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PubMed2002

Gender influences beliefs about health and illness in diabetic subjects with severe foot lesions.

BACKGROUND: No studies have been found regarding beliefs about health and illness in patients with diabetic foot ulcers investigated from a patient perspective. Beliefs might affect self-care and health. AIM: To explore beliefs about health and illness among patients with severe diabetic foot lesions that might affect self-care practice and care-seeking behaviour. METHOD: The study design was explorative. A purposive sampling procedure was used. Focus group interviews were held, with 10 women and 11 men under 65 years (working age) and six women and 12 men over 65 years (range 23-83 years) with present or previous diabetic foot lesions managed at a specialized multidisciplinary diabetic foot clinic. FINDINGS: Foot problems were perceived by participants as caused by both external and internal factors related to the individual. Self-care was practised to restore health when ill and in daily foot care. When help was needed it was sought in the professional sector. Women were active in self-care and preventive care, searched for information and tried to adapt to the situation. Men more often sought help for acute problems, discussed more foot-related problems, had a pessimistic view of the future, showed a passive attitude, accepted information given and used more complementary care from the lay sector (wife) and/or the professional sector (district nurse, home care staff, podiatrist). Foot lesions caused deterioration of perceived health and quality of life due to decreased ability to be active. CONCLUSION: The present study emphasizes the need to take into account the existence of different beliefs about health and illness, especially regarding gender, in the prevention and management of the diabetic foot.

Adult↗
PubMed2002

Improving the accessibility of condoms in South Africa: the role of informal distribution.

Lack of access to condoms presents a fundamental barrier to HIV prevention across most of sub-Saharan Africa. One strategy to enhance the accessibility of condoms is to promote their informal distribution outside of health facilities through existing social networks. To investigate the prevalence and practices of informal condom distribution, we administered a questionnaire to individuals procuring condoms at 12 public health facilities in four regions of South Africa. Of the 554 individuals interviewed, 269 (48%) reported either giving or receiving condoms informally in the month before the study. In multivariate analysis, reporting informal condom distribution was associated with increased education, male gender, multiple sex partners and recent condom use. The specific practices involved in giving or receiving condoms differed between males and females, with women more likely to involve family members and men more likely to involve friends. These results indicate that informal condom distribution is surprisingly common among individuals procuring public sector condoms in South Africa, and begin to suggest the gendered nature of informal condom distribution networks. While these findings require confirmation in other populations, the practices of informal condom distribution described here provide an excellent opportunity for enhancing condom accessibility and delivering other interventions for HIV prevention.

Adolescent↗
PubMed1997

Health technology assessment: decentralized and fragmented in the US compared to other countries.

This paper presents the results of the first comprehensive international survey to catalogue health technology assessment (HTA) activities. By 1995, there were formal HTA programs in 24 countries established mostly in the late 1980s and early 1990s. European countries generally have one or two federal or provincial HTA programs each, Canada has an extensive network of federal and regional organizations coordinated by a central body and the US has 53 HTA organizations, the vast majority of which are in the private sector. While the commitment of the US government to HTA has been erratic, the private sector has been witness to an expansion of HTA activities by insurance companies, hospitals, medical/device manufacturers, consulting firms and health professional societies. In contrast to other developed countries, the current state of technology assessment in the US is decentralized, fragmented and duplicative. We conclude by discussing the importance of a US HTA agency at the national level.

Canada↗
PubMed2000

[Malnutrition: a secular challenge to child nutrition]

