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At least 1,009 records · Page 56Linked to original sources
PubMed2007

Baby Friendly Hospital Initiative practices and breast feeding duration in a cohort of first-time mothers in Adelaide, Australia.

OBJECTIVE: to investigate the relationship between adherence to six of the Baby Friendly Hospital Initiative (BFHI) Ten steps to successful breast feeding and the duration of breast feeding in first-time mothers. DESIGN: a prospective study to assess the duration of breast feeding up to 6 months postpartum. Survival analysis techniques (Kaplan-Meier curves and Cox proportional hazard models) were used to interpret the data. PARTICIPANTS: 317 women who had given birth to their first baby (at term) in a large teaching maternity hospital in Adelaide, South Australia, during the period March to November 2003. FINDINGS: ignoring all other factors, we found that women whose babies received a bottle feed, used a pacifier or dummy, or who used a nipple shield during their postnatal stay, were at significantly greater risk of weaning (p0.05). After adjusting for socio-demographic variables, self-efficacy, intended duration of breast feeding, and method of delivery, the results unexpectedly showed that the only significant predictor of early weaning was breast feeding on demand. However, a composite variable indicating use of one or more of nipple shields, a dummy or bottle feeds while in hospital resulted in a significantly greater risk of weaning (p=0.05). IMPLICATIONS FOR PRACTICE: socio-demographic and cultural factors may be more important determinants of the duration of breast feeding than some of the very specific hospital practices targeted in the Ten steps to successful breast feeding. From a public health perspective, we may influence the duration of breast feeding through better post-discharge support services, or through interventions that improve attitudes to breast feeding in specific socio-cultural and economic groups.

Adult↗
PubMed2002

[Application of the new coding standards for introducing diagnosis related groups (DRGs) in ophthalmology].

For all in-patients a fundamental change of hospital financing based only on diagnosis related groups (DRGs) is planned in Germany for 2004. Patients are grouped into different DRGs according to their coded diagnoses, operations and procedures. Hence, the quality of coding is essential for adequate reimbursement of cases and thus for hospital financing. The legal framework of coding is supplied by the so-called "general and special coding guidelines for coding diseases and procedures", presented jointly by the associations representing hospitals and public and private health insurance companies in early 2002. These German coding standards regulate how coding must be performed in daily practice and therefore have a major influence on the grouping of patients into DRGs. Because of their importance this paper describes the practical application of current coding standards. Specifically in Ophthalmology the problem exists that for many procedures adequate coding numbers are still missing, thus impairing further development of the DRG system.

Diagnosis-Related Groups↗
PubMed2000

In rural Ugandan communities the traditional kinship/clan system is vital to the success and sustainment of the African Programme for Onchocerciasis Control.

In rural Ugandan communities where onchocerciasis is meso- or hyper-endemic, control of the disease is now being carried out using a strategy of community-directed programmes for the annual distribution of ivermectin to all persons eligible to take the drug. For these programmes to achieve their annual target coverage of at least 90% of the population eligible to take ivermectin, and to continue to sustain themselves for 10-15 years or more, even after external donor funding ceases, it has been found essential to replace the initial community-based strategy, imposed from outside, by a community-directed strategy developed by the community members themselves. Furthermore, it is essential for success that full use be made of the traditional social system, which is very strong in all rural communities in Uganda. This system is based on patrilineal kinships and clans, governed by traditional law, and in it women pay an important role. If this system is ignored or by-passed by government health personnel or by the sponsors and promoters of the programme, the communities are likely to fail to reach their targets. When rural communities increase in size and complexity, following development and the arrival of migrant families, they become semi-urbanized. The kinship/clan system is then weakened, community-directed drug distribution is much more difficult to organize, and coverage targets are not often achieved. This effect is of minor importance in a rural disease, such as onchocerciasis, but is likely to be of greater significance in the control of diseases, such as tuberculosis and lymphatic filariasis, which thrive in urban environments.

Community Health Workers↗
PubMed1998

Collaboration between schools of nursing and local education agencies to provide health care services to pre-kindergarten through twelfth grade students: elements of cooperative agreements.

Establishing cooperative relationships between schools of nursing and local education agencies for the delivery of health care services to children from pre-school through the twelfth grade is a process all too often characterized by numerous legal, insurance, and administrative roadblocks. While nursing faculty and their students may wish to cooperate with professional educators and their students to enhance the health care of the children, there are obstacles. Both institutions are represented by attorneys, insurance companies and others who must attend to aspects of the process other than direct health care delivery. A model for joint planning and a list of elements of effective agreements are offered as a way of engaging all parties in a constructive and useful process of collaboration.

Adolescent↗
PubMed1993

Evaluation of the West Australian School Development in Health Education Project.

