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At least 649 records · Page 36Linked to original sources
PubMed2002

Bulgarian population in transitional period.

In the transition period from a communist to market-oriented economy, Bulgaria faces several public health challenges. One of them is the decline in population (estimated fall from current 8.25 million to around 6 million in 2045), mainly due to emigration and pronounced fall in fertility. Infant mortality is still relatively high (over 15/1,000 live births), and the incidence of tuberculosis is on the rise. Total mortality shows a steady upward trend from 12.1/1,000 in 1990 to 14.3/1,000 in 1998. Trends in ischemic heart disease are comparable to those in other Central and Eastern European countries, but stroke mortality is notably higher. This calls for detailed epidemiological studies of risk factors, such as salt consumption, as well as preventive programs for detection and control of high blood pressure. The problems of smoking and alcohol abuse should be addressed by a coordinated public health and legal measures.

Adult↗
PubMed2006

Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women's health across the nation.

OBJECTIVES: We investigated whether vasomotor symptom reporting or patterns of change in symptom reporting over the perimenopausal transition among women enrolled in a national study differed according to race/ethnicity. We also sought to determine whether racial/ethnic differences were explained by sociodemographic, health, or lifestyle factors. METHODS: We followed 3198 women enrolled in the Study of Women's Health Across the Nation during 1996 through 2002. We analyzed frequency of vasomotor symptom reporting using longitudinal multiple logistic regressions. RESULTS: Rates of vasomotor symptom reporting were highest among African Americans (adjusted odds ratio [OR]=1.63; 95% confidence interval [CI]=1.21, 2.20). The transition to late perimenopause exhibited the strongest association with vasomotor symptoms (adjusted OR = 6.64; 95% CI = 4.80, 9.20). Other risk factors were age (adjusted OR=1.17; 95% CI=1.13, 1.21), having less than a college education (adjusted OR = 1.91; 95% CI = 1.40, 2.61), increasing body mass index (adjusted OR=1.03 per unit of increase; 95% CI=1.01, 1.04), smoking (adjusted OR=1.63; 95% CI=1.25, 2.12), and anxiety symptoms at baseline (adjusted OR=3.10; 95% CI=2.33, 4.12). CONCLUSIONS: Among the risk factors assessed, vasomotor symptoms were most strongly associated with menopausal status. After adjustment for covariates, symptoms were reported most often in all racial/ethnic groups in late perimenopause and nearly as often in postmenopause.

Adult↗
PubMed2006

Stages of change and transitioning for adolescent patients with obesity and hypertension.

When exploring an adolescent patient's readiness to transition his/her health care to adult practice, it is important to understand the processes that allow for change and which promote self-efficacy and self-care. The large numbers of adolescents with hypertension and obesity, possible antecedents to adult kidney disease, require attention be paid to promoting lifestyle changes and adherence to treatment regimens as these patients enter adulthood. Transitioning to adult care is in many cases an externally imposed change, but a young patient's readiness for this change may be amenable to intervention based on the Stages of Change Model. This article reviews the impact of adolescent obesity and hypertension on future health, the application of the Stages of Change Model in health care and specifically with adolescents, and the concept of transitioning for young patients with special health care needs. The authors suggest that the application of the Stages of Change Model, including the use of motivation interviewing and cognitive-behavioral techniques, may encourage lifestyle change and treatment adherence and assist in preparing patients for transition to the adult health care setting.

Adolescent↗
PubMed1996

The impact of globalization on the determination and management of ethical choices in the health arena.

In this paper, the meaning and significance of ethical choices in the arena of health under conditions of globalization are explored. The paper first discusses globalization, its theorized sources and consequences, exposing connections between globalization and local developments in diverse milieux. It is pointed out that the ways in which global and local developments interact are related to specific socio-historical and cultural configurations of every locality. Paradoxes which attend the conceptualization of ethical choices under these conditions are highlighted. Finally, conclusions are drawn about how multimethod research, including research designed to elicit emic theory, can contribute to an understanding of what is implied by the management of ethical choices, and of how ethical problems in the health arena can be approached.

Diffusion of Innovation↗
PubMed2001

Village-based primary health care in the Central Highlands of Vietnam.

This paper describes the first year of an ongoing village health care and economic development project in the Krong Buk district of Dak Lak province in Vietnam's Central Highlands. The project serves 21 villages with a total population of just over 15,000. Most belong to ethnic minority groups. Physicians from the province capital of Boun Me Thuot were trained by a multi-disciplinary team of American health care workers to be trainers and supervisors of 21 village health care workers (VHWs). Two months later, a VHW from each village was trained in primary and preventive health care by the physician-supervisors. Since this initial training, each VHW has been provided with materials, medicines and monthly supervision by the physician-supervisors. The health care component has been complemented by an economic development project based on a system of small loans. Data from the first year of monthly reports and from a baseline survey are presented in this paper.

Adolescent↗
PubMed2006

Rebuilding a health care system: war, reconstruction and health care reforms in Kosovo.

