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PubMed1998

An interactive perspective of health education for the tropical disease control: the schistosomiasis case.

Some municipalities in Brazil have been requesting orientation for the implementation of health education programs related to the control of schistosomiasis. This demand was based on experiences in the development of health education researches, strategies and materials for school-age children, involving the communities and secretaries of health and education. Motivated by this request and the recently implemented plan of health services (Unified Health System-Sistema Unico de Saúde-SUS) that gives autonomy to the municipalities to utilize health resources and services in Brazil, this paper presents an interactive perspective of planning health education research and programs. The purpose of this perspective is to stimulate a reflection on the needs and actions of institutions and people involved in health education research and/or programs to obtain sustainability, commitment and effectiveness--not only in the control of schistosomiasis, but also in the improvement of environmental conditions, quality of life and personal health. This perspective comprises interaction among three levels related to health education programs: the decision level, the executive level and the beneficiary level. The needs and lines of action at each of these levels are discussed, as well as the ways in which they can interact with each other. This proposal may lead to useful interactive ways of planing, organizing, executing and evaluating health education research and/or program, not only towards the prevention and control of the disease at stake, but also to promote health in general.

Brazil↗
PubMed1998

Community-based rehabilitation and stigma management by physically disabled people in Ghana.

Community-Based Rehabilitation (CBR) has been recommended by the World Health Organization as an antidote to the poor coverage of rehabilitation facilities in the developing countries. This attempt is to make it possible for disabled people to receive the help they need to be able to go about their daily activities aided by trained personnel from their own communities. Research has however indicated that many disabled people do not patronize rehabilitation programmes. Many who give it a try leave dissatisfied. Most of the disabled people will rather migrate to the cities to beg. Many reasons, including economic and location of rehabilitation centres in the cities, have been assigned for this trend of affairs. This paper however sees the problem as attempts by disabled people and their families to manage 'felt' and 'enacted' stigma. The paper seeks to question the importance of Community-Based Rehabilitation, since experienced and perceived stigma seem to be more pronounced in the rural areas, and begging is often seen as the fastest way to gain some independence, reduce stigma and avoid stigmatized environments.

Adolescent↗
PubMed2004

Is evidence-based implementation of evidence-based care possible?

Traditional approaches to disseminating research findings have failed to achieve optimal healthcare. In a systematic review of 235 studies of guideline dissemination and implementation strategies, we observed the following: there was a median 10% improvement across studies, suggesting that it is possible to change healthcare provider behaviour and improve quality of care; most dissemination and implementation strategies resulted in small to moderate improvements in care; multifaceted interventions did not appear more effective than single interventions. The interpretation of our systematic review is hindered by the lack of a robust theoretical base for understanding healthcare provider and organisational behaviour. Future research is required to develop a better theoretical base and to evaluate further guideline dissemination and implementation strategies.

Australia↗
PubMed1999

Critical incident stress management and the assaulted staff action program.

Critical Incident Stress Management (CISM; Everly & Mitchell, 1999) is a clinical and administrative approach to address the psychological sequelae in the aftermath of critical incidents. CISM is a comprehensive, multicomponent crisis intervention procedure that spans pre-incident preparedness to acute crisis to post-crisis follow up. The Assaulted Staff Action Program (Flannery, 1998) is a voluntary, system-wide, peer-help, CISM crisis intervention program for employee victims of patient assault. ASAP's crisis intervention procedures and empirical results are used to illustrate the potential power and effectiveness of CISM approaches. The implications are discussed.

Crisis Intervention↗
PubMed2001

Principles for shaping working conditions according to ILO conventions and EC directives.

The strategy for the improvement of occupational safety and health is presented. The role of the state and the workers in shaping working conditions has changed over the years, and this process is traced through ILO and EC documents. There must be a coherent up-to-date national policy in this field. Safety and the protection of the workers' health is perceived by the Community legislation not only in the terms of the worker's individual interest, but also from a social viewpoint, consisted in striving for general improvement of the work environment. The Community regulations aspire to satisfy the public interest, and directives set the maximum level of protection but also serve as minimum standards not infringing the more favourable national regulations. They define requirements that should already be met at the planning and designing stages.

