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PubMed1999

[Case management for maintaining occupational status of handicapped patients. A model trial by the Bavarian federal district office].

Under the German social security system, medical benefits and services fall under the health insurance system, while vocational ones are the responsibility of the employment offices. In seamless transition cases, health funds almost exclusively rely on the relevant provisions of Book three--employment promotion--of the Social Code. Notwithstanding, sickness benefits frequently extend over the maximum period possible, i.e., 18 months, although the presence of disablement has been confirmed much earlier, and transition into unemployment certainly is no perspective either. Case Managements targeted at keeping disabled persons in employment have now been set up in several Bavarian employment offices. In close cooperation with the health funds' medical services, as well as in a number of other instances, they undertake early interventions to maintain employment, thus seeking to stem the traditional further course of disabled people still employed into the long waiting lines faced with at the rehabilitation agencies, or into unemployment and subsequent costly occupational reorientation, with continued joblessness awaiting them afterwards. The Case Management approach set out and analyzed in this article is intended as a model to be taken up elsewhere, having proven its benefit for people with disabilities while being cost-effective from an overall economic perspective due to its preventing the need to grant unemployment benefits and costly retraining. Guided by rehabilitation counsellors, the Case Managements are directed at rehabilitees and companies alike, and may take action through technical work aids, integration allowances, or skills adjustment programmes. For speedier, focussed implementation of the services offered, they "purchase" support and back-up from experienced agencies in the field, drawing on so-called "free" funding resources available under book three of the Social Code. Very good results using the model outlined have already been reported by the Nuremberg, Traunstein and Würzburg employment offices.

Case Management↗
PubMed2002

'It is a different war to fight here in Sweden'--the impact of involuntary migration on the health of refugee families in transition.

Involuntary migration and adaptation to a new cultural environment is known to be a stress factor. The aim of the study was to explore the impact of involuntary migration on the family health in order to identify specific health care issues related to refugee families in transition living in Sweden. Data was collected through interviews with 16 members of 10 different refugee families from Balkan countries, Kurdistan and Africa for which permission was obtained from the chairman of the local ethnic organizations in a municipality in the southern part of Sweden. In interpreting the material, analysis was made using a contextual approach with reference to phenomenography. The analysis resulted in four qualitatively different descriptive categories characterizing the health of the families: a distressed family living under prolonged tension; a contented family who leads a satisfactory life; a frustrated family who cannot lead a fully satisfactory life and a dejected family who feels deserted. Stressors seeking asylum, facing unemployment and changed roles, interacted negatively within the family. A friendly and understanding attitude from the host country was the main factor in promoting the health of the refugee families. Nursing interventions should therefore assist the families accordingly in order to promote the stability of the family system.

Adult↗
PubMed1994

A national study of transitional hospital services in mental health.

OBJECTIVES: Shifts in care for the seriously mentally ill from inpatient to community-based treatment have highlighted the importance of transitional care. Our objectives were to document the kinds and quantity of transitional services provided by psychiatric hospitals nationally and to assess the impact of hospital type (psychiatric vs general), ownership (public vs private), case mix, and revenue source on provision of these services. METHODS: A national sample of nonfederal inpatient mental health facilities (n = 915) was surveyed in 1988, and data were analyzed by using multiple regression. RESULTS: Half (46%) of the facilities surveyed provided patient follow-up of 1 week or less, and almost all (93%) conducted team review of discharge plans, but 74% provided no case management services. Hospital type was the most consistent predictor of transitional care, with psychiatric hospitals providing more of these services than general hospitals. Severity of illness, level of nonfederal funding, urbanicity, and teaching hospital affiliation were positively associated with provision of case management. CONCLUSIONS: Transitional care services for mentally ill patients leaving the hospital were found to be uneven and often inadequate. Reasons for broad variation in services are discussed.

Aftercare↗
PubMed2005

The impact of loss of Medicaid on health service utilization among persons with HIV/AIDS in New York City.

