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PubMed2006

Knowledge, attitude and practice of Nigerian women towards breast cancer: a cross-sectional study.

BACKGROUND: Late presentation of patients at advanced stages when little or no benefit can be derived from any form of therapy is the hallmark of breast cancer in Nigerian women. Recent global cancer statistics indicate rising global incidence of breast cancer and the increase is occurring at a faster rate in populations of the developing countries that hitherto enjoyed low incidence of the disease. Worried by this prevailing situation and with recent data suggesting that health behavior may be influenced by level of awareness about breast cancer, a cross-sectional study was designed to assess the knowledge, attitude and practices of community-dwelling women in Nigeria towards breast cancer. METHODS: One thousand community-dwelling women from a semi-urban neighborhood in Nigeria were recruited for the study in January and February 2000 using interviewer-administered questionnaires designed to elicit sociodemographic information and knowledge, attitude and practices of these women towards breast cancer. Data analysis was carried out using Statistical Analysis Software (SAS) version 8.2. RESULTS: Study participants had poor knowledge of breast cancer. Mean knowledge score was 42.3% and only 214 participants (21.4%) knew that breast cancer presents commonly as a painless breast lump. Practice of breast self examination (BSE) was low; only 432 participants (43.2%) admitted to carrying out the procedure in the past year. Only 91 study participants (9.1%) had clinical breast examination (CBE) in the past year. Women with higher level of education (X2 = 80.66, p < 0.0001) and those employed in professional jobs (X2 = 47.11, p < 0.0001) were significantly more knowledgeable about breast cancer. Participants with higher level of education were 3.6 times more likely to practice BSE (Odds ratio [OR] = 3.56, 95% Confidence interval [CI] 2.58-4.92). CONCLUSION: The results of this study suggest that community-dwelling women in Nigeria have poor knowledge of breast cancer and minority practice BSE and CBE. In addition, education appears to be the major determinant of level of knowledge and health behavior among the study participants. We recommend the establishment and sustenance of institutional framework and policy guidelines that will enhance adequate and urgent dissemination of information about breast cancer to all women in Nigeria.

Journal Article↗
PubMed2000

The need to ensure that the globalization of information and telematics does not destabilize health-care worldwide.

Modern telecommunication transcends institutional, organizational and cultural boundaries. In the context of health-care, this means that information, enquiries, demands and service provision can be routed anywhere, free of institutional or natural control. The Internet makes information available to anyone regardless of its quality, source or intention. Organizationally initiated applications such as telemedicine are usually intended to reinforce local systems, but their very design and intention indicate a potential rapidly to transcend inherited but electronically ineffectual boundaries. The consequences of such uncontrolled globalization of health-care activities will range from beneficial empowerment and quality improvement, to detrimental effects such as overloading of experts, and undermining of stable health-care systems. The major unplanned societal re-engineering effects in a paper-based culture are likely to be significant and global institutions need to respond by creating positive global frameworks and policies.

Clinical Competence↗
PubMed2002

Mental health system reform: a multi country comparison.

In recent years many countries have embarked on various types of health and mental health reform. These reforms have in large part been driven by governments' concerns for cost containment which has, in turn, been driven by an increasing process of global marketization and the need to control national deficits. A critical issue in these reforms is the increased emphasis on the use of "market mechanisms" in the delivery of health and mental health services. This paper uses a policy analysis framework to compare recent developments in the mental health sector in Canada, the United States, Britain and Australia. The common framework to be used for this will focus on: the defining characteristics of the society; legislative mandate; sectorial location (within or separate from health sector); funding streams; organising values of the system; locus of service delivery; service technologies; the role of social work; interprofessional dynamics; the role of consumers; and evaluation of outcomes at multiple levels. This analysis provides an opportunity to explore similarities and differences in mental system reform and in particular identify the challenges for social work in the field of mental health in the 21st century.

Australia↗
PubMed2001

Managed care for Medicare: some considerations in designing effective information provision programs.

Consumer information-processing theory provides a useful framework for policy makers concerned with regulating information provided by managed care organizations. The assumption that consumers are rational information processors and providing more information is better is questioned in this paper. Consumer research demonstrates that when faced with an uncertain decision, consumers adopt simplifying strategies leading to sub-optimal choices. A discussion on how consumers process risk information and the effects of various informational formats on decision outcomes is provided. Categorization theory is used to propose guidelines with regard to providing effective information to consumers choosing among competing managed care plans. Public policy implications borne out of consumer information-processing theory conclude the article.

Age Factors↗
PubMed2001

Assessment of community mental health care in the Federation of Bosnia-Hercegovina (FBH) after the 1992-95 war.

