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At least 991 records · Page 55Linked to original sources
PubMed1994

Comparison of suicide rates among industrial groups.

Suicide rates among industrial groups were examined systematically using death certificate data from 1984 through 1989 in Alabama. Poisson log-linear modelling was used to estimate the rate ratios (RR) of industries compared to a referent and to adjust for confounding. Marked differences in suicide rates were found among industrial groups. The rates ranged from 5.31 to 62.36 per 100,000 population per year. People employed in public administration had the lowest rate. In comparison with public administration, the construction industry had the highest risk (adjusted RR = 11.8, 95% confidence interval (CI): 9.6-14.6). Employees of the mining industry experienced a similarly high risk (adjusted RR = 11.5, 95% CI: 8.2-16.3). Persons employed in farming, agriculture services, forestry, and fisheries, manufacturing, and transportation, communications, and other public utilities industries had intermediate risks. Smaller elevations of suicide rates compared to public administration were observed in the wholesale trade, retail trade, finance, insurance, and real estate, and services industries. The differences of suicide rates may be related to sociodemographic differences, self-selection for occupation, ease of access to lethal agents, or job stress.

Alabama↗
PubMed1990

Retrenchment or realignment? U.S. mental health policy and DRGs.

The introduction of DRGs for financing health care is dramatically changing the system of delivery and provision in the U.S. To understand the consequences, it is important to focus not only on cost-containment issues but also on new institutional mechanisms fashioned to reshape health care delivery and provision. A realignment among the major actors is occurring, with the state adopting a central role in redefining its own function in the health care system, constructing a new framework and agenda for change, and enlisting the participation of other social actors in implementing change. The specific features of this realignment are analyzed in the context of mental health DRGs. This article concludes that, based on the consequences of DRGs to date, we ought to look beyond present indicators of retrenchment in the health care system to how the unique features of the American welfare state are continuing to evolve.

Community Mental Health Centers↗
PubMed2003

Dietary determinants of dental caries and dietary recommendations for preschool children.

OBJECTIVES: The purpose of this review, commissioned by the Administration for Children and Families, the Health Resources and Services Administration, the Health Care Financing Administration, and the Department of Agriculture's Food and Nutrition Service, was to update the evidence of the dietary factors that affect dental caries, and subsequently formulate dietary recommendations for preschool children based on principles of cariology. METHODS: Literature on the dental caries process, dietary factors affecting dental caries initiation and progression, nutrition education and counseling were reviewed and synthesized. Dietary guidelines for children at various ages were then constructed based on the review. RESULTS: Dental caries in preschool children is due to a combination of factors, including colonization of teeth with cariogenic bacteria, type of foods and frequency of exposure of these foods to the cariogenic bacteria, and susceptible teeth. Caries risk is greatest if sugars are consumed at high frequency and are in a form that is retained in the mouth for long periods. Sucrose is the most cariogenic sugar because it can form glucan that enables firm bacterial adhesion to teeth and limits diffusion of acid and buffers in the plaque. There is emerging interest in the effects of tooth development and its role in the future dental caries risk of the child. CONCLUSIONS: Nutrition education and counseling for the purposes of reducing caries in children is aimed at teaching parents the importance of reducing high frequency exposures to obvious and hidden sugars. Guidelines include: avoiding frequent consumption of juice or other sugar containing drinks in bottle or sippy cup; discouraging the behavior of a child sleeping with a bottle; promoting non-cariogenic foods for snacks; fostering eating patterns consistent with Food Guide Pyramid; limiting cariogenic foods to mealtimes; rapidly clearing cariogenic foods from the child's oral cavity either by tooth brushing or by consumption of protective foods; and restricting sugar containing snacks that are slowly eaten (e.g., candy, cough drops, lollipops, suckers). Along with nutritional factors, a comprehensive approach to preventing dental caries in preschool children must include improved general dietary habits, good oral hygiene, appropriate use of fluorides, and access to preventive and restorative dental care.

Child Nutrition Sciences↗
PubMed1977

The nursing home: occupational therapy services in an institution.

The nursing home as an institution was described by presenting information from the literature and from the author's personal experience. Sociological definitions of the term institution were applied to the nursing home, and the negative effects of the institutionalization process on older persons were discussed. The plight of the residents was further exemplified in a discussion of the setting, staffing, financing, and services of nursing homes. Finally, the need for occupational therapy services was indicated, and therapists were urged to assume available jobs as therapists, consultants, or administrators in nursing homes as an initial step toward meeting this need.