OBJECTIVES: To examine predictors of losing Medicaid and the impact of losing Medicaid on health service utilization for persons living with HIV/AIDS. DESIGN: The data are from the Community Health Advisory and Information Network (CHAIN), an on-going longitudinal survey representative of adults with HIV/AIDS in NYC (N = 698) (1994-1997 data). Change of Medicaid coverage between survey waves was considered a "transition" yielding three groups: "no transition", "transition to insurance", and "transition to no insurance". METHODS: To determine predictors of transitions and the impact of transitions on health service utilization, multinomial logistic regression was used to compare the three groups. RESULTS: There were 114 transitions and 792 cases without transitions, with transitions decreasing over time. Thirty percent of transitions were from Medicaid to no insurance. Transitions to insurance were more likely among the employed and those with incomes over 15,000 US Dollar. Transitions to no insurance were more likely among AIDS cases, recent immigrants, and people less than 30-year-old. People in both transition groups were less likely than people who retained Medicaid to have experienced a life event in the pre-transition period. Those with transitions to insurance reported decreased hospital and drug treatment. People who became uninsured reported decreased use of routine and preventive care, decreased health information and advice and decreased use of private doctors and outpatient clinics. CONCLUSION: While the rate of transitions from Medicaid was relatively low, such transitions were associated with greater variability in quality of health care and greater difficulty accessing primary care among the uninsured.

Adult↗
PubMed1998

Relocating elderly people and nursing staff from the NHS to the independent sector.

The results of the study reported here highlight the difficulties and potential problems facing re-provision programmes of mental health services. Relocation of services affects not only patients and staff, it also has implications for the education of staff and managers. Without appropriate preparation for relocation, the potential negative effects for older patients could be life threatening. For the staff, relocation could mean new ways of working for which they may not have been prepared. The current educational format does not appear to be sensitive enough to adapt to the pace of policy changes. The management process of re-provision programmes requires more than financial accounting. Preparation for relocation of patients and staff is of paramount importance to achieve the maximum benefits.

Adult↗
PubMed2001

Health care issues facing adolescents with congenital heart disease.

The number of children with congenital heart disease surviving beyond adolescence is rapidly increasing. Consequently, pediatric health providers not only have to address medical issues associated with the cardiac condition but must begin to develop programs that assist adolescents and their families in dealing with special health care needs for the young patient to successfully move into the adult world. Transitional health-related issues facing the adolescent with congenital heart disease including medical follow-up, insurability, employability, sexuality, and reproduction are described. Discussion about advising and counseling both patient and parents is included.

Adaptation, Psychological↗
PubMedDate not supplied

Malaysia mental health country profile.

Malaysia is a tropical country in the heart of south east Asia with a population of 24 million people of diverse ethnic, cultural and religious backgrounds living in harmony in 330,000 km(2) of land on the Asian mainland and Borneo. Malaysia, which lies on the crossroads of trade between east and west Asia, has an ancient history as a centre of trading attracting commerce between Europe, west Asia, India and China. It has had influences from major powers that dominated the region throughout its history. Today the country, after independence in 1957, has embarked on an ambitious development project to make it a developed country by 2020. In this effort the economy has changed from one producing raw material to one manufacturing consumer goods and services and the colonial health system has been overhauled and social systems strengthened to provide better services for its people. The per capita income, which was under 1,000 US dollars at independence, has now passed 4,000 US dollars and continues to grow, with the economy largely based on strong exports that amount to over 100 billion US dollars. The mental health system that was based on institutional care in four mental hospitals at independence from British colonial rule in 1957 with no Malaysian psychiatrists is today largely based on over 30 general hospital psychiatric units spread throughout the country. With three local postgraduate training programmes in psychiatry and 12 undergraduate departments of psychiatry in the country--all started after independence--there is now a healthy development of mental health services. This is being supplemented by a newly established primary care mental health service that covers community mental health by integrating mental health into primary health care. Mental health care at the level of psychiatrists rests with about 140 psychiatrists most of whom had undertaken a four-year masters course in postgraduate psychiatry in Malaysia since 1973. However, there continues to be severe shortages of other professionals such as clinical psychologists and social workers in mental health services. There are a few specialists, and specialized services in child, adolescent, forensic, rehabilitative, liaison or research fields of mental health. In the area of services for women and children, as well as the disabled in the community, there are strong efforts to improve the care and provide services that are in keeping with a caring society. New legislation on these are being passed every year and the setting up of a Ministry for Women's Affairs is one such move in recent years. Mental health in Malaysia has been slow in developing but has in the past decade seen important strides to bring it on par with other branches of medicine.

Adolescent↗
PubMed2001

The promise and limits of private medicine: health policy dilemmas in Nigeria.

