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PubMed2003

Computer literacy enhancement in the Teaching Hospital Olomouc. Part I: project management techniques. Short communication.

Information explosion and globalization make great demands on keeping pace with the new trends in the healthcare sector. The contemporary level of computer and information literacy among most health care professionals in the Teaching Hospital Olomouc (Czech Republic) is not satisfactory for efficient exploitation of modern information technology in diagnostics, therapy and nursing. The present contribution describes the application of two basic problem solving techniques (brainstorming, SWOT analysis) to develop a project aimed at information literacy enhancement.

Computer Literacy↗
PubMed1992

To prescribe or not to prescribe: on the regulation of pharmaceuticals in less developed countries.

An important source of failure in markets and justification for government intervention in the health sector of LDCs is imperfect information. Pharmaceutical use is one area in which widespread problems have been noted [1, 2] with substantial misuse, improper diagnosis and problems of compliance noted among both the population at large and health care providers, presumably due to a lack of information concerning appropriate use. One possible instrument vis-a-vis the regulation of pharmaceuticals in LDC's (and in developed countries as well) is the decision by public health officials to make a particular drug available over the counter (OTC) to consumers or to require a prescription from a licensed professional. The choice is one of balancing two competing risks. On the one hand, allowing self-prescription by the consumers who do not have medical training risks gross errors of diagnosis and mistaken prescriptions with possibly serious health consequences. On the other hand, requiring the intervention of a skilled professional runs the risk that the patient does not receive the appropriate, potential life saving, drug at all. With medical personnel in very short supply in many parts of the developing world, the real cost (including travel time and expense) of visiting licensed medical facilities can be prohibitively high. This paper presents a very general methodology for evaluating the tradeoff between these competing risks. The problem can be considered one of determining the value of information (in the form of a more accurate diagnosis through the intervention of a skilled professional) as a particular (and costly) mechanism for obtaining this information.(ABSTRACT TRUNCATED AT 250 WORDS)

Developing Countries↗
PubMedDate not supplied

Using the Essential Public Health Services as strategic leverage to strengthen the public health response to diabetes.

If current trends continue, health systems will soon be overwhelmed by type 2 diabetes mellitus. Successful population-based diabetes prevention and control efforts require a sound and continually improving infrastructure. In states and U.S. territories, the Diabetes Prevention and Control Programs supported by the U.S. Centers for Disease Control and Prevention's Division of Diabetes Translation serve as a fulcrum for building and refining the infrastructure that links diverse and dynamic partners dedicated to increasing the years and quality of life and achieving health equity among people with and at risk for diabetes. The National Public Health Performance Standards offer a conceptual framework that articulates the requisite infrastructure and services provided by an interconnected network of intersectoral partners to strengthen the public health response to diabetes. These standards associated with the Essential Public Health Services are valuable tools to assess the status of the performance of the health system's infrastructure to guide improvement. The process of engaging system partners in a system-wide assessment informs and leverages cross-sectoral assets to improve health outcomes for citizens in communities shouldering the growing burden of diabetes.

Centers for Disease Control and Prevention, U.S.↗
PubMed2002

Coupling proton movements to c-ring rotation in F(1)F(o) ATP synthase: aqueous access channels and helix rotations at the a-c interface.

F(1)F(o) ATP synthases generate ATP by a rotary catalytic mechanism in which H(+) transport is coupled to rotation of a ring of c subunits within the transmembrane sector of the enzyme. Protons bind to and then are released from the aspartyl-61 residue of subunit c at the center of the membrane. Proton access channels to and from aspartyl-61 are thought to form in subunit a of the F(o) sector. Here, we summarize new information on the structural organization of subunit a and the mapping of aqueous accessible residues in the fourth and fifth transmembrane helices (TMHs). Cysteine substituted residues, lying on opposite faces of aTMH-4, preferentially react with either N-ethyl-maleimide (NEM) or Ag(+). We propose that aTMH-4 rotates to alternately expose each helical face to aspartyl-61 of subunit c during the proton transport cycle. The concerted helical rotation of aTMH-4 and cTMH-2 are proposed to be coupled to the stepwise mechanical movement of the c-rotor.

