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PubMedDate not supplied

When insurance status is not static: insurance transitions of low-income children and implications for health and health care.

OBJECTIVES: Among low-income children, to characterize the frequency of transitions in health insurance coverage and examine associations of transitions with health status and health care access. METHODS: Data from the 1999 National Survey of America's Families were used in weighted analyses to identify sociodemographic characteristics associated with health insurance transitions for children living in households with income <200% of the federal poverty level over the preceding 12 months. In logistic regression models, we examined associations of insurance transitions with children's health status (fair/poor health), postponement of children's medical care or prescription medications, and lack of physician visits. RESULTS: Among 27.93 million low-income children in 1999, 5.7 million (20.4%) had experienced an insurance transition in the preceding year. Non-Hispanic black children (24.5%) and children whose parents did not have a partner or spouse (23.5%) were significantly more likely than other children to have experienced transitions. Hispanic children (16%) were least likely to have experienced transitions. Compared with children with continuous private coverage, children who had transitioned from public to private coverage were more likely to report fair or poor health, children who experienced transitions that included a period of no coverage were more likely to report postponed medical care and prescription drugs, and children who experienced a no-coverage-to-private-coverage transition were more likely to have foregone physician visits. CONCLUSION: Transitions in insurance coverage affect many low-income children and may represent barriers to their health care. Considering insurance transitions may provide a more complete picture of children's health and health care utilization.

Child↗
PubMedDate not supplied

[To innovate the practical nurse; focus based on professional competencies (I)].

The Nursing practice has entered into a period of rapid, global changes which require firm support in order to maximize their role in the health field. Together with the transitional situation health systems are undergoing, this obliges nurses to search for new innovative methods to comply with their professional duties and for the creation of instruments that facilitate the increase in the quality treatment nurses provide, as well as the mechanisms through which excellence in educational preparation and professional compliance are recognized. In the following pages, the authors deal with this focus based on professional competencies as a tool which nears these objectives.

Certification↗
PubMed1997

The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin.

OBJECTIVE: To estimate the economic efficiency of using pravastatin to prevent the transition from health to cardiovascular disease in men with hypercholesterolaemia. DESIGN: Economic benefit analysis based on data from the West of Scotland coronary prevention study. Treatment specific hazards of developing cardiovascular disease according to various definitions were estimated. Scottish record linkage data provided disease specific survival. Cost estimates were based on extracontractual tariffs and event specific average lengths of stay calculated from the West of Scotland coronary prevention study. SUBJECTS: Men with hypercholesterolaemia similar to the subjects in the West of Scotland coronary prevention study. MAIN OUTCOME: Cost consequences, the number of transitions from health to cardiovascular disease prevented, the number needed to start treatment, and cost per life year gained. RESULTS: If 10,000 of these men started taking pravastatin, 318 of them would not make the transition from health to cardiovascular disease (number needed to treat, 31.4), at a net discounted cost of 20m Pounds over 5 years. These benefits imply an undiscounted gain of 2,460 years of life, and thus 8121 Pounds per life year gained, or 20,375 Pounds per life year gained if benefits are discounted. Restriction to the 40% of men at highest risk reduces the number needed to treat to 22.5 (5601 Pounds per life year gained (undiscounted) and 13,995 Pounds per life year gained (discounted)). CONCLUSIONS: In subjects without evidence of prior myocardial infarction but who have hypercholesterolaemia, the use of pravastatin yields substantial health benefits at a cost that is not prohibitive overall and can be quite efficient in selected high risk subgroups.

Anticholesteremic Agents↗
PubMedDate not supplied

Access to health care in a system transition: the case of Bulgaria.

OBJECTIVE: Throughout the 1990s, the Soviet-style model in central and eastern Europe that provided free health services has been subject to radical reforms. Socio-economic inequalities have also increased but there is little information on inequalities in health care utilization. This paper examines the pattern of illness behaviour in Bulgaria, seeking evidence of inequalities in access to services and eliciting users' pathways to care. DESIGN: Analysis drew on a representative population survey in Bulgaria (1997). The financial determinants of service use were tested in a multivariate model adjusted first for age, and then for age, marital status and self-reported health. In-depth interviews with users and providers addressed pathways to care, use of connections and other informal strategies to obtain care. RESULTS: As expected, rates of illness vary with income, with highest rates among the poor. After adjustment for illness, consultation rates are relatively equal across income levels, with the exception of worse-off women who tend to consult more. For first contact, there are few differences according to income, with the better off preferring secondary level. Pathways slightly differ, with women more often treated in primary care. Private sector utilization is low. Qualitative research reveals well-established strategies to obtain more advanced care, including use of connections, informal payments and use of emergency services. CONCLUSIONS: An apparent lack of inequalities in access to care conceals a more complex picture in which income and gender influence the pathways taken through the system.

