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PubMed1986

Health care in transition. Consequences for young physicians. Council on Long-Range Planning and Development.

Individuals planning for a career in medicine must weigh a number of factors into their decisions. Increasingly, they must understand the nature of the socioeconomic environment of health care, including the extent of competition with other physicians and other health professionals; the degree of autonomy from health care institutions, government, and third-party payers; the impact of demographic or technological changes; and the economics of medical practice. This report analyzes the environment of medicine, emphasizing those elements that will be most important to medical students and resident physicians. It focuses on three stages of a physician's career: obtaining a medical education, beginning to practice medicine, and maintaining a viable practice.

Adolescent↗
PubMed1996

Managing the transition to integrated health care organizations.

Today's successful community hospitals should and will evolve into integrated health care organizations (IHCOs) that will share several common characteristics. IHCOs will have a community--not a membership--orientation, and this will be a distinguishing characteristic and a source of market appeal. The transition to IHCO will be a slow one, and to prosper, the IHCO will have to accommodate both price-oriented markets and traditional ones. Successful IHCOs will expand technical skills and capabilities to control costs and quality. New strategic competencies will have to be developed, and to do this, emerging IHCOs will improve the ability of managers to support decisions and sell them both to the buyers and the public at large. Excellent patient care will rest upon better trained, advised, and informed management teams. Making the change to an IHCO will take time and money, but organizations that make steady progress are likely to succeed.

Community Health Planning↗
PubMed1977

Carotid-vertebral artery blood transit time in health and in neurological patients: a preliminary study by a non-invasive impedance method.

Thirty-one healthy subjects and nineteen neurological patients covering a range of chronic neurological and neurovascular syndromes were examined by an electrical impedance method. Two estimates of carotid-vertebral artery transit times were measured: one time taken between the Q wave of the EKG to the commencement of the next succeeding impedance pulse-volume wave (CT1), and the other, this estimate together with the time to maximum point of the impedance wave (CT2). Results indicated prolonged circulation times for the patients as compared with the controls without relevance to age in the case of CT1, although transit times did increase with age for CT2. It is suggested that this impedance technique may be valuable in the initial screening of transient cerebral ischaemia.

Adolescent↗
PubMed1994

Influence of antidepressants on whole gut and orocaecal transit times in health and irritable bowel syndrome.

BACKGROUND: Antidepressants are used in the treatment of irritable bowel syndrome but it is unclear whether any symptomatic improvement is due solely to correction of an associated affective disorder, or whether these drugs have effects on bowel function which may be of therapeutic benefit. Intestinal transit is known to be abnormal in some irritable bowel syndrome patients. METHODS: We have studied the effects of imipramine, a tricyclic antidepressant with mixed pharmacological properties, and paroxetine, a selective 5-hydroxytryptamine re-uptake inhibitor, on intestinal transit times. RESULTS: Median (range) whole gut transit time was lower in 10 diarrhoea-predominant irritable bowel syndrome patients, 22.2 (3.6-51.6) h, compared to 28 control subjects 39.6 (7.2-68.4) h, (P < 0.05). Similarly, orocaecal transit time was shorter at 55 (30-90) min in diarrhoea-predominant irritable bowel syndrome patients compared to 75 (40-150) min in controls, (P < 0.05). Four days' administration of imipramine increasing to a daily dose of 100 mg prolonged both orocaecal and whole gut transit times in 12 control subjects and six diarrhoea-predominant irritable bowel syndrome patients. In contrast, 30 mg paroxetine daily for 4 days reduced orocaecal transit time in ten controls and eight irritable bowel syndrome patients, but had no effect on whole gut transit time. CONCLUSION: Short-term administration of antidepressants alters intestinal transit, but the selective 5-hydroxytryptamine re-uptake inhibitor, paroxetine, has different effects to the tricyclic drug, imipramine. These effects on transit precede any effects on mood. Although there is a high prevalence of affective disorder in irritable bowel syndrome clinic patients, these drugs may have additional therapeutic actions on the gut. These actions might be taken into account when prescribing antidepressants in irritable bowel syndrome.

Adult↗
PubMed1996

Hungary: a health system in transition.

