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PubMed2004

Environmental risks in childhood.

Differences between children and adults with respect to exposure rates, absorption of chemicals, metabolism, and organ development make children uniquely vulnerable to environmental hazards. Moreover, biology does not exist outside of the social life of the child. At least two important implications flow from these findings. First, pediatricians must pay closer attention to the conditions of childhood and the specific details of a child's life in attempting a complete understanding of childhood diseases, particularly their sources in environmental and social conditions. At a minimum, pediatricians must inquire more carefully about environmental exposures and children's complaints in order to make accurate diagnoses. Perhaps equally critical, pediatricians must engage in more aggressive prevention efforts. While they often try to prevent exposure by educating parents about keeping household chemicals away from young children, they might likewise consider that the information they possess about children's special vulnerability to environmental risks could usefully inform political and social decisions to protect children from those risks. This includes, for example, supporting air pollution standards that are protective of children and advocating for stricter controls for certain chemicals to reduce health risks for this vulnerable group.

Child↗
PubMed1999

The Atascadero State Hospital experience. Engaging patients in violence prevention.

When it comes to caring for the forensic psychiatric inpatient, there is no "how to" book. In the forensic hospital environment, the commingling of severe and persistent mental illness with criminality poses vexing clinical challenges and complex moral dilemmas not faced in either general psychiatric or correctional environments. While providing evaluation and treatment in our maximum security forensic environment, we continually strive to create and maintain a therapeutic milieu as we fulfill our social mandate to protect the public from the dangerous "criminally insane." Few studies guide us. We do know that within the forensic population there is a spectrum of psychopathology to manage, some of which responds to traditional psychotherapeutic techniques and some of which does not. For example, patients with psychopathic traits may not respond well to traditional treatment methods (Rice, 1997). As forensic psychiatric staff, we sometimes feel as if we are making it up as we go, adapting and blending psychiatric theory with knowledge from penology and criminal justice science to provide a safe environment conducive to growth for patients, the majority of whom may be considered "violence-prone" persons (Toch, 1969). Change is a characteristic of public-sector settings (Smoyak, 1991). Forensic hospitals must continually strive to monitor, refine, and improve their organizational systems as they respond and adapt to constant change. Despite the inherent challenges posed when collaborating with forensic patients, the VAC has achieved some notable successes. Staff and patients have been encouraged to work together to create and maintain a milieu where violence is neither assumed nor condoned. An active collaboration and partnership with our forensic patients has been one component of the hospital's successful violence reduction program. We trust that ASH's successful effort to collaborate with patients on the issue of violence reduction may be of use to other forensic hospitals faced with similar challenges.

California↗
PubMed1995

The health impact of economic sanctions.

Embargoes and sanctions are tools of foreign policy. They can induce a decline in economic activity in addition to reducing imports and untoward health effects can supervene, especially among older persons and those with chronic illnesses. Often, violations of the rights of life, health, social services, and protection of human dignity occur among innocent civilians in embargoed nations. This paper examines the effects of embargoes and sanctions against several nations, and calls for studies to determine ways in which economic warfare might be guided by the rule of humanitarian international law, to reduce the effects on civilians. It suggests that the ability to trade in exempted goods and services should be improved, perhaps by establishing uniform criteria and definitions for exemptions, operational criteria under which sanctions committees might function, and methods for monitoring the impact of sanctions on civilian populations in targeted states, particularly with regard to water purity, food availability, and infectious-disease control. Prospective studies are advocated, to generate the data needed to provide better information and monitoring capacity than presently exists.

Delivery of Health Care↗
PubMed1983

Social issues in perinatal screening for sickle cell anemia.

We are living in a time of fascinating scientific achievement in the biomedical field of genetics. The revolutionary methodologies of this biomedical technology produce new ideas and new options for the quality of our life. While this paper is focused on prenatal testing for sickle cell anemia, it simultaneously illustrates the general complexity of public health issues and points out that some emerging scientific values may be more harmful than beneficial to the public because they are inappropriate priorities and do not deal with problems that truly affect the public's health. Special attention is given to issues of ethical significance demonstrating that scientific objectives have been emphasized and that beneficence and respect for persons are principles that have been neglected in Prenatal Sickle Cell interventions. Lastly, this paper advocates social policy to protect the at risk groups from what may become irresponsible public health paternalism.

