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PubMed2002

[Home hospitalization in light of demographic changes and new health challenges].

OBJECTIVE: Today, the most important demographic change taking place is the rapid aging of the population. While this phenomenon is having a growing and profound impact on all spheres of society, its greatest impact is in the health area, affecting all levels of health care and leading to the need for new resources and new structures. Out of that, in many countries have come different alternatives as well as in-patient, outpatient, and in-home programs that are geared toward improving health care and helping set priorities. One of these new initiatives is home hospitalization, or home health care. One objective of this study was to describe and analyze the characteristics of a population in Spain that was assisted through home hospitalization (HH). Another objective of the study was to comment on the role that HH can play as a mechanism for integration and coordination between health care levels, in the face of the challenges occurring with the reorganization of health care policies and programs, especially those directed at the elderly. METHODS: A retrospective descriptive study was done of patients assisted through HH in Sanitary Area 9 of the Autonomous Community of Valencia, which is on the eastern coast of Spain. The area's population was 321,361, of whom 60,079 (18.7%) were 60 or older, including 43,044 (13.4%) who were 65 or older. A descriptive study of the analyzed variables was done, with the mean and standard deviation being computed for quantitative variables, and the absolute and relative frequencies (percentages) being calculated for the qualitative variables. RESULTS: Of the patients studied, 78% of them were 65 or older, with an average age of 73 years. They were predominantly women. Of the total group, 72% of them had chronic diseases, and 67% had at least one associated secondary diagnosis. There was an important problem of communication between the two principal levels of care, primary care and hospital care, which obviously had an impact on the patients and on the quality and effectiveness of their health care. Furthermore, it was found that HH finds its greatest utility with and is an effective tool for an adult or elderly population that has multiple chronic degenerative or terminal diseases. CONCLUSIONS: The results of this study highlight the need to create or strengthen channels and mechanisms for interinstitutional communication that will guarantee continuity of care. The ongoing, effective care of the health and well-being of elderly persons requires different levels of health interventions. This care should be comprehensive, adequate, integrated, of high quality, humanized, timely, and coordinated between the two principal levels of health care. In the final analysis, these factors will determine the quality of the health care for geriatric patients and the capacity to solve their health problems.

Adult↗
PubMed2006

Institutional and economic determinants of public health system performance.

OBJECTIVES: Although a growing body of evidence demonstrates that availability and quality of essential public health services vary widely across communities, relatively little is known about the factors that give rise to these variations. We examined the association of institutional, financial, and community characteristics of local public health delivery systems and the performance of essential services. METHODS: Performance measures were collected from local public health systems in 7 states and combined with secondary data sources. Multivariate, linear, and nonlinear regression models were used to estimate associations between system characteristics and the performance of essential services. RESULTS: Performance varied significantly with the size, financial resources, and organizational structure of local public health systems, with some public health services appearing more sensitive to these characteristics than others. Staffing levels and community characteristics also appeared to be related to the performance of selected services. CONCLUSIONS: Reconfiguring the organization and financing of public health systems in some communities-such as through consolidation and enhanced intergovernmental coordination-may hold promise for improving the performance of essential services.

Community Health Services↗
PubMed1996

Drug utilisation patterns in the Third World.

Drugs are not available to the majority of the population in developing countries. Aggravating factors include weak healthcare structure, inadequate financial resources, nonavailability of pharmaceuticals, lack of drug legislation and policy, ineffective drug utilisation and the prevalence of self-medication. Although most of the population lives in rural areas, available funds are mostly utilised for urban areas. The use of drugs by injection is common in developing countries. In addition, many patients self-medicate because most drugs are available without a prescription from a doctor. There is therefore a great need for prescriber education in rational drug use, and for public education in the use of commonly used drugs. National health and drug policies should be formulated which incorporate the essential drug concept, and drug legislation needs to be revamped and implemented effectively. These measures may be helpful in providing better healthcare to the majority of the population in developing countries.

Delivery of Health Care↗
PubMed2006

Healthcare rationing in Spain: framework, descriptive analysis and consequences.

This paper describes the main healthcare rationing policies implemented in Spain over the last 2 decades, and analyses the consequences of these policies on the healthcare system, patients, healthcare practitioners, the pharmaceutical industry and policymakers. The primary explicit healthcare rationing policies utilised in Spain include a catalogue that defines the healthcare rights of citizens. However, the existing system may lead to inequity between regions, and is not structured to direct resources towards the most cost-effective options. Health technology assessment requires further work before it can be utilised widely for the development of rationing strategies. Selective reimbursement of drugs and drug co-payments provide only short-term results and appear to have little long-term impact on expenditure. Implicit rationing instruments, especially waiting lists, have had a significant effect on healthcare quality and the welfare of citizens, and have contributed to keeping the Spanish healthcare budget under control. Newer regulations should integrate some form of economic evaluation within the policy-making processes associated with healthcare. Further research is needed to identify those efficient and equitable rationing instruments that are most likely to improve health interventions for an aging society that is increasingly demanding of health services.

