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Reducing disparities in utilization of mamography: reaching dually eligible women in Connecticut.

This article describes a two-pronged intervention by the health care Quality Improvement Organization (QIO) for Connecticut to address the disparity in rates of mammography screening between women eligible for both Medicare and Medicaid (i.e., "dually eligible") and other Medicare beneficiaries. The interventions were directed beneficiaries. One intervention addressed information and access needs of the target population: an education session was followed by a mobile mammography van session at low-income housing sites in specific geographic areas. The second intervention was a culturally-sensitive direct mailing to dually eligible beneficiaries across the state. Implementation methods are described including: defining and identifying the target population; specifying the disparity; developing community collaboration; and testing the mail materials. Preliminary results of the education sessions and community testing of the direct mail materials generated information about the target population. Issues in implementation and analysis include: reaching the target population, building community relations, and developing design approaches to test the intervention.

Aged↗

[Specifics of food intake by schoolchildren in the rural areas of Moldova].

149 schoolchildren, 14-15 years old, from 4 rural communities pending on 4 different Moldova counties have been investigated using the one day questionnaire technique. From the entire studied group, only 7.4% are do not eat breakfast before attending school. 35.5% of the schoolchildren consider their sugar intake to be excessive, without taking into account the sugar major role in nervous cell function. The average daily intake for fresh fruits, vegetables and milk is in most cases adequate, but significant differences are present between the communities, related with the socio-economic status of the families and, also, with nutritional.

Adolescent↗

Quality of life in Parkinson's disease--Indian scenario.

UNLABELLED: The subjective sense of well being is central to the concept of quality of life (QoL) and a good QoL should be the ultimate goal to any therapeutic measure. In Parkinson's disease (PD), several rating scale are in vogue to measure the QoL, namely PDQ-39, PDQ-8, SF-36, Likert scale etc. Parkinson's Impact Scale (PIMS) has been used in this study to assess the QoL which includes 10 items. METHODOLOGY: Thirty two patients of Parkinson's disease satisfying the UK Parkinson's disease brain bank diagnostic criteria, ranging from HY stage I to IV have been recruited. UPDRS was also administered to them. Statistical analysis was performed using Spearman rank correlation and multivariate stepwise regression analysis using SPSS for windows. RESULT: Seventy two percents were male, all getting levodopa, 72% got anticholinergics. Monthly income varied from Rs.800 (US dollars 17.10) to Rs.15,000 (US dollars 320) pm. Eighty eight percent belonged to HY II-III. UPDRS score ranged from 3-85 (40.4 +/- 18.6). PIMS total score ranged from 1-22 (10.4 +/- 6.1). DISCUSSION AND CONSLUSION: The QoL deteriorates with H-Y staging, the UPDRS score, not with advancing age as seen in other studies. It is also significantly influenced by duration of the disease and financial security. Surprisingly, the family and community relations were not significantly affected with advancing disease, perhaps due the close family and social tie up among Indians. So, measurement of QoL should be made an essential part to the routine assessment of PD patients to get a complete scenario of the problem. PIMS can serve as a comprehensive tool for the same suitable for use in the OPD.

Aged↗

Objections to the development risk defence.

In Europe the Council Directive of the European Community relating to product liability was enacted in 1985. The Directive allows the producer to use six defences. One of these is particularly interesting: 'that the state of scientific and technical knowledge at the time when he put the product into circulation was not such as to enable the existence of the defect to be discovered'.

Consumer Product Safety↗

Fund-raising strategies in hard times: what works for hospitals.

"It's been tough going" for fund-raising since the economy began its downturn earlier this year, says John Good, vice-president for community relations and development at Beverly (MA) Hospital. Like many hospitals, his institution has been hit hard by declining corporate contributions. Fortunately, individuals have stepped in to pick up the slack for Beverly. But hospitals are competing with a host of other worthy causes for philanthropic dollars.

Anniversaries and Special Events↗

Returns on equity for not-for-profit hospitals.

This study examines the circumstances in which a large third-party payer or regulator might want to set hospital prices to yield a positive rate of return on equity capital. The level of return is shown to depend on the willingness of donors to make funds available in the community relative to the (derived) demand for capital to produce output. It is shown that the appropriate price might well be set to yield a zero or below-market return, and that the return to not-for-profit firms should generally be less than that to for-profit firms, if for-profit firms are to be active in the market.

Capital Financing↗

Dental health problems of the geriatric population.

