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The primary health care model of public health has been implemented in many countries around the globe since the Declaration of Alma Ata in 1978, without pilot testing the primary health care model. Therefore, many public health researchers have sought methods of improving primary health care by creating evidence-based models. Many of these researchers recognize the role of behavioral models in public health. These offshoots of primary health care include the ecological, care, central human capabilities, and the SPECIES models. Holistic self-management education and support is a capacity-building philosophy that ensures active involvement of consumers of health care in the planning and implementation and evaluation of health care services. It helps consumers of health care to achieve the desired improved quality of health and life in managing and sustaining their health at the grassroots level. The care model addresses disease management ideals of the in the original primary health care model. The SPECIES model addresses those aspects of the primary health care model that include the cultural and social factors, as well as individual health education and support in the original primary health care model. The ecological model offers an improvement of the socioeconomic ideal in the original primary health care model. Improving the health of individuals will prevent illness, thereby reducing health care costs and lessening the current strain on an overburdened health care system in Zimbabwe. Holistic self-management education and support links health care delivery systems with social processes. It is a best practices model that could better serve Zimbabwean girls and women by contributing positively to the national challenges in health care, thereby meeting the Zimbabwean primary health care and safe motherhood goals. It is here recommended that holistic self-management education and support must be pilot tested before being adopted as the most appropriate model for ensuring population health.
The possibilities of creating a health care resources registry and its operating in Croatia as well as the importance of information in health system are described. At the Croatian Institute of Public Health, monitoring of human resources is performed through the national Health Workers Registry. It also covers basic data on all health units, bed capacities of health facilities included. The initiated health care computerization has urged the idea of forming one more database on physical resources, i.e. on registered medical devices and equipment, more complete. Linking these databases on health resources would produce a single Health Care Resources Registry. The concept views Health Care Resources Registry as part of the overall health information system with centralized information on the health system. The planned development of segments of a single health information system is based on the implementation of the accepted international standards and common network services. Network services that are based on verified Internet technologies are used within a safe, reliable and closed health computer network, which makes up the health intranet (WAN--Wide Area Network). The resource registry is a software solution based on the relational database that monitors history, thus permitting the data collected over a longer period to be analyzed. Such a solution assumes the existence of a directory service, which would replace the current independent software for the Health Workers Registry. In the Health Care Resources Registry, the basic data set encompasses data objects and attributes from the directory service. The directory service is compatible with the LDAP protocol (Lightweight Directory Access Protocol), providing services uniformly to the current records on human and physical resources. Through the storage of attributes defined according to the HL7 (Health Level Seven) standard, directory service is accessible to all applications of the health information system. Directory service does not follow the history of attribute changes, and is optimized for a large number of authorizing inquiries. With it, one follows the following objects and attributes: persons, groups of people (patients, physicians, other personnel), roles (right of access and administrator permissions), organizational units, unit locations, devices and services (according to the list of services and procedures). One can add to the Health Care Resource Registry such attributes as are nonessential for inclusion in the directory service, but are of public health value. Authentication, authorization and digital signature are done by means of Smart Cards, which are used as protective elements against access to system functions, and simultaneously as a physical medium for the storage of the official certificate with which documents are signed digitally. As FINA (state financial control agency) has completed a system for certificate issuance and verification, the option of official digital signature is also available as a computer network service. Any changes taking place in the directory service are transferred by XML messages to a separate part of the Registry that reads them and automatically modifies records in the relational database. Because data input and data changes are made in health units, this makes the data updated and directly connected with health working operations. This avoids all one-time data collection campaigns using form filling about the devices and equipment in the future. As it is very difficult to monitor from a central standpoint how accurate and update the information is, it is necessary to delegate the permissions and duties associated with making changes to the directory service. By this organizational setup, the time needed to ensure data quality control is reduced. In the case described, the Health Care Resource Registry becomes an indicator of change, acquiring certain characteristics of an analytical system. An analysis of topical data renders possible proactive action and makes more effective the planning and utilization of available resources. Providing answers on the current data quickly could also be important to solution-seeking in emergencies. The present proposal to establish the Registry is intended to facilitate the future process of planning and striking a balance between investments in human and physical resources. For health expenditure control, having reliable information related to the use and purchase of new medical technology is particularly important. World Health Organization and European Union have also emphasized the need to develop new indicators in this area.