Aquaporins↗
PubMed2003

An electronic post market surveillance system for medical devices.

An important issue in the health care sector is the collection of information about adverse incidents relative to medical devices and the exchange of this information among Health Care Institutions, Manufacturers and Competent Authorities. We present an Electronic Post Market Surveillance System, which solves in an efficient and secure way the above problem and it is compliant to the International Standards. The system consists of the PMS Server Application installed in the manufacturers/suppliers premises and the PMS Client Application installed in the Health Care Institutions. The PMS applications are used for the management of the PMS Reports and Responses with important features such as the user-friendly interfaces, interoperability and different implementations depending on the performance and cost requirements. The messages are in XML format and the security is based on public-private key cryptography. The system was evaluated in a systematic way by a variety of users, who were satisfied by the system functionality and efficiency.

Equipment and Supplies↗
PubMed2005

Male participation in family planning: results from a qualitative study in Mpigi District, Uganda.

The aim of this study was to determine men's perceptions about family planning and how they participate or wish to participate in family planning activities in Mpigi District, central Uganda. Four focus group discussions were conducted with married men and with family planning providers from both the government and private sector. In addition, seven key informants were interviewed using a semi-structured interview guide. The results indicate that men have limited knowledge about family planning, that family planning services do not adequately meet the needs of men, and that spousal communication about family planning issues is generally poor. However, almost all men approved of modern family planning and expressed great interest in participating. The positive change of the beliefs and attitudes of men towards family planning in the past years has not been recognized by family planning programme managers, since available services are not in line with current public attitudes. A more couple-oriented approach to family planning is needed. Measures could include, for example, recruiting males as family planning providers, offering more family planning counselling for couples, and promoting female-oriented methods with men and vice versa.

Adult↗
PubMed2006

Genetic research and genetic information: a health information professional's perspective on the benefits and risks.

BACKGROUND: The completion of the Human Genome Project, and recent breakthroughs in identifying the genes both directly responsible for and contributing to the severity of specific diseases and disabilities in humans offer great potential for future health care. AIM: The aim of the paper is to inform the health information community of these developments in order to foster debate over their wide-reaching implications. METHODS: The article outlines recent research in this area and explains how our growing understanding opens the way for improved diagnosis of disease, detection of possible predisposition to specific diseases, the interaction between genetics and environmental aspects such as diet, as well as enabling gene therapy and preventative actions. This new knowledge also opens the way for the use of pharmacogenetic information to enhance the efficacy of pharmaceuticals and to avoid toxic reactions. RESULTS: These advances have significant social, legal and ethical implications. Most countries have limited legislative control over the use and protection of genetic information about individuals. CONCLUSION: There is a role for health information professionals to play in promoting wider public knowledge of genetic research and its implications, in fostering public debate on key issues, and in seeking clearer policies in the health sector concerning the use of genetic information about individuals.

Genetic Counseling↗
PubMed2004

The effect of benefits, premiums, and health risk on health plan choice in the Medicare program.

OBJECTIVE: To estimate the effect of Medicare+Choice (M+C) plan premiums and benefits and individual beneficiary characteristics on the probability of enrollment in a Medicare+Choice plan. DATA SOURCE: Individual data from the Medicare Current Beneficiary Survey were combined with plan-level data from Medicare Compare. STUDY DESIGN: Health plan choices, including the Medicare+Choice/Fee-for-Service decision and the choice of plan within the M+C sector, were modeled using limited information maximum likelihood nested logit. PRINCIPAL FINDINGS: Premiums have a significant effect on plan selection, with an estimated out-of-pocket premium elasticity of -0.134 and an insurer-perspective elasticity of -4.57. Beneficiaries are responsive to plan characteristics, with prescription drug benefits having the largest marginal effect. Sicker beneficiaries were more likely to choose plans with drug benefits and diabetics were more likely to pick plans with vision coverage. CONCLUSIONS: Plan characteristics significantly impact beneficiaries' decisions to enroll in Medicare M+C plans and individuals sort themselves systematically into plans based on individual characteristics.