Health Care Rationing↗
PubMed1993

Predictors of volunteer status in a retirement community.

In the present study, actual volunteers, latent volunteers, conditional volunteers, and definite nonvolunteers living in a retirement community are compared on social-structural, role, environmental, resource, lifestyle, and individual difference variables. Three functions emerged from the discriminant analysis. Actual volunteers attend church frequently, are free of activity limitations due to health, have volunteered previously, and belong to several clubs and organizations. Latent volunteers engage in informal religious behaviors, attend church about once a month, are about seventy years old (i.e., they are younger than the other groups), and are very satisfied with their neighborhood. Conditional volunteers engage infrequently informal religious behavior, have no instrumental activity limitations due to health, did not attend college, have very high neighborhood satisfaction, and are seventy-four years old (i.e., older than latent volunteers and actual volunteers). Implications for recruiting latent and conditional volunteers are discussed.

Age Factors↗
PubMed1999

Alternatives to minimize the environmental impact of large swine production units.

Large swine production facilities have become controversial additions to the agricultural landscape as their numbers and sizes have increased. In addition to being larger enterprises, these units have involved greater specialization, the influx of outside capital, and the employment of labor without extensive investment in the enterprise. Major complaints have included water pollution and odors. Water pollution complaints have been related to surface and groundwater resources. Accidental spills, structural failure, and purposeful discharges have been noted. Odor problems are most often related to manure management techniques. Large anaerobic lagoons and irrigation of lagoon effluent have the potential to emit odors that travel long distances. Fortunately, technology and management alternatives exist to achieve higher levels of environmental acceptability. More effective water pollution and odor control alternatives generally increase construction and operating costs. Producers, regulatory officials, and the local public have an opportunity to interact to achieve progress in establishing acceptable compromises. This article identifies the range of existing and evolving alternative strategies and provides some assistance to producers and neighbors in achieving the necessary equilibrium.

Animal Husbandry↗
PubMed2005

Making it better: building evaluation capacity in community mental health.

This paper describes a province-wide initiative aimed at building the capacity of community mental health programs to participate in program evaluation and development by transferring knowledge, promoting discussion and developing resources. Active involvement of stakeholders and evaluation of the current capacity of the field informed the ongoing development of the initiative. Recovery served as a guiding framework for formulating and understanding community mental health outcomes. Despite the interest of the field in evaluation activities, programs were constrained by limited resources and accountability structures. Sustainability of the project would be enhanced by direct work with programs to facilitate application of Continuous Improvement.

Canada↗
PubMed1994

Experienced faculty orientation offerings: do they meet faculty needs?

The purposes of this descriptive study were to identify existing orientation protocols for seasoned nurse faculty who change academic positions and which orientation protocols these faculty perceived helpful. Subjects were drawn from 460 NLN-accredited generic baccalaureate programs. All subjects (N = 372) had a minimum of three years' prior teaching experience and were employed at the institution within 1990-91 and 1991-92. A two-part questionnaire, adapted from Mills (1983), was used. Some form of orientation was offered to 81% of the sample, with 27% reporting an orientation of less than one day. Topics addressed by orientation programs for the majority of the sample included conceptual framework and curriculum; teaching and library resources; and organizational structure. Areas not addressed included introduction to local nursing organizations and the community in general. Results suggest that experienced faculty receive some form of orientation. The scope is limited, with such topics as clinical placement and student evaluation omitted.

Adult↗
PubMed1978

The managerial role of the department chairperson in schools of allied health: present and future.

The environment in which schools of allied health must exist is extremely turbulent and chaotic. The key to survival in such an environment lies in the creativity and effectiveness of those involved in the management of educational programs at all levels. In particular, it is the department chairperson who may critically influence the growth or decline of individual programs. This paper utilizes a simple conceptual management model to examine the role of the chairperson in a school of allied health. Goal setting, organizational structure, reward systems, resource utilization and interpersonal relationships are discussed and interrelated with respect to the department, school, university, health care system, state and federal government. The model as applied here reduces the idea of contingency management to a few simple operational steps and allows the chairperson to systematically deal with the changing environment, internal and external. As a consequence, departmental goals may be pursued in a logical, but flexible, fashion.

Administrative Personnel↗
PubMed1999

[Follow-up chest radiography in surgical breast cancer patients].

