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PubMed1978

[Environment. Preventive health action in the creation of the environment].

The present quantitative importance of prevention is in Switzerland extremely low in comparison to the health budget of the national community. It has taken in recent years increasing place however in speeches and talks as well as in medical thinking. Prevention presently tends to be seen as a medical specialty among others and perhaps prefigures a new form of medicine, the object of which would be the societal body more than the body of the sick individual. In this perspective (would that be good?), a new type of physician-informatician-statistician might be trained, with the mission to manage and supervise the health status of the population. Preventive health action through the environment at large could fulfill an important role in the foreseeable developments. New health "morals" are currently emerging, which are bringing together numerous adepts. This might mean that the time of a "health society" (or health-determined society) is not far.

Attitude to Health↗
PubMed1977

Community education for cardiovascular health.

To determine whether community health education can reduce the risk of cardiovascular disease, a field experiment was conducted in three northern California towns. In two of these communities there were extensive mass-media campaigns over a 2-year period, and in one of these, face-to-face counselling was also provided for a small subset of high-risk people. The third community served as a control. People from each community were interviewed and examined before the campaigns began and one and two years afterwards to assess knowledge and behaviour related to cardiovascular disease (e.g., diet and smoking) and also to measure physiological indicators of risk (e.g., blood-pressure, relative weight, and plasma-cholesterol). In the control community the risk of cardiovascular disease increased over the two years but in the treatment communities there was a substantial and sustained decrease in risk. In the community in which there was some face-to-face counselling the initial improvement was greater and health education was more successful in reducing cigarette smoking, but at the end of the second year the decrease in risk was similar in both treatment communities. These results strongly suggest that mass-media education campaigns directed at entire communities may be very effective in reducing the risk of cardiovascular disease.

Adult↗
PubMed1979

Health beliefs of hypertensive patients in a family medicine residency program.

This paper presents the results of a survey of the hypertensive patient population in a university family medicine practice to determine health beliefs, patient perceptions of the severity of their condition, stated levels of compliance to drug regimens, frequency of drug side effects, and frequency of physician discussions of drug side effects and diet. Health beliefs were then associated with diastolic hypertension and increase in medication dosage over a four-month period. Results of the survey sharpen the focus of patient education efforts by the family physician on specific attitudes, beliefs, and treatment issues which are most appropriate for the hypertensive patient. The physician may improve his/her management of hypertensive patients by: (1) anticipating prevalent myths and misconceptions which patients have concerning hypertension; (2) alleviating patient anxiety by stressing that control of blood pressure decreases the likelihood of complications; (3) effectively communicating to each patient the current status of his/her condition at each visit; and (4) initiating discussion of side effects through direct questioning for those effects most frequently seen.

Adult↗
PubMed1978

A causal model of health services for diabetic patients.

A causal model of health services which includes patient and provider variables, perceived access to care, utilization of services, continuity of care, technical quality of the care process, technical quality of the care outcome, and patient satisfaction is applied to a group of diabetic patients enrolled in the Seattle Prepaid Health Care Project. The enrollees received comprehensive health services at zero out-of-pocket cost from either a prepaid group practice plan or an independent practice plan. Surveys were periodically conducted to determine health status, satisfaction, and demographic characteristics of the enrollees; utilization of services was monitored throughout the experiment. The causal model is operationalized through the use of path analysis. Significant relationships (p less than or equal to .10) were established between satisfaction and perceived access to care, family size, sex, and professional qualifications of the provider; between outcome of care and health status, female education, and physician performance; between physician performance and professional qualifications; between continuity of care and health status and female education; between utilization and perceived access, specialty of provider, and provider system; and between access to care and provider system. The policy implications of the results are discussed.

Consumer Behavior↗
PubMed1978

Epidemiologic investigations of styrene-butadiene rubber production and reinforced plastics production.