Aged↗
PubMed1992

Nutrition promotion for mature adults: a case study in peer education.

The peer education model, which enables trained learners to instruct their peers, was tested in a case study involving senior citizens in a nutrition education program. The case study approach, using action research, was chosen because the project involved the description and analysis of a unique group of 32 mature adults. Topics selected for presentation in the three two-hour sessions were selected by open consensus of the entire participating body. Six members of the group volunteered to engage in a preliminary training program. These individuals became known as volunteer peer educators (VPE), who subsequently took full responsibility for disseminating the nutrition information to their peers. Educational materials to meet the goals of the program were compiled by the researcher in a resource manual for each of the volunteer peer educators. Techniques of participant observation for data collection and qualitative analysis were used. The satisfactory implementation of the program was due in great part to group selection of the learning episode; to a relaxed atmosphere; to enthusiasm on the part of the VPE; to the availability of a good resource manual and a facilitator who provided a strong organizational framework. The peer education model was found to be a particularly useful tool in providing nutrition information to a much broader sector of the senior population than can be currently reached via public health programs.

Aged↗
PubMed2001

Infrastructure of pharmaceutical research and development in Japan.

OBJECTIVE: To examine the roles of different types of hospitals in implementation of multicenter Phase II/III trials in Japan, specifically focusing on two dichotomies: public versus private, and academic versus nonacademic. Possible explanation was sought as to why a hospital of one category was more likely to participate in specific types of trials in the Japanese medical environment. METHODS: A database containing attributes of published clinical trials (n = 217) was established from four journals featuring reports of clinical trial results. The preferences of public and academic hospitals for specific types of trials were estimated by applying a linear regression model. The trial compositions of these institutions were also estimated, taking the actual prevalence of trials in 1995 into consideration. RESULTS: Public sector hospitals, which were established for particular policy purposes in the national healthcare system, were more likely to accept trials in some fields (e.g., cardiovascular diseases, anesthesiology, antineoplastics, pediatrics) and of some kinds (e.g., Phase II rather than Phase III trials, trials supervised by the principal investigator in the public sector). Academic hospitals also showed preferences for some types of trials (e.g., cardiovascular diseases, dermatology; Phase II rather than Phase III trials). The analysis focusing on public hospitals suggested that policy purposes were achieved at least in some fields such as antineoplastics and anesthesiology. CONCLUSIONS: Japanese clinical trials were unevenly distributed between public and private sectors, and also between academic and nonacademic sectors. These data provide fundamental information about the clinical research environment for future pharmaceutical research and development strategies and policies.

Academic Medical Centers↗
PubMed1999

Global estimates of fatal occupational accidents.

Data on occupational accidents are not available from all countries in the world. Furthermore, underreporting, limited coverage by reporting and compensation schemes, and non-harmonized accident recording and notification systems undermine efforts to obtain worldwide information on occupational accidents. This paper presents a method and new estimated global figures of fatal accidents at work by region. The fatal occupational accident rates reported to the International Labour Office are extended to the total employed workforce in countries and regions. For areas not covered by the reported information, rates from other countries that have similar or comparable conditions are applied. In 1994, an average estimated fatal occupational accident rate in the whole world was 14.0 per 100,000 workers, and the total estimated number of fatal occupational accidents was 335,000. The rates are different for individual countries and regions and for separate branches of economic activity. In conclusion, fatal occupational accident figures are higher than previously estimated. The new estimates can be gradually improved by obtaining and adding data from countries where information is not yet available. Sectoral estimates for at least key economic branches in individual countries would further increase the accuracy.

Accidents, Occupational↗
PubMed2001

Global directions for reforming health systems and expanding insurance. What is suitable for the Arab Gulf countries?

Most countries are exploring and implementing reforms of their health care systems. The Arab countries in the Gulf are no exception after establishing modern governmental health care systems accessible to all and free of charge. Current problems of the Arab systems include financial, managerial and quality issues. The private sector in these countries has no defined national role and is gowing abruptly and unplanned. The paper presents the major global health reform directions, analyzing the current activities in the Arab Gulf countries and proposing certain practical relevant approaches for health reform, and expansion of insurance in these activites.