Bosnia-Hercegovina is in the process of reforming its health care system. One realises that this is a complex matter that will cost a great deal of time and effort. The findings suggest that the highest priority now is the development of the 'mental health strategic and action 'plan', which includes (as a component of the overall PHC strategy) legislation, financing mechanisms, a clear statute for the CMHCs and staff, and to define the relationship with other PHC services. In addition, it is recommended that the authorities should take a more decisive co-ordinating and leading role. To this end, a special Mental Health Task Force assisted by a professional advisory group on mental health and/or professional consultants could be established. In order to realise a real cost-effective community-based care, it is inevitable to allocate enough funds to these primary mental health care services and initiatives such as sheltered living and family support initiatives (eventually to reallocate funds from expenditures on hospital-based care). A mental health reform does not happen in a vacuum and therefore can not be accomplished without 'negotiating' with other sectors/ministries, e.g., Ministries of Finances, Social Affairs/Displaced Persons and Refugees, International Trade and Economy. A multi-sector approach is considered indispensable. Overall management of CMHCs should be strengthened. In addition, it is important that CMHCs exchange information and promote standardised protocols and procedures to enhance comparability and structured referral. The planned Management Information System is a good example, but should be implemented as soon as possible in all CMHCs. Other initiatives to improve professional networking might include (community mental health) newsletters, round table conferences, etc. Further skills training of CMHC staff and management might be difficult to define as long as it is not clear what practical skills are required. Technical Assistance to the (mental) health sector should primarily focus on the overall framework and policy. Training should be tailored to the actual needs and focus primarily on local capacity building via training-of-trainers. Health prevention and promotion, i.e. information provision to the general public and community participation in terms of support for self-help groups and consumer groups, deserve more attention than it has received so far.

Bosnia and Herzegovina↗
PubMed1995

Germany at the crossroads: national identity and the challenges of immigration.

"In Germany the discussion [of immigration] is taking place between two extreme positions, one that denies Germany is de facto an immigration country...and one that compares Germany with traditional immigration societies like the United States, Canada, or Australia. As will be demonstrated, both arguments are too simplistic.... To illustrate the importance of migration movements for Germany's national fabric, first an overview of the history of pre- and postwar migrations and refugee movements as well as their effects on the domestic situation in Germany are presented. Next, the origins of the contradictory nature of the current asylum, citizenship and naturalization regulations and the need to redefine Germany's legal framework, immigration policy, and national identity after unification are discussed."

Demography↗
PubMed2004

Healthcare compunetics.

Changes in life expectancy, healthy life expectancy and health seeking behaviour are having an impact on the demand for care. Such changes could occur across the whole population, or for specific groups. Changes for specific groups will be particularly affected by policy initiatives, while both these and wider changes will be affected by people's levels of engagement with their health and the health service itself. Levels of education, income and media coverage of health issues are also important. These factors could also encourage an increase in people caring for themselves and their families or community. People are now expecting a patient-centred service with safe high quality treatment, comfortable accommodation services, fast access and an integrated joined-up system. The uptake of integrated Information and Communication technologies (ICT) will be crucial. Healthcare Compunetics, the combination of computing and networking customised for medical and care, will provide the common policy and framework for combined multi-disciplinary research, development, implementation and usage.

Artificial Intelligence↗
PubMed2005

Working IT out in e-Science: experiences of requirements capture in a HealthGrid project.

This paper reports on our experiences of being involved in requirements capture for a HealthGrid project. Large scale, collaborative projects with multiple partners tend to experience numerous problems in the requirements capture phase (and often beyond) and HealthGrid projects are no exception. Projects with highly innovative objectives often have additional sets of problematics, however. In carving out new visions of, for example, clinical research and healthcare service delivery, HealthGrid projects have to reckon with--and work within--existing healthcare policy, legislative frameworks, professional cultures and organisational politics as well as the more common integration problem of dealing with legacy systems. Such factors are not conducive to the achievement in healthcare of the e-Science vision of seamless integration of information and collaborative working across administrative, professional and organisational boundaries. In this paper, we document some of the challenges we encountered in investigating the requirements for eDiaMoND, a flagship pilot UK e-Science project. We discuss what we might learn from these challenges, especially approaches to requirements capture that are appropriate for projects with innovative aims and are also sensitive to representing and addressing what may be complex professional and organisational interests.

Computer Communication Networks↗
PubMed2006

[Romantic magnetism: The patient. The woman. The republic].

This paper, based on case studies, aims to present some aspects of the animal magnetism that developed in the Germany of the first decades of the nineteenth century. These aspects constitute, or at least imply, important innovations within the framework of contemporary medical practice and consist of: the recognition of the importance of the words of patients and their own knowledge of their bodies; the emergence of the figure of woman as an independent and singular subject in which the aspects indicated above are emphasized; and, finally, the latent potential of this medical theory for reform within the framework of policy.