Developments in health are easily among the best known human development indicators. Comparisons of life expectancy, infant mortality, access to safe water and similar data indicate the positions of individual countries. The political and economic processes which these indices reflect, or which inform the nature of health policy, are often not as clear or visible. These structural factors are either frequently ignored or mentioned only in passing, as illustrated in a recent paper published in this journal on the private medical enterprise in Nigeria (Ogunbekun et al. 1999). According to the authors, the generally low quality of public health services and high user fees have combined to make private medicine the 'unavoidable choice' of Nigerians. They identify benefits of private medicine as higher technical efficiency and contributing to fill the gap created by inadequate public sector services and to medical training. This paper argues that these claims are exaggerated, and that the authors seem to ignore Nigeria's political and economic processes, the health seeking behaviour of Nigerians, as well as the prevailing causes of morbidity and mortality. It is suggested that whereas the contributions of private medicine are significant, there are also several limitations, some of which originate from its for-profit raison d'être. The ultimate aim of health development must include improved access to services and better health status for the majority of the people. Without any form of public supported programme of payments in Nigeria, these objectives are circumscribed, especially with high fees in the private system. It is concluded that while private medicine will continue to be available for those who can afford it, it is unlikely to provide solutions to Nigeria's morbidity and mortality problems, particularly in relation to epidemics such as the growing burden of HIV/AIDS.

Delivery of Health Care↗
PubMed2003

A population-based longitudinal study of cognitive functioning in the menopausal transition.

BACKGROUND: No longitudinal studies have tracked cognitive performance through the menopausal transition and thus the impact of the transition on cognition, independent of aging, is not known. The authors hypothesized that a decline in cognitive functioning occurs as women progress through the menopausal transition, independent of age, educational level, family income, ethnicity, and baseline self-perceived health. METHOD: The authors began a population-based, longitudinal study in January 1996 with yearly follow-up interviews. This report includes follow-up through November 2001. The authors randomly selected African American and white women from a census of two contiguous Chicago communities. After screening for eligibility (age 42 to 52 years, premenopausal or early perimenopausal, no exogenous hormone use in the past 3 months, and no hysterectomy), 868 agreed to participate. Women who became pregnant, had a hysterectomy, or began using hormones were censored from that time onward. This study reports on 803 women for whom cognitive assessments were available. The authors assessed working memory (Digit Span Backward) and perceptual speed (Symbol Digit Modalities Test). RESULTS: Contrary to the hypothesis, the authors found small but significant increases over time during the premenopausal and perimenopausal phases. This trend was not accounted for by chronological age, education, family income, ethnicity, or baseline self-perceived health. CONCLUSIONS: Transition through menopause is not accompanied by a decline in working memory and perceptual speed.

Adult↗
PubMed1999

Strong bones in later life: luxury or necessity?

Osteoporosis is a global problem which will increase in significance as the population of the world both increases and ages. This report looks at how the demographic changes in different countries of the world will be reflected in the incidence and cost of osteoporotic disease. Comparisons are made between the data collected by the European Union's Report on Osteoporosis in the European Community, issued in June 1998, and some of the data available from other parts of the world. The importance of prevention, early detection and appropriate treatment is stressed, as well as the need for national health services to provide reimbursement of the costs of prevention, diagnosis and treatment for high-risk groups.

Adult↗
PubMedDate not supplied

[Trends in mental health of residents in a big agricultural-industrial region].

The dynamics of mental health of the population of the Altai Territory evaluated within a ten-year study (1991-2000) revealed pronounced negative processes with the most essential ones being in the children and teenagers category. The complicated social-and-economic transformations conducted in Russian society during the last decade of the past century, which entailed the misadjusted response in a majority of population, exerted an unfavorable influence on the mental health condition. The authors suggested a system of measures and arrangements targeted at neutralizing the detected negative trends in the population mental health; the above system can be successfully used in any country's region.

Adolescent↗
PubMedDate not supplied

Longitudinal patterns of offending during the transition to adulthood in youth from the mental health system.

Arrest rates among the population of youth who have been served in child mental health systems are known to be high during adolescence and young adulthood, but individual longitudinal patterns have not been examined. The present study used developmental trajectory modeling, a contemporary method used widely in criminology, to examine clusters of individual criminal justice involvement patterns at ages 8 through 25, from database records of 131 individuals in public adolescent mental health services. Three groups of particular concern emerged: one with increasingly high offense rates and two with moderate to high violent offense rates that did not desist. Offense patterns in these groups indicate that early intervention should occur before age 15. Some risk factors were identified. Peak offending for most groups occurred between ages 18 and 20. Implications of these findings for mental health services during the transition to adulthood are offered.

Adolescent↗