Developing Countries↗
PubMedDate not supplied

[Qualitative research and health promotion in the Community of Madrid].

This article provides an account of the qualitative research experiment conducted by the Public Health Administration of the Autonomous Community of Madrid from 1991 to date. This research was divided into two working areas, that is, the "Sociocultural Health Information System" and the "Research Program". The former analyses what health means for the inhabitants of the Autonomous Community of Madrid, the factors involved therein, the value they place thereon and its relative importance among all of their interests as a whole. The latter researches specific aspects of the health/illness processes identified by the experts in the development of Public Health programs. People envisage health in their own way and have their own health-related cultural models, not always the same as those put forward by the health care system, which have a determining bearing on their actions. The mere verification of social facts has revealed itself to be insufficient as regards understanding and helping to transform human behavior, questions of ideology and emotion take on major importance in this regard. Structural research, through the use of qualitative methods, affords us the possibility of gaining knowledge of these matters, setting the course of Health Education and Health Promotion measures. The aim is to feed back the information generated to the different sectors of the population involved, to institutions and professionals in the health care, social and educational fields, as well as to organizations related to Health Promotion, with the aim of generating changes in the institutions and developments in thinking of society at large.

Health Promotion↗
PubMed2003

Contraception before and after termination of pregnancy: can we do it better?

AIM: To compare contraceptive use pre- and post-therapeutic abortion in 1995, 1999 and 2002 in a New Zealand clinic. METHODS: Retrospective, consecutive case review of women presenting for therapeutic abortion. Anonymous data included demographic details, contraception used at conception, and post-termination contraception. RESULTS: Pre-conception contraceptive use is significantly declining, with post-termination condom choice increasing. This is predominantly due to increasing numbers of Asian women presenting for abortion. In 2002, 97% of Asian women used no contraception or only condoms pre-conception, and 62% chose condoms or abstinence post-termination. Oral contraceptives are used significantly less by Asian than European women both pre-termination (p = 0.0002) and post-termination (p = 0.00001). Other ethnic groups showed little change in contraceptive use over the study periods. CONCLUSIONS: It is speculated that ethnic Chinese women lack adequate contraceptive education, demonstrate distrust of non-barrier methods, believe men should provide the prophylactic, and mistakenly believe contraception unnecessary for the first week following menstruation. Abortion may be used for family planning rather than as back up for contraceptive failure. Young Chinese arriving in New Zealand require immediate sexual health education including accurate contraceptive information. Liaison between primary healthcare sectors and policy makers of immigration and other services assisting overseas students is recommended to provide culturally appropriate education.

Abortion, Legal↗
PubMed2003

[National strategy in the battle against scorpion stings and envenomations. Application and evaluation].

Scorpion stings represent the first cause of poisoning with an incidence of 30 to 50% of all declared cases in the Centre Anti Poison of Morocco (CAPM). Aware of this increasing problem, the CAPM paid special attention to this pathology. Thanks to its retrospective and prospective studies, the scorpion species mapping has been determined as well as the demographic features of stung patients, the nature and the chronology of clinical events in scorpion envenimation, and the epidemiological, clinical and therapeutical factors of severity. On this basis, the CAPM worked out a national strategy to struggle against scorpion stings whose aim was to decrease the morbidity and mortality caused by stings of scorpion as well as to rationalise economic expenses. The components of this strategy were based on the training of the medical and paramedical staff, on information, education, communication involving different sectors, on identification of needs and on follow-up and assessment. A nationwide campaign was implemented to change the population and health-care staff's behaviour regarding this pathology. Its evaluation permitted to improve the compilation of cases with census of 14104 cases, to reduce lethality rate and to rationalise expenses while banishing some medicines and avoiding useless hospitalization.

Animals↗
PubMed2003

Public key infrastructures for health.