Anemia, Sickle Cell↗
PubMed2003

[Epilepsy and driving in Argentina. A new proposal].

Current laws and regulations concerning epilepsy patients and driving exist in different countries all over the world. Patient's seizure-free intervals, physician's responsibilities, type of seizures and other requirements make these laws and regulations vary from country to country and even from state to state in the same country. In Argentina, in law No. 24.449, Decree Regulation No. 779/95, article 33 on Physical Aptitude, epilepsy is included, and the NE02 code "bans" anyone with epilepsy from being licensed; while NE03 "bans" anyone with an abnormal electroencephalogram. Based on laws from Argentina and foreign countries regarding driving and other issues that concern people with epilepsy, we propose that: 1) Physicians must counsel patients on their responsibilities over their disease and driving, and document on the medical record that this has been done. 2) Patients must take 1-year seizure-free period before being licensed again. 3) Patients are compelled to an annual medical update and to disclose the antiepileptic drugs (AED's) they are taking. 4) Driving restriction for patients having their AED's reduced or switched, during that period and up to six-months after finishing the process. 5) Doctors are not obliged to report to the State cases with seizures or epilepsy. 6) In paragraph "Neurological Aptitudes Criteria", about NE02 and NE03 Codes, the expression "inept" should be switched to "to be evaluated". 7) Ban a person with any history of seizure or epilepsy from being licensed to drive school buses, trucks and public transportation. These changes in our regulations will have the following advantages: 1) An increase in the number of reports to Motor Vehicle Authorities. 2) An improvement of the clinical/neurological controls. 3) They also will avoid, in great proportion, seizure-related motor vehicle crashes and property damage. 4) The up-dating of our laws/regulations/codes. 5) Not only because of medical, but also for its legal and social implications: a) protect physicians from being drawn into the legal foray, b) epileptic patients are legally protected, c) increase the security in the streets and therefore in our community.

Accidents, Traffic↗
PubMed1992

Developments and trends in Social Security, 1990-1992: overview of principal trends.

The article that follows is a reprint of Part I of a report presented by Dalmer D. Hoskins, Secretary General of the International Social Security Association (ISSA), to the organization's XXIVth General Assembly (November 1992, Acapulco). It identifies and interprets the major trends currently influencing the evolution of social security programs around the world, and analyzes these developments against the backdrop of the current economic, demographic, and social environment in which these programs operate. (Part II of the report analyzes the changes according to each major branch of social security; an annex to the report provides more detailed information and source citations in reference to these changes.) The ISSA is a nongovernmental international organization headquartered in Geneva, Switzerland. It is made up of 321 social security-related institutions, including the U.S. Social Security Administration, in 122 countries. The Association's aim is to protect, promote, and develop social security worldwide.

International Agencies↗
PubMed1989

[What protects health? On the research status and importance of personal resources in managing daily stresses and life change events].

In recent developmental and psychosomatic studies the focus shifts from pathogenic to health protective factors. Literature on coping with daily stresses, life events and biographic determinants is reviewed. Despite conceptual (negative health definitions, divergent theoretical backgrounds and values) and methodological problems (reliance on self-report and trait measurement) moderate, however consistent health protective affects of personal resources are shown. These are mainly generalized attitudes of persons toward self and their environment (e.g. optimism, internal locus of control, self-efficacy, commitment). Contrasting influential concepts (sense of coherence, hardiness) the bias toward self-reliant, internal control as health protective resource is criticized and a plea is made for conjoint consideration of health-protective influences of social relationships.

Adaptation, Psychological↗
PubMed1986

[Liability in veterinary medicine].

In order to promote the optimum exercise of the profession, the occupational group developed disciplinary standards of its own. To protect itself from socially improper procedures, from default and from its consequences, society developed standards of civil law. When a veterinarian is insufficiently equipped for adequate treatment of a patient, this patient will be referred to a veterinary surgeon who has acquired the necessary accomplishments in the section concerned; high standards of attainment will be imposed on this veterinarian. The fact that the referring veterinarian and the one to whom the patient was referred each retain their own responsibilities, is illustrated in examples. All this may result in a further improvement in quality of veterinary health care in the Netherlands.