The United States National Institute for Occupational Safety and Health (NIOSH) began an epidemiologic study of workers employed in the styrene-butadiene rubber (SBR) industry during 1976. This study was prompted by reports of relatively high numbers of leukemia deaths occurring within SBR production work populations. Simultaneous with the initiation of this investigation, the University of North Carolina released a report associating an excess risk of death due to hematopoietic and lymphatic malignancies among workers producing several synthetic rubbers, including SBR. This report presents NIOSH's preliminary mortality observations and a discussion of progress made on the analyses of contaminants found in two SBR production facilities. Currently, NIOSH is determining the feasibility of doing an epidemiologic study in the reinforced plastics industry. Interest in this study developed as part of an effort to determine health hazards associated with occupational exposure to styrene. Most of the technology for the reinforced plastics industry developed in the 1950s, and therefore this process represents a relatively new industry. This report also includes information on environmental conditions observed in the reinforced plastics industry and enumerates some of the complicating characteristics of this industry which increase the complexity of this study.

Bone Marrow Diseases↗
PubMed1979

[Periodontal status in a group of Swiss soldiers age 28-32 years].

139 soldiers aged 28-32 years of a medical corps unit of the Swiss army were examined for their periodontal conditions. On 3 surfaces of all teeth, plaque deposits were assessed according to the Plaque Index System (Silness and Löe, 1964) and gingival health determined according to the Gingival Index System (Löe and Silness, 1963). Calculus deposits were evaluated on the 6 representative teeth of Ramfjord (1959). On 4 surfaces of the same teeth, pocket depths and loss of attachment were measured. The mean P1I was 1.38, the mean GI 1.11. The mean pocket depth was 2.52, and the mean loss of attachment was 1.38. The results of this study were compared with those of a previous study by Curilović et al. (1972). It was concluded that periodontal disease progressed in the Swiss male population between 20 and 30 years at an annual rate of 0.18 mm loss of attachment despite all the efforts in preventive dentistry.

Adult↗
PubMed1979

An analysis of case mix complexity using information theory and diagnostic related grouping.

Case mix complexity measurements are essential to determine health care efficiency and effectiveness. Measures of patient care processes and outcomes must be adjusted for case mix before valid comparisons can be made. Hospital reimbursement, particularly prospective reimbursement, must take into account differences in case mix. In addition, a key variable for hospital classification is case mix. There are, however, no widely accepted easily computed case mix measures. Information theory measures of case mix have been developed but their acceptance has been limited by a lack of verification of their basic assumption that concentration of disease is related to clinical complexity. We discuss the rationale underlying the mathematical computaton of information theory measures and demonstrate a statistically significant relationship between clinical measures of case mix complexity and information theory measures of case mix complexity.

Costs and Cost Analysis↗
PubMed2026

Determinants of private health insurance uptake and its association with healthcare utilization in Gulf Cooperation Council countries: a systematic review.

All Gulf Cooperation Council (GCC) countries have a multi-payer healthcare system that comprises governmental health coverage (GHC), funded by the government, and private health insurance (PHI), mainly sponsored by employers and purchased by individuals. Both are expected to influence healthcare utilization and contribute to system efficiency and patient well-being. This systematic review explored the determinants of PHI uptake and its association with healthcare service utilization in the presence of GHC in GCC countries. We systematically searched CINAHL, PubMed, Scopus, Web of Science, and Cochrane Library for peer-reviewed studies published between January 2012 and October 2022. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) checklists for both quantitative and qualitative studies, following PRISMA guidelines. Twenty-six studies met the inclusion criteria. Determinants of PHI uptake were mapped to Andersen's Behavioral Model of Health Services Use (BMHSU) and categorized into (1) predisposing factors (sex, age, marital status, and education), (2) enabling factors (employment/income and health system-related factors such as access and perceived service quality), and (3) need factors (health status, including chronic noncommunicable diseases). PHI uptake was positively associated with being male, married, highly educated, employed with a high income, and having chronic diseases. PHI was positively associated with healthcare utilization, particularly routine check-ups, preventive services, and the use of prescribed medicines. In GCC countries, PHI uptake is influenced by sociodemographic and socioeconomic characteristics, health status, and perceived service quality. PHI is also associated with higher healthcare utilization, underlining the need for evidence-informed policies that enhance equity and expand coverage.

Humans↗
PubMed1978

Health behaviour and its determinants among insulin-dependent diabetics. Results of the diabetes Warsaw study.