Certification↗
PubMedDate not supplied

A better balance.

Explore the source record for details and available documents.

Health Plan Implementation↗
PubMed2004

Treating sudden cardiac arrest in a school setting.

Sudden cardiac arrest occurs when the heart's electrical system fires very rapidly and in an uncoordinated manner, rendering the heart incapable of pumping blood through the circulatory system. The heart begins to tremble uncontrollably, like a quivering bowl of jelly. The victim becomes unconscious, stops breathing, and typically has no pulse or signs of circulation. Unless this condition is reversed, death follows in a matter of minutes. Defibrillation ("shocking a patient") is the only effective means of re-setting the heart's normal electrical impulses.

Defibrillators↗
PubMed2004

[Public health, prevention and federalism: insights from the implementation of the federal law on health insurance].

OBJECTIVES: In 1996, the new Swiss law on health care insurance (KVG) introduced the coverage of certain preventive measures. This provided an opportunity to include research-based public health issues in federal health policy. The present article examines the problems with which the realization of those goals in a Federalist health care system with strong cantonal autonomy as it is found in Switzerland was confronted. METHOD: Comparative qualitative case studies design (vaccination of school age children and screening-mammography). RESULTS: Switzerland's federalist health care system strongly hinders the realisation of the Confederation's public health goals. Prevention falls into the cantons' autonomy and the federal KVG (Krankenversicherungsgesetz; Health insurance law) only regulates the coverage of the services provided, but does not contain any instruments to assure implementation in consistency with the policy goals. Under those circumstances, conflicts of interest between the implementing actors, varying cantonal preferences, and scarce resources block the implementation of public health goals. CONCLUSIONS: The results imply stronger leadership of the Confederation in prevention policy and an improved consideration of implementation aspects in approving new measures to obligatory insurance coverage.

Adult↗
PubMed1996

The fall and rise of cost sharing in Kenya: the impact of phased implementation.

The combined effects of increasing demand for health services and declining real public resources have recently led many governments in the developing world to explore various health financing alternatives. Faced with a significant decline during the 1980s in its real per capita expenditures, the Kenya Ministry of Health (MOH) introduced a new cost sharing programme in December 1989. The programme was part of a comprehensive health financing strategy which also included social insurance, efficiency measures, and private sector development. Early implementation problems led to the suspension in September 1990 of the outpatient registration fee, the major revenue source at the time. In 1991, the Ministry initiated a programme of management improvement and gradual re-introduction of an outpatient fee, but this time as a treatment fee. The new programme was carried out in phases, beginning at the national and provincial levels and proceeding to the local level. The impact of these changes was assessed with national revenue collection reports, quality of care surveys in 6 purposively selected indicator districts, and time series analysis of monthly utilization in these same districts. In contrast to the significant fall in revenue experienced over the period of the initial programme, the later management improvements and fee adjustments resulted in steady increases in revenue. As a percentage of total non-staff expenditures, fiscal year 1993-1994 revenue is estimated to have been 37% at provincial general hospitals, 20% at smaller hospitals, and 21% at health centres. Roughly one third of total revenue is derived from national insurance claims. Quality of care measures, though in some respects improved with cost sharing, were in general somewhat mixed and inconsistent. The 1989 outpatient registration fee led to an average reduction in utilization of 27% at provincial hospitals, 45% at district hospitals, and 33% at health centres. In contrast, phased introduction of the outpatient treatment fee beginning in 1992, combined with somewhat broader exemptions, was associated with much smaller decreases in outpatient utilization. It is suggested that implementing user fees in phases by level of health facility is important to gain patient acceptance, to develop the requisite management systems, and to orient ministry staff to the new systems.

Cost Sharing↗