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PubMedDate not supplied

Substance abuse and women's health.

The prevalence of illicit drug use is higher among men than women, but new drug use occurs at twice the rate for females as for males. Recent data from emergency rooms and medical examiners support this pattern, but females were more likely than males to report use of tranquilizers, antidepressants, and some nonbarbiturate sedatives. Recent data show that men outnumbered women in drug treatment admissions for all drugs except tranquilizers. However, the 1984 National Institute of Mental Health Epidemiologic Catchment Area Survey shows drug abuse and dependence to be the second most commonly reported disorder for women. Smoking is the most common form of drug dependence in our society, and it has a major impact on women's health. Lung cancer is now the leading cause of cancer deaths among women. Smoking poses a special risk of coronary heart disease for women using oral contraceptives. The incidence of emphysema among women has also risen sharply. Smoking during pregnancy carries special, serious risks. Research strongly suggests that the use of marijuana during pregnancy carries significant risks, including low birth weights and fetal abnormalities. Opiate addiction among women is uncommon, but it carries disproportionate health risks for these women and their offspring; infants born of addicted mothers have much higher morbidity and mortality rates than infants in general. Acquired immune deficiency syndrome is a grave risk to women using intravenous drugs and to their children. There are a number of health problems associated with psychoactive drug use among elderly women. In addition to research, the National Institute on Drug Abuse has focused a number of its activities on the special problems and needs of women. The Institute is collaborating with the health care community to place increased emphasis on prevention and treatment services for women and is working with organizations in the public and private sector to ensure that current information about drug use is effectively disseminated.

Adolescent↗
PubMedDate not supplied

[Child malnutrition in the Mexican rural environment: an analysis of national nutrition surveys].

The national food surveys of 1974, 1979 and 1989 were analysed in order to evaluate the levels and tendencies of the malnutrition prevalence in children one to five years old. The malnutrition prevalence maintained its level with minor changes: it increased from 49 to 53 per cent in the group with -1 SD, and from 17 to 19 per cent in those with -2 SD, in relation with the WHO [correction of OMS]-NCHS standards. If the information is analysed by social sectors, it is possible to conclude that the apparent stability is due to a process of nutritional polarization: the areas that had lower figures improved as the poor and Indian areas with high prevalence of initial malnutrition deteriorated even more.

Anthropometry↗
PubMed1993

Simple mathematical relations between the acetabular anteversion and sector angles.

Acetabular anteversion is an important parameter of the hip joint. It is measured at CT of the hip, as are the more recently introduced acetabular sector angles. These angles give information on the anterior and posterior support from the acetabulum to the femoral head. Some simple mathematical relationships between these angles are presented.

Hip↗
PubMed2000

Parenting and physical punishment: primary care interventions in Latin America.

Physical punishment is a form of intrafamilial violence associated with short- and long-term adverse mental health outcomes. Despite these possible consequences, it is among the most common forms of violent interpersonal behavior. For many children it begins within the first year of life. The goal of this study was to determine the feasibility of involving public sector primary health care providers to inform parents about alternatives to physical punishment. The study used a qualitative design utilizing focus groups and survey questionnaires with parents and providers at six clinic sites chosen to be representative of public sector practice settings in Costa Rica and in metropolitan Santiago, Chile. The data were collected during 1998 and 1999. In the focus groups and surveys the parents voiced a range of opinions about physical punishment. Most acknowledged its common use but listed it among their least preferred means of discipline. Frequency of its use correlated positively with the parents' belief in its effectiveness and inversely with their satisfaction with their children's behavior. Some parents wanted to learn more about discipline; others wanted help with life stresses they felt led them to use physical punishment. Parents reported they chose other family members more frequently as a source of parenting information than they did health care providers. Some parents saw providers as too rushed and not knowledgeable enough to give good advice. Providers, in turn, felt ill equipped to handle parents' questions, but many of the health professionals expressed interest in more training. Parents and providers agreed that problems of time, space, and resources were barriers to talking about child discipline in the clinics. Many parents and providers would welcome a primary-care-based program on physical punishment. Such a program would need to be customized to accommodate local differences in parent and provider attitudes and in clinic organization. Health care professionals need more training in child discipline and in the skills required to interact with parents on issues relating to child behavior.