A topic seldom considered and even more rarely discussed among the dental components of the health professions is presented. The dentist's preoccupation with hosts of dental treatment problems has left little time for considering the perplexities of aging, critical illness, or dying or dead patient's relatives. Community dentistry has now forced upon our consciousness the fact that perhaps the subject is one which must not be avoided, if we are to fulfill completely our professional obligations to the public.

Aged↗

[Sarcoidosis and profession (author's transl)].

This paper is basing on hitherto not published results of a dynamic community-related epidemiologic study, passed by data processing on sarcoidosis within the territory of the district of Cottbus (860000 inhabitants). The completely registered new cases of sarciodosis during the years 1961-1975 (1647 cases) have been recorded using the following epidemiologic parameters: profession, age, sex, education, residential district, personal status and so on. The classification according to professional groups was carried out correspondingly to an appropriate modification of the professional catalogue of the WHO. Under consideration of the hitherto very contradictory data in literature--the result of our investigation points to the importance of this epidemiologic parameter. Conclusions could be drawn also as to morbidity, pathogenesis and prophylaxis results. The correlation between profession, education and residential district allows interpretations on the causes of regional differences in the incidence of sardoidosis in rural districts. In the district of Cottbus there is an accumulation of sarcoidosis in rural districts respectively in professional branches prevailing there.

Adult↗

Stress in the police service.

In this study, the sources of stress among supervisory police officers were explored. It was found that one of the major sources of stress across all managerial levels among the police was the perception that the police service was inhibited by unnecessary bureaucratic and outside obstacles, e.g., increased paperwork, interdepartmental politics, lack of adequate planning and resources and the inability of the courts to prosecute offenders. It was also found that junior and middle supervisory police officers were adversely affected by lack of available manpower and long working hours, whereas senior officers were affected more by the conflict in maintaining positive policing as well as good community relations.

Adult↗

Enhancing the delivery of cancer care to the disadvantaged: the challenge to providers.

Few attempts have been made to document and highlight the challenges faced by professionals who work with medically and economically disadvantaged persons seeking cancer care. This report analyzes and summarizes the testimony presented by such professionals at a series of nationwide hearings in 1989 sponsored by the American Cancer Society. The purpose of the hearings was to document the effects of economic and medical disadvantage on the development of cancer and cancer care. Among those presenting testimony were persons with personal cancer experiences, family members, and partners of cancer patients, healthcare providers, and related community liaisons. Professionals who worked with disadvantaged persons shared their experiences during the hearings. They suggested that the beliefs and attitudes of their peers were a major deterrent to providing cancer care. Processes and systems discouraged referrals. Lack of access to resources to serve the needs of the disadvantaged was the greatest obstacle to care.

Attitude of Health Personnel↗

[The Ostringer (Prevention) Model. Results of family medicine supervised "community behavioral medicine"].

To evaluate the German intervention model of "Community-related Behavioural Medicine" in reducing cardiovascular risk during a major prevention study (phase I) and to investigate the efficiency of a long-term evaluation by establishing a Local Health Information System for which cooperating primary care physicians carry responsibility (phase II). In the intervention city of Bruchsal (GCP evaluation, phase I), the cardiovascular risk factors were reduced: smoking (-9.4%), obesity (-17.1%), hypertension (-51.4%) and hypercholesteremia (-12.8%). In the general practices of Oestringen (LOHIS-evaluation, phase II), the prevalence of smoking, from 1992 to 1994 (-23.8%, p < 0.01) as well as hypertension (-22.2%), p < 0.01) continued to decrease; there was no further reduction of hypercholesteremia and over-weight.

Adult↗

Institutional racism and the medical/health complex: a conceptual analysis.

Presented in this paper is a theoretical framework for understanding and applying the concept of institutional racism to the medical/health care system. Medicine and health are viewed as vital social institutions that reflect the norms, values and social stratification systems of the larger society. Institutional or systemic patterns of racism are legitimated and promulgated through accepted standards, criteria, and organizational processes within the medical health complex that have the effect of discriminating against the minority group. It is maintained that racism is manifested (overtly or covertly) through history, ideology, community relations, research, education and the professions, and differential treatment. Focusing on investigators who have conducted studies of "racial bias" in the diagnosis and treatment of coronary artery disease, the author discusses some of the shortcomings of this research, from an institution racism perspective. Differential treatment researchers are encouraged to include social theory as part of their analysis and to explain the practical significance of their findings for the equitable delivery of health care. It is suggested that, because of wider structural changes occurring in American society, issues related to racism within medical and health institutions will become increasingly more important.

Coronary Disease↗

[CINDI (Countrywide Integrated Noncommunicable Diseases Intervention) in Germany. A model for life style oriented, medical primary care for the population].