Hungary has an area of 93,030 square kilometers (35,900 square miles), the size of the state of Indiana in the United States. It is landlocked by the Czech Republic and the Slovak Republic to the north, Austria to the west, Yugoslavia to the south, and Romania and the Soviet Union to the east. Although the health care system is based on the Soviet system, there have been dramatic changes since 1991, when the soviet Union and its Eastern European partners discarded their communist structures and the Soviet empire was disbanded. In this report, the current Hungarian health care system and the political structure in which it is housed will be described in terms of a key set of characteristics and their subparts. The purpose of this approach is to facilitate comparison of the Hungarian system with other national health care systems. An expanded version of this article will appear in an upcoming second edition of the College's book, International Health Care: A Framework for Comparing National Health Care Systems, by Drs. Mendoza and Henderson.

Demography↗
PubMed1996

The 'market' for medical and health information in transition: the case of the Hong Kong Hospital Authority libraries.

The last few years have been a period of transition not only for hospitals and their governance but also for post-graduate medical education in Hong Kong. Both trends have a direct impact on the information market place. This article starts by studying the provision of medical and health-related information in Hong Kong. The two university medical and dental libraries, together with the hospital and health sciences libraries in government hospitals and the Department of Health, house the major collections on medicine and health care. The demand for medical and health care information is increasingly felt with the takeover of 39 hospitals by the statutory Hong Kong Hospital Authority in 1991. The major problems and issues in planning for library information services are the historically uneven development of libraries, discrepancies in funding, the changes in organizational and management structure, and the competition with higher development priorities within the organization. In view of current technology and the availability of rich external resources, the adopted strategies tend towards the formation of 10 library service networks, development of integrated library information systems on the Health Authority-wide area network, and the devolution of management responsibilities. The future challenges in store for the information professional are examined.

Community Networks↗
PubMed2005

Child health services in transition: II. Mothers' perceptions of 18-month-old children in the light of socio-economic status and some subjective factors.

AIMS: To analyse mothers' self-assessed quality of interaction with their children and their opinions about child difficulty with respect to socio-economic status and subjective factors: postnatal depression, social isolation, sense of coherence and locus of control. METHODS AND MATERIAL: A comprehensive questionnaire was completed by 1039 mothers of 18-mo-old children participating in the baseline measurements of a Swedish multicentre study developing and testing a new psychosocial model for the child health services. RESULTS: All subjective factors, including the number of factors, showed significant associations with perceived interaction and difficultness. Effect sizes of subjective factors ranged from about 0.3 to 1 SD for interaction, and from about 0.2 to 0.8 SD for difficultness. As for difficultness, effect sizes were larger for boys. There were no associations between high socio-economic status and high-quality interaction or low child difficultness: the few significant differences in fact favoured low-status children. CONCLUSION: The results provided some contradictory findings to the well-known association between high socio-economic status and favourable outcome. This result is of practical relevance for interventions: supportive programmes cannot be limited to areas and families of low socio-economic status. Positive effects may ensue if subjective factors like those studied here can be promoted among parents and children through the child health services.

Child Health Services↗
PubMedDate not supplied

Informal caregiving burden: an overlooked aspect of the lives and health of women transitioning from welfare to employment?

Informal caregiving occurs among communities in all socioeconomic strata and is largely provided by women. Although an extensive amount of research focusing on caregiver burden has been conducted within nursing, little is known about informal caregiving among low-income women, particularly within the context of welfare reform. This study examined the extent of informal caregiver burden in low-income women transitioning off welfare and the relationship between informal caregiving and maintaining employment. A random sample of 32 adults who had recently received welfare was obtained (n = 31 women), although there was significant difficulty locating potential subjects. Sixty-three percent of participants were providing nonparental forms of informal caregiving. Caregiver burden scores among this group were highest in the time-dependence dimension of caregiving. Over 30% of participants reported having to leave a job within the past year because of their caregiving responsibilities. These findings suggest that the informal caregiving responsibilities of low-income women may be an overlooked aspect of welfare reform policy. Given the emphasis on case management and policy advocacy in their roles, public health nurses are uniquely positioned to partner with local welfare-to-work organizations, educate program staff, and further develop existing assessment processes to better address caregiving responsibilities within low-income families.

Adult↗
PubMed2005

Moving beyond ward based treatment: a public mental health hospital's transition to a treatment mall.

Saint Elizabeths Hospital in Washington D.C. implemented a treatment mall in 2002. The authors place the mall's development within the context of the Hospital's problems associated with ward-based treatment. They describe objectives in developing the mall, steps taken to prepare staff and hospitalized persons, and the mall's structure and programs. Providing treatment in a mall setting increased active treatment, expanded opportunities for trainees and staff, and improved monitoring of treatment activities.