Adolescent↗
PubMed1994

An audit of hearing aid quality in Denmark. II: Type of defects.

In this investigation the type of defects in hearing aids (HAs) is described, and the stability of HAs is evaluated, based on prospective longitudinal data over an observation period of 2 years. An exchange of information between the Danish national hearing health service and hearing aid manufacturers, representing the private sector, demonstrates that overall external components to which the HA-user has access, are frequently defective. However, with time, internal components, to which the HA-user has no access, are frequently defective within the first year of use, whereas external components malfunction significantly more frequently after 3 years of use. Among the dispensed hearing aids, 11% were defective at the fitting, indicating insufficient quality control by the manufacturers. A prospective longitudinal investigation of 1141 defective HAs revealed that 12% of behind-the-ear HAs become defective within the first year of use, exhibiting the greatest stability. After 2 years of use, all in-the-canal HAs are defective, while only 33% of the in-the-ear HAs remain intact. It is concluded that the established exchange of information between the public and private sectors offers valid information on the quality of HAs; that the quality and stability of HAs is insufficient; and that the quality should be improved, (based on international criteria).

Correction of Hearing Impairment↗
PubMed1989

Private-sector care for chronically mentally ill individuals. The more things change, the more they stay the same.

Two profit-making industries, nursing homes and board-and-care homes, care for about one million chronic mental patients. This care is primarily custodial and probably not very different from the care patients received in the public sector prior to deinstitutionalization. Moreover, certain characteristics of privately owned facilities encourage poor patient care so as to maximize profit. The problem could be ameliorated if chronic mental patients were strong and informed consumers or if the public sector strongly regulated proprietary care. However, neither of these two conditions now hold. Perhaps the apparent difficulties in significantly improving care for chronically mentally ill individuals despite seemingly major changes in policy reflect a fundamental problem in overall social policy--a reluctance to care for chronically indigent individuals of all kinds.

Chronic Disease↗
PubMed1992

AIDS: what does economics have to offer?

AIDS is rapidly becoming a major health problem in developing countries. Limited empirical information is available about the impact of AIDS on the household, the community, the health sector and the broader economy. Special problems exist in estimating the direct economic costs of AIDS in developing countries, including large out-of-pocket expenditures on health care and shortages of drugs and supplies; the difficulties of valuing resources used in caring for people with AIDS; and the lack of treatment alternatives. The calculation of indirect costs is complicated by difficulties in calculating the value of non-market production and international comparisons of the value of healthy life years lost may be erroneous, due to the higher level of average wages in developed countries. Existing evidence on the impact of AIDS at the household, community, sectoral and macroeconomic level is reviewed. Special attention is given to the impact of AIDS on the health sector and the resource allocation decisions which are made at this level. A policy-relevant research strategy would include addressing the particular information needs of the health sector, as well as studies which can help to inform government policy to mitigate the impact of AIDS at the household, community, sectoral and macroeconomic levels.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Information technology in health care. A new industrial policy program].

Health care is chosen as one of the major target sectors under a national industrial policy program for information technology. The program offers direct support to industrial information technology projects. The part of the program related to health care is executed partly by the Ministry of Health and Social Affairs, partly through a new program under the Royal Norwegian Council for Scientific and Industrial Research. This program is called IT in health care and runs 1989-92. During this five-year period the health care program has a total budget of approximately NOK 85 million for research and development. The funds are used for projects with a distinct industrial objective, and emphasis is placed on cooperation between health care services, research and industry.

Health Services↗
PubMedDate not supplied

Pressure sore management in the independent sector: 1.

Little is known about pressure sore prevention and treatment in the independent sector. With a rapidly increasing number of care settings taking over responsibility for continuing care, particularly for elderly people, it is important that essential nursing care is provided at nationally agreed standards. This is the first of two articles which explore current practice in the independent sector of a large northern city. Background information on the study, details of data collection and analysis and baseline data on current practice are presented. This study investigates the extent of evidence-based practice, equipment use, educational needs, patient and informal carer involvement and maintenance of quality of care. Initial conclusions indicate that pressure sore management in the independent sector is evidence-based. However, in many areas of practice, personal observations and experience continue to take precedence over research evidence.

