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PubMed1999

Data needs in studies on equity in health and access to care--ethical considerations.

In order to study equity in health and access to care in an appropriate way, data are needed on an individual level and must include information about health, mortality, morbidity, utilization of care, age, sex, residential area, family situation and the social and economic circumstances of each individual. These data must be collected at several points of time during a life cycle. This is a demanding task requiring many resources and methodological and ethical considerations. The ethical and political trade-off is between our demand for knowledge and a fair distribution of resources in order to achieve equity in health and access to care and the need to administrate sensitive data without threatening personal integrity. In presenting results from Swedish studies, it is argued that the benefits of using registers for this kind of epidemiological research by far outweigh the risk of using registers.

Data Interpretation, Statistical↗
PubMed2003

The early childhood caries prevention program in Palau.

Early Childhood Caries is a significant public health problem in Palau. Data have shown that nearly 80% of children ages 3-5 years of age in Palau experience dental caries and a significant number of these children require general anesthesia to treat or remove painful or infected carious teeth. In response to this growing problem, the Division of Oral Health has systematically developed a prevention program in collaboration with the Maternal and Child Health Unit under the Ministry of Health. The core program involves integrating preventive oral health services into all regular prenatal and postnatal care programs and improving the capacities of health professionals to provide such services. The program promotes the idea that oral health is an important component to overall health and all efforts are made to integrate oral health into broader public health initiatives. Both health and process outcomes are being monitored by an oral health surveillance system, while preliminary data show improved oral health among young children. This paper takes a closer look at the development of the Palau program.

Child, Preschool↗
PubMed2003

A case/comparison study in the Eastern Region of Ghana on the effects of incorporating selected reproductive health services on family planning services.

OBJECTIVE: to assess the impact on the provision of family planning (FP) services when FP providers were also trained to provide additional, selected, reproductive health services. DESIGN: case/comparison study. PARTICIPANTS AND SETTINGS: twenty-four FP service delivery points in which training in sexually transmitted infection prevention and control services or post-abortion care services had been initiated (case facilities), were compared to 19 control facilities in which similar provider training had not yet been targeted. All settings were located in the Eastern Region of Ghana. MEASUREMENTS: service statistics for three study years (1996-1998) were reviewed. Structured interviews with providers, managers and clients provided qualitative data concerning impact and satisfaction. FINDINGS: case facilities which had integrated these additional reproductive health (RH) services experienced consistently higher numbers of clients and the total number of clients receiving FP services increased over time. There was also a statistically significant increase in continuing FP clients within case facilities. In contrast, the number of FP clients serviced in the comparison area remained basically unchanged over time. KEY CONCLUSIONS: interviews conducted with providers and managers in both types of settings indicated strong support for receipt of training to provide these integrated services and a request for additional training in an even broader array of RH and adult/child services. Clients also perceived the benefit of additional RH services and perceived these services to be of high quality. IMPLICATIONS FOR PRACTICE: expanding the repertoire of clinical skills of FP providers, enabling these practitioners to render RH services that augment basic FP services, has the potential to increase the number of new and continuing FP clients, and increases the satisfaction of both providers and consumers with respect to these services.

Abortion, Induced↗
PubMed1981

[Preliminary study on the integration of occupational medicine into the Swiss health system].

The aim of our research project is to gather the necessary data in order to introduce a nationwide discussion on the development in Switzerland of occupational health and its place inside our health system. Two types of data will be collected: on one hand the needs, which should be expressed at different levels: employees, employers, undertakings, inspection offices, specialists. On the other hand, preventive actions will be listed. To fulfill the objective of this research project, several means will be used such as foreign and international literature, gathering of epidemiological figures, interviews. As a conclusion, suggestions will be made as regards the actions to be undertaken in order to meet the needs.

Health Services Research↗
PubMed2026

Understanding Suicide through Coroners' Narratives: implications for primary care from a mixed‑methods study of 157 Coroners' reports.

