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PubMedDate not supplied

Recommendations to strengthen the role of lady health workers in the national program for family planning and primary health care in Pakistan: the health workers perspective.

BACKGROUND: This study was planned to assess the strengths and weakness of the National Program for Family Planning and Primary from the Lady Health Workers (LHIW) perspective. We conducted this study in order to develop recommendations for strengthening LHWs' role in Primary Health Care (PHC) in Pakistan in consultation with the health workers. METHODS: A qualitative study, based on key informant interviews, was carried out in Karachi, Pakistan. A total of 20 workers were interviewed. Analysis was carried out by grouping similar responses in a matrix and then analysis with reference to context. RESULTS: Motivations for joining program included financial benefits, convenient timings and an opportunity to serve humanity. Training was deemed satisfactory but clinical training was resented because of doctors' attitudes. Further training needs identified included basic information about common ailments, reproductive issues and basic clinical skills. Major strengths of the program mentioned included provision of services at grass root level, reinforcement of health messages and the community acceptability of workers. Weaknesses mentioned included the contractual nature of job, low salaries, irregularity of payment, no career development and poor logistical support. CONCLUSION: Giving LHWs permanent government employee status and a raise in salary may strengthen the workers functions. Eligible LHWs should be given incentives (skills, career development, financial). The community must be educated about assigned role and responsibilities of LHWs and patient referral system by the LHW needs to be strengthened. The valuable role of LHWs in PHC in Pakistan must be acknowledged and further improvements pursued.

Family Planning Services↗
PubMed1977

[Health and disease. Critical thoughts on the health concept of the World Health Organisation (WHO) (author's transl)].

In recent times, health politics has crystallized more and more into a independent branch of social politics. Health as well as disease, have become a central topic of public and individual discussion. A elucidation of the relevant concepts seems to be urgently required. The article, starting from the well-known WHO definition of health, attempts a critical discussion of the concepts of "health" and "disease". It becomes apparent that, according to the present state of knowledge, neither can be conclusively defined, by either medical or psychic scientific methods. The material is subjected rather to a constant change decisively dependent on psychic currents at the time in question.

Disease↗
PubMedDate not supplied

[Comments on theory development in "public health". Berlin Public Health Research Committee--partial projects "Goals and goal indicators for public health in East and West Berlin"].

Due to extensive government funding, public health research in Germany presently goes through times of revival and relative prosperity. The multiprofessionality of its background, its nearly disrupted scientific tradition in Germany, and the idiosyncrasies in their understanding of "health" among different professions impede the development of a common scientific identity. This paper underscores the importance of semantic precision and the avoidance of pretentious, overstrained theories in favour of pragmatic scientific approaches. Complementary to its action-oriented rationale, the German public health community should more than ever devote itself to health objectives and outcomes.

Berlin↗
PubMed1993

Patient acceptance of two health status measures: the Medical Outcomes Study Short-form General Health Survey and the Duke Health Profile.

BACKGROUND: The Medical Outcomes Study Short-Form General Health Survey (MOS-SF) and the Duke Health Profile (DUKE) are brief, reliable, valid, and practical health status measures with potential applications in clinical research. We compared patient acceptance, ease of completion, and adequacy of capture (of the patient's self-perception of health) of these instruments in a primary care setting. METHODS: The MOS-SF, DUKE, and assessment questionnaires were administered to 79 patients in a university-based family practice. Patient acceptance of each instrument was assessed with Likert scale questions. Patients then compared the two instruments for relative ease of completion, preference, and completeness of capture. RESULTS: Both forms assessed each item well, but the DUKE scored statistically significantly better than the MOS-SF on four of six patient acceptance questions and both ease of completion items. There were no significant differences for capture items. CONCLUSIONS: Although both instruments are well accepted, investigators may favor the DUKE over the MOS-SF for situations in which patient acceptance or ease of completion is a key issue.

Adult↗
PubMed1978

Consumer-choice health plan (first of two parts). Inflation and inequity in health care today: alternatives for cost control and an analysis of proposals for national health insurance.

The financing system for medical costs in this country suffers from severe inflation and inequity. The tax-supported system of fee for service for doctors, third-party intermediaries and cost reimbursement for hospitals produces inflation by rewarding cost-increasing behavior and failing to provide incentives for economy. The system is inequitable because the government pays more on behalf of those who choose more costly systems of care, because tax benefits subsidize the health insurance of the well-to-do, while not helping many low-income people, and because employment health insurance does not guarantee continuity of coverage and is regressive in its financing. Analysis of previous proposals for national health insurance shows none to be capable of solving most of these problems. Direct economic regulation by government will not improve the situation. Cost controls through incentives and regulated competition in the private sector are most likely to be effective.