Adult↗
PubMedDate not supplied

State child mental health efforts to support youth in transition to adulthood.

The ability of state child mental health (MH) systems to facilitate the transition to adulthood of adolescents in their systems was studied by interviewing members of the Children, Youth and Families Division of the National Association of State Mental Health Program Directors (NASMHPD). Results demonstrated that transition services within the state child MH systems are sparse, nationally. Continuity of services as youth age into adulthood is hampered because of generally separate child and adult MH systems, each with separate policies defining who accesses those services, lack of clarity about procedures to access adult MH services, and lack of shared client planning between adult and child MH systems. These findings suggest that adolescents in state child MH systems have difficulty accessing services that will help them with the difficult task of learning to function as an adult. Public MH systems should examine their capacity to provide transition supports and make needed improvements.

Adolescent↗
PubMedDate not supplied

The nurse's role in school-based mental health promotion: easing the transition into adolescence.

The developmental phase of adolescence is a critical transition that can be influenced by many factors. The author identifies some of the significant mental health problems for the "high-risk" adolescent. The importance of the Student Assistance Program and the role that the psychiatric/mental health nurse specialist plays in the context of this program are reviewed.

Adaptation, Psychological↗
PubMed1999

Preparing patients and health professionals for the transition to chlorofluorocarbon-free inhalers: the British perspective.

The National Asthma Campaign is the independent United Kingdom charity working to conquer asthma in partnership with people with asthma and all who share their concern through a combination of research, education, and support. We are viewed by people with asthma, health professionals, National Health Service managers, and policy makers as 1 of the United Kingdom's leading authorities on asthma and, in particular, the leading independent charity in the field. Through historic precedent and current research, it was clear to us, alongside the other relevant stakeholders, that the transition to chlorofluorocarbon-free inhalers would be 1 of the biggest changes in medication ever to take place in the United Kingdom and a potential period of considerable instability. To avoid that instability and to facilitate a positive transition process, the National Asthma Campaign worked closely with the government (Department of Health), health professionals, pharmaceutic industry, and other patient and¿or campaigning groups to ensure effective information dissemination; and support was available to the appropriate audiences. It is difficult to conclude at this stage how successful the strategy has been. As the transition gains in momentum and more chlorofluorocarbon-free products are released on to the market, it will become more apparent how much of a success the process has been.

Asthma↗
PubMed2002

A Tanzanian perspective on the nutrition transition and its implications for health.

OBJECTIVE: The purpose of this paper is to describe social and economic changes related to shifts in diet and activity and to present prevalences for chronic diseases associated with the nutrition transition. DESIGN: Observations about social changes are descriptive, based on published reports and personal observations. Prevalence and trends data are based on a Ministry of Health published report and, for infants and toddlers, on primary data. SETTING: Disease prevalences for diabetes mellitus and hypertension are taken from four sites, representing underdeveloped, semi-developed and well-developed rural communities and Dar es Salaam, the largest city in Tanzania. The prevalences of underweight and overweight for infants and toddlers are taken from a small periurban clinic in Tanzania. SUBJECTS: Adults over 15 years of age are included in the prevalence data for chronic disease. The urban sample is stratified by occupation and ethnicity. The data for infants and toddlers include newborns to those aged 23 months. RESULTS: An increase in the prevalence of diabetes and hypertension was observed. Simultaneously, there have been rapid changes in diet and physical activity related to urbanisation and modernisation. The highest prevalences for diabetes and hypertension were among high-ranking executives. CONCLUSION: The increase in chronic disease could be related to the rise in the number of high-ranking executives. Simultaneously, per capita income has gone down, and malnutrition prevalence has risen. Programmes are being developed to simultaneously monitor trends in overweight while preventing protein-energy malnutrition and micronutrient deficiency.

Adolescent↗
PubMed1993

Patient care information systems and physicians: the transition from technology icon to health care instrument.

We have discussed several important transitions now occurring in PCIS that promise to improve the utility and availability of these systems for the average physician. Charles Babbage developed the first computers as "thinking machines" so that we may extend our ability to grapple with more and more complex problems. If current trends continue, we will finally witness the evolution of patient care computing from information icons of the few to clinical instruments improving the quality of medical decision making and care for all patients.

Attitude to Computers↗