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PubMed2006

Within-state availability of transition-to-adulthood services for youths with serious mental health conditions.

OBJECTIVE: This study describes the existence and nature of services within state child and adult mental health systems that support the transition from adolescence to adulthood. METHODS: State child and adult mental health administrators from all but one state were interviewed by telephone with a semistructured questionnaire regarding transition services in their state mental health system, such as supported housing, vocational support, preparation for independent living, and dual diagnosis treatment. Eight states were deemed sufficiently decentralized to render state-level administrator reports invalid. Specific service data from the remaining 41 states and the District of Columbia were analyzed with descriptive statistics. RESULTS: One-quarter of child state mental health systems and one-half of adult state mental health systems offered no transition services, and few provided any kind of transition service at more than one site. Most types of transition services were available at all in less than 20 percent of the states. CONCLUSIONS: Across the United States transition support services are lacking. The adult system in particular will require major transformation to provide the service capacity that is needed to meet the current standards of transition service accessibility for young Americans with serious mental health conditions.

Adolescent↗
PubMed1996

[Public health and medical corps in transition: the case of Crete at the beginning of the 20th century].

This article deals with the transformation of the public health system in Crete at the turn of the century, when the island was placed under the protection of the European Powers. Cretan archives, especially those from the town of Rethimno, provide a wealth of information on this subject. They show that the new ruling powers, with the declared objective of safeguarding their soldiers, required local authorities to keep a close watch over epidemics, indeed to lock up populations considered dangerous for public health, such as lepers and prostitutes--who did not fail to put up a strong resistance. While providing equipment for hospital facilities, which were still primitive, the Powers also introduced legislation concerning the practice of medicine, from which Muslim Cretans were gradually excluded. The rate at which medical care was provided increased markedly at the beginning of the twentieth century, in particular in the principal towns. The Rethimno notarial archives reveal that this new and well qualified medical corps belonged to the world of prominent citizens, and while ministering to the town's health needs, they held considerable political and economic power.

Colonialism↗
PubMed2003

The transition from paediatric to adult health care services for young adults with a disability: an ethical perspective.

Young children with disabilities and their carers or parents tend to form a long-term dependent relationship with a paediatrician throughout childhood. At some stage when the young person with a disability reaches early adulthood, the relationship is severed. This paper draws upon recent research undertaken by the authors that describes the difficulties experienced by young people with disabilities as they go through the transition from paediatric care to adult mainstream health care services. The purpose of this article is to present the argument that the dependent, paternalistic relationship that tends to exist between young people with disabilities (and/or their carers) and paediatricians throughout childhood does not facilitate the successful negotiation of adult mainstream health care services, nor optimally promote the well-being of these young people with disabilities. It is proposed that the promotion of autonomy (or self-determination) via a well planned transition program will increase the likelihood that young adults with disabilities and/or their carers will be empowered to successfully negotiate the current mainstream health care system in Australia, and will enhance the well-being of young adults with disabilities.

Adolescent↗
PubMed1999

Marital transitions, marital beliefs, and mental health.

In this paper, we examine whether people's beliefs about the permanence, desirability, and importance of marriage moderate the impact of marital transitions--including marital losses and gains--on depression, a disorder associated with both marital status and role transitions. Using two waves of panel data from the National Survey of Families and Households (N = 10,005), we find that a marital loss results in increased symptoms, whereas a marital gain results in decreased symptoms. We also find, however, that the negative effects of a marital loss are greater for people who believe in the permanence of marriage than they are for those who do not. Conversely, the positive effects of a marital gain are greater for people who believe in the desirability and importance of marriage than they are for those who do not. Our results highlight the potential utility of more systematically incorporating people's beliefs--and sociocultural factors more generally--into theory and research on the impact of stressors on mental health.

Adult↗
PubMed2004

Effects of marital transitions on changes in dietary and other health behaviours in US women.

BACKGROUND: Previous studies have indicated that married people have lower mortality and are generally healthier. Most previous studies have been cross-sectional and few studies investigated the effect of marital transition on health. With a prospective design and repeated measures of variables, we sought to analyse the temporal relation between marital transition and change in health behaviours. METHODS: We followed up 80 944 women aged 46-71 for 4 years (1992-1996). All information was self-reported. We used multivariate-adjusted linear and logistic regression models to examine the impact of changes in marital status on concomitant changes in health behaviours, controlling for potential confounders and baseline health behaviours. RESULTS: Compared with women who remained married, women who divorced/widowed had body mass index (BMI) decreases of 0.65 kg/m(2) (P < 0.001) and 0.44 kg/m(2) (P < 0.001), respectively. Compared with women who remained unmarried, women who remarried had an increase in mean BMI of 0.41 kg/m(2) (P < 0.001). Women who divorced increased physical activity by 1.23 metabolic equivalent hours (MET)/week (P = 0.07) compared with women who stayed married. Among non-smokers and past smokers, women who divorced/widowed had more than a twofold increased risk of relapsing/starting smoking (OR = 2.47, 95% CI: 1.56, 3.89; OR = 2.08, 95% CI: 1.56, 2.76, respectively) than women who stayed married. Divorced and widowed women had decreased vegetable intake relative to women who stayed married (-2.93 servings/week [P < 0.001] and -1.67 servings/week [P < 0.001], respectively). CONCLUSIONS: These patterns suggest both health-damaging and health-promoting changes accompanying divorce and widowhood, and generally health-promoting changes following remarriage.