OBJECTIVE: To review current knowledge about child malnutrition, including the historical aspects of the problem, its dimension as a childhood public health problem, its natural history, physiopathology, clinical features, diagnosis and treatment, and strategies used by the health sector to control this disease. METHODS: Information was collected by researching the Medline system, the Bireme library, internet sites of interest, catalogues of publications produced by Brazilian governmental organizations and international institutions dealing with child nutrition. RESULTS: The review pointed out that despite recent world prevalence reduction, child malnutrition is a major public health problem in developing countries. Malnutrition, in any of its forms, contributes for more than 50% of deaths among children under 5 years in those countries. Mortality rates of severely malnourished children treated as in patients have been unchanged for the last five decades. Guidelines for improving the treatment and reducing mortality rates of severely malnourished children treated in hospitals were recently defined by the World Health Organization. Even though some positive results have been achieved by the health sector in reducing child malnutrition prevalence, the effectivity of the interventions is often low. Lack of food might limit the success in treating and preventing malnutrition. Factors that may contribute to the effectiveness of interventions against malnutrition include approaches which reassure the confidence of health professionals about achieving positive results with the proper treatment of malnourished children, establishment of an effective relationship between health professionals and mothers, as well as practical support to mothers in recognizing them as valuable active agents for their children nutrition rehabilitation at the household level. CONCLUSIONS: Throughout the centuries, malnutrition has been the biggest challenge faced by developing countries in order to guarantee to children under five years of age their right of being well nourished and healthy. The current challenge is the proper use of the available scientific knowledge on child nutrition to further reduce the figures for all the types of child malnutrition.

Journal Article↗
PubMed2005

A survey of UK clinical librarianship: February 2004.

AIM: This article will describe a survey carried out in February 2004, the aim of which was to summarize the form and content of clinical librarian (CL) and other similar outreach information services to UK health professionals in the acute (secondary or tertiary) sector. OBJECTIVES: (i) To survey the activities and views of UK information professionals offering information services involving the librarians' presence in the clinical setting, (ii) to develop a tool to explore critical aspects of this form of information work, (iii) to create a contacts database for UK CLs, to be made available on the Internet. METHODOLOGY: All known information specialists/librarians offering CL or similar services were surveyed. The semi-structured questionnaire was piloted. Respondents were asked to consider their activity over a period of 4 weeks. RESULTS: Twenty-six people responded to the invitation to take part and met the inclusion criteria. CONCLUSIONS: A summary of a 'typical' clinical librarian revealed by this survey is given, with a major conclusion that there is a very mixed picture of activity. Opinion on how far CLs should go in fully appraising search results is uncertain. The survey suggests reasons for this and the developments that may influence change are discussed. Recommendations for future research and development are offered.

Clinical Medicine↗
PubMedDate not supplied

Building knowledge in literacy and health.

Health and literacy share an interesting relationship. The complexities of the relationship between literacy and health need to be recognized by policy-makers and practitioners to dispel myths, reduce stigma attached to low literacy, and empower disadvantaged groups. As we engage in building knowledge in the field, there is a need for multi-sectoral collaboration, both quantitative and qualitative information, and more effective ways to communicate with and educate people with low literacy. At the Second Canadian Conference on Literacy and Health, research reported indicates that in terms of what we know, the field has focussed on: linking literacy and health; examining intervention programs; exploring e-health and rural health; evaluating programs; and empowering people. In exploring what we need to know, researchers at the conference identified the need to understand: the extent of literacy sensitivity among health care providers in diverse settings; the impact of using plain language and readability formulas; the effectiveness of approaches to instructing literacy; and the incorporation of health content and health literacy goals into literacy instruction. Further, we need to create accessible ways of sharing knowledge in the field to build and strengthen existing multi-sector partnerships within and between communities.

Canada↗
PubMed2000

Recent trends in the financing of substance abuse treatment: implications for the future.

OBJECTIVE: This article focuses on the implications of a recent study of substance abuse (SA) and mental health treatment expenditures for substance abuse treatment policy. Public and private expenditures for SA treatment are estimated and compared with those for mental health and all health care in the period between 1987 and 1997. METHODS/DATA SOURCES: Estimates of SA treatment expenditures were segregated from the Health Care Financing Administration's National Health Accounts across the ten-year period. Information about use, charges, and payments by provider type, payer, and diagnosis was obtained from numerous nationally representative data sets and large claims databases. Those data were used to estimate SA treatment expenditures in the general service sector. For the specialty sector two specialty facility surveys were used to estimate SA treatment expenditures. Information from the two sectors was combined and reconciled to the National Health Accounts. PRINCIPAL FINDINGS. A dramatic shift in SA expenditures away from private financing and toward public payers, as well as a shift away from hospital treatment settings, occurred between 1987 and 1997. CONCLUSIONS: Evidence from this article and other research suggests that growth in SA expenditures has been contained relative to growth in all health spending. How savings from SA treatment are being invested and whether expenditure levels are appropriate to supply treatment of acceptable quality needs further study.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Modelling collaborative care information--the nursing perspective.