Animals↗
PubMed1993

[Tuberculosis in cooperative workers].

Out of 67 cooperators with tuberculosis treated at the city antituberculosis dispensary the advanced disease was found in 68.5% of the cases. Of them 67.7% discharged tubercle bacilli, 38.4% had multiple caverns. Among the reasons for a severe specific process in the lungs are intensive labour, late working hours, lack of social and health protection.

Adult↗
PubMed1994

The sex ratio of suicide rates in China.

Suicide is the leading cause of non-natural deaths in China. Female suicide rates are higher than male rates, and the rural suicide rate is 2.8 times higher than the urban rate. In 16,568 cases of suicide, the male to female ratios observed were 0.92 and 0.81 in urban and rural areas, respectively. The male to female ratio of the suicide rates in China is close to that of other Asian countries (1.2-1.5), but much lower than that in 26 European countries. In about two-thirds of all suicides, family disputes and love disappointments are the precipitants. The higher rate of suicide among women probably reflects the fact that Chinese women are of low social and economic position, and have few social resources to protect them, especially in remote areas.

Cause of Death↗
PubMed1996

[Between family-oriented help and child protection--interventions within the scope of the child and youth aid law: an unsolvable dilemma?].

The new child care and protection legislation (German Social Aid) emphasises the support of the parents' responsibility for education. In addition, it includes separate provisions and opportunities for counseling and supporting young children and adolescents in crisis situations. Finally, it requires the Youth Welfare Office to inform the Guardianship Court if a legal decision is required to avert a threat of the child's welfare. In the process of making the complex precise and responsible decision on the prognosis for the child, the experts from the Youth Welfare Office mus decide weather to respond to a threat to the child with family-oriented support, of with intervention concerning parental care that will usually lead to the separation of the child from its social setting.

Adolescent↗
PubMed1997

[Are life experiences of children significant for the development of somatic disease? A literature review].

This review presents the relationship between serious life events, chronic family difficulties and illness, and focuses on how healthy children cope. Hospitalised children had experienced about twice as many serious life events as children in healthy environments. Known diseases related to stress are eczema, upper respiratory tract infections, asthma, ulcerative colitis, heart disease in adults, juvenile rheumatoid arthritis, fibromyalgia and juvenile diabetes. Research on healthy children at risk (resiliences) has revealed a number of social and interpersonal protective factors. A modified biopsychosocial model, for the purpose of understanding the health status and care of children at high risk, is presented. More research is needed to understand these multietiological diseases in order to develop strategies for the promotion of good health.

Adaptation, Psychological↗
PubMed1997

Vulnerability to victimization, concurrent problem behaviors, and peer influence as predictors of in-school weapon carrying among high school students.

Previous research has indicated the potential relevance of three constructs in the prediction of adolescent weapon carrying, (a) general delinquency, (b) self-protection, and (c) social influence. The current study tests the independent associations between in-school weapon carrying and these three constructs. The sample consisted of 504 students from seven southern California high schools. Overall, 25% of the sample carried a weapon to school in the last year. Self-defense was the most commonly reported reason for in-school weapon carrying. The results from a simultaneous logistic regression analysis indicated increased risk of in-school weapon carrying among students who are male, who are affiliated with gangs or tagging crews, who are exposed to peers who carry weapons to school, and who feel vulnerable to being victimized. Prevention programs targeted at reducing in-school weapon carrying may benefit from a comprehensive focus that includes efforts to reduce involvement in other problem behaviors, influence norms regarding weapon carrying, and reduce actual and perceived vulnerability to victimization.

Adolescent↗
PubMed1998

Nonprofit conversion: theory, evidence, and state policy options.

