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PubMed1996

[Foreigners and naturalized French citizens: a slow social diversification (1982-1990)].

"Two decades of economic recession have brought about profound transformations in the social structure of France's working population. In this article we focused on an analysis of socioprofessional statistics from the censuses of 1982 and 1990 (the first ones to use the new terminology) as means of understanding the role and status in these developments of populations produced by immigration. The social gap between working people of foreign origin and the birthright French remains quite considerable. Nevertheless, despite the economic situation, the social homogeneity of the minority population seems to be fading. Although the great majority of working people from a foreign background are still employed in low-echelon industrial and service jobs, there is a tendency for this homogeneity to blur slightly." (SUMMARY IN ENG AND SPA)

Demography↗
PubMed1995

Breast abscesses in Nigeria: lactational versus non-lactational.

This review of 299 cases of breast abscesses seen over a 10-year period (1981-1990) at the University of Calabar Teaching Hospital in Nigeria seeks to establish the current status of breast abscesses in the tropics. Lactational breast abscess constitutes 95% of breast abscesses while non-lactational breast abscess constitutes only 5% in this review. The commonest pathogen cultured from lactational breast abscess is Staphylococcus aureus and the disease responds to incision and drainage and systemic antibiotics, while non-lactational breast abscess is caused mostly by anaerobic organisms, usually with underlying mammary duct ectasia. The low incidence of non-lactational breast abscess corresponds to the low incidence of cigarette smoking and mammary duct ectasia in Nigerian women. While the high incidence of lactational breast abscess corresponds to the high rate of breast feeding and low level of personal hygiene in the low income group Nigerian women in which the disease is commonest. Economic recession has also reduced patronage of artificial feeds thus intensifying breast feeding and consequent lactational breast abscess.

Abscess↗
PubMed1999

Gendered histories: garment production and migration in Mexico.

Data gathered in Aguascalientes during the 1990s are used to analyze how the garment industry in Mexico has responded to economic recession and trade liberalization. In particular, the relationship between industrial change and gendered patterns of migration are explored. The author concludes that "migration over recent years has increasingly allowed working women the possibility of entering a transnational labour force and given them important labouring and living experiences on both sides of the border."

Americas↗
PubMed1999

Developing health insurance in transitional Asia.

Many European and Asian economies are currently undergoing a process of economic transition away from state based command systems to market led economies. The impact of transition, such as a decline in public expenditure, break up of state enterprises and economic recession, has affected levels of funding available for social sectors. In the health sector, health insurance is being introduced as a way of alleviating the decline in funding arising from these processes. Most of the Former Soviet Union and a number of other Asian transition economies are currently introducing, extending or considering payroll based systems of health insurance. Comparisons with many Latin American countries, where social security based insurance has been encouraged since the first World War, can be illuminating. Experience suggests that, various factors have impeded or permitted development in these countries. General processes of economic change (transition factors) tend to affect all economies attempting to change the basis for public funding of services. Structural factors, such as urbanisation and the level of state or industrial employment, act as longer term inhibitors to the extension of coverage. These factors vary considerably across transition economies. This suggests that while a social security base for insurance may be a viable option for smaller industrialised European transitional economies, this is not the case for many of larger less industrialised economies. It is unclear how insurance will develop in the future. If a separate insurance fund is maintained it is important that its' purchasing function is developed. Otherwise it is not clear what value is added to the current health system. If entitlement is to be based on contribution, with the fund based on geographic or employment groups, systems for ensuring access for those not in employment and not classified as socially protected must be developed.

Asia↗
PubMed1984

[Psychiatric emergencies : specific phenomenon.].

In as much as it is situated at a crossroads, emergency psychiatric practice provides a remarkable observation point in relation to a number of new facts: the recession, unemployment, the lack of health, the growth and development of the autonomy of the para-psychiatric professions, deinstitutionalization, the poorly-defined extension of the field of psychiatry. The réponse, even the site of this response, to demands for urgent service, its ties to medicine and to society, represent major questions. The essential reasons for providing emergency psychiatric care remain the curtailment of pathology, the early assumption of care, the reduction of errors in diagnosis and the teaching of psychiatry in the medical milieu. Although seemingly evident, these affirmations deserve to be evaluated, to be the subject of epidemiological and démographie research. Beginning with the new problems posed by the economic recession, and in the face of the situation of medicine and psychiatry, the author describes two critical situations concerning the current organization of emergency care: the saturation of transitory units and the connections between the specialties.