Aged↗
PubMed2000

Dietary determinants of dental caries and dietary recommendations for preschool children.

OBJECTIVES: The purpose of this review, commissioned by the Administration for Children and Families, the Health Resources and Services Administration, the Health Care Financing Administration, and the Department of Agriculture's Food and Nutrition Service, was to update the evidence of the dietary factors that affect dental caries, and subsequently formulate dietary recommendations for preschool children based on principles of cariology. METHODS: Literature on the dental caries process, dietary factors affecting dental caries initiation and progression, and nutrition education and counseling were reviewed and synthesized. Dietary guidelines for children at various ages were then constructed based on the review. RESULTS: Dental caries in preschool children is due to a combination of factors, including colonization of teeth with cariogenic bacteria, type of foods and frequency of exposure of these foods to the cariogenic bacteria, and susceptible teeth. Caries risk is greatest if sugars are consumed at high frequency and are in a form that is retained in the mouth for long periods. Sucrose is the most cariogenic sugar because it can form glucan that enables firm bacterial adhesion to teeth and limits diffusion of acid and buffers in the plaque. There is emerging interest in the effects of tooth development and its role in the future dental caries risk of the child. CONCLUSIONS: Nutrition education and counseling for the purposes of reducing caries in children is aimed at teaching parents the importance of reducing high frequency exposures to obvious and hidden sugars. Guidelines include: avoiding frequent consumption of juice or other sugar-containing drinks in the bottle or sippy cup, discouraging the behavior of a child sleeping with a bottle, promoting noncariogenic foods for snacks, fostering eating patterns consistent with the Food Guide Pyramid, limiting cariogenic foods to mealtimes, rapidly clearing cariogenic foods from the child's oral cavity either by toothbrushing or by consumption of protective foods, and restricting sugar-containing snacks that are slowly eaten (e.g., candy, cough drops, lollipops, suckers). Along with nutritional factors, a comprehensive approach to preventing dental caries in preschool children must include improved general dietary habits, good oral hygiene, appropriate use of fluorides, and access to preventive and restorative dental care.

Bacteria↗
PubMedDate not supplied

Entrepreneurial propensity in health care: models and propositions for empirical research.

We maintain that entrepreneurial propensity is a focal construct in entrepreneurial research. We synthesize the literature to develop models depicting the antecedents and consequents of entrepreneurial propensity in a network of other constructs and variables of interest in the health care industry. We advance propositions for empirical investigation and validation of competing research models associated with entrepreneurial propensity. We conclude with a discussion of directions of future research.

Capital Financing↗
PubMed2004

A national evaluation of school breakfast clubs: evidence from a cluster randomized controlled trial and an observational analysis.

STUDY OBJECTIVE: To measure the health, educational and social impacts of breakfast club provision in schools serving deprived areas across England. DESIGN: A cluster randomized controlled trial and an observational analysis. SETTING: England, the UK. INTERVENTION: funding to establish a school-based breakfast club vs. control (no funding). MAIN RESULTS: Intention to treat analysis showed improved concentration (Trail Making Test Part A) amongst the intervention group at 3 months. Fewer pupils within the intervention group reported having skipped classes within the last month and fewer pupils within the intervention group reported having skipped 1 or more days of school within the last month at 1 year. Observational analysis at 1 year showed a higher proportion of primary-aged breakfast club attendees reported eating fruit for breakfast in comparison to non-attendees. A higher proportion of breakfast club attendees had borderline or abnormal conduct and total difficulties scores (primary-aged pupils) and prosocial score (secondary-aged pupils). CONCLUSIONS: Analyses revealed a mixed picture of benefit and apparent disbenefit. This study illustrated the challenges of evaluating a complex intervention in which the evaluators had less control than is usual in randomized trials over recruitment, eligibility checking and implementation. If the impact of new policy initiatives is to be assessed using the most robust forms of evaluation, social policy needs to be organized so that evaluations can be constructed as experiments. This is likely to prove most difficult where the perceived value of implementing an intervention rapidly is high.

Absenteeism↗
PubMed2004

10 years beyond the Health Security Act failure: subsequent developments and persistent problems.