Community Mental Health Services↗
PubMed1990

Life beyond pediatrics. Transition of chronically ill adolescents from pediatric to adult health care systems.

Transition from pediatric to adult health care is fraught with difficulties. On the one hand, the adult care system is not properly prepared to receive patients who are survivors of the so-called childhood disorders. On the other hand, patients and families have difficulty leaving the protective environment created by pediatric caregivers, who in turn may have mixed feelings about letting the patients go. Normalization of development and social adaptation for chronically ill adolescents, however, should include a change in the environment in which health care is received. This article examines some of the issues surrounding transition and transfer from pediatric to adult health care systems and propose some avenues toward implementation of such programs.

Adolescent↗
PubMed2002

Mental health and welfare transitions: depression and alcohol abuse in AFDC women.

From a selection perspective, does prior dysfunction select women into welfare or serve as a barrier to leaving welfare? From a social causation perspective, does entering or exiting welfare lead to changes in well being? These questions were analyzed in panel data for over 3,600 women drawn from the National Longitudinal Survey of Youth for the period 1992-94. Welfare is associated with both depression and alcohol consumption cross-sectionally. This link appears to derive in small part from selection into welfare by depression (in interaction with marital status), butdepression and alcohol abuse did not operate as barriers to leaving welfare. Entering welfare was clearly associated with increased depression and alcohol consumption, but confidence in an apparent beneficial effect on alcohol symptoms of leaving welfare for employment was limited by small sample sizes. These findings are located in the context of the 1996-welfare reform and the recent economic expansion. One implication is that community psychology should consider welfare entry as a risk factor similar to adverse employment changes such as job loss.

Adolescent↗
PubMed1990

Conditions for the transition to home health care.

A number of changes in health care thinking have been taking place during the past years; these changes are in the financial system, in professional thinking and in political views. As one of the consequences, general hospitals in the Netherlands are thinking of entering home health care for professional and financial reasons. Most probably this may be done now if the management dares to take some risks. However, many conditions still need to be adapted to that situation. Most importantly, it is absolutely necessary to achieve a functional co-operation between professional groups in home health care. Hospital pharmacists should do their home work to make clear what extra value they can bring into home health care. Undoubtedly there are possibilities for the hospital pharmacy in home health care as part of the whole hospital policy in that direction.

Government↗
PubMed1998

Transitions in health-related quality of life during the first nine months after diagnosis with prostate cancer.

Health-Related Quality of Life (HRQOL) is an important outcome measure in the study of prostate cancer. There are few data regarding the effect of sociodemographic variables, such as insurance status, educational level, marital status or income, on HRQOL. We examined whether these or other sociodemographic and clinical variables are predictive of HRQOL outcomes using an observational database of prostate cancer patients accrued from a wide array of clinical practice settings. We studied 131 patients with newly-diagnosed prostate cancer who had been followed for at least nine months. Patients were enrolled in CaPSURE(TM), a large, observational database of patients with prostate cancer. General and disease-specific HRQOL were measured with established, validated instruments at diagnosis and nine months later. Sociodemographic data and co-morbidity counts were recorded at baseline. Multivariate regression analysis was used to determine whether sociodemographic or clinical variables were predictive of baseline HRQOL or HRQOL changes during the study period. Several sociodemographic and clinical variables demonstrated significant associations with HRQOL. We found improvements in general and disease-specific domains of HRQOL during the nine months after diagnosis. For married patients, Emotional Well-Being and Family Functioning scores were better at baseline (+11.8, P<0.02), but Family Functioning declined over the nine month study period (-18.5, P=0.0006). Older patients had slightly better baseline performance in several domains of HRQOL, but experienced greater HRQOL decrements over time than did younger patients. Increasing comorbidity was associated with worse baseline general HRQOL. Early tumor stage was predictive of better scores in general HRQOL domains at baseline. Limited palpable disease stage (T2A/T2B) was predictive of worse Sexual Function and Sexual Bother at nine months (-8.6, P=0.04; -24, P=0.008). After initial decreases, patients appear to experience an improvement in general and disease-specific HRQOL within nine months of initial diagnosis with prostate cancer. Marital status is associated with better HRQOL, while advancing age is associated with more significant HRQOL declines over time. Patients with lower stage disease were noted to have better general HRQOL at baseline, although decreases in the physical domains were noted at nine months. These data shed new light on patients' experience with prostate cancer and suggest that HRQOL outcomes over time may occur in a predictable manner.

Journal Article↗