PURPOSE: We investigated to what extent the diagnostic findings of chest radiography can improve prognosis and treatment in surgical breast cancer patients. We also reviewed the literature and our personal findings to choose the optimal follow-up frequency to meet therapeutical and management needs, including radiation protection. MATERIAL AND METHODS: We retrospectively reviewed 1556 chest radiographs of 195 surgical patients with M0 breast cancer performed January 1990 to December 1996. Patient's history and clinical data were accurately reviewed to investigate the relation between protocol type and results. The maximalist or intensive protocol featured 3 chest radiographs a year, even in the absence of any specific signs; the results were reviewed in terms of early diagnosis and prolongation of life. RESULTS: Only 13% of the examinations had been performed following a specific clinical indication, while 87% had been performed for a generic referral. Recurrences were found in 0.6% only of the latter examinations, which means that radiography provided no diagnostic improvement or important change in treatment in as much as 99.4% of cases. In 1997 radiographic follow-up was made triannual instead of biannual as it used to be. DISCUSSION AND CONCLUSIONS: In the absence of specific clinical indications, chest radiography can be performed in the two projections once a year. More aggressive protocols requiring more frequent examinations are not justified, as the patient's life expectancy is not increased. Yearly examinations permit to meet economic and management needs, with a better use of time, staff and materials. Moreover, the clinical-diagnostic yield is not affected by the skipping of unselected examinations. Finally, another pro is the technical thoroughness of the examination with orthogonal projections and the possibility to use ionizing radiations, which improves the management of clinical risks. Maximum radiologist-oncologist cooperation in clinical practice can improve both diagnostic efficiency and treatment efficacy, by reducing the population dose and rationalizing the use of human, instrumental, structural and financial resources.

Breast Neoplasms↗
PubMedDate not supplied

[Role of specialized care services of the national health service in the framework for the prevention of occupational risks (II)].

INTRODUCTION: Since 1986, the Government of Navarra has taken over the functions of security and health as part of the health 'area', with a broad conception of health, avoiding separating the citizen from the worker. In 1993, the Instituto Navarro de Salud Laboral created, under the direction of the departments of Health and Labor, combined diverse functions and resources, integrating preexisting structures into a technical department to be responsible for the overall health care of workers. DEVELOPMENT: The structure is based on two coordinated pillars, security and hygiene at work and occupational health. As more specifically to do with health, we describe the systems of epidemiological information and vigilance and programs for occupational disabilities, health activities in industry and investigation of diseases. The Unidades de Salud Laboral link the workplace with the public health service. The occupational health plan of Navarra will set out future strategies. CONCLUSIONS: It is necessary to involve neurologists in occupational health. Occupational risks and injury are everyone's problem. The neurologist's role in accidents is usually of health care; detection of illness is more difficult when an occupational relationship is not considered. Data from work should be included in the clinical history. The official figures for occupational neurological diseases are ridiculous and more cases should be detected. There should be a fluid relationship between neurologists, occupational doctors and experts in prevention.

Humans↗
PubMed2001

Is population coronary heart disease risk screening justified? A discussion of the National Service Framework for coronary heart disease (Standard 4).

Standard 4 of the National Service Framework (NSF) for coronary heart disease (CHD) describes population cardiovascular risk screening at primary care level. General practitioners (GPs) are expected to deliver this standard and have their performance monitored as part of their clinical governance programme. Although CHD is an important preventable health problem in the United Kingdom (UK), the effectiveness of primary prevention screening programmes are minimal, even within clinical trial settings, and their cost-effectiveness is not clear. The National Screening Committee has identified clear standards for establishing a screening programme in the UK and the activities described in Standard 4 do not fulfill many of these criteria. Specifically, there are no plans for central organisation and co-ordination, no agreed quality assurance standards, and no uniform system for performance management. The clinical, social, and ethical acceptability of the interventions mandated have not been established, and GPs are left to consider how to redirect resources to achieve the standard. We argue that the benefits of population cardiovascular screening must be established through properly conducted trials and, if a programme is introduced, adequate resources and management structures must first be identified.

Coronary Disease↗
PubMed2001

Developing community capacity and improving health in African American communities.

Community-based programs have produced mixed results. Community capacity is thought to be a major determinant of program effectiveness. Thus, enhancing community capacity may increase the beneficial effects of existing programs and enhance future program effectiveness. This highlights the need to focus on understanding the components of capacity and the methods of enhancing capacity. Although we are just beginning to examine and understand key concepts, community capacity is probably influenced by both relatively nonmodifiable characteristics (such as demographic factors, institutional resources, and social structures) and relatively modifiable characteristics (such as knowledge, skills, and the ability and willingness of members and agencies to work collaboratively). In their relationships with community members and agencies, academicians and public health practitioners may help acquire categorical funding to enhance opportunities to build community capacity and their own capacity as well. The relationship between academicians/practitioners and community members/agencies probably is influenced by a host of characteristics which determine the degree to which capacity can be built. This paper discusses: the key components of capacity; the factors that influence building capacity through collaborations; a community health advisor (CHA) model which both builds on sociocultural aspects of African American culture and is consistent with methods for building community capacity; and how modifications to this model allow it to be compatible with categorically funded projects.