Aged↗
PubMed2003

Analysing health care systems performance: the story behind the statistics.

This commentary paper argues that the Asia-Pacific region would benefit from a home-grown version of the European Observatory on Health Care Systems to inform health sector policy: an Asia-Pacific Observatory. The countries in this diverse region, ranging from highly developed to very poor countries, are undergoing dramatic and diverse health sector changes, often on the basis of little evidence and with little information on successes and failures in neighbouring countries. The international community also is interested in knowing more about the many distinctive models of Asia-Pacific health care. While statistical comparisons are important, health policymakers and researchers need to understand the story behind the statistics in order to interpret the numbers and to formulate policies and strategies. Health system profiles therefore are useful instruments that describe how a complex health sector works, offer a comparative framework for cross-national comparisons, identify trends in health system design, and with standardised measures and regular updates measure progress against benchmarks. These reports and expanded analyses have influenced both national and Europe-wide debates on health policy. In the Asia-Pacific region, health systems research has built up a critical mass of studies and people with strong links across countries. The next ambitious steps are to identify sponsors able to support an enterprise that transcends national boundaries and to begin a project of comparative studies of national health systems.

Asia, Southeastern↗
PubMed1998

Mental health expectancy--the European perspective: a synopsis of results presented at the Conference of the European Network for the Calculation of Health Expectancies (Euro-REVES). Medical Research Council Cognitive Function and Ageing Study Group.

The increase in life expectancy observed over the last decade has particular relevance for mental health conditions of old age, such as dementia. Although mental disorders have been estimated to be responsible for 60% of all disabilities, until recently population health indicators such as health expectancies have concentrated on calculating disability-free life expectancy based on physical functioning. In 1994, a European Network for the Calculation of Health Expectancies (Euro-REVES) was established, one of its aims being the development and promotion of mental health expectancies. Such indicators may have an important role in monitoring future changes in the mental health of populations and predicting service needs. This article summarizes the proceedings and recommendations of the first European Conference on Mental Health Expectancy.

Aged↗
PubMed2004

Differences in resting cardiovascular parameters in 10- to 15-year-old children of different ethnicity: the contribution of physiological and psychological factors.

BACKGROUND: The health status of children in the North West Province of South Africa was examined using the Transition and Health during Urbanization in South Africa in Children study. This is an epidemiological, cross-sectional study for which 1,244 children between 10 and 15 years of age were recruited from 44 schools. PURPOSE: Our objective was to investigate whether differences exist between resting cardiovascular parameters of Black, White, colored, and Indian children and evaluate the contribution of physiological and psychological factors. METHODS: Blood pressure was monitored with the Finapres apparatus. By means of the Fast Modelflo software program, the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure, heart rate, cardiac output (CO), total peripheral resistance (TPR), and "Windkessel" compliance (Cw) of the arterial system were obtained. The psychological data were obtained by validated questionnaires. RESULTS: After correction for body mass index, the SBP of the White children was significantly higher (p < .05) than the SBP of the other ethnic groups. The DBP showed no significant differences. The TPR measurements of the Black and colored children were significantly higher (p < .05) than the TPR of the White children, and the Cw measurements of the Black and colored children were significantly lower than the Cw of the White children. Significant correlations (p < .05) were found between the SV, CO, TPR, Cw, and the total score on violence in the Black and colored children. CONCLUSIONS: There are differences in the resting cardiovascular parameters in the different ethnic groups studied. The higher levels of violence to which the Black and colored children are exposed could alter vascular sensitivity to sympathetic stimulation. This may contribute via the higher -adrenergic sensitivity to the pathogenesis of hypertension in their later lives.

Adolescent↗
PubMed2006

[The effect of structural adjustment on health conditions in Latin America and the Caribbean, 1980-2000].