Ten years after the failure of President Clinton's Health Security Act (HSA), the United States continues to face multiple stresses in health care, including large numbers of uninsured individuals, increasing costs, questions about quality, and dissatisfaction with managed care. Using the framework of the HSA-particularly universal coverage, spending and managed competition, insurance for low-income persons, and patients' rights-the post-HSA evolution and current status of the US health care system is traced and lessons to guide future actions are outlined. Neither incremental legislation nor private sector changes in health care organization and financing during the past decade have ameliorated the problems addressed by the HSA, and new troubles have emerged. These problems affect every group in the country and continue to deteriorate health care, yet there has been no political support for large-scale reform. The core components of a vision for future action-universal coverage, quality improvement, cost containment, and subsidies for the economically vulnerable-are essential. There is a pressing need to construct a clear vision that would tie together incremental steps into a rational approach to comprehensive reform and to actually move toward the realization of that vision.

Health Care Reform↗
PubMed1984

Tracing foundations' pattern of giving for health care construction.

The philanthropic contributions of foundations have long been recognized as an important source of low-cost capital for hospitals. But to what extent do foundations contribute to hospitals' capital needs for construction and equipment? The authors discuss the findings of an HHS study that queried foundations to discover the extent to which they are providing such funds, what purposes the grants serve, and the criteria that institutions must meet.

Capital Expenditures↗
PubMed1994

Research in general practice: international problems--international solutions.

Although research in primary care has a higher profile than ever before, its impact on professional practice and on government planning often seems less than it should be. In the first part of the paper, the different research agendas of governments, health departments, professional associations and colleges, and of universities are explored. In the second part of the paper a research project which attempts to define and measure quality of care given to patients with a 'marker' health problem (arthritic pain) is developed from the stage of asking questions to interpreting findings. In the third part of the paper, a number of conflicts between research agendas, styles of research, and needs and expectations of different 'purchasers' and 'providers' are explored using the themes and the details of the earlier parts of the paper as illustration, and a model is constructed to help explain why research, practice and policy making often live less easily together than is good for each. The importance of creating a supportive climate for research, of providing adequate infrastructure, and of making appropriate training available is emphasized.

Administrative Personnel↗
PubMed1992

Clandestine migrant workers in Japan.

The author assesses the problem of illegal labor migration to Japan. "Labor policies, regulations, types of immigration violations, and the role of the recruitment industry are described. Most of the estimated 200,000 illegal workers are employed in small and medium sized enterprises, especially construction and manufacturing, which pay them wages well below the normal rate. A key issue is the infringement of human rights of these illegal workers, who lack the protection of labor laws and the social security system."

Asia↗
PubMed2003

Mental health. Clean sweep.

A private finance initiative-built psychiatric unit has replaced a crumbling hospital block in Essex. Chapters House includes single rooms for patients, with two-way doors for safety. It was designed by a specialist architect to create a more comfortable and pleasant environment.

Community Mental Health Services↗
PubMed2006

Development of a rating form to evaluate grant applications to the Hogg Foundation for Mental Health.

Reliance on subjective grant proposal review methods leads private philanthropies to underfund mental health programs, even when foundations have mental health focuses. This article describes a private mental health foundation's efforts to increase the objectivity of its proposal review process by developing a reliable, valid proposal rating form. Staff from the Hogg Foundation for Mental Health, an administrative unit of The University of Texas at Austin, developed the items for the grant proposal rating form (GPRF). Four interns, who had educational backgrounds equivalent to the foundation's grant-making staff, used the GPRF to independently rate 20 grant proposals previously reviewed by the foundation. Internal consistency and interrater reliability were very good. It had good face and construct validity and moderate criterion validity. The GPRF's psychometric properties are sufficient to recommend its use in the foundation's review process and suggest private philanthropies' grant proposal review processes can be made more objective and reliable without compromising validity.

Evaluation Studies as Topic↗
PubMed1997

Avoiding double-counting in pharmacoeconomic studies.

