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PubMed1989

Low utilization of community health workers: results from a household interview survey in Burkina Faso.

A representative household survey was carried out in order to study the utilization of community health workers (CHW) in relation to other sources of health care. We found three main results: (1) For mild diseases, villagers consulted their CHW only in 8.8% of mild diseases, in 69% the family remained the main provider of primary care. (2) In the case of serious diseases, which the CHW was supposed to identify and refer, the villagers bypassed the CHW in 96.5%. The professional health worker were consulted directly in the majority of serious disease. (3) Sick infants were not taken to the CHW for treatment. (4) No pattern of referral between professional and CHWs could be traced. Severity of disease and perceived effectiveness of the treatment were the most important determinants of health seeking behavior. Availability, distance, and cost of travel and drugs were important service related determinants. Individual and household characteristics such as income, ethnicity, and household size were only weakly associated with choice of curative care. Reasons for the low utilization of CHWs are outlined and policy implications discussed.

Attitude to Health↗
PubMed1990

Towards rational medicine use: is there a role for children?

Irrational, wasteful, and even dangerous medicine use is a serious problem in developing countries. It is important to work to solve it through the provision of safe, efficacious and affordable drugs, through strengthening the drug regulatory systems and through the education of health care providers. However, it is important as well that the population learns to use medicines wisely. Educating children in developing countries about appropriate use of medicines is a strategy that has the potential to improve medicine use throughout the communities where the children live and for future generations. Currently, very few children's health education curricula include anything on appropriate medicine use, and what exists has not been based on what children know, or on their behavior or expectations relative to medicines in the context of their cultures. Support is sought for the inclusion of rational medicine use in comprehensive school health curricula and researchers are encouraged to develop and evaluate culturally sensitive, age appropriate, and acceptable medicine use education programs.

Attitude to Health↗
PubMed1995

The role of pharmaceuticals in the privatization process in Vietnam's health-care system.

The socialist republic of Vietnam had a centrally planned economy and a well-distributed health-care system that was free to all. Since 1989 the government implemented a free market policy (Doi Moi). Authorities tried to shift part of the cost to users of health care and to improve aspects of the health-care system that appeared to be ineffective. Private practice of physicians and pharmacists was introduced in Vietnam. The introduction of privatization had consequences for the public health services at provincial, district, village and hamlet level. This has changed the character of the health-care system. Pharmaceuticals play an important role in the transactions between practitioners and patients, because they are the tangible goods that are exchanged in the transactions between users and providers of health care. Medical anthropologists interprete use and ideas on pharmaceuticals in terms of local cultural categories or as metonymic signs of technologically advanced societies from whence they come. Use of pharmaceuticals can also be understood in a historical and political context. This article describes pharmaceuticals in the process of privatization in Vietnam and the way they are seen by the Vietnamese in the context of political change. Their use carries meanings of medicines about transformations in political economy and as such this can be seen as a metaphor for the changing Vietnamese health-care system.

Cost Control↗
PubMedDate not supplied

Training program in Japan for health caretakers from developing countries.

In 1979, the International Center for Medical Research was organized in Kobe University School of Medicine and promoted the scientific cooperation through invitation of foreign scientists from developing countries as the Core University of Medical Science of Japan Society for the Promotion of Science (JSPS). Perinatal medicine is one of the main subjects in this program and we have accepted more than thirty neonatologists from Indonesia, Philippines, Thailand and other developing countries.

Developing Countries↗
PubMedDate not supplied

Methadone maintenance: predictors of outcome in a Canadian milieu.

This hypothesis-generating study attempts to identify patient characteristics predicting the successful outcome of methadone maintenance in the treatment of narcotic addiction. The sociodemographic characteristics as well as the general emotional health of 51 addicted individuals in Montreal were studied at entry into the program and are correlated with success one year after entry. The success of the Montreal program, defined as retention in the program and urine samples negative for opiates, is comparable to results reported from many North American clinics. A history of foster care before age 15 is the only characteristic significantly correlated with both retention and negative urines. Emotional health, previous treatment experiences, job status, and level of education do not correlate with success. All addicted individuals applying to a treatment program should therefore be accepted for a trial of treatment while further research on greater numbers of subjects may eventually identify predictors of successful outcome.

Adolescent↗
PubMed2004

Pathways to psychiatric care and reform of the public health care system in Poland.