Introducing the technological step into this new 3rd millennium, advanced communication means like global networks including the Internet become more and more important for a fast and convenient information exchange across regional and even national borders. Concerning the sector of public and private healthcare and welfare, new health information system, or citizens' information systems in general, are coming up to meet the needs of the whole information society. Thus, developing and implementing those systems is one of the most important aims of the present and the near future. Access to, and communication of, relevant patient-related administrative and medical information items always means a secure and trustworthy way of dealing with data. Concerning the main aspects of specific legal, social, ethical, technical, organisational, and even political requirements for secure access and secure communication of health data in terms of data protection, data security, privacy, safety and quality using unprotected networks as, e.g., the Internet, there is a strong and even growing need for the fundamental technology of Trusted Third Parties to meet the whole range of the security categories as integrity, confidentiality, availability, accountability, and access control.

Computer Security↗
PubMed2005

Spending on medicines in Israel in an international context.

BACKGROUND: Like most developed countries, in the last decade Israel's healthcare system has been subject to cost-containing measures in the drug sector. OBJECTIVES: To provide comparative information in an international context on the level of outpatient drug expenditures in Israel, both total and those publicly financed, and to analyze how these have changed with time during the last decade. METHODS: Using definitions of the OECD (Organization of Economic Cooperation and Development), internationally comparable data on total expenditure and public expenditure on medicines in Israel are provided. The Israeli estimates are based on data from the Ministry of Health audited reports of financial activities of the health management organizations and from the family expenditure surveys carried out by the Central Bureau of Statistics. Per capita total and public expenditures in Israel are analyzed over time, as are their share of national expenditure on health and of gross domestic product. Israel expenditures are then compared with those for individual member countries of the OECD, as well as a 21 country average, from 1992 to 2002. RESULTS: Analysis of the Israeli expenditure data shows a considerable reduction in growth of per capita total and public expenditures on medicines since 1997. Growth in the share of total drug expenditure of NEH and of GDP has also been constrained since 1997. In an international context, per capita expenditure on medicines in Israel, particularly what is publicly financed, is one of the lowest. Furthermore, its share of NEH and GDP is also very low compared to other countries. This substantive gap in spending on medicines between Israel and other countries has increased since 1997. CONCLUSIONS: Israel, a medium-income country with a lower than average level of expenditure on health compared to OECD countries, has a particularly low level of expenditure on medicines. Whereas the share of health expenditure of GDP in Israel is similar to the international average, the share of drug expenditure of GDP is well below the average. In addition to structural and longer-term factors contributing to Israel's low per capita spending on medicines, such as the young population and the apparently low level of actual prices paid by most institutional purchasers, recent years are witness to the growing impact of National Health Insurance budgetary pressures on HMOs as well as continual increases in prescription cost sharing by patients. The impact is felt both on the demand side (higher copayments, administrative and prescribing restrictions) and perhaps more crucially on the supply side (price competition, mainly from generics). Substantial extra public funding for the addition of new drugs to the NHI basket in recent years has had no overall impact on these longer-term spending patterns.

Developed Countries↗
PubMedDate not supplied

Telemedicine: experience at SGPGIMS, Lucknow.

Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) located in Lucknow, capital of Uttar Pradesh, a state in Northern India, is a tertiary level referral academic medical center involved in teaching and training of super specialist medical professionals with 22 academic departments. It is the first tertiary care hospital in public healthcare sector in India to adopt Information Technology (IT) for healthcare delivery. The Hospital Information System (HIS) was implemented in 1998 to record, store, process and retrieve health data of all the patients. This software was developed in-house in collaboration with Center for Development of Advanced Computing (C- DAC), Pune. Later in the year 1999, telemedicine activities were initiated in the form of testing the concept and technology. The first research grant was availed of in the year 2001, which helped in creating an infrastructure for telemedicine. Regular tele-healthcare and tele-educational services were introduced for the postgraduate students of medical colleges of Orissa. These services have now been extended to educate the doctors of other medical colleges and community centers in other states. Besides, the Institute is associated with organizational activities and in policy initiatives of the government. All the activities are in project mode and are being financially supported by government agencies such as Indian Space Research Organisation (ISRO) and Department of Information Technology. Looking at the need of skilled manpower in the field of telemedicine and e-health, a school of telemedicine is coming up in the campus, which will also provide core infrastructure for research and development.

Academic Medical Centers↗