Collaborative care has been adopted by many countries as a preferred care delivery model to provide well coordinated holistic care to patients with chronic illnesses as they move between different healthcare sectors during the course of their illnesses. Effective communications and information exchange between collaborative care team members across the health care sectors is considered one of the critical success factors of collaborative care. This paper describes the adoption of a modified Health Level 7 development framework to analyze information exchange requirements, develop the standard clinical data contents and structures for populating the collaborative care messages. It also describes how example nursing data structures are mapped into sample Health Level 7 message segments.

Cooperative Behavior↗
PubMed2004

A broader view of marketing: implications for surgeons.

The health care sector of the economy is changing. There is unprecedented growth in the health care sector, and competitive forces have a more prominent role. In addition, consumers have become more informed and as a result, more empowered. Patients in the health care sector are no exception to this trend. As patients become more informed, it is imperative that health care providers become more effective at marketing their services. In general, physicians typically have received little training in the field of marketing, which results in potentially limited understanding of the key marketing issues being faced in today's health care environment. We identify and examine several key marketing issues critical to the success of health care providers in today's environment. Further, we offer some managerial recommendations designed to address each of these issues.

Advertising↗
PubMed1987

Policy on management of Federal information resources.

OMB Circular No. A-130, Management of Federal Information Resources, sets basic policy for the management of information and information technology by Federal agencies. The circular makes a distinction and explains the relation between access to information and dissemination of information. Further work on application of the Circular's general principles will focus especially on electronic filling and the proper roles of the public and private sector.

Government↗
PubMed2006

Information. Mapping the money.

Dr Foster Intelligence aims to improve the use and accessibility of information to offer people more control over their care. It will also provide management with the information required to make effective business decisions. The new service will be 'taking advantage of private-sector expertise for public-sector advantage.

Access to Information↗
PubMed1999

Telecommunication in healthcare for a better coordination between hospitals and GP's: routine application of the "ISAR-Telematics" project.

With the development of new information and communication technologies, the nature of data exchange between healthcare professionals is modified by the use of telematics tools. With the implementation of the "Réseau Santé Social" of the smart cards CPS and Sesam-Vitale, hospitals and private clinics are installing their hospital information systems, while general practitioners are computing their patient records. The environment is therefore suitable for the installation and diffusion of telematics services, allowing a better exchange of information between the physicians of a geographical sector. The RITHME intercommunication platform was developed in the ISAR-Telematics and IRISI European projects. It ensures several communication functions, such as movements of patients (in/out/inside) the hospital, management and mailing of letters and reports, specific information on prescribed treatments, or data concerning the hospital structure. This platform is tested in the town of Armentières in the large city of Lille (North of France). It is currently being routinely used to accelerate and secure data exchanges between all the physicians working in this area.

Family Practice↗
PubMed2005

NACCHO GP Network--enhancing communication in Aboriginal health.

BACKGROUND: Communication between general practitioners, information sharing, and GP support are important issues, especially for those in rural and remote areas. Internet based links can facilitate enhanced communication. OBJECTIVE: This article describes the new internet based communication forum for GPs working, or interested in the health of, Aboriginal and Torres Strait Islander peoples. DISCUSSION: The NACCHO GP Network is the first on-line service to provide focussed information for GPs in the Aboriginal community controlled health sector. It also provides a place for GPs, locums and general practice registrars to raise issues and share ideas and information on Aboriginal health practice. The NACCHO GP Network has the potential to reduce isolation and address the support needs of GPs, and enhance the interaction of the Aboriginal community controlled sector with general practice organisations.