In cost-utility analyses of pharmaceutical treatments, the costs are measured in monetary terms and the effects are measured as quality-adjusted life years (QALYs) gained. QALYs are constructed by assigning life years a quality weight between 0 (dead) and 1 (full health). A potential problem in cost-utility analysis is that some consequences, in principle, can be included both in the costs and in the quality adjustment, which can lead to double-counting. This article outlines the double-counting problem in cost-utility analysis. It shows that the potential for double-counting depends on how healthcare and income losses resulting from disease are financed, and on how the questions that assess the quality weights are phrased. Double-counting can be avoided by telling respondents to assume that healthcare costs and income losses are fully reimbursed when quality weights are assessed. The quality weights would then capture the change in health and leisure, and the other consequences could be included in the cost estimation.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Financial requirements for health services demands for diabetes and hypertension in Mexico: 2001-2003].

This paper presents the results of a prospective study aimed at identifying financial requirements to provide and finance healthcare services during the period 2001-2003, for high blood pressure and diabetes, the two main chronic diseases demanding healthcare services in Mexico. The study population was drawn from Mexico's three main healthcare institutions: The Ministry of Health (SSA); the Mexican Institute of Social Security (IMSS); and the Institute for Social Security and Services for State Workers (ISSSTE). The costing method was based on instrumentation and consensus techniques per average case management. Six Box-Jenkins probabilistic models were constructed to estimate the epidemiologic change for the period 2001-2003. Study findings suggest that if risk factors and healthcare provision models remain unchanged, the financial consequences would have a greater impact on the Ministry of Health, followed by IMSS and ISSSTE. Financial requirements for both diseases will account for nearly 2% of the total budget allocated to the uninsured, and 3.5% for the insured population. Indirect costs showed a similar trend in the three institutions, representing nearly 23% above total direct costs.

Ambulatory Care↗
PubMed2004

Activities of daily living in patients with dementia: clinical relevance, methods of assessment and effects of treatment.

Disability, characterised by the loss of ability to perform activities of daily living (ADL), is a defining feature of dementia that results in growing caregiver burden and the eventual need for alternative care or nursing home placement. Functional decline in patients with dementia can also result from causes other than dementia, such as comorbid medical and psychiatric illnesses and sensory impairment. ADL consists of instrumental ADL (IADL) [complex higher order skills, such as managing finances] and basic ADL (BADL) [self-maintenance skills, such as bathing]. Assessment of IADL and BADL is recommended to establish a diagnosis of dementia. Functional assessment also helps the healthcare provider to offer appropriate counselling regarding safety concerns and need for custodial care. Functional capacity measures have been used increasingly in pharmacological trials of patients with Alzheimer's disease (AD) and related dementias, although at the present time these measures are generally not primary outcome measures. Functional impairment is not a uniform construct; rather, it is multifaceted and can be measured with various clinical instruments. Many scales have been validated for use in patients with AD for characterising functional impairment and evaluating the efficacy of treatment. Research to date indicates that cholinesterase inhibitors have the potential for modest but meaningful beneficial effects on ADL in patients with mild-to-moderate AD. Memantine also has promising beneficial effects on functional abilities in persons with moderate-to-severe AD. Assessment of ADL as a primary efficacy measure using a validated scale that is non-gender biased and cross-nationally relevant is recommended in new treatment trials of patients with AD and related dementias.

Activities of Daily Living↗
PubMed1954

Experience with excreta-disposal programmes in rural areas of Brazil.

As part of a wide public-health programme for rural areas of Brazil, the Serviço Especial de Saúde Pública (SESP) has, since 1944, placed considerable emphasis on the problem of excreta disposal. Except in a few cities where conditions justified the construction of sewer systems, projects were started for the erection of pit privies, some 18,000 having been built up to 1952. The projects are conducted by specially trained personnel ("guardas"), who first carry out a sanitary survey of the area concerned, at the same time explaining the benefits of sanitation to the people. A general plan having been drawn up, construction is begun under the supervision of the guardas, who strive to enlist the co-operation of the house-owners as far as possible.Various types of privy have been tried, local building materials being used wherever possible. In almost all cases, however, concrete slabs have been used, covering a hole which may vary in width, but which is generally 2 m deep. Where possible, the SESP has sought the financial collaboration of the local authorities, but the earlier projects were entirely financed by the SESP.Surveys carried out before the projects were started and 3-4 years later show that in certain areas the fall in the percentage of the examined population found positive for Ancylostoma was from 37.6 to 25.4 and all severe infestations (over 500 eggs per g of faeces) had disappeared. This result, though appreciable, would probably have been greater had all the inhabitants used the privies and had they been better maintained.

Brazil↗