Suicide is a major public health concern, and general practice is often a recent point of contact before death. While mental illness is well recognised, the broader social and contextual factors influencing suicide risk remain under-reported in primary care and epidemiological research Aim To describe the demographic, clinical, and psychosocial characteristics of individuals who died by suicide, integrating coronial quantitative data with qualitative narrative accounts to identify implications for primary/ secondary care and public health. Design and setting Explanatory sequential mixed‑methods study of 157 consecutive deaths by suicide recorded by coroners (2018-19) across five English local authorities. Method Demographic, clinical, and social data were extracted from coroners' records and summarised descriptively. Narrative case summaries were coded and analysed thematically to identify contextual, relational, and service factors preceding death. Results Of 157 individuals: 79% were male; 65% lived in the most deprived IMD quintile; 85% had a diagnosed mental health condition; 62% had a long‑term physical illness; 41% had a previous suicide attempt. About half consulted a GP in the preceding three months; mental health featured in about half of those consultations. Common stressors were relationship breakdown (37.2%), housing instability (22.1%), and work pressures (18.2%). Seven interlinked themes were identified: Mental health; Alcohol/Substance use, Physical health; Social connectedness; Life course trauma, Socioeconomic and Structural Vulnerability; Healthcare access. Service transitions were key vulnerability points Conclusion Coroners' records offer important insights into the complex circumstances preceding suicide and highlight opportunities for GPs to recognise intersectional complexity and support integrated, cross-sector suicide prevention approaches.

General Practice↗
PubMedDate not supplied

Information and communication systems for the assistance of carers based on ACTION.

Recent advances in telecommunication technologies allow the design of information and communication systems for people who are caring for others in the home as family members or as professionals in the health or community centres. The present paper analyses and classifies the information flow and maps it to an information life cycle, which governs the design of the deployed hardware, software and the data-structure. This is based on the initial findings of ACTION (assisting carers using telematics interventions to meet older persons' needs) a European Union funded project. The proposed information architecture discusses different designs such as centralized or decentralized Web and Client server solutions. A user interface is developed reflecting the special requirements of the targeted user group, which influences the functionality and design of the software, data architecture and the integrated communication system using video-conferencing. ACTION has engineered a system using plain Web technology based on HTML, extended with JavaScript and ActiveX and a software switch enabling the integration of different types of videoconferencing and other applications providing manufacturer independence.

Adult↗
PubMed2003

Integrating mental health care into residential homes for the elderly: an analysis of six Dutch programs for older people with severe and persistent mental illness.

Integrating mental health care into residential homes for the elderly is a potentially effective model to address the complex care needs of older chronically mentally ill people. Because no research was available on the implementation of such integrated care in practice, six programs already operating in the Netherlands were analyzed. At the administrative level, three types of cooperative arrangements existed: a psychiatric hospital renting a unit in a residential home for the elderly, a psychiatric hospital stationing mental health professionals in a residential home on a permanent basis, and a residential home employing its own psychiatrically trained staff. At the operational level, contrasting views emerged on the relation-ship between physical and mental health care; these were delivered separately or in integrated form. In either case, the employees trained as elder care workers or as psychiatric nurses had difficulties understanding each other because they held different ideas about good-quality care. These care visions can be characterized as the care-giving approach (care workers) versus the problem-oriented and the rehabilitation approaches (nurses). At the housing level, two models existed: mentally ill patients having apartments in a separate unit (concentrated housing) or located throughout the facility (dispersed housing). The most promising model appears to be the one in which a psychiatric hospital assigns mental health professionals to work in a residential home, where they remain administratively and operationally distinct from the standard residential services. Whether or not the psychiatric residents should be housed in separate units could not be decided based on this study.

Activities of Daily Living↗
PubMed2001

Just how integrated are integrated delivery systems? Results from a national survey.

This article examines three emergent processes in physician-hospital integrated delivery systems (IDSs). We find these processes are underdeveloped based on data gathered from a national sample of hospitals drawn from nine health care systems. These processes are also loosely coupled with the structures used to integrate physicians and hospitals, as well as with the environmental context in which they occur. Such loose coupling entails both advantages and disadvantages for IDSs.