BACKGROUND: The effective coordination of mental health service provision is a requirement for successfully reforming mental health care from a hospital-focused system towards a more decentralized, community-oriented one. Implementing such coordination is particularly challenging in a decentralized, multi-layered health and social care system such as exists in Germany. AIM OF THE STUDY: (i) To investigate the coordination and planning of mental health service provision performed at and between the local, Länder and federal political levels in Germany; (ii) to outline the disparities in coordination and planning of mental health service provision that exist between the different political levels and locate key-authorities; (iii) to determine whether a decentralized, multi-layered health and social system such as Germany's allows for adequate coordination. METHOD: (i) Analysis of mental health legislation and policy documents; (ii) guided interviews with officers and consultants of the government units responsible for mental health affairs of the 16 Länder and the federal Ministry of Health and Social Security; (iii) submission of results to the interviewed experts for verification. RESULTS: Multi-professional boards and posts for coordinating and planning mental health services are widely implemented on local state and federal level in Germany. Most of them operate without being required by legislation. The sickness and pension funds are represented in less than half of the boards on state level. Boards on local and on state level are mainly concerned with coordinating social mental health care and have little influence on medical mental health care. Mental health policy documents exist federally and in most Länder. All but one of the mental health legislations of the Länder (present in 12 out of the 16 Länder) also considers regulations concerning coordinating and planning mental heath services. The key-authorities for mental-health policy, legislation and service implementation is with the 16 Länder. The federal government however plays an important frame setting role. Actual service provision is a local responsibility. DISCUSSION: Since the beginning of mental health reforms 25 years ago and in particular in recent years, structures for the coordination and planning of mental health service provision have been established countrywide at local, Länder and federal levels. However, there are hardly any structures that connect the Länder and local levels and act as a source of independent quality assurance. The coordination boards at the Länder level include almost all the parties involved in mental health care, with the exception of sickness and pension funds that are, for the most part, absent. Thus the coordination boards are mainly restricted to governing social services in mental health care. Despite this, the countrywide establishment of diverse boards for the structured coordination of mental health service provision can be regarded in itself as a success, although little is known of the processes and impact of this framework. There are, however, indications that coordination is still restricted to the traditional interfaces and dividing lines of the mental health care system, which they seem unable to overcome. IMPLICATION FOR HEALTH POLICIES: The reform of mental health service provision towards a more community-orientated approach requires sophisticated coordination. The countrywide establishment of structures for the coordination and planning of mental health service provision has been largely possible in Germany. It does, however, require further analysis, since coordination beyond the traditional boundaries seems unlikely. Therefore, incentives are needed in order to encourage "adequate coordination" as well as integration with other parts of the mental health care system.
This notice corrects an error made in a Federal Register notice with respect to information regarding requirements for health maintenance organizations (HMO's).
In an urban environment, carbon monoxide is produced by incomplete combustion, particularly in motor vehicles. Air pollution caused by CO produced by motor vehicles is controlled by legislation. Legal regulations have considerably lowered emission levels authorized for new vehicles and total CO emission levels. CO levels in the environment (urban environment in general and zones close to motorways) have thus declined. CO remains a public health concern both as a pollutant and as an indicator of air quality. We recall here the more recent approaches used to assess CO-related hazards developed by the Environmental Protection Agency in the United States and pertinent conclusions backing up previously defined reference levels. We then report recent French data concerning CO emission, environmental levels and evaluation procedures for different situations of human exposure: geographical situations, mode of transportation, police force, air sentinels. The third part of this article is devoted to biological data (interaction between CO and hemo-proteins, CO neurotransmitter?) and epidemiological data (serial surveys). The discussion centers on the limitations of epidemiological data and on the difficulty in evaluating hazards solely on the basis of a carboxyhemoglobin threshold. This latter point is particularly important because carboxyhemoglobin is only one of many indicators of air quality. Finally recommendations are proposed concerning weather-related aspects, evaluation of human exposure, and ways of improving biological and epidemiological data.