Health behaviour of a group of insulin-dependent diabetics and some factors influencing it have been described and analyzed. Aspects of health behaviour measured were: adherence to diet, insulin injection technique, urine self-testing and the pattern of action adopted in response to hypo- and hyperglycemia. Data were collected in 1975, from 170 insulin-dependent diabetics, aged 18-41, with known diabetes of from 6 months to 12 years duration. A standard questionnaire included items on health behaviour, knowledge of the disease and other factors. Of the subjects studied only 40% stated that they adhered to diet prescription. Occasional insulin injections were missed by 15%. Half the patients restricted diet or increased insulin dose in hyperglycemia but only 18% regularly tested urine for sugar. An important determinant of health behaviour was the level of understanding of the disease, which was found to be low among 58%. The present health education system for diabetic patients in Poland is discussed.

Adolescent↗
PubMed1979

A method for determining patients' perceptions of their health needs.

Success or failure in establishing a meaningful relationship between physician and patient depends to a large extent on how fully the patient communicates, and the physician understands, his/her health needs. Return visits, compliance with the physician's prescribed regimen, and the effectiveness of the treatment and rehabilitation are also closely related to the disclosure and assessment of the patient's health needs. A model of how health needs are determined is presented. Various behavioral outcomes which follow the identification of a health problem and assessment of health needs by a patient are discussed. A Health Needs Assessment Questionnaire is presented in English and Spanish to be used and tested as an aid to the family physician in assessing patient's health needs at the first encounter.

Attitude to Health↗
PubMed1979

[Community health as a determinant of the nursing curriculum].

This paper summarizes the experience acquired under the first university-level program for the basic training of nurses in Peru. It describes the gradual refining of the academic curriculum, which was designed not only to train people as competent professionals, but also to acquaint them with the country's basic social problems. Four levels of teaching-learning were defined in wide-ranging discussions in which various academic and professional sectors connected with the health field participated. Establishing a process of steps of increasing complexity has considerably facilitated the integration of community health, the scientific method, and mental health into the structure of the curriculum. The practice of community nursing was heavily emphasized, and it was endeavored to strike a balance between hospital experience and work in communities themselves. The program includes specific studies community groups spanning such aspects as control of the more common disease, epidemiologic surveillance, and accident and disaster prevention. Practical work in community health care earns the same credit as hospital internship. The paper closes with a description of the experience of a specific program conducted in the self-managed city of Villa El Salvador under an agreement between the community and the university. The writer also notes that the intense campaign to publicize the program is having an effect because most nurse-training institutions in Peru are tending to add community nursing to their curricula.

Community Health Nursing↗
PubMed1979

The breast reconstruction patient and her health insurance carrier.

To determine policies of health insurance companies regarding payment for breast reconstruction following mastectomy, we polled 50 companies selected at random, as well as every Blue Cross-Blue Shield company. To verify that insurance carriers' replies represented their practices, we polled 96 plastic and reconstructive surgeons in 47 states. Although most health insurance carriers claim to fully cover breast reconstruction following mastectomy for cancer, practices vary widely; many postmastectomy patients receive incomplete or no coverage for reconstruction. Two major reasons for discrepancies appear to be (1) inadequate coverage prompted by unrealistic conception of reconstruction on the part of carriers and (2) specific contractual exclusion. We suggest (1) educating lay and professional persons about breast reconstruction, (2) encouraging more realistic coverage from insurance companies, and (3) if necessary, legislative protection for the postmastectomy patient.

Breast↗
PubMed1978

Health status among low-income elderly persons: rural-urban differences.

This research compares the health status of low-income elderly persons in rural and urban areas. Using data from the Social Security Administration's 1973 national survey of low-income aged and disabled, the study demonstrates that the prevalence of many chronic disorders and impairments is significantly greater among the rural aged than for their cohorts in more urban areas. These differences persist after controls for age, sex, and race are introduced. No significant differences between rural and urban elderly were apparent in the utilization of health services. The determinants of chronic health status of the elderly have already occurred, by and large, and an explanation of disorders and impairments cannot be found by examining current sociodemographic status. Such an explanation is contained in the accumulated effects of years of residence in differing social, economic, and physical environments.

Aged↗