Aged↗
PubMed1999

[Experience in the development of information systems at the canton level].

In the aim of need and necessity of stronger orientation and more efficient aim realization 35 Strategy SZO (health information system) country members should have the health information system able to provide information support to their National strategy "Health for All until 2005". Such a health information system should provide the information support for the planning process, monitoring and health evaluation, health care and work in public-health services sector. The experiences in the work of information system organization in Tuzla Canton Public Health Institute should be seen from two aspects: Aspect of the information system significance in the framework of the social-medical, epidemiological, hygiene-ecological and other activities of the Institute; Aspect of the information system development within the Public Health facilities of Canton in relation to the automatic data processing important for registration, tracking and recognition of success and population health care needs. From the aspect of establishing the information system in the area of Tuzla Canton and the Public Health Institute role, there is a need for adequate high technology technical equipment, with the task to enable practical realization of defined projects and in such a way, varied acceleration of work giving as a result usable information. The canton Public Health Institute needs as follows: necessary resources for free information system work; to provide free computer access to all; to ensure connection with other PHI through communications. In this way the canton Public Health Institute information system would be connected with other information systems in the field of health. In would be a base for development of integrated health information system. The information system is desirable aim for the work of Public Health Institute, method of selection and leading content of modernization. Analysing the Bill of Law on Health Care, a defectiveness has been noticed, since the information system is not regulated. Therefore, the need to be issued by Lay is of great importance. A statement that all projects on local information systems, started before war or during the war have been stooped, joins to the aforesaid, and also a series of independent information system in different health segments, which are not connected into one, unique information system. In any case, this disparaged the quality of medical decision making and therefore, providing of high-quality services at all levels of health work.

Bosnia and Herzegovina↗
PubMed2002

Will the new Australian health privacy law provide adequate protection?

Amendments to the original Privacy Act (1988) come at a key point in time, as a national medical record system looms on the Australian horizon. Changes to The Privacy Act have the potential to define a level of information privacy prior to the implementation of such a system. We have therefore collected expert opinions on the ability of the Health Privacy Guidelines (enacted in December 2001 under The Privacy Act and hereafter more specifically known as Health Privacy Legislation) to ensure the privacy and security of patient information. We conclude that the legislation is flawed in its capacity to withstand an increasingly corporatised health sector. Deficiencies in consent requirements, together with feeble enforcement capabilities, mean The Legislation cannot effectively ensure that personally identifiable information will not end up in corporate third party hands. To significantly bolster the new legislation, we argue that it should be supplemented with explicit health data legislation and privacy auditing.

Access to Information↗
PubMed2006

Improving library services for graduate nurse students in New Zealand.

BACKGROUND: Graduate students are expected to have basic information literacy skills. Knowing how to access and select relevant information and then utilize that information is a necessary skill in today's knowledge and information-age world. In the health-care sector, the rise in evidence-based medicine has brought into focus the importance of information literacy skills for nurses. In the case described, information literacy skills are embedded in the curriculum and strengthened in collaboration with library staff. AIMS: To identify graduate student nurses' use of the library, and the library's response to findings. METHODS: A case-study approach was used with both quantitative and qualitative data. An anonymous questionnaire was distributed to all nurses enrolled in graduate courses in the second semester of 2002. Interviews were then undertaken with library staff. RESULTS: The university library services were not used by 43% of graduate nursing students and the library responded by developing a number of initiatives. CONCLUSIONS: Finding a deficit in use of the library by graduate nurses, this paper outlines the response by the library to improving awareness of services, access and providing education in a bid to improve literacy skills.

Computer Literacy↗
PubMed1988

Competition and the quality of care: the importance of information.

Whether competitive mechanisms sacrifice quality in their efforts to control the costs of health care will depend on the ability of consumers to make informed choices of providers and the ability of providers to make informed decisions in using services in diagnosis and treatment. The availability of relevant information on the quality of providers and the effectiveness of services to both consumers and providers will determine the effects of competition on quality. We describe the types of information needed, how it can be developed, and the roles that government and the private sector must play in developing and disseminating this information.