English Abstract↗
PubMed1990

[Young and economically precarious: an analysis of the situation of couples].

Changes in the economic status of young married and unmarried couples in Canada are examined for the period 1960-1989. The impact of the economic recession created by the restructuring of the economy in the early 1980s on the income of the young is analyzed. The authors investigate the impoverishment of young couples and compare it "with the evolution of income among older couples and analyze the impact of various factors, [such] as job stability, wage level and relative contribution of both partners." (SUMMARY IN ENG AND SPA)

Age Factors↗
PubMed1987

Relation of economic change to Swedish health and social well-being, 1950-1980.

To what extent, and through what mechanisms, does the deterioration of economic conditions affect the health of the population at the national level? In this paper, the author presents the results of a study of Swedish data, analyzing the post-World War II changes in mortality rates in relation to deleterious economic changes, especially unemployment, business failure rates, and declines in real per capita income. The analysis uses a version of the 'Economic Change Model of Pathology' which includes the influence of health risks related to patterns of consumption and production. It is found that economic growth plays a principal role in reducing mortality at nearly all ages, and specifically mortality due to total cardiovascular disease, cerebrovascular disease, total heart disease, ischemic heart disease, total malignancies, disorders of infancy, and motor vehicle accidents. Economic recession, by contrast, is related to increases in total mortality for virtually all age groups, in both sexes, for major causes of death and causes due to psychopathological conditions. Per capita alcohol consumption, by specific beverage, is an important risk to mortality rates in cerebrovascular disease, malignancies, cirrhosis, motor vehicle accidents, suicide, homicide, and infant diseases. Cigarette consumption rates are positively related to mortality due to cardiovascular, malignant, and infant diseases; fat consumption rates are positively related to cardiovascular and cancer mortality.

Economics↗
PubMed1993

[Gastroduodenal ulcers during the period of acute economical crisis].

The occurrence and development of acute ulcers in Sofia during the period of heavy economical recession--January trough February 1991--is analyzed. There is a clear cut increase in the total number and rate of acute duodenal ulcers from 2 to 14%. No gastric ulcer cases are recorded. The young age group--up to 40 years of age--is mainly affected (79% of cases). The incidence among the female population shows a noticeable rise. Difficult living, working and social conditions, associated with inadequate feeding regimen with diets, poor in meat and vitamins, are taken to be the underlying factors of acute ulcers development during the period in question.

Adult↗
PubMed1999

Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya.

Urbanization is an important demographic phenomenon in sub-Saharan Africa, and rural-urban migration remains a major contributor to urban growth. In a context of sustained economic recession, these demographic processes have been associated with a rise in urban poverty and ill health. Developments in health service provision need to reflect new needs arising from demographic and disease ecology change. In malaria-endemic coastal Kenya, we compared lifelong rural (n = 248) and urban resident (n = 284) Mijikenda mothers' responses to childhood fevers. Despite marked differences between the rural and urban study areas in demographic structure and physical access to biomedical services, rural and urban mothers' treatment-seeking patterns were similar: most mothers sought only biomedical treatment (88%). Shop-bought medicines were used first or only in 69% of the rural and urban fevers that were treated, and government or private clinics were contacted in 49%. A higher proportion of urban informal vendors stocked prescription-only drugs, and urban mothers more likely to contact a private than a government facility. We conclude that improving self-treatment has enormous potential to reduce morbidity and mortality in low-income urban areas, as has frequently been argued for rural areas. However, because of the underlying socio-economic, cultural and structural differences between rural and urban areas, rural approaches to tackle this may have to be modified in urban environments.

Adult↗
PubMed2001

Moving upward in a downturn.

As the recent bursting of the new economy bubble has shown, business cycles are still wih us. The question, then, is, what executives should do to help their companies weather these downturns. As in so many instances, there are conventional approaches that appear to make sense in the short term. But while these approaches seem reasonable in the heat of the moment, they can eventually damage competitive positions and financial performance. Drawing on extensive research of Fortune 500 companies that have lived through industry downturns and economic recessions over the past two decades, Darrell Rigby, a director of Bain & Company, reveals how companies need to go against the grain of convention and exploit industry downturns to harness their unique opportunities for upward mobility. The author explains that every downturn goes through three phases. He examines each phase and shows how successful players navigate the huge waves of a downturn. Smart executives, he says, don't panic: they look bad news in the eye and institutionalize an approach to detecting storms. Rather than hedge their bets through diversification, they focus on their core businesses and spend to gain market share. They manage costs relentlessly during good times and bad. They keep a long-term view and strive to maintain the loyalty of employees, suppliers, and customers. And coming out of the downturn, they maintain momentum in their businesses to stay ahead of the competition they've already surpassed. Every industry will face periodic downturns of varying severity, says Rigby. But executives with the vision and ingenuity to take unconventional approaches can buoy their companies to new heights.