Analysis of Variance↗
PubMed1991

The benefits of the application of geographical information systems in public and environmental health.

One of the most important issues in public and environmental health today concerns the type of instruments that can be used to devise quick, reliable and scientifically valid methods of rapid assessment which, in turn, can be utilized in health research and in the planning, monitoring and evaluation of health programmes. As the applications of geographical information systems (GIS) relate to the collection, storage, integration, management, retrieval, analysis and display of spatial data, it is not surprising that the potential usefulness of this new technology in the fields of health research and policy is beginning to be realized. This article seeks to demonstrate the opportunities which the use of geographical information systems can offer to research and policy on health issues. The article first describes the principles and objectives of GIS before going on to discuss hardware and software developments as well as the variety of application fields, organizations and users. Some examples of current applications are provided to illustrate the type of work being undertaken. The final sections address issues specifically related to the application of GIS in health research and policies in the European context.

Computers↗
PubMed2004

[Indicators of quality for medical records and ambulatory care in Maringá (state of Paraná, Brazil), 1991: an exercise in evaluation].

This study sought to establish health-care quality indicators based on data from routine clinical records produced by the Municipal Health Department in Maringá, Paraná State. Records for 7813 patients seen in the month of October 1991 at three Integrated Health Centers (IHC) were assessed to determine whether the recorded information allowed for the formulation of quality indicators. Indicators of data quality, demand, coverage, resolubility, and geographic distribution of the clientele by IHC were formulated. Some 49.7% of records had no diagnostic hypothesis, and 14.8% of recorded diagnoses were illegible, 78% of visits were by residents of the IHC's cachement areas; there was a low estimated coverage of pre-natal care of 37%; an estimated 70% of children under one year of age residing in the area were seen during the month; patients seen in October 1991 had a mean of 3 physician visits per person during the preceding year and 4.3% of records specified a referral to another service. Patient records in the centers studied are precarious as information services for either routine internal use or external evaluation. In spite of these deficiencies, it was possible to extract some indicators of quality; however, significant improvements in recording are needed to support more in-depth evaluation.

English Abstract↗
PubMed2005

Integrating service learning into a curriculum to reduce health risks at alternative high schools.

Service learning has been identified as a promising approach to reduce sexual risk behavior, among other outcomes. This study used qualitative data analysis to offer suggestions for optimally integrating service learning into a program to reduce sexual risks among alternative school students. Data were collected from student participants in the All4You! Project using classroom materials, focus groups, and individual interviews. Project educators and project staff also provided data through summary forms and field notes. Qualitative data analysis revealed 5 strategies for creating positive service experiences for alternative school students: (1) find appropriate service-learning sites, (2) create staff support, (3) maintain appropriate student participation and behavior; (4) enhance student reflection on service-learning experiences, and (5) address students' self-images.

Adolescent↗
PubMed2006

Diffusion of innovations and network segmentation: the part played by people in promoting health.

OBJECTIVE: The objective of this study was to describe how diffusion of innovations theory can integrate mass media, interpersonal communication, and social network analysis. These principles can be used to implement and tailor data-based health promotion activities. GOAL: The goal of this study was to develop a model for using and incorporating interpersonal communication into health promotion programs designed to encourage behaviors that reduce the spread of sexually transmitted diseases (STDs)/HIV. STUDY DESIGN: The authors conducted a review of selected studies that exemplify how diffusion of innovations theory has applied interpersonal communication to promote STD/HIV preventive health behaviors. RESULTS: Few studies have incorporated interpersonal communication as an intervention strategy to encourage STD/HIV preventive behavior. Interventions that have used interpersonal communication have observed successes in health promotion and increases in safer sex behaviors. CONCLUSIONS: This study shows that social network analysis can be used to design more appropriate and perhaps more effective health promotion programs.

Communication↗
PubMed1984

Redefinition of school nursing practice: integrating the developmentally disabled.