Communication↗
PubMed2000

The NHS patient information lottery: it is whom you see rather than what you need.

OBJECTIVE: To examine the current scale of provision of patient information materials by consultant surgeons in UK NHS and private sector hospitals. DESIGN: Secondary analysis of the responses of 12,555 surgical patients to surveys evaluating surgical services provided by specific consultants. SETTING: 7 NHS Trusts and one private sector hospital distributed throughout the UK. MAIN OUTCOME MEASURES: Provision of information materials by hospital, surgeon, and case-mix. Comparison of this service with patients' evaluations of surgeons' verbal communication in the outpatient clinic. RESULTS: Great variation exists between surgeons of the same specialty, and between hospital surgical directorates as a whole in the routine provision of supportive information materials to patients undergoing surgery. This variation cannot be explained solely by clinical need. Patients treated in private hospitals were less likely to receive information materials compared to patients treated within the NHS. CONCLUSIONS: Provision of printed information materials to patients by clinicians appears to be arbitrary. With the prospect of national performance frameworks in the foreseeable future, it is reasonable to assume that not only will the content of patient information be determined by quality standards but, in addition, its availability will be decided by clinical need rather than the clinician's preferences or interests.

Aftercare↗
PubMedDate not supplied

What do Canadian seniors say supports their quality of life? Findings from a national participatory research study.

BACKGROUND: A national project investigated seniors' perceptions of the influences upon their quality of life. The seven participating cities were Montreal, Quebec City, Ottawa, Toronto, Regina, Vancouver and Whitehorse. The project focussed on policy decisions affecting the quality of life of seniors. It was a participatory study in which seniors controlled the direction and shape of the project in each city. METHODS: Focus groups and individual interviews with seniors and stakeholders. Data analysis used qualitative methods to see the world through the eyes of participants. Each project was committed to hearing the voices of seniors and their views on which issues were affecting the quality of their lives. RESULTS: Across the seven cities, seniors highlighted access to information, health care, housing, income security, safety and security, social contacts and networks, and transportation as key issues that affect the quality of life of seniors in Canada. CONCLUSIONS: The findings affirm the value of participatory activities that involve seniors working with other sectors as a productive policy-informing approach. The Seniors' Quality of Life projects demonstrate the conceptual power of the determinants of health perspective to understand seniors' quality of life issues. While seniors considered health care to be a continuing concern, they also recognized socio-economic issues as significantly affecting the quality of their lives.

Access to Information↗
PubMed2004

Preventing the cure from being worse than the disease: special issues in hospital outsourcing.

Like private sector organizations, hospitals are increasingly outsourcing services from food/cafeteria and security and facilities maintenance to the consulting and training of personnel and information technology (IT) functions. Also like private sector organizations, while hospitals seek the cure that will improve services at less cost, without careful management, the cure can be worse than the disease.

Canada↗
PubMedDate not supplied

[The role of private insurance in public health care systems: conceptual framework and policies].

The structure of the health care system ans specifically the type and amount of the public and private mix is not a closed issue. This article provides and update of the arguments that justify public intervention in health, and emphasizes the failures of the private insurance market that call for mandatory universal health insurance, although that does not necessarily mean that state has to be the insurer. The relationship between both sectors and the variables determining the relative level of expenditure in both are also analyzed. Following the literature on the public provision of private goods, the level of expenditure in a democracy is seen to depend on the preferences of the median voter, where private insurance usually tops up public insurance. The key variable determining the decision to buy additional private insurance is the difference in quality, defined broadly, between both sectors. Concerning policies, the appropriateness of fiscal incentives to promote the uptake of private insurance is discussed and it is concluded that there is no clear evidence of its suitability. Also, it is argued that models in which the public and private sectors appear totally segregated or totally integrated are preferable to intermediate models, in which both sectors appear combined. Medical coverage bought by an informed agent in exchange for a capitation payment seems a better way to integrate the private sector than through a system of vouchers.

Delivery of Health Care↗