Commerce↗
PubMed1992

Paying for efficiency: what price the quality of hospital care?

Economic recession prompts governments and health service ministers to seek increased efficiency in the production of hospital services in order to reconcile increasing demands with scarce resources. As one approach to the problem, the National Health Strategy is recommending pilot schemes, similar to those which have been introduced in both the United Kingdom and the Netherlands, which involve the separation of purchaser from the provider of hospital services. It is argued that such separation, with the introduction of competition between providers of hospital services for contracts placed by publicly funded Area Health Boards, will increase efficiency and accountability in the use of resources. However, this argument ignores the hospital management's ability to keep costs down by altering the quality of hospital care in ways which are difficult to monitor by purchasing agencies. The article considers the effects the introduction of managed competition is likely to have on the quality of hospital services. The outcome is uncertain and competition may improve some dimensions of quality while jeopardizing others. If managed competition is tried in Australia, the opportunity should also be taken to examine its impact on the quality and outcomes of hospital care.

Australia↗
PubMed2001

Circadian variation of the onset of acute myocardial infarction in the Osaka area, 1998-1999: characterization of morning and nighttime peaks.

The onset of acute myocardial infarction (AMI) shows characteristic circadian variations; that is, a definite morning peak related to biologic rhythms and a vague nighttime peak related to socioeconomic factors. The recent economic recession in Japan may change the circadian variation, especially the nighttime peak. This study evaluated the recent circadian variation of AMI in Osaka and specified the patient subgroups showing either a morning or nighttime peak predominantly. Of 1,609 consecutive patients with AMI registered from April 1998 to January 2000, 1,252 whose onset of AMI was definitely identified were studied. The day was divided into six 4-h periods with a morning peak between 08.01 h and 12.00h, and nighttime peak between 20.01 h and 24.00h. When subgroup analysis was performed, female patients aged 65 years or more showed a morning peak alone and male patients aged less than 65 years with an occupation and the habits of cigarette smoking and alcohol intake showed a nighttime peak alone. Thus, in Osaka nighttime socioeconomic factors may currently be more potent triggers of AMI than the morning surges in younger male workers who smoke and drink.

Adult↗
PubMed1984

Selected myths guiding the Reagan Administration's health policies.

This article analyzes four major assumptions that guide the Reagan Administration's health policies: 1) the Administration received an overwhelming popular mandate to reduce the federal role in the U.S. health sector; 2) the size and growth of federal social (including health) expenditures are contributing to the current economic recession; 3) the costs to business of federally imposed health and safety regulations have contributed to making the U.S. economy less competitive; and 4) market intervention is intrinsically more efficient than government intervention in regulating the costs and distribution of health resources. Based on these assumptions, the main characteristics of the Reagan Administration's health policies have been 1) a reduction of federal health expenditures and, very much in particular, expenditures to the poor, handicapped, and elderly; 2) a weakening of federal health and safety regulations to protect workers, consumers, and the environment; and 3) the further privatization and commodification of medical services. This article shows that there is no evidence to support the assumptions on which these policies are based. Quite to the contrary, all available evidence shows the opposite: 1) the majority of Americans want an expansion of federal health expenditures and a strengthening of federal health regulation; 2) U.S. government expenditures and regulations are much more limited than those of other countries whose economies are performing more satisfactorily; and 3) those countries with larger government interventions have more efficient health care systems than the American one, where the "free market" forces are primarily responsible for the allocation of resources. Thus, major Reagan Administration health policies are based on myth rather than reality.

Economic Competition↗
PubMed1999

Reforming health service delivery at district level in Ghana: the perspective of a district medical officer.