OBJECTIVE: To describe the contributions of nonprofit hospitals and health plans to healthcare markets and to analyze state policy options with regard to the conversion of nonprofits to for-profit status. DATA SOURCES/STUDY SETTING: Secondary national and state data from a variety of sources, 1980-present. STUDY DESIGN: Policy analysis. DATA COLLECTION/EXTRACTION METHODS: Development of a conceptual economic framework; analysis of empirical, legal, and theoretical literature; and review of statutes, rules, and court decisions. PRINCIPAL FINDINGS: Three main rationales support special status for nonprofits, especially hospitals: charity care, other community benefits, and consumer protection. The main social rationale for for-profits is their incentives for better efficiency. There are reasons to expect that nonprofit and for-profit goals differ; however, measured differences in community hospital cost, prices, and quality between nonprofit and for-profit hospitals are undetectable or inconclusive. Nonprofit hospitals do provide more uncompensated care than for-profit hospitals. Similarities between nonprofit and for-profit hospitals may exist because nonprofits may set norms that for-profits follow to some degree. States have substantial power and discretion in overseeing nonprofit conversions. Some have regularized oversight through new legislation that constrains, but does not eliminate, state officials' discretion. These statutes may be deferential to converting entities and their buyers or may be very restrictive of them. CONCLUSIONS: Overseeing the appropriate disposition of nonprofit assets in individual conversions is extremely important. States should also monitor local market conditions through community benefits assessments and other data collection, however, to accurately assess (and possibly redress) what is lost or gained from conversion. Local market conditions are likely more important in determining hospital behavior than ownership form. Potentially, a mix of for-profit and nonprofit hospitals in a given market may improve market performance due to constraints the two ownership types may exercise over one another. If nonprofits disappear, the states may need to maintain quality and access norms through regulation.

Community-Institutional Relations↗
PubMed2000

Statement 'the use of patient-related information in medical research and the health system'.

Patient-related information is regularly recorded in surgeries and hospitals. The health system produces such 'person-related health data' in astronomical numbers. Millions of data are entered into and processed by the computing systems of many different institutions. They are used for the treatment of patients and the calculation of health fund benefits and in addition, given a systematic and methodologically controlled evaluation, they can be used to detect health risks, assess more accurately the consequences of risks and diseases, compare the benefits of different therapies, or rank health care goals. Since health data are person-related their recording and use are subject to the consent of the person in question. Besides, the information which the patient provides or which is established regarding the patient, is protected by the confidentiality to which all doctors are held; if it is passed on to calculate health benefits it is protected by the confidentiality of social security data. Beyond this moral and legal protection the use of person-related health data requires explicit legal justification. In view of the multitude of uses which the current level of data processing affords, no legal regulation can determine every possible instance comprehensively and definitively in advance. Rather, a moral and legal evaluation of each instance is needed. It is not without reason that the data protection laws contain more or less comprehensive general clauses and indeterminate legal concepts. The Central Ethics Commission at the German Medical Association (Bundesärztekammer) has put out a statement on these matters. It asks the legislature to improve the protection for individuals with respect to the use of patient data for research in medicine and the health system in accordance with EU-Directive (No. 95/46/EG of 24 October 1995). Moral and legal problems occur mainly when, for objective reasons, the consent of the persons in question cannot be obtained, yet the further use of the data is important in order to improve the care of the patients. The Central Ethics Commission suggests the establishment of independent bodies along the lines of ethics commissions to undertake the necessary judgments between individual protection and the importance of the purpose for which the data are to be used. It further argues that if used in medical research or the health system the data are given the same degree of protection as they were by the doctor to whom they were first confided.

Confidentiality↗
PubMed1997

Biosocial bases of antisocial behavior: psychophysiological, neurological, and cognitive factors.

In this paper we review biosocial research and theory in the area of antisocial behavior. In particular, we focus on interactions between biological and social variables in predicting antisocial outcome. While many psychological researchers make statements concerning the potential importance of biosocial interactions, very few researchers actually test for such interactions in their data. The few studies that have reported biosocial interactions suggest that biological variables can protect against antisocial behavior in socially vulnerable individuals, and that social variables can protect against antisocial behavior in biologically vulnerable individuals. Further research is necessary to determine whether the effects of biosocial interactions on antisocial outcome are dependent upon particular biological or social factors. Preliminary evidence suggests that policy interventions that ameliorate the effects of perinatal risk factors could protect against antisocial and violent outcome.

Adolescent↗