Australia↗
PubMed1992

Dutch information policies in the near future.

The Dutch Ministry of Welfare, Health and Culture played an important part in Picture Archiving and Communicating Systems (PACS)-related activities in the Netherlands. It subsidized a large Dutch PACS project, which took place in the period 1986-1989. Moreover the ministry subsidized this workshop on the Technology Assessment of PACS. In this paper, the Director of the Information Policy department of the ministry explains the backgrounds of Dutch policy in the support of development and evaluation of information technologies applied in the health care sector in general and, more specifically, of PACS.

Government Agencies↗
PubMed1998

Nurses' requirements for information technology in the next millennium.

The main purpose of this study was to identify nurses' requirements for information technology in the next millennium. We distributed 350 questionnaires in a teaching hospital in Brazil and in the USA. We received 86 from Brazil and 78 from USA. Besides the capabilities of computers to be used in different sectors of human actions, nurses' requirements for information technology can not be considered sophisticated. Nurses in Brazil prefer a standalone system. In contrast, in USA they prefer systems that could be integrated to the whole healthcare system. Also, in the USA, nurses were more comfortable with use of computers than nurses in Brazil. In general terms, nurses in both countries feel that computer systems could make their practice easier and more efficient.

Attitude to Computers↗
PubMed1986

Implications of diagnosis related groups (DRGs) for the management of hospitals.

Although tremendous advances have been made in the diagnosis and treatment of patients, hospital administrative systems have progressed relatively slowly. The types of information available to managers in industrial sectors are not available in the health sector. For this reason, many phenomena, such as the variations of average costs and lengths of stay between different hospitals, have remained poorly explained. The DRG system defines groups of patients that consume relatively homogeneous quantities of hospital resources. On the basis, it is possible to standardize average lengths of stay and average hospital costs in terms of the differences in case mix treated. Thus DRGs can serve as an explanation of variations in these factors between different hospitals, and also (but not only) for prospective reimbursement schemes. As in a number of other European countries, a project has been set up in Switzerland to examine the possibilities of using DRGs in hospital management, planning and financing.

Cost Control↗
PubMed1987

Problem solving ability in aging and dementia: normative data on a non-verbal test.

A non-verbal problem solving task, viz. a simplified version of Shallice's London Towers Test, was given to 131 normal subjects to obtain normative data relating to age, education and sex. The test was built up in its easiest possible feature in order to be administrable also to demented patients, therefore possibly becoming part of the neuropsychological diagnostic procedures of the demential syndromes. Although this version of the test proved to be very easy and therefore likely to yield a statistically treatable wide distribution of scores in demented patients, the age-related decline of performance in normals was apparent. Education and sex showed no significant influence on the test-performance. With correction of the raw scores for age and with knowledge of the distribution of scores in the normal population, this test is now ready to assess the normality of the scores of a new subject according to his age, giving information on this otherwise still uncovered sector of cognitive abilities.

Adult↗
PubMed1994

Record linkage in a regional mental health planning study: accuracy of unique identifiers, reliability of sociodemographics, and estimating identification error.

Assembling information about individuals over time allows health managers and researchers to describe the progression of diseases, the care history of individuals and the sequences of care episodes that potentially result in improving individuals' health status. However, current mental health statistics generally focus on sets of events rather than groups of individuals making it impossible to distinguish between two different persons being admitted and the same person being admitted twice. Accurate figures on treatment prevalence cannot be generated and multiservice users across time or across agencies will inflate the statistics used to plan needed services. The capacity to link consistently defined bits of information together is critical to developing a reliable information system. This article examines the adequacy of using unique identifier codes to accomplish linkage by focusing on one example of record linkage that incorporates mental health information from both community and institutional sectors in one region of Ontario, Canada. Findings indicate that unique "cradle to grave" identifiers do not guarantee accuracy if manual transcription is involved.

Databases, Factual↗