OBJECTIVE: - Since 01.01.1999 a reform of the health care system in Poland has been realised based on the general health insurance act. We attempt to use the pathway method, especially measuring of time intervals along pathways, as a way of making accessibility to mental health services operational. METHOD: - In a period of 2 months all patients aged 15 and over who had not sought care from any public or private psychiatric service during the previous 365 days, were interviewed by psychiatrists, using the Polish version of the WHO Encounter Form. RESULTS: - A total of 228 patients were seen. The study reveals that the median interval between first seeing a primary care giver and arrival at a mental health service was 12 weeks, which is much longer than all other European centres in previous studies. CONCLUSION: - Making use of the pathway method and, in particular, median interval analysis between the onset of the mental health problem and seeing mental health professionals (MHPs) has shown practically limited access of patients, with a new episode of care to psychiatric services in both epidemiological catchment areas. This method seems to be a simple and inexpensive way of monitoring the accessibility to MHP in the period of health care reform.

Adolescent↗
PubMed2005

Can we estimate the 'social' value of a QALY? Four core issues to resolve.

There is growing interest in estimating the 'societal' willingness to pay (WTP) for a quality adjusted life year (QALY) to help public health system decision-makers determine whether a health care programme should/not be undertaken. However, there is a lack of clarity in this debate concerning four core issues: (i) is 'social' WTP simply the sum of 'individual' WTP; (ii) will 'individual' WTP map directly into 'social' WTP; (iii) is 'personal' income the appropriate budget constraint; (iv) should WTP be adjusted for ability to pay? This paper outlines the relevance and importance of each of these issues in the hope of encouraging a wider debate on the core issues that empirical studies will have to explore to discover whether such a value may be obtained.

Australia↗
PubMed2006

Effects of financial disadvantage on use and non-use of after hours care in Australia.

Policy addressing the provision of primary care after hours (AH) is currently in flux because of concerns about equity of access and cost. In this study we examine the effects of socioeconomic disadvantage on access to AH care and episodes of not seeking AH care when needed among users and non-users of AH care. The effects of health on these relationships were also explored. The total sample consisted of 5538 users of AH care and 891 non-users of AH care who were randomly selected for telephone interviews. Factors determining AH care included accessibility that is structural barriers to use of care such as distance and transport, as well as affordability and availability. Logistic regression was used to determine the impact of financial disadvantage on episodes of not seeking AH care. Barriers to use of AH care and household health were subsequently added to the models to assess their impact. The results suggested that there were inequities in access to AH care but these were a function of barriers to AH care use rather than financial disadvantage per se. Accessibility and availability were significant barriers to use of AH clinics among both user and non-user samples. Affordability was only a significant barrier among users of AH care. The study suggests that policy aimed at reducing these barriers may effectively address inequities in AH care but that to be optimally effective policy change would also need to be accompanied by changes in consumer awareness.

After-Hours Care↗
PubMed2004

Safety of outpatient tonsillectomy in children: a review of 6 years in a tertiary hospital experience.

OBJECTIVE: We present our experience with outpatient tonsillectomy in children and critically review safety to support the outpatient policy. STUDY DESIGN AND SETTING: We conducted a retrospective chart review from January 1995 through December 2000 in the pediatric otolaryngology unit of a tertiary care university hospital. RESULTS: One thousand two hundred forty-three patients were accepted in the outpatient program with permissive criteria. Postoperative observation time ranged from 3 to 5 hours (median, 4.5 hours). The overall rate of complications was 9.3% (n = 116). Primary and secondary bleeding rates were 6.27% (n = 78) and 0.48% (n = 6), respectively. Thirty-six children (2.9%) had major bleeding; 2 of them were not identified in day-hospital (0.16%). Discharge was delayed in 103 patients (8.3%), and 13 patients showed complications after discharge (about 1% readmission rate). CONCLUSION: Our program outcomes support safety. Outpatient surgery is meant to provide comfort to the patient and efficiency to the health care system, without impairing safety; in our experience, most tonsillectomies in children comply with these objectives. SIGNIFICANCE: Outpatient tonsillectomy in children may be safe even with permissive criteria, when an appropriate setting is available.

Ambulatory Surgical Procedures↗
PubMed2004

Physical, mental and social factors associated with frequent attendance in Danish general practice. A population-based cross-sectional study.