Many countries in sub-Saharan Africa face the problem of organizing health service delivery in a manner that provides adequate quality and coverage of health care to their populations against a background of economic recession and limited resources. In response to these challenges, different governments, including that of Ghana, have been considering or are in the process of implementing varying degrees of reform in the health sector. This paper examines aspects of health services delivery, and trends in utilization and coverage, using routine data over time in the Dangme West district of the Greater Accra region of Ghana, from the perspective of a district health manager. Specific interventions through which health services delivery and utilization at district level could be improved are suggested. Suggestions include raising awareness among care providers and health managers that increased resource availability is only a success in so far as it leads to improvements in coverage, utilization and quality; and developing indicators of performance which assess and reward use of resources at the local level to improve coverage, utilization and quality. Also needed are more flexibility in Central Government regulations for resource allocation and use; integration of service delivery at district level with more decentralized planning to make services better responsive to local needs; changes in basic and inservice training strategies; and exploration of how the public and private sectors can effectively collaborate to achieve maximum coverage and quality of care within available resources.

Developing Countries↗
PubMedDate not supplied

Access and payment for health care: the poor of Northern Vietnam.

In common with many developing countries, Vietnam has begun to introduce user fees at community and district level. This is part response to the transformation of the economy, economic recession, and the growing acceptability of alternative forms of health finance. This article examines the impact of these charges on the rural poor. Results from a 1995 survey in North Vietnam suggest that the poor generally delay treatment, make less use of government health facilities, and pay more for each episode of illness than the rich. There is evidence that the poor are forced to reduce consumption of essential goods or to borrow to meet these charges. A significant minority are deterred from using facilities. The current system of exemptions fails to provide adequate protection to the poor and a completely new system is required. The results suggest that it is the poor in poorer communes that are most affected by high user fees and it is to these areas that any assistance from government or donors should be targeted.

Data Collection↗
PubMed1985

Restructuring health services in Canada: challenges for policy makers, planners and managers in the eighties.

Is downsizing the latest jargon word applied to rationalization, a new concept or a different manifestation of a long term trend in health services management? At present, Canada is struggling to implement feasible reductions of expansionary pressures in the health care system. While provincial governments tend to see the issue as one of controlling chronic excess demand, federal government is still concerned to ensure free access to care on an equitable basis. Thus the problems of downsizing can be expressed by the provinces in terms of an ideological struggle with an unfeeling central government which does not understand their problems; although all know they are really about the feasibility of continuing to provide a service to meet demand. The present economic recession enables provincial governments to appeal to their voters for supporting a new way. Earlier, the appeal was to consumers to become involved in health service organization management and this policy succeeded, to a degree, where there were fluorishing grass roots communities; albeit that the service continued to be driven by professionals. Now the appeal is to taxpayers for their strong support in cost cutting. This has been more successful. Provincial governments are now permitted to 'touch the untouchables', that is to downsize the medical profession and previously sacrosanct health care institutions. They also are exploring the feasibility of introducing a two-tier system which would provide basic care for everyone and extra care for those able to pay, thus side-stepping federal conditions. By reorganizing support in this way, provincial governments have extended the range of policy choices, and two types of planning, the rational and the political, have now become combined into strategic management activity.

Canada↗
PubMedDate not supplied

Hospital utilization and reimbursement method in Brazil.

Urban private hospital discharges in Brazil increased enormously during the last decade. Several measures were taken in an effort to slow the rate of increase in hospital admissions and the escalation of hospital costs, which were out of control by the end of the last decade. The introduction of a new case-based reimbursement method, late in 1983, not only contributed to increased hospitalizations, but to changed hospital case mix, as private hospitals shifted from more costly to less costly patients. This occurred especially in the most developed areas of the country, where the concentration of profit-making hospitals is very high. The case-based prospective payment method can be seen as a good managerial tool for use in comparing hospital performance. However, it seems not to be a good mechanism for controlling health care expenditures, especially when profit-making hospitals dominate the provision of hospital care. Any decrease in hospitalization by private hospitals in Brazil has been caused by the severe economic recession, which hit the Brazilian economy hard, and by the shift in hospital admissions from private to public hospitals, not by the introduction of the new reimbursement method which has changed the unit of payment from 'patient day' to case or procedure.

Brazil↗
PubMed1989

Some socioeconomic factors in the selection of blood pressure drugs in New Orleans, Louisiana.

Socioeconomic factors are important in the selection of drug therapy for hypertension in New Orleans. With a preponderance of blacks, and an economic recession in the city, the availability of a large variety of effective and relatively safe hypertensive medications does not in itself solve the problem of providing a lifetime of antihypertensive medication. We must know our patients well and take into consideration income, age, home environment, and family situation. Only then can drug therapy that is appropriate to this complex milieu be prescribed.

Black or African American↗