OBJECTIVE: To assess the impact of structural adjustment on health indicators in Latin America and the Caribbean during 1980-2000. METHODS: This was an ecological study. Public spending and per capita gross domestic product (pcGDP) figures were obtained from the World Bank, and life expectancy (LE) and infant mortality (IM) figures were obtained from the World Health Organization. Structural adjustment (government downsizing) was assessed by looking at the change in the amount of spending taken up by the government (or the reduction in public spending) in Latin American and Caribbean countries during 1980-1990. Changes in health indicators were measured in terms of the percentage variation in LE and IM. The variations found in Latin America and the Caribbean were compared to those seen in different groups of countries in other parts of the world during 1980-2000. Pearson's chi squared test was used to explore the associations between the decrease in public spending and health indicators. In order to estimate the health effects of such changes, a multivariate linear regression model was created, with adjustments for pcGDP. RESULTS: A deceleration in the rise of LE and in the decline of IM in Latin America and the Caribbean was noted, especially over the period from 1980 through 1990. Significant associations were observed between health indicators and the change in public spending in all groups of countries included in the study. When adjustments were introduced into the multiple regression model, the only associations that remained were seen in Latin America and the Caribbean. CONCLUSIONS: In the decade of 1980, adjustments in macroeconomic policies had a negative effect on social indicators, specifically those that had to do with health conditions in Latin America and the Caribbean. Such an effect lasted throughout the following decade.

Caribbean Region↗
PubMed2004

E-leadership in the digital age: the equilibrium, the codes and the digital gap.

Malaysia's experience in implementing the Integrated Telehealth Project has placed her way ahead in the arena of world Telehealth. Thus, she has become the focus point, reference point and benchmark for similar endeavors around the world. In fact, it would not be presumptuous to state that the Integrated Telehealth project is a trail-blazing pioneer with e-leadership experience and skills developed over the last few years. It is hoped that the Integrated Telehealth concept will find acceptance and credence globally.

Developing Countries↗
PubMed2005

The performance of health workers in Ethiopia: results from qualitative research.

Insufficient attention has been paid to understanding what determines the performance of health workers. This paper reports on findings from focus group discussions with both health workers and users of health services in Ethiopia, a country with some of the poorest health outcomes in the world. We describe performance problems identified by both health users and health workers participating in the focus group discussions, including absenteeism and shirking, pilfering drugs and materials, informal health care provision and illicit charging, and corruption. In the second part of the paper we present four structural reasons why these problems arise: (i) the ongoing transition from health sector dominated by the public sector, towards a more mixed model; (ii) the failure of government policies to keep pace with the transition towards a mixed model of service delivery; (iii) weak accountability mechanisms and the erosion of professional norms in the health sector; and (iv) the impact of HIV/AIDS. The discussions underline the need to base policies on a micro-analysis of how health workers make constrained choices, both in their career and in their day to day professional activities.

Ethiopia↗
PubMed2006

Transitions between the public mental health system and jail for persons with severe mental illness: a Markov analysis.

Proposed changes to the mental health care system are usually debated in terms of either health benefits or costs savings. However, because of the extensive intersection between the mental health system and the criminal justice system, changes in the organization and financing of mental health services may change the jail detention rate. We analyze jail incarcerations for felonies and non-felonies following the start of a public managed mental health care program in King County, Washington (including Seattle). We analyze unique data that tracks individuals in and out of the public mental health, Medicaid, and criminal justice systems for 1993-1998. In this manuscript we examine individuals with severe mental illness who were enrolled in the Washington state Medicaid program. The final sample size has monthly observations on 6766 unique individuals aged 18-64. We estimate Markov models of the monthly transition probabilities among living in the community with no public mental health treatment, receiving inpatient or outpatient mental health or substance abuse services, or being in jail for either a felony or non-felony charge. The transition probabilities are adjusted for demographics and policy changes that occurred during our study period. There is little evidence of any change in the jail detention rate for severely mentally ill users of the county mental health system in contrast with other SMI individuals following the public managed care program.

Acute Disease↗
PubMed1991

Liberal benefits, conservative spending. The Physicians for a National Health Program proposal.

The Physicians for a National Health Program proposes to cover all Americans under a single, comprehensive public insurance program without copayments or deductibles and with free choice of provider. Such a national health program could reap tens of billions dollars in administrative savings in the initial years, enough to fund generous increases in health care services not only for the uninsured, but for the underinsured as well. We delineate a transitional national health program budget that would hold overall health spending at current levels while accommodating increases in hospital and physician utilization. Future national health program spending would be indexed to the growth in gross national product adjusted for demographic, epidemiologic, and technologic shifts. Financing for the national health program would transfer funds into the public program without disrupting the general pattern of current revenue sources. We suggest a funding package that would augment existing government health spending with earmarked health care taxes. Because these new taxes would replace employer-employee insurance premiums and substantial portions of current out-of-pocket expenditures, they would not increase health costs for the average American.

Budgets↗