OBJECTIVE: To describe the main economic-healthcare indicators of Aragon Areas 2 and 5 in 1992. To quantify in economic terms the value of the medical and nursing consultations carried out by Primary Care teams. DESIGN: Cost-analysis type study (total costs). The criteria for attributing indirect costs were established by consensus. The data correspond to 1992 (real spending by each centre). The cost of the consultations was calculated in function of the overall activity undertaken and in line with the type of consultation. SETTING: Areas 2 and 5, Aragon. Calculation of the cost per consultation only for Primary Care teams (PCT). RESULTS: Spending per inhabitant and per year, both overall and broken down into care and pharmacy costs was 20,140 for PCT's (8,805 pesetas + 11,355 pes) and 23,153 pes for the traditional model (7,677 + 15,476 pes). Costs per consultation were: 1,031 pes for General Medicine plus 2,537 on Pharmacy; 1,765 pes for Paediatrics plus 716 on Pharmacy; 972 on nursing. Costs per consultation were also offered in function of the duration of each type of consultation and the health-care delivered. CONCLUSIONS: Overall, PCT's generated less expense per each insured person than the traditionally-based Consulting rooms. This situation is mainly due to Pharmacy costs, where the difference is over 4,000 pesetas. The evaluation of service costs in function of attendance supposes that, between two teams of equal composition and the same volume of spending, the more efficient will be that which produces the greater amount of services.
BACKGROUND: About 11-14% of children with special health care needs (CSHCN) have unmet needs during a given year. Little is known about the determinants of unmet health care needs for CSHCN. AIMS OF THE STUDY: The objective of this study was to explore the association between access to care (unmet needs) among CSHCN and their caregivers' mental health status as well as children's mental health status. METHODS: We surveyed a random sample of 1,088 caregivers of CSHCN who resided in the District of Columbia during the summer and fall of 2002. In the survey, we collected information on children's unmet needs mental health status (PARS) and their caregivers' mental health status (CES-D). We estimated the association between mental health status determinants of unmet needs adjusting for selection bias associated with plan choice (partially capitated managed care versus FFS) with an instrumental variables probit estimation technique. We used caregivers' preferences about physicians and hospitals networks, and whether the caregiver and child had the same last name to identify the plan choice equation. RESULTS: We found that caregivers with symptoms of depression were 26.3% more likely to report any unmet need, 67.6% more likely to report unmet hospital and physician need, 66.1% more likely to report unmet mental health care need and 38.8% more likely to report unmet need for other health care services. Caregivers of children with poor psychological adjustment were 26.3% more likely to report their child had an unmet need and 92.3% more likely to report an unmet mental health care need. DISCUSSION: Our analyses show that children whose caregivers experience symptoms of depression are significantly more likely to encounter difficulties obtaining needed medical and mental health care services. Furthermore, the findings reported here indicate that children with poor psychological adjustment are significantly more likely to experience unmet needs for medical and mental health care services. Our study has some limitations. First, most of the children in our sample are African-American, so these findings may differ for children of other races. Second, these findings may not be applicable to CSHCN who reside in rural areas. Third, we recognize the possibility that child and caregiver mental health is potentially endogenous. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The mental health status of CSHCN and their caregivers are barriers to care. IMPLICATIONS FOR HEALTH POLICIES: Policymakers should be concerned about the mental health status of children with special health care needs and their caregivers as such problems appear to be barriers to obtaining care. Therefore, to adequately address the access problems of children with special health care needs, policy must address the mental health problems of children and their caregivers. Providing mental health care for caregivers and children has the potential for improving overall access for CSHCN. IMPLICATION FOR FURTHER RESEARCH: Future research should determine the causal relationship between mental health problems of CSHCN and their caregivers and the level unmet health care needs.