The WHO project "CINDI" (Country-wide Integrated Noncommunicable Diseases Intervention) is being implemented in 23 European countries and in Canada. The central goal of this project is the development of across-country strategies to combat chronic diseases caused by unhealthy lifestyles. The more Europe grows together the more it will be necessary to have such strategies. The health sector of the individual countries is shaped by cultural and/or civilizatory conditions. Such a strategy has to account for the country's specific shape of the health sector and the experience made in this point has to result in the establishment of structures and the creation of measures across Europe and worldwide. In the first step, members of the CINDI family are to ascertain country specific informations which in the second step should be used for the development of the strategy. The paper refers to the contribution made so far by CINDI Germany with regard to the first step. The "3 Level Conception of Family Physicians"-recommended by the Society of physicians of Germany the model "Community - related behavioural medicine" - which has been developed to put the above mentioned conception into practice - and quality assurance in the framework of medical primary care from the focus of the paper.

Adolescent↗

Why rural practice?

In a national study of rural registered nurses, over 3,500 listed family or community-related reasons for practicing in rural areas. On the other hand, at least half stated that job-related factors would influence them to leave their present positions.

Adult↗

Intensity and predictors of treatment received by adolescents with unipolar major depression prior to hospital admission.

We sought to characterize the type and intensity of treatment received in the community by 80 adolescents with unipolar major depressive disorder prior to hospital admission for this index episode of illness. Structured clinical interviews were used to rate the presence and severity of a wide range of depressive symptoms and to derive global measures of episode subtype and degree of impairment. Multiple sociodemographic and clinical variables were considered as predictors of level of antidepressant treatment exposure. Although the majority of patients sought help prior to admission, only 58% received antidepressant medication, and fewer than half of these treated patients received levels of treatment deemed adequate by conventional standards. More aggressive levels of pharmacotherapy were received by only a small minority of the sample, and overall severity of illness had little effect on intensity of treatment. Specific clinical features associated with endogeneity were the most robust predictors of more intense antidepressant pharmacotherapy. A disturbingly high proportion of adolescents with serious depressive illness receive less than optimally aggressive treatment in the community relative to the seriously handicapping nature of their illness. The potential implications of these observations are considered.

Adolescent↗

The legacy of a community mobilisation project to reduce alcohol related harm.

The Community Mobilisation for the Prevention of Alcohol Related Injury (COMPARI) project was established to investigate how alcohol related harm could be reduced within the Geraldton community through community action. Twenty-two major component activities were carried out over three years. On completion of the demonstration phase the project was taken over by the community and evolved into the region's main alcohol and drug service provider. This research seeks to identify the legacy of COMPARI from interviews with 23 key informants and from serial measures of alcohol consumption and harm. Key informants indicated that the original community prevention focus of the project has been diluted and there is more emphasis on individual prevention through education and training. A culture of intersectoral collaboration on alcohol issues has endured and this contributes to better use of resources and higher levels of treatment referral. There was also strong acknowledgement that the local committee was crucial in sustaining the project. Since the inception of COMPARI, local alcohol consumption has decreased and a proxy measure of alcohol harm, weekend, night, hospital accident and emergency occasions of service, also indicates better outcomes in Geraldton. The original project initiated cultural and structural change in the way alcohol problems are dealt with in Geraldton and this has produced on-going benefit for the community.

Alcohol Drinking↗

Sexual behavior and AIDS-related knowledge among community college students in Orange County, California.

Whereas college students are not identified as a high-risk group for acquiring the HIV infection, they exhibit high-risk behaviors consistent with their age group, including multiple sexual partners and high rates of unprotected intercourse. This study was conducted to determine levels of HIV-related sexual behavior, along with knowledge and attitudes among students attending community colleges in a relatively affluent multiethnic community. This study used a random sample survey (N = 319) of students attending selected classes at four community colleges in Orange County, California, to assess HIV/AIDS knowledge, attitudes, and patterns of past and present sexual behavior. The level of student knowledge concerning HIV disease was found to be relatively high, and pronounced differences in knowledge and sexual permissiveness were identified as a function of ethnicity and religion, with Asians showing lower knowledge and lower concern about HIV, and religion/religiosity related to these variables and also to levels of sexual permissiveness. Respondents' comfort in asking a partner about his/her sexual history was positively associated with their level of self-esteem, and negatively related to peer pressure in this population. As in previous studies of college populations, HIV knowledge per se does not confer a protective effect against high-risk behavior. However, knowledge was found to be an enabling factor with regard to students' comfort levels in asking about their partner's sexual histories, and in requesting that partners take an AIDS test.

Acquired Immunodeficiency Syndrome↗