In December 1990, the National Centre for Research into the Prevention of Drug Abuse was invited to evaluate the School Development in Health Education Project (SDHE), a national program tested in Western Australia (WA) in 1991. A formative evaluation indicated the project was moderately successful in achieving the objectives in the operational plan. Schools involved reported the project was successful, and they agreed to continue health planning meetings during 1992. The evaluation also indicated that while most schools achieved macro-level change, they achieved little at the micro level. A significant outcome for SDHE WA was the successful application for three-year funding to continue and expand the project as the West Australian School Health program (WASH). Recommendations generated from the SDHE evaluation produced a shift in emphasis for the WASH program from the "action research" orientation of the national program to more content-based professional development. This study highlights the important role formative evaluation can play in developing and refining health education programs.

Adolescent↗
PubMed2001

Developing a comprehensive school suicide prevention program.

Since the 1950s, the suicide rate for adolescents more than tripled, and suicide currently ranks as the third-leading cause of death among 15-to-24 year-olds. Comprehensive school suicide prevention programs should include primary, secondary, and tertiary prevention components. This paper discusses these components as they relate to suicide prevention, and it provides practical steps for incorporating each component within a school system. All steps are based on a review of the professional literature. Three questions are explored: What can school professionals do to help in preventing adolescent suicide? What should school professionals do when a student threatens suicide? What should school professionals do after a student commits suicide?

Adolescent↗
PubMed1996

Mental health reform in Georgia, 1992 to 1996.

In 1992 Georgia embarked on an ambitious reform of its public mental health system. Regional mental health authorities were created with consumers and family members as decision makers. Reform legislation required that hospital and community funds be combined to provide for flexible shifting of funds to communities as use of state hospitals decreased. However, after four years and at a cost of almost $15 million, few tangible results can be demonstrated. In fact, hospital admissions have increased since 1991. Further, a proposal for a Medicaid section 1115 waiver that would permit managed care organizations to assume responsibility for key decisions threatens to undermine the decision-making authority of regional mental health authorities. This paper summarizes the background leading to Georgia's reform, reviews its accomplishments, and suggests lessons to be gained from Georgia's experiences.

Cost Allocation↗
PubMed2004

Facilitating participation of students with severe disabilities: aligning school based occupational therapy practice with best practices in severe disabilities.

School-based occupational therapy is the largest employer of occupational therapists. School-based occupational therapists work extensively with students with severe disabilities. Over the past decade, one significant change in the field of severe disabilities has been the advocacy of best practices. This paper discusses the implications of best practices for school-based occupational therapy practice and examines strategies that occupational therapists use to tackle such challenges. Focuses of the discussions are centered on the issues relative to curriculum, educational setting and instructional strategies. The theme of Activity and Participation proposed in International Classification of Functioning (WHO, 2001) guides our discussions. Specific strategies in aligning school-based occupational therapy practice with best practices in severe disabilities are proposed and highlighted.

Adolescent↗
PubMed1997

Consumers, gag rules, and health plans: strategies for a patient-focused market.

The "gag rule" controversy has become a symbol of new tensions and changing relationships among patients, physicians, and health plans. This paper offers a consumer-focused analysis of these fundamental issues from the point of view of a patient with a chronic illness. It starts with a case study of a specific individual and then considers the systemic incentives and other factors that lead to conflicts among patients, physicians, and health plans. This consumer focus invites the reader to consider managed care with the following question in mind: "What would you want for yourself it you were the patient?" The paper suggests that many private-sector initiatives, as well as government actions, could contribute to a better health care market. Among the reform strategies discussed are (a) professional responsibility and private-sector standards, (b) consumer assistance, and (c) government regulation. All of us, including persons with chronic illness, need a consumer-focused health system. So, too, do physicians and health plans that want to provide excellent care for all of their patients.

Communication↗
PubMed2004

Structural problems in the German hospital system.

The German health care system has been based on the Hospital Financing Act, which the German government introduced in 1972. According to that, the federal states plan hospitals and make investments. The health insurance funds finance the operating costs. But now the Hospital Financing Act is obsolete, because both the health insurance funds and the federal states are in financial trouble and try to avoid the costs, which are nevertheless rising. In order to freeze costs, the legislators have introduced a new remuneration system, called DRGs (Diagnosis Related Groups), which will be mandatory from 2007 onwards. In this system, the treatment provided will be coded and remunerated on the basis of the primary diagnosis. Periods of hospitalisation and different remuneration systems will no longer be relevant. Transparency and quality will thus be promoted, and the upshot will be more competition among the hospitals. Hospitals that cannot meet quality standards will lose patients and will ultimately have to close. Other participants in the health care system, such as, for example, nursing staff, physicians, pharmacies, rehabilitaion centres and patients, will also be concerned in many ways. The consequences of the DRGs for the health care system, its future development and possible alternatives are discussed in this article.

Cost Control↗
PubMed2004

Barriers to tobacco cessation counseling and effectiveness of training.

The oral health care appointment provides a unique opportunity for tobacco cessation counseling (TCC). This literature review examines the effectiveness of training oral health care professionals for TCC, including the barriers to providing counseling. Undergraduate education and continuing education are both effective methods for training health care professionals in TCC. Identifying barriers to TCC may enhance its effectiveness, and should be addressed in the American Dental Hygienists' Association's "Ask, Advise, Refer" initiative.

Counseling↗