Results of three needs assessment studies which had the purpose of providing direction for school nursing practices which would address some of the unmet health needs of today's children and adolescents are reported. Results provide specific examples of how school nurses have not been meeting school health needs through an analysis of one specific need -- integrating the developmentally disabled into the regular school setting. Data were collected from parents, teachers and other supportive personnel in schools by interview and survey methods. Environmental assessments were conducted and the policies and procedures governing health-related activities required by special need students were reviewed. The data indicated that for developmentally disabled students, nurses were not performing the commonly accepted functions of nursing and were not transposing their knowledge of the components of health care ordinarily provided in health care settings to care provided in nontraditional health care settings. Examples of nursing functions and the activities needed to fulfill those functions are provided.

Adolescent↗
PubMed2002

Integration mechanisms and hospital efficiency in integrated health care delivery systems.

This study analyzes integration mechanisms that affect system performances measured by indicators of efficiency in integrated delivery systems (IDSs) in the United States. The research question is, do integration mechanisms improve IDSs' efficiency in hospital care? American Hospital Association's Annual Survey (1998) and Dorenfest's Survey on Information Systems in Integrated Healthcare Delivery Systems (1998) were used to conduct the study, using IDS as the unit of analysis. A covariance structure equation model of the effects of system integration mechanisms on IDS performance was formulated and validated by an empirical examination of IDSs. The study sample includes 973 hospital-based integrated health care delivery systems operating in the United States, carried in the list of Dorenfests Survey on Information Systems in Integrated Health care Delivery Systems. The measurement indicators of system integration mechanisms are categorized into six related domains: informatic integration, case management, hybrid physician-hospital integration, forward integration, backward integration, and high tech medical services. The multivariate analysis reveals that integration mechanisms in system operation are positively correlated and positively affect IDSs' efficiency. The six domains of integration mechanisms account for 58.9% of the total variance in hospital performance. The service differentiation strategy such as having more high tech medical services have much stronger influences on efficiency than other integration mechanisms do. The beneficial effects of integration mechanisms have been realized in IDS performance. High efficiency in hospital care can be achieved by employing proper integration strategies in operations.

Cross-Sectional Studies↗
PubMed2000

Kaiser Permanente: integrating around a care delivery model.

The risk-adjusted payment model mandated for Medicare + Choice organizations by the Balanced Budget Act of 1997 has significant implications for health care organizations that offer the Medicare + Choice program. Chronic medical conditions in the ambulatory care setting will become the focus of data capture, requiring significant retooling of ambulatory care operations. Health care organizations in California currently do not have the capital available to invest in the information management tools that will be required. Private practitioners continue not to have the technology and expertise to capture the data needed to run the model. Nevertheless, the risk-adjusted payment model presents the potential to better integrate care delivery around the continuum of health care needs of the population.

Aged↗
PubMed1995

The nursing minimum data set, standardized language, and health care quality.

Providers and consumers of health care have been attempting to define quality for the past several decades. The article describes one of nursing's contributions to the multidisciplinary health care quality revolution: its ability to provide a more complete and holistic picture of the consumer (patients/clients). Nursing's focus on responses to health care problems, not just illness events in isolation, provides insight into causes and effective management strategies for health problems. The Nursing Minimum Data Set (NMDS) documents patient/client responses, interventions, patient-sensitive outcomes, and resource consumption. By implementing the NMDS, nursing collaborates with other health care professionals to identify the needs of patient populations as well as the needs of individual patients. The article examines the relationship of the NMDS to other health care databases used in quality measurement, describes the integral role of standardized language in implementing the NMDS, provides examples of NMDS data analyses to address specific aspects of quality measurement, and outlines a methodology for using nonstandardized data.

Humans↗
PubMed2001

National Electronic Disease Surveillance System (NEDSS): a standards-based approach to connect public health and clinical medicine.

The National Electronic Disease Surveillance System is a broad initiative focused on the use of data and information systems standards to advance the development of efficient, integrated, and interoperable surveillance systems at the state and local levels facilitating sharing of appropriate data across jurisdictions. This initiative is designed to facilitate the electronic transfer of information needed for public health from clinical information systems in the health care industry, to reduce provider burden in the provision of information, and to enhance both the timeliness and quality of information provided.

Centers for Disease Control and Prevention, U.S.↗