This article explores the complexity of a health care system reforms in a post-conflict situation. It describes how the health care system was revamped immediately after the war, and then reorganized with Primary Health Care (PHC) as the fulcrum for change. It highlights the coordination problems, typical of a post-war situation when un-coordinated humanitarian assistance pours in. From the vantage points of Ministry of Health officials, the article details how the change process has gone over the years, the directions it has taken and the lessons learnt. It notes that reforms are often so fast that they outstrip the absorption capacity of the potential change agents because of their inadequate preparation for the new roles and responsibilities. This in turn threatens to undermine and weaken the very system that the reforms seek to strengthen. Several options adopted for change in Kosovo's health care system are at varying levels of implementation today. Some commentators have questioned if the policy for the new health care system has failed. We contend that there have been major organizational successes. But there are also shortcomings. There is also a potential danger that the health care system could partly revert to the old system. While some of the successes and shortcomings may be specific to Kosovo, many lessons learnt from Kosovo apply to health care reforms elsewhere.

Budgets↗
PubMed1998

Assessing change in quality of life using the Oral Health Impact Profile.

UNLABELLED: Traditionally, longitudinal studies of oral health have measured only disease progression and ignored improvements in health. OBJECTIVES: This study examines methodological issues that arise in longitudinal assessment of change in oral health-related quality of life (OHRQOL). METHODS: Baseline and 2-year follow-up data were used from an observational longitudinal study of 498 people aged 60 years or more living in South Australia. Oral health-related quality of life was measured using the Oral Health Impact Profile (OHIP). Three hypothesized risk predictors (tooth loss, problem-based dental visits and financial hardship) were selected to examine the effects of four methods of measuring change: categorical measures of improvement, deterioration and net change, and a quantitative measure of net change in OHIP scores. RESULTS: Some 31.7% of people experienced some improvement and 32.7% experienced some deterioration in OHRQOL. All three high-risk groups had approximately twice the rate of deterioration in OHRQOL compared with their corresponding low-risk groups. Surprisingly, high-risk groups also had higher rates of improvement. When measured categorically, these effects did not cancel one another, indicating that improvement and deterioration in OHRQOL can be experienced simultaneously. However, quantitative analyses cause improvements and deteriorations to cancel, and analysis of mean OHIP scores created a spurious impression that change in OHRQOL did not differ between dental visit groups. Furthermore, changes in mean OHIP scores were masked by regression to the mean. CONCLUSIONS: Oral health-related quality of life measures capture both improvement and deterioration in health status, creating new complexities for conceptualizing and analyzing change in longitudinal studies.

Aged↗
PubMed2003

The public health roles of health visitors and school nurses: a survey.

This article describes a qualitative study that examined the family centre public health role of health visitors and the child-centre public health role of school nurses. A telephone survey of key health visitor and school nurse informants in the West Midlands was undertaken. Respondents to the survey were asked to give examples of practice that related to Holman's (1992) public health typology. A wealth of data were obtained, which included 344 different examples of practice interventions. The majority of examples of practice given by the respondents were categorized as primary preventive interventions. The least represented concerned community empowerment and health protection. The findings of the survey give evidence of the current transitional nature health visitor and school nurse practice. Identified is some reorientation in practice and adoption of currently advocated models of public health, which have community participation, empowerment, and health protection as essential features.

Attitude of Health Personnel↗
PubMed2004

"Change yourself and the whole world will become kinder": Russian activists for reproductive health and the limits of claims making for women.

This article views reproductive health activism as a fruitful site for analyzing the cultural logics through which legitimate claims for women's needs become expressed and circumscribed. It begins from the observation that in the United States and Britain, reproductive health has been a key arena for feminist political claims and struggles for women's rights, bodily integrity, access to health care, and demands for authority in relations with experts. These concerns and struggles have not, however, emerged in all postsocialist contexts, and new activism in Russia reveals strikingly different agendas. Innovative groups of health providers seeking to increase women's access to birth control methods and safe sex, home birth opportunities, and improved health services work outside of feminist perspectives and reject political paths for change. By examining the ideological inspirations, cultural logics, and political-economic constraints shaping the outreach work of Russian health practitioners, the article explains how and why health activism became a site for personal "spiritual" revival and the strengthening of nuclear families. It also explores how conditions following the collapse of socialism have further legitimized activists' rejection of political agendas for change.

Female↗
PubMed2003

[The quest for adequate health care for the elderly: literature review and the application of an instrument for early detection and prediction of diseases].

The increase in the elderly population demands changes in health care models by policymakers to deal with the substantial cost increase This article addresses patient access flow and the definition of priorities in an outpatient unit. A short questionnaire (8 questions) was used to assess enrollment and ranking of the elderly at risk of repeated hospital admissions, considered as a proxy for frailty. In a sample of 360 individuals, 75.8% of the elderly population was classified as "low risk". However, approximately 11% of the sample was considered to be at "medium" or "high" risk of becoming ill and requiring intensive use of health services. Our findings corroborate the usefulness (for promoting an effective health system for the elderly) of the proposed questionnaire as a tool to classify the elderly in different "frailty groups", using a hierarchic definition of vulnerability. The proposed ranking procedure can help adjust the portal of entry into the system, as used thus far in most Brazilian health facilities. The article concludes by suggesting that the validity of the method be tested in a prospective study.

Age Distribution↗