Costs and Cost Analysis↗
PubMed2006

Rural-urban differences in health and health behaviour: a baseline description of a community health-promotion programme for the elderly.

STUDY OBJECTIVE: To (1) describe the setting and design of the Good Ageing in Lahti Region (GOAL) programme; (2) by using the baseline results of the GOAL cohort study, to examine whether living in urban, semi-urban, or rural communities is related to risk factors for chronic diseases and functional disability in ageing individuals. DESIGN: The baseline data of a cohort study of ageing individuals living in three community types (urban, semi-urban, rural). Data were collected by two questionnaires and laboratory assessments. SETTING: Fourteen municipalities in the Lahti region (Päijät-Häme County) in Finland. PARTICIPANTS: A regionally and locally stratified random sample of men and women born in 1946-50, 1936-40, and 1926-30. A total of 4,272 were invited and 2,815 (66%) participated. MAIN RESULTS: Elevated serum cholesterol, obesity, disability, sedentary lifestyle (<2 times/week walking), and high fat intake were more prevalent in rural vs. urban and semi-urban communities. After adjustment for sex, age, education, obesity, diet, physical activity, smoking, and alcohol use, rural communities remained the only community type with increased (p<0.05) probability for high BMI (OR 1.33) and high waist circumference (OR 1.43). CONCLUSIONS: The unfavourable health and lifestyle profile, together with an old population, makes health promotion for elderly citizens a special challenge for rural communities such as those in Päijät-Häme County, Finland. Most, if not all, of the differences in health between the three community types were explained by educational background, physical activity, and smoking.

Aged↗
PubMed2003

The health care system under French national health insurance: lessons for health reform in the United States.

The French health system combines universal coverage with a public-private mix of hospital and ambulatory care and a higher volume of service provision than in the United States. Although the system is far from perfect, its indicators of health status and consumer satisfaction are high; its expenditures, as a share of gross domestic product, are far lower than in the United States; and patients have an extraordinary degree of choice among providers. Lessons for the United States include the importance of government's role in providing a statutory framework for universal health insurance; recognition that piecemeal reform can broaden a partial program (like Medicare) to cover, eventually, the entire population; and understanding that universal coverage can be achieved without excluding private insurers from the supplementary insurance market.

Consumer Behavior↗
PubMed1983

National health care surveys and health care management. Examples from the National Center for Health Statistics.

The bulk of medical care in the United States is provided in hospitals, physicians' offices, and nursing homes. The National Center for Health Statistics conducts three health record surveys that collect information on patient and provider characteristics and the services provided in these three settings. This paper describes each of these three surveys in terms of background (scope and data set), design, collection, processing procedures, and data dissemination. In addition, specific examples of how the survey data have been or can be used for management purposes in terms of monitoring, evaluating, and planning the utilization of health care in the United States are given.

Ambulatory Care↗
PubMed1983

Indicators for planning of health services: assessing impacts of social and health care factors on population health.

Community health planning requires identification of the level of access to care and factors which affect the differentials in use of health services. In formulating strategies or alternatives for planning, some assessment of the current level or patterns of health services must be made. It is this element of the planning process that is addressed in this paper. In this study sixty-five specifically designated areas (medical market areas) in the Province of Quebec, Canada were selected. The analysis was performed using data obtained from a large scale study of physicians' responses to the introduction of universal medical care insurance in Quebec. Our analysis offered an opportunity to observe the impact of Medicare on access to care for those thought to be underserved.

Catchment Area, Health↗
PubMed1986

Pregnant adolescents' health-information needs. Implications for health education and health seeking.

The prenatal health information needs of 142 predominantly black, urban, and low-income adolescents (mean age = 16.9 years) were assessed by questionnaire early in the third trimester of pregnancy. Factor analysis identified three clusters of health topics labeled new morbidity, depressed somatization, and pregnancy. Relationships of these factors to self-esteem and health seeking were assessed in a subset (n = 57). A high score on depressed somatization was associated with low self-esteem and missed postpartum visits. Implications for planning prenatal education and effecting appropriate health-seeking behaviors are discussed.

Adolescent↗
PubMed2004

Mental health: integrated network and family-oriented model for co-operation between mental health patients, adult mental health services and social services.