Knowledge of which factors are prompting patients to seek primary care is important to the ongoing effort to improve management in general, and management of frequent attenders (FAs) in particular. We conducted a cross-sectional population-based study with the aim at examining associations between physical, mental and social factors and frequent attendance in general practice. We collected questionnaire and registry data in the County of Aarhus (630,000 inhabitants), Denmark. Half of the county general practices (132 practices, 220 GPs) were selected randomly. FAs were defined as the top 10% attenders over the past 12 months. A questionnaire including SF-36 and questions about physical and mental health and social conditions was sent to age and gender stratified samples of FAs and non-FAs from these practices. Impairments (SF-36) associated with frequent attendance were physical in 54-71% (prevalence difference (PD): 16-33%, adjusted prevalence ratio (adj. PR): 1.1-1.7), mental in 58-70% (PD: 17-25%, adj. PR:1.1-1.4) and social in 40-59% (PD: 13-28%, adj. PR:0.9-1.5). Among FAs, 46-88% had used three or more different drugs (PD: 26-39%, adj. PR:1.5-2.3) and 27-41% had been referred one or more times to outpatient specialists (PD: 4-19%, adj. PR:1.2-2.5). Although our data cannot determine the direction of causality, they clearly demonstrate that FAs carry a large burden of physical, mental and social impairments which underpins the complexity and heterogeneity of the problems which they present. The results make clear that biopsychosocial management is a core issue in FA management in general practice.

Adult↗
PubMed2005

Reform strategies in Georgia and their impact on health care provision in rural areas: evidence from a household survey.

The transition resulting from the break-up of the Soviet Union significantly affected the health care systems and population health status in the newly independent States. The available body of evidence suggests that contraction of public resources resulting from economic slowdown has led to the proliferation of out-of-pocket payments and private spending becoming a major source of finance to health service provision to the population. Emerging financial access barriers impede adequate utilization of health care services. Most transition countries embarked on reforming health systems and health care financing in order to tackle this problem. However, little evidence is available about the impact of these reforms on improved access and health outcomes. This paper aims to contribute to the assessment of the impact of health sector reforms in Georgia. It mainly focuses on changes in the patterns of health services utilization in rural areas of the country as a function of implemented changes in health care financing on a primary health care (PHC) level. Our findings are based on a household survey which was carried out during summer 2002. Conclusions derived from the findings could be of interest to policy makers in transitional countries. The paper argues that health financing reforms on the PHC level initiated by the Government of Georgia, aimed at decreasing financial access barriers for the population in the countryside, have rendered initial positive results and improved access to essential PHC services. However, to sustain and enhance this attainments the government should ensure equity, improve the targeting mechanisms for the poor and mobilize additional public and private funds for financing primary care in the country.

Adolescent↗
PubMed2006

Horizontal equity in health care utilization evidence from three high-income Asian economies.

This paper compares the extent to which the principle of "equal treatment for equal need"(ETEN) is maintained in the health care delivery systems of Hong Kong, South Korea and Taiwan. Deviations in the degree to which health care is distributed according to need are measured by an index of horizontal inequity. Income-related inequality in utilization is split into four major sources: (i) direct effect of income; (ii) need indicators (self-assessed health status, activity limitation, and age and gender interaction terms); (iii) non-need variables (education, work status, private health insurance coverage, employer-provided medical benefits, Medicaid status (low-income medical assistance), geographic region and urban/rural residency and (iv) a residual term. Service types studied include western doctor, licensed traditional medicine practitioner (LTMP), dental and emergency room (ER) visits, as well as inpatient admissions. Violations of the ETEN principle are observed for physician and dental services in Hong Kong . There is pro-rich inequity in western doctor visits. Unusually, this inequity exists for general practitioner but not specialist care. In contrast, South Korea appears to have almost comprehensively maintained ETEN although the better-off have preferential access to higher levels of outpatient care. Taiwan shows intermediate results in that the rich are marginally more likely to use outpatient services, but quantities of western doctor and dental visits are evenly distributed while there is modest pro-rich bias in the number of LTMP episodes. ER visits and inpatient admissions in Taiwan are either proportional or slightly pro-poor. Future work should focus on the evaluation of policy interventions aimed at reducing the observed unequal distributions.

Asia↗
PubMed2005

Breeding soundness and libido examination of Belgian Blue and Holstein Friesian artificial insemination bulls in Belgium and The Netherlands.

Data on breeding soundness and libido evaluations in Belgian Blue (BB) bulls are scarce. The present study compared results of breeding soundness and libido evaluations of young BB bulls to young Holstein Friesian (HF) bulls prior to acceptance into an AI program. Breed differences for breeding soundness exist between BB and HF bulls, as 93.7% of the young BB bulls failed the breeding soundness examination (BSE) compared to 59.3% of the HF bulls (P=0.0005). Within the BB breed, differences were present between bulls of different ages, and bull selection for better fertility with increasing age apparently influenced the results. The number of reasons for which bulls failed the test differed between the age groups in the BB breed, whereas a tendency for more failure reasons in the BB breed was noticed in the breed comparison. The most important reasons for failure were sperm morphology and scrotal circumference (SC), but far more BB bulls failed for these traits compared to the HF breed (82.8% versus 56.0% and 43.8% versus 17.6% in the BB and the HF breed for sperm morphology (P=0.0005) and SC (P<0.0001), respectively). The high proportion of BB bulls with a substandard SC and poor sperm morphology might suggest an increased prevalence of testicular hypoplasia or degeneration within this breed. Concerning libido, the reaction time did not differ either between breeds or between age groups within the BB breed, whereas mounting enthusiasm, although not different between the two breeds, did decline with increasing age, probably due to the greater mating experience of the older bulls. All in all, libido did not seem to be different between the breeds.