INTRODUCTION: The purpose was to examine whether health-promotion programs offered by California health plans are a serious attempt to improve health status or a marketing device used in an increasingly competitive marketplace. The research examined differences in the coverage, availability, utilization, and evaluation of health-promotion programs in California health plans. METHODS: A mail survey was done of the 35 HMOs (86% response) and 18 health insurance carriers (83% response) licensed to sell comprehensive health insurance in California in 1996 (some plans sell both HMO and PPO/indemnity products). The final sample included 30 commercial HMOs and 20 PPO and indemnity plans. The 1996 California Behavioral Risk Factor Survey (BRFS) of 4,000 adults was used to estimate population participation rates in health-promotion programs. RESULTS: California's HMOs in 1996 offered more comprehensive preventive benefits and health-promotion programs compared to PPO and indemnity plans. HMOs relied on a more comprehensive set of health-education methods to communicate health information to members and were more likely to open their programs to the public. HMOs are also more likely to have developed relationships with community-based and public health providers. Participation in health-promotion programs is low (2%-3%), regardless of plan type, and most health plans limit evaluations to assessment of member satisfaction and utilization. Only 35%-45% of HMOs, and no PPO/indemnity plans, assess the impact of health-promotion programs on health risks and behaviors, health status, or health care costs. CONCLUSION: For the majority of California's PPO and indemnity plans, health promotion is not an integral part of their business. For the majority of HMOs, health-promotion programs are offered primarily as a marketing vehicle. However, a substantial minority of HMOs offer health-promotion programs to achieve other organizational goals of health improvement and cost control.
PROBLEM/CONDITION: School health education (e.g., classroom instruction) is an essential component of school health programs; such education promotes the health of youth and improves overall public health. REPORTING PERIOD: February-May 1998. DESCRIPTION OF SYSTEM: The School Health Education Profiles monitor characteristics of health education in middle or junior high schools and senior high schools in the United States. The Profiles are school-based surveys conducted by state and local education agencies. This report summarizes results from 36 state surveys and 10 local surveys conducted among representative samples of school principals and lead health education teachers. The lead health education teacher coordinates health education policies and programs within a middle/junior high school or senior high school. RESULTS: During the study period, most schools in states and cities that conducted Profiles required health education in grades 6-12. Of these, a median of 91.0% of schools in states and 86.2% of schools in cities taught a separate health education course. The median percentage of schools in each state and city that tried to increase student knowledge in selected topics (i.e., prevention of tobacco use, alcohol and other drug use, pregnancy, human immunodeficiency virus [HIV] infection, other sexually transmitted diseases, violence, or suicide; dietary behaviors and nutrition; and physical activity and fitness) was >73% for each of these topics. The median percentage of schools with a health education teacher who coordinated health education was 38.7% across states and 37.6% across cities. A median of 41.8% of schools across states and a median of 31.0% of schools across cities had a lead health education teacher with professional preparation in health and physical education, whereas a median of 6.0% of schools across states and a median of 5.5% of schools across cities had a lead health education teacher with professional preparation in health education only. A median of 19.3% of schools across states and 21.2% of schools across cities had a school health advisory council. The median percentage of schools with a written school or school district policy on HIV-infected students or school staff members was 69.7% across states and 84.4% across cities. INTERPRETATION: Many middle/junior high schools and senior high schools require health education to help provide students with knowledge and skills needed for adoption of a healthy lifestyle. However, these schools might not be covering all important topic areas or skills sufficiently. The number of lead health education teachers who are academically prepared in health education and the number of schools with school health advisory councils needs to increase. PUBLIC HEALTH ACTION: The Profiles data are used by state and local education officials to improve school health education.