BACKGROUND: Co-operation between mental health care units and the social services is important in the case of people with social problems who also suffer from mental health problems. However, participation of patients and their families in the treatment process, and co-operation between them and the professionals, are also important. Communication between the professionals, patients and their family members, and the professionals is a crucial factor for co-operation. AIMS AND OBJECTIVES: The aim of this study was to elucidate the experiences and importance of co-operation for the patients. The data consisted of interviews with 22 mental health patients who were also clients of municipal social services. METHOD: The grounded theory approach was used, focusing on the informants' experiences of the integrated network and family-oriented model for co-operation. RESULTS: The findings indicate the importance of the participation of patients and their social networks in psychiatric care or the treatment process. Meetings should be characterized by open and reflexive discussions with all participants' points of view being included, so that fruitful co-operation is possible. However, some negative experiences were also reported, all of which were connected with the professionals' behaviour. CONCLUSIONS: Trust and honesty are essential elements in relations between professionals and psychiatric patients, but it cannot be assumed that they will develop naturally. It is the professionals' responsibility to adjust their behaviour so that these elements can be created in a mutual process between patients and professionals. Multidisciplinary teams are a necessity in family-oriented co-operation between psychiatry and social services, and in a satisfactory caring process. RELEVANCE TO CLINICAL PRACTICE: Nurses' work is often individually oriented and nurses are ruled by routines in their work. The mental health caring process should be seen as a shared process between the patient, his/her human environment and professionals for which nurses need skills to their interaction with patients and their social network.

Adult↗
PubMed1999

The impact of the monetary crisis and the development of a health and social safety-net with a special note on donor participation--real life experiences on the role of health services in public health.

South-East Asia (i.e. Indonesia) has enjoyed economic boom and rapid unbridled growth for the last decade. This rapid expansion was fuelled by cheap labour, foreign and local investments and the extensive development of the oil and non-oil sector. Dark clouds, however, loomed on the economic and financial horizons of these rapidly developing 'tiger' economies. Indonesia was not only affected by various facts-of-life elements which contributed to these grave forecasts but also by a wave of natural disasters on an unprecedented scale, with devastating social and economic effects on the poor and susceptible groups. Although economic recovery will take time, the most pressing and practical measure remains the need to create a health and social safety net to maintain the health, social and nutritional status of the "population-at-risk". This paper is an exposure of "lessons learnt" and the invaluable role of health services and public health to the negative impact of the monetary crisis experienced by various inter-sectors, which the authors believe can be used as a long-term investment measure in other countries.

Delivery of Health Care↗
PubMed1993

Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs.

OBJECTIVE: To determine the effects of the Arthritis Self-Management Program 4 years after participation in it. METHODS: Valid self-administered instruments were used to measure health status, psychological states, and health service utilization. RESULTS: Pain had declined a mean of 20% and visits to physicians 40%, while physical disability had increased 9%. Comparison groups did not show similar changes. Estimated 4-year savings were $648 per rheumatoid arthritis patient and $189 per osteoarthritis patient. CONCLUSION: Health education in chronic arthritis may add significant and sustained benefits to conventional therapy while reducing costs.

Aged↗
PubMed1997

After graduation, what? An analysis of the job placements of graduates of public health maternal and child health training programs. Project of the Association of Teachers of Maternal and Child Health.

OBJECTIVES: In 1995, the Association of Teachers of Maternal and Child Health (ATMCH) decided that information about the employment status of program graduates was essential to attempts to improve MCH curricula. METHOD: ATMCH requested information from 13 MCH programs in schools of public health funded by the federal Maternal and Child Health Bureau and 12 provided information about their master's degree graduates in the 1990-1994 period, including the year of graduation, degree, Bureau traineeship support, position held, and employing agency. RESULTS: The total number of graduates was 742. Four programs averaged less than 8 graduates per year (small); six, 10-16 (midsize); and two more than 22 (large). More than 90% of graduates received a M.P.H. In the 10 programs that provided data on Bureau support, 46% received traineeship support from the Bureau. Midsize programs had the largest percentage of graduates receiving traineeship support. Overall, 45% of graduates were in administrative positions, 32% were involved in patient care, 20% were in policy-analytic positions, and 3% in other positions. Forty-seven percent of program graduates entered into or continued in community-based agencies, 18% in government agencies, 17% in academic or research agencies, and 18% in other agencies. Program size was significantly associated with both position and the agency in which the graduate was employed. Bureau traineeship support was associated with employing agency. CONCLUSIONS: The study suggests the need for changes in MCH curricula, enhanced education opportunities in specialty skill areas, and an ongoing survey of graduates of MCH programs.

Adult↗