Black or African American↗
PubMed2001

Developing community capacity and improving health in African American communities.

Community-based programs have produced mixed results. Community capacity is thought to be a major determinant of program effectiveness. Thus, enhancing community capacity may increase the beneficial effects of existing programs and enhance future program effectiveness. This highlights the need to focus on understanding the components of capacity and the methods of enhancing capacity. Although we are just beginning to examine and understand key concepts, community capacity is probably influenced by both relatively nonmodifiable characteristics (such as demographic factors, institutional resources, and social structures) and relatively modifiable characteristics (such as knowledge, skills, and the ability and willingness of members and agencies to work collaboratively). In their relationships with community members and agencies, academicians and public health practitioners may help acquire categorical funding to enhance opportunities to build community capacity and their own capacity as well. The relationship between academicians/practitioners and community members/agencies probably is influenced by a host of characteristics which determine the degree to which capacity can be built. This paper discusses: the key components of capacity; the factors that influence building capacity through collaborations; a community health advisor (CHA) model which both builds on sociocultural aspects of African American culture and is consistent with methods for building community capacity; and how modifications to this model allow it to be compatible with categorically funded projects.

Black or African American↗
PubMedDate not supplied

Assessment and treatment of tinnitus patients using a "masking approach.".

Audiology clinics are increasingly being asked to provide tinnitus treatment services to patients who are severely distressed by tinnitus. It is unclear what levels of tinnitus care are available at different audiology clinics across the nation. Some clinics have staff who are experienced with the tinnitus masking technique or with tinnitus retraining therapy (TRT), whereas other clinics may limit their care to the provision of hearing aids. This article is an attempt to provide some basic information for those clinicians who would like to provide at least a minimum level of care for their tinnitus patients using the tinnitus masking approach. The most important requirement is a commitment by the clinician to assemble some basic resources and to structure the clinical schedule so that adequate time is available for historical review, evaluation, trial and selection of devices, and tinnitus counseling. A minimum set of measurements is recommended for inclusion in the tinnitus evaluation process. This informal review summarizes a variety of clinical observations culled from years of direct patient care experience. A tinnitus questionnaire is provided to help clinicians review potentially relevant issues.

Acoustic Stimulation↗
PubMed2004

Rheumatic patients in primary and secondary care: differences in structure of diagnoses and working load within a five-year period.

AIM: To compare conditions handled by family doctors and rheumatologists and analyze changes in the distribution of work between primary and secondary care. METHODS: The study population consisted of patients listed with five family doctors. The number and structure of patients with rheumatic diseases and dynamics of visits were examined on the basis of yearly reports dating from 1999 to 2003. Statistics for 1999-2003 were analyzed to provide a background for data concerning outpatient rheumatic care at the University Hospital. A 2-month survey of all consecutive patients referred to rheumatology outpatient center was performed. RESULTS: The number of visits per patient to a family doctor has decreased to 3.0 in 2003 while the number of visits of rheumatic patients to family doctors has increased to 5.9. In 2003 rheumatic patients made up 16.9% of all family doctors' patients, while their number of visits constituted 33.5% of the total visits to a family doctor. The share of visits to a family doctor by rheumatoid arthritis patients has decreased, whereas the share of patients with osteoarthritis has increased. Waiting time for a specialist appointment in 2004 does not exceed three weeks. Out of all the patients referred to rheumatologists, 31.2% were patients with rheumatoid arthritis and 10.4% with osteoarthritis. Patients assessed the availability of rheumatologists as excellent in 47% of cases. CONCLUSION: Since a new model of primary health care was implemented, the division of work between primary and secondary care has been rearranged and currently corresponds to the patient structure and available resources in outpatient care.

Estonia↗
PubMed2004

[Advance of chemistry and bioactivities of catechin and its analogues].

Catechin and its analogues are varied and distributed widely. They have significant bioactivity on clearing free radical, anti-cancer, anti-flammatory, anti-allergic, anti-mutation, anti-aging, improving liver function, and so on. Recently, catechins (GTC) in green tea have given rise to comprehensive attention all over the world, and will have a wonderful prospect. The progress in studies of the structures, spectrum characters, resources and bioactivities of catechin and its analogues has been reviewed.

Animals↗
PubMed2005

[Surgeons' fees--What they should be?].

Changes in medical technology and economic conditions in Japan require that we reexamine the allocation of medical resources and the structure of surgeon's fees. A new payment system based on Diagnosis Procedure Combination (DPC) and an associated cost accounting system went in to use in 2001. Through quantitative analysis and critique of data gathered by these new systems, it might be possible to establish fair surgeons' fees and to improve the efficiency of the medical care delivery system. For its social responsibility and autonomy, the profession of medicine should take an active leadership role in current health care reforms.

Fee-for-Service Plans↗