate of transport of tracer molecules across the epithelial surface. Furthermore, determination of the level of mucus secretion and its composition are a valuable tool. These parameters for immunity, integrity and functionality, or a combination thereof, are indispensable to investigate the influence of intestinal microorganisms on intestinal health.

Animals↗
PubMed2000

Maori health: key determinants for the next twenty-five years.

Five key factors that will impact on Maori health over the next twenty-five years are examined: demographic change, participation in society, environmental adaptation, access to te ao Maori, and policies for health. Arising from these determinants a number of implications are discussed including changes in the demographic dependency ratio as the balance between those who are either too young or to old to work alters; the extent of Maori participation in the wider society; tools for improved adaptation to modern environments; access to culture and heritage; recognition of the health impacts of government policies as well as policies and programmes developed by Maori authorities. The importance of Maori leadership and a capacity for long term planning is emphasized.

Adaptation, Physiological↗
PubMedDate not supplied

The Health Self-Determinism Index.

This study is a psychometric evaluation of a new measure of motivation in health behavior. The Health Self-Determinism Index was completed by 202 randomly selected adults via a mail survey. The multidimensionality of the construct was supported through the factorial isolation of four subscales: self-determined health judgments, self-determined health behavior, perceived competency in health matters, and internal-external cue responsiveness. These four factors accounted for 56% of the total explained variance in the measure. The alpha reliability coefficient for the total scale is .84; the internal consistency of the four subscales is supported by alpha reliability coefficients of .75, .75, .67, and .69, respectively. With refinement, this measure will enable exploration of client antecedents and correlates of motivation in health behavior. Further, specific nursing interventions can be examined for their ability to alter clients' motivation in relation to specific health behaviors. Finally, the role of motivation in predicting health outcomes can be explored.

Attitude to Health↗
PubMed1981

Modelling determinants of health.

The linear regression procedure of stepwise elimination has been used to examine the association between a range of environmental variables and infant mortality rates (IMR) in Sri Lanka. The nature of the water supply was found to be significantly associated with IMR. Latrines were significantly associated with IMR once qualitative differences between districts were allowed for. Other 'environmental determinants of health', 3 indices of housing quality and the presence of electricity supplies, were not significant. The cost of effecting changes in IMR by extending subsidies to water supply improvements is estimated.

Developing Countries↗
PubMed2003

The determinants of health care expenditure: testing pooling restrictions in small samples.

Health care expenditure has increased substantially in all Western industrialized countries in the last decades. The necessity to contain the increase in health care expenditure has motivated the analysis of its determinants to explain differences across countries and health systems. However, recent studies have questioned the use of cross section data arguing that health systems are too different to allow for such comparisons. In this paper we investigate whether this criticism is really justified. We analyze the variations of health care expenditure in OECD countries relative to income, population aging and technological change. Our analysis is based on pooled cross section data and time series. Firstly, formulating error correction models for individual countries we demonstrate that in almost all cases the investigated variables are cointegrated. Secondly, we use a bootstrap framework for inference and examine whether the influence of explanatory variables is unique across countries. Applying recursive estimation procedures we find evidence for cross country homogeneity during the period 1961-1979. In the last two decades health care dynamics become more and more country specific thus indicating divergence of health systems and the growing importance of country-specific effects in the explanation of differences in health care expenditure.

Analysis of Variance↗
PubMed2001

Effects of lifestyle factors on ultrasonographically determined bone health in Japanese women.

The objective of this study was to determine by ultrasonographic measurements, an inexpensive and radiation-free technique, the association between bone health and lifestyle factors among a large population of Japanese women. Two hundred and fifty-six pre-menopausal women and 585 post-menopausal women who underwent a voluntary medical check-up for osteoporosis in 1996-1997 were analyzed. There were significant positive correlations between the bone density (designated as the stiffness value) vs the weight, the height and the body mass index of the subjects only in the post-menopausal group. Negative correlations were also found between the bone density vs the age and the years since menopause. Our data using ultrasonographic technique agree well with previous studies using other devices. In both groups, subjects with current or past exercise habits had higher stiffness values. Dietary habits had no effects on the stiffness value. Smoking habits had a trend towards negative effects and alcohol consumption seemed to have a trend towards positive effects on the stiffness value in post-menopausal women, but these effects did not reach statistical significance. Positive effects of current exercise on bone density were maintained after adjustment for past exercise habits. These results support the effectiveness of exercise begun in adulthood. Having a good exercise habit is one of the most effective ways of maintaining good bone health.

Adult↗
PubMedDate not supplied

The case for child development as a determinant of health.

The complex relationship between life course and social/economic-psychosocial conditions in a given society has a powerful determining effect on human health. The socioeconomic gradient emerges from a complex mixture of psychosocial and material influences operating at various levels of social aggregation and, also, a series of biological responses whose character and significance vary over the life course. Biological embedding and the "latency" and "pathways" model incorporate the notion of a critical period in development; the pathways model emphasizes the cumulative effect of life events and the ongoing importance of social/economic-psychosocial conditions throughout the life cycle. The models, although conceptually complementary, result in ideological conflict and lend themselves to different policy directions.

Child↗