Age Factors↗
PubMed1995

Preventing relapse. Guidelines for the pediatrician.

Preventing relapse into substance use means first helping the teenager to develop a state of recovery. This involves completing a First Step of a 12-Step program, whereby the teenager accepts that drugs and alcohol have been destructive in his or her life and that moderate use is impossible. Thus, abstinence is necessary in a productive life. Parental support is also established. The two more common causes of relapse are being in the presence of alcohol- and drug-using peers and the presence of co-existing psychiatric problems.

Adolescent↗
PubMed1983

Present and future training of foreign ophthalmologists in the USA. Perspective of Association of University Professors of Ophthalmology.

A questionnaire entitled "Present and Future Training of Ophthalmologists in the USA" was sent to members of the Association of University Professors of Ophthalmology. Data obtained from the questionnaire indicate that: the complex regulations pertaining to training foreign medical graduates (FMGs) in the USA are often not fully understood by the chairmen, most programs are willing to accept but do not actively recruit FMGs, there are a number of obstacles encountered in selecting and training FMGs, and most resident and fellowship positions are filled by US graduates.

Education, Medical, Graduate↗
PubMed2003

National Health Insurance and the antenatal care use: a case in Taiwan.

Many studies have found evidence for the importance of antenatal care on pregnancy outcomes. This paper focuses on the determinants of antenatal care use in Taiwan and provides a comparison of access to care before and after National Health Insurance (NHI) was implemented in 1995. A negative binomial model is applied to data from the 1989 and 1996 Taiwan Maternal and Infant Health Surveys to analyze antenatal care use. The results show that women in some situations had more antenatal care visits than average regardless of NHI implementation. These situations include: having a highly educated husband; gaining more weight than average during pregnancy; experiencing a first pregnancy; carrying twins or triplets; having care provided by a doctor rather than other caregivers; and switching to another health care facility during pregnancy. Regarding societal change, the trend toward delaying pregnancy is causing a change in care use. Additionally, three changes in care patterns after NHI are noteworthy. First, antenatal care visits at maternity clinics increased more than visits at hospitals. Second, before NHI's implementation, women who did blue-collar work or farm work sought care more frequently than housewives, but after NHI began government employees and businesswomen sought care more frequently. Third, antenatal care visits of mothers living in Taiwan's central area increased more than visits of those in the northern area. The expansion of medical care in aboriginal areas and outlying islands may prove to be one of NHI's best achievements.

Adult↗
PubMed2004

Impact of the case payment reimbursement method on the utilization and costs of laparoscopic cholecystectomy.

The purpose of this study was to examine the relationship between adoption of case payment for laparoscopic cholecystectomy (LC) and the growth rate of LC, outcomes of patients undergoing LC, and total healthcare expenditures on cholecystectomy. We used the claims data from Bureau of National Health Insurance (BNHI) to identify patients who underwent LC and open cholecystectomy (OC). Data were available from January 1996 to October 1997 and from January 1998 to October 1999, enabling use to compare data from before and after the introduction of the new case payment system. Results showed that the volume and the proportion of LCs increased after adoption of the new payment method. We did not find a sharp increase in the cholecystectomy rate during the study period. In terms of outcomes, the admission rate for emergencies decreased; the surgery mortality rate decreased, but the readmission rate increased. The average cost and length of hospital stay for LC subjects decreased; however, the total cost of cholecystectomy increased. The impact on LC of the introduction of a case payment method failed to reduce total health expenditures for cholecystectomy.

Adolescent↗
PubMed1995

Programmatic vestibular rehabilitation.

Although the use of vestibular exercises for patients with persistent vertigo and dysequilibrium has received some attention for many years, organized vestibular rehabilitation therapy programs have only recently been introduced. The benefits of such programs are becoming widely accepted. They typically involve a three-pronged approach: habituation exercises designed to facilitate central nervous system compensation by extinguishing pathologic responses to head motion, postural control exercises, and general conditioning activities. This article will describe the programmatic approach to vestibular rehabilitation, emphasizing selection criteria and reviewing results that may be anticipated when this treatment modality is used in a variety of patient populations.

Humans↗