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PubMed1993

Contributions of empirical research to medical ethics.

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine.

Cardiopulmonary Resuscitation↗
PubMed1992

Are hospital ethics committees really necessary?

CONCLUSION: Ethics committees are crucial at this point in the history of medicine. They serve as a forum where various ethical issues can be raised, discussed, critically examined, and "where a number of disciplines come together to examine the implications of contemporary medicine upon life." If ethics committees are to be helpful, there must be realistic expectations and accurate descriptions of their functions. This writer, along with most others, would conclude that ethics committees should in no way be involved in the actual decision-making process. Rather, the IEC should involve itself only through educational offerings, policy development, and voluntary consultation at the request of a provider or a patient. This type of committee will avoid certain pitfalls which could compound the process of decision making and very possibly not be of benefit to the patient. The decision-making process belongs to the physician and the patient, not to an ethics committee.

Attitude↗
PubMed1999

Addressing language barriers to health care, a survey of medical services in Switzerland.

Two descriptive, quantitative cross-sectional surveys including all services of internal medicine and psychiatric services examined how Swiss medical services address the problem of language barriers in health care and how they respond to the high number of allophone patients. Of all the medical services (MS), 244 responded to the questionnaire (Internal medicine: 166; Psychiatry: 78; overall response rate 86.6%). Half of them (51%) estimated the proportion of allophone to the total number of patients at 1-5%. Only 4% of the MS collected statistics on the number of allophone patients (2 internal medicine, 8 psychiatric services). A third of the MS perceive communication with allophone patients as significantly difficult. Only 14% often use qualified interpreters, while 79% often use relatives, 75% often health staff, 43% often employees. Qualified interpreters are less frequently used in internal medicine than in psychiatry. There is an expressed need for qualified interpreters speaking Albanian, Bosnian/Serbo-croat, Tamil and Kurdish. Only 11% of the studied MS have a budget for interpreters, and 17% have access on an interpreter service. 48% express the need to have access to interpreter services. There is a need to raise the awareness of health professionals on the advantages of having access to trained interpreters and on the limits of using relatives as translators. This calls for coordination at national level, policy development and training, in order to ensure adequate communication and quality care for migrants.

Cross-Sectional Studies↗
PubMed1980

[Housing quality in cities from the tenant's point of view].

Since the demand for higher quality of live has been the big discussion, also the call for a more livable city has become more and more frequent. For urban development policy it is necessary to workout conceptionally the different demands for a higher living quality. First it is essential to define the content of the term Quality of Live. In this article one tries to show how the term is broken-up in it's components and how it can be empirically tested with help of indicators. Results from different studies show what the needs of the inhabitants are and how much weight the different quality components have for different population groups. The results show that in all groups of inhabitants-aside from the superior features of a city (infrastructure)-the component living environment plays an important role. If it is rated in a negative sense, it is often the ground of leaving the city-especially for families.

Environment Design↗
PubMed1995

The role of psychiatrists in community mental health centers: a survey of job descriptions.

There is little data about the role of psychiatrists within CMHCs. To gain perspective on this issue, job descriptions for medical directors and staff psychiatrists were collected from 214 CMHCs. The data demonstrated that most CMHCs want fully trained psychiatrists involved in a variety of activities in addition to prescribing medication. Policy development was specifically included as part of the medical director's job for 69% of the CMHCs, and 50% mentioned training as part of the staff psychiatrist's job. Although job descriptions may not accurately reflect the actual roles of the psychiatrist in all cases, these data suggest that CMHCs support a multifaceted role for their psychiatrists.

Community Mental Health Centers↗
PubMed1996

Health care reform and rural mental health: severe mental illness.

Service needs of rural severely mentally ill and strengths of rural communities are addressed. Health care reform policy development at present appears to neglect the seriously mentally ill in general and rural services specifically. Examples of strategies to meet the needs for health care, psychiatric treatment, psychosocial rehabilitation and appropriate housing are described. The advantages and drawbacks of such efforts are considered.

Community Health Workers↗
PubMed1998

Mental health and substance abuse treatment services for dually diagnosed clients: results of a statewide survey of county administrators.

Finding are presented from a survey of administrators of county departments of mental health and alcohol and drug programs in California regarding services for individuals with co-occurring mental and substance abuse disorders. A total of 47 counties responded (84% response rate). The survey findings indicate that collaboration across county mental health and alcohol and drug services primarily occurs through information sharing, coordination of services, and joint projects. Fewer than one-half of the counties responding provide integrated programs, and the most frequently provided services are outpatient counseling and case management. Administrators cited historical differences between the two service systems and societal stigma as the greatest barriers to service delivery. Two opposing strategies for state action were suggested, either establishing specific funding set-asides or blending funding for services. Counties varied widely in their ability to estimate unmet service needs. Implications for policy development related to the dually diagnosed are discussed.

Adult↗
PubMedDate not supplied

Sex and the teacher--learner relationship in medicine.

As the numbers of women medical students, residents, and faculty increase, sexuality in teacher-learner relationships will present challenges for individuals and institutions. Ethical and legal guidelines regarding sexual harassment and contact already exist for many medical schools, hospitals, and professional organizations, as well as state and federal law. Individuals and institutions can begin to address these issues through policy development and educational sessions addressing human sexuality, communication skills, and the process of becoming a physician.

Adult↗
PubMed2004

Workplace characteristics and work disability onset for men and women.

OