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PubMed1986

[Group health care].

The transition from individual to group health care entails a response to multidisciplinary scientific systems, the enlistment of community participation, and an effort to make the professionals aware of the need to work as a team. The author points to the need to change the information system so that the professional-to-be will acquire a mentality and method of work appropriate for group care. In the architecture of service facilities structural changes must also be provided for the care of groups rather than individuals. In short, the change entails a review of all the elements of care.

Community Health Services↗
PubMed2000

The Croatian Health Survey--SF-36: I. General quality of life assessment.

The objective of the Croatian Health Survey was the assessment of population health related quality of life in the transitional environment of Croatia. Health status measures incorporate dimensions such as physical, psychological, and social functioning, role performance and perception of wellbeing. In order to assess health status, "The medical outcome study 36-item short-form health survey (SF-36) model" was used. A total sample of 5048 inhabitants (1983 males and 3065 females), 18 years and over, represents approximately 1% of the general population of Croatia. Mean scores were as follows: physical functioning (PF) 69.94, role-physical (RP) 63.01, bodily pain (BP) 64.51, general health (GH) 53.40, vitality (VT) 51.85, social functioning (SF) 72.96, role-emotional (RE) 72.42, mental health (MH) 61.71 and health transition (HT) 44.79. Results of the SF-36 health survey in Croatia are very much like the results in other European countries with indication that general quality of life is lower in Croatia.

Adolescent↗
PubMed1995

Transitions in mortality and health: theory, comparison and historical evidence.

"The central aim of the present article is to review the theoretical and historical bases of the comparative perspective, in which the theory of epidemiological transition is normally used in order to improve our understanding of peripheral transitions in the evolution of the European mortality rate between 1860 and 1960.... We propose not so much a new theory speculating on the causes of the advances, which are irreversible after a certain point in the survival of western populations during the nineteenth and twentieth centuries, as a new way of looking at existing interpretations. Specifically, we have attempted to justify the need for a perspective which gets away from the usual approach, based on a sequential arrangement of the stages within a scale of evolution, and on a causal impulse behind those stages, deriving from a global socio-economic process."

Demography↗
PubMed2002

Economic transition should come with a health warning: the case of Vietnam.

STUDY OBJECTIVE: s: To assess the affordability of health care to poor rural households in Vietnam under conditions of transition from a planned to a market economy and, in light of other transitional experience, inform policy on increasing access of the poor to affordable care of acceptable quality. DESIGN: Observational study by cross sectional socioeconomic survey, longitudinal healthcare seeking survey, and qualitative semi-structured interviews and focus group discussions; qualitative follow up over six years. SETTING: Four rural communes in north of Vietnam between 1992 and 1998. SURVEY PARTICIPANTS: 656 households (2995 people) selected by systematic random sampling. MAIN RESULTS: Compared with non-poor households, poor households had significantly lower average per capita rates of healthcare consultation and expenditure (p<0.01 in both cases). Poor households delayed and minimised healthcare seeking, especially of expensive hospital services. Two thirds of average healthcare spending by poor households was on relatively inexpensive but frequent acts of local ambulatory care. The poor restrained their healthcare seeking but not in proportion to income: for households reporting illness, the average proportion of income devoted to health care was 21.9% for the poor compared with 8.2% for the non-poor (p<0.01). To meet healthcare costs, many poor households reduced essential consumption, sold assets and incurred debt, threatening their future livelihood. CONCLUSIONS: In the short-term the poor need exemption from public sector user fees in both primary and hospital care. In the longer run the government budget and prepayment schemes should replace direct user charges in healthcare finance. Transitional economies like Vietnam should preserve the public health services built up under the planned economy. Market reforms that stimulate growth in the economy appear inappropriate to reform of social sectors.

Ambulatory Care↗
PubMed1996

Causes of change in the health of populations: a biopsychosocial viewpoint.

In the current review, a biopsychosocial perspective is applied to current changes in the health of populations. It is proposed that the psychosocial environments either promote health or precipitate disease. Changes in the types of stress that people experience as well as its prevalence over time are discussed. In addition, possible biological mechanisms linking the psychosocial environments to health are presented. "Food for thought" is the possible interaction between the physical/chemical and the psychosocial environments and changes in health of individuals. Clearly, our traditional view of disease mechanisms is not sufficient to understand recent phenomena, such as environmental illness and chronic fatigue syndrome. Issues worthy of further discussions are the role of the "just-in-time" society, where individuals increasingly have to change jobs, cope with reorganizations and increased production pressure, and its impact on health and well-being. Further, in what way can we develop better models to truly assess the impact of an increasingly complex interaction between individual and environmental factors on health? A major obstacle to enhancing our understanding of causes of change in the health of populations is the use of inappropriate or outdated statistical analytical models. Finally, it is suggested that prospectively controlled studies of the impact on health of changes in the health and welfare systems are carried out. This would further add to our understanding of factors contributing to changes in the health of population.

Environmental Health↗
PubMed2005

Health care in China: the role of non-government providers.

While China's health services are primarily financed by out-of-pocket spending (private financing), health care providers, especially the hospital industry, are still dominated by state ownership and government control (public provision). Even though the private sector plays an increasing role in the ambulatory sector, private services are not included in the social insurance benefit package, and thus, it primarily serves self-paying patients. The ambiguity of the government policy toward private provision stems from concerns that an increasing private sector would drive up costs and its services may be of questionable quality. This paper tries to gather evidence on the relative performance of private and public sector in China. Neither literature review nor our primary data analysis provides any support for the notion that the private sector charges a higher price and they serve primarily the better-off people. Quite on the contrary, available data seem to suggest that not only the private sector tends to serve disproportionately the low-middle income groups (this may well be due to its relative lower direct and indirect costs), consumer satisfaction also seems to be higher with regards to certain dimensions of the private than public sector.

Adolescent↗
PubMedDate not supplied

Four ways to teach PHC in a changing world.

Nurse educators are challenged to revise teaching/learning methods to support community-based primary health care (PHC) systems. The key elements are: integrating education with the realities of practice and people's needs; moving communities to strive towards solving their own health problems; and recognizing the socioeconomic health determinants. Described below are four educational methods based on PHC: inquiry-based learning, IMPACTS (a game to encourage multisectoral collaboration), distance education and community-based education.

Education, Nursing↗
PubMedDate not supplied

A window of opportunity for the transformation of national mental health policy in Turkey following two major earthquakes.

Striking at the nation's highly populated industrial heartlands, two massive earthquakes in 1999 killed over 25,000 people in Turkey. The economic cost and the humanitarian magnitude of the disaster were unprecedented in the country's history. The crisis also underscored a major flaw in the organization of mental health services in the provinces that were left out of the 1961 reforms that aimed to make basic health services available nationwide. In describing the chronology of the earthquakes and the ensuing national and international response, this article explains how the public and governmental experience of the earthquakes has created a window of opportunity, and perhaps the political will, for significant reform. There is an urgent need to integrate mental health and general health services, and to strengthen mental health services in the country's 81 disparate provinces. As Turkey continues her rapid transformation in terms of greater urbanization, higher levels of public education, and economic and constitutional reforms associated with its projected entry into the European Union, there have also been growing demands for better, and more equitably distributed, health care. A legacy of the earthquakes is that they exposed the need for Turkey to create a coherent, clearly articulated national mental health policy.

Adolescent↗
PubMed2005

Theorizing about causes at the individual level while estimating effects at the population level: implications for prevention.

The dominant philosophy of modern epidemiology is individualism, despite the limitations of epidemiologic tools and methods when considering the individual level. We pursue information on increasingly reductionist causes in our search for knowledge of causes of specific cases. Philosophical reasoning and empiric evidence suggest that this search may not be as fruitful as proponents claim. I argue that using individualism to guide our search for causes of disease hinders our effectiveness in contributing to disease prevention, because the positive predictive values of most established genetic and environmental risk factors for noninfectious diseases are too low to be quantitatively convincing to an individual.

Disease↗
PubMed2004

Health care delivery: perspectives of young people with chronic illness and their parents.

OBJECTIVE: To identify and compare perceptions of health care service delivery held by young people with chronic illness and their parents. METHODS: A convenience sample of young people with chronic illness and their parents were invited to complete a confidential self-report survey. The adolescents were aged 13-18 years inclusive and attended a specialist medical clinic. RESULTS: Participants comprised 53 young people (response rate 88%, 53/60) and 45 parents (response rate 75%, 45/60). Both young people and their parents rate honesty, confidentiality, having good medical knowledge and good listening skills as the most important qualities for a health care provider. Compared to the parent group, fewer young people report the presence of these desired qualities in their current health care provider. A quarter of young people (25%, 13/53) report they do not always trust health professionals to keep their information confidential, and 19% (10/53) of young people report having withheld information from a health professional due to a lack of trust. Some parents and young people would like to discuss a wider range of health topics, including mental health issues, than they currently do with their health provider. Young people and their parents report limited planning with their current health provider for transition to adult health services. CONCLUSIONS: Young people with chronic illnesses have significant levels of dissatisfaction with the health care they receive; this has the potential to impact on their use of health care services and their health outcomes. There is a need for increased provider awareness of the important qualities of health care service delivery to young people.

Adolescent↗