Animals↗
PubMedDate not supplied

Euthanasia. The issue of resuscitation.

Euthanasia in this country is illegal, but issues surrounding 'do not resuscitate' guidelines raise the questions on the right to a death with dignity for many nurses. In this paper the author discusses the statement by the British Medical Association and the Royal College of Nursing on cardiopulmonary resuscitation and advises health practitioners to use this statement as a guideline for their own policy and framework in hospitals and not to accept this framework as implicit.

Ethics, Medical↗
PubMed2001

[Policy science and health policy].

Policy science provides the analytical frameworks to examine (1) the process of policy formation and implementation (Issue definition, Agenda setting, Alternative development, Decision and implementation, and Appraisal); (2) the initial and final shapes of policy content (Temporal and special distribution of costs and benefits, Selection of administrative organizations, and Choice of instruments to secure policy compliance); and (3) the effects and efficiencies of policy (Expected and unexpected effects of policy, beneficial and adverse ones). These three aspects are closely associated, and determine the functions of policy in society. Overseas, the application of policy science framework to health issues has thus far produced substantive knowledge which helps to improve both the policy making and policy designs, and at the same time, has provided good opportunities on which the workings of health and policy, both at the social and individual levels, are explored. The paper first outlines the themes and frameworks of political science, and then, introduces their application to the field of health. Issues associated with human life and health have special characteristics that distinguish them from those of other market commodities: special values placed on life and health, information inequality between service providers and consumers, and externalities, leading to a variety of moral hazards and market failures. Furthermore, there are some conflicts in values and technical opinions in society, regarding both the ends and means of health policies. In addition to the main topics in the field, empirical studies, from Japan or from other countries, are also summarized. Finally, future research needs and expectations are addressed.

Efficiency, Organizational↗
PubMedDate not supplied

National service frameworks: what are they?

This article describes policy developments surrounding the creation of national service frameworks. The national service framework for mental health is used as an example to highlight the content of the framework and the way it has been received.

Evidence-Based Medicine↗
PubMedDate not supplied

A framework for an institutional high level security policy for the processing of medical data and their transmission through the Internet.

BACKGROUND: The Internet provides many advantages when used for interaction and data sharing among health care providers, patients, and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality, integrity, and availability of information. It is therefore essential that Health Care Establishments processing and exchanging medical data use an appropriate security policy. OBJECTIVE: To develop a High Level Security Policy for the processing of medical data and their transmission through the Internet, which is a set of high-level statements intended to guide Health Care Establishment personnel who process and manage sensitive health care information. METHODS: We developed the policy based on a detailed study of the existing framework in the EU countries, USA, and Canada, and on consultations with users in the context of the Intranet Health Clinic project. More specifically, this paper has taken into account the major directives, technical reports, law, and recommendations that are related to the protection of individuals with regard to the processing of personal data, and the protection of privacy and medical data on the Internet. RESULTS: We present a High Level Security Policy for Health Care Establishments, which includes a set of 7 principles and 45 guidelines detailed in this paper. The proposed principles and guidelines have been made as generic and open to specific implementations as possible, to provide for maximum flexibility and adaptability to local environments. The High Level Security Policy establishes the basic security requirements that must be addressed to use the Internet to safely transmit patient and other sensitive health care information. CONCLUSIONS: The High Level Security Policy is primarily intended for large Health Care Establishments in Europe, USA, and Canada. It is clear however that the general framework presented here can only serve as reference material for developing an appropriate High Level Security Policy in a specific implementation environment. When implemented in specific environments, these principles and guidelines must also be complemented by measures, which are more specific. Even when a High Level Security Policy already exists in an institution, it is advisable that the management of the Health Care Establishment periodically revisits it to see whether it should be modified or augmented.

Access to Information↗
PubMed2005

Assessing the policy environment.

This article proposes a basic framework for assessing the policy environment. Environment is a key concept in nursing's much-discussed "metaparadigm," but the policy environment is rarely considered. Too often, bedside nurses do not recognize the policy dimensions of clinical practice issues. Yet nursing assessment involves identifying and appraising aspects of patients' situations that are salient to their responses to actual or potential health problems. Policy may be such a salient factor, as it shapes the physical aspects of patients' surroundings; the relationships possible between practitioners and patients; the institutions in which health care is offered; and, on a broader scale, the prospects for global survival. This article proposes a question-based framework for clinical practice nurses to use in assessing the policy environment.

Health Policy↗