PROBLEM/CONDITION: School health education (e.g., classroom training) is an essential component of school health programs; such education promotes the health of youth and improves overall public health. REPORTING PERIOD: February-May 1996. DESCRIPTION OF SYSTEM: The School Health Education Profiles monitor characteristics of health education in middle or junior high schools and senior high schools. The Profiles are school-based surveys conducted by state and local education agencies. This report summarizes results from 35 state surveys and 13 local surveys conducted among representative samples of school principals and lead health education teachers. The lead health education teacher is the person who coordinates health education policies and programs within a middle or junior high school and senior high school. RESULTS: During the study period, almost all schools in states and cities required health education in grades 6-12; of these, a median of 87.6% of states and 75.8% of cities taught a separate health education course. The median percentage of schools that tried to increase student knowledge on certain topics (i.e., prevention of tobacco use, alcohol and other drug use, pregnancy, human immunodeficiency virus [HIV] infection, other sexually transmitted diseases, violence, or suicide; dietary behaviors and nutrition; and physical activity and fitness) was > 72% for each of these topics. The median percentage of schools that tried to improve certain student skills (i.e., communication, decision making, goal setting, resisting social pressures, nonviolent conflict resolution, stress management, and analysis of media messages) was > 69% for each of these skills. The median percentage of schools that had a health education teacher coordinate health education was 33.0% across states and 26.8% across cities. Almost all schools taught HIV education as part of a required health education course (state median: 94.3%; local median: 98.1%), and more than half (state median: 69.5%; local median: 82.5%) had a written policy on HIV infection among students and school staff. A median of 41.0% of schools across states and a median of 25.8% of schools across cities had a lead health education teacher with professional preparation in health and physical education, and < 25% of schools across states or cities had a lead health education teacher with professional preparation in health education only. Across states, the median percentage of schools, whose lead health education teacher had received in-service training on certain health education topics, ranged from 15.6% for suicide prevention to 51.4% for HIV prevention; across cities, the median percentage ranged from 26.2% for suicide prevention to 76.1% for HIV prevention. A median of 19.7% of schools across states and 18.1% of schools across cities had a school health advisory council. Of the schools that received parental feedback (state median: 59.1%; local median: 54.2%), > 78% reported receiving positive feedback. INTERPRETATION: More than 75% of schools have a required course in health education to help provide students with the knowledge and skills they need to adopt healthy lifestyles. ACTIONS TAKEN: The School Health Education Profiles data are being used by state and local education officials to improve school health education and HIV education.
BACKGROUND: In the famous definition of the World Health Organization, health is 'a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity'. Until now, the distribution and determinants of the positive end of the health spectrum have not been studied extensively. In an exploratory analysis, we have compared the determinants of excellent health and of ill-health using data from a postal survey among 18,973 people in a region in the southeastern Netherlands. METHODS: Excellent health was defined as the presence of a very good self-assessment of health in the absence of any self-reported chronic condition or health complaint, and was present in 8.2% of the survey population. Ill-health was defined as the presence of two or more self-reported chronic conditions, four or more health complaints and a less-than-good self-assessment of health, and was present in 10.5% of the survey population. The remainder of the survey population was used as a reference group. Two sets of explanatory variables were available: a set of seven socio-demographic variables and a set of nine specific risk factors. Logistic regression analysis was used to assess the strengths and patterns of the associations between the determinants and the two outcome variables, excellent health and ill-health, controlling for age and gender. RESULTS: Both the socio-demographic variables and the specific risk factors had largely similar (but mirrored) patterns of association with excellent health and with ill-health. Important socio-demographic determinants of excellent health (and of ill-health) were education, employment status and urbanization (as well as age and gender). Important specific risk factors were leisure exercise, housing problems, smoking, negative life events, obesity and alcohol intake. The percentage of deviance accounted for by each of these sets of determinants was two to three times as large in the case of ill-health as in the case of excellent health. CONCLUSION: The processes by which excellent health is generated probably have much in common with those which generate ill-health. At the same time it is obvious that our understanding of the determinants of ill-health is better than that of the determinants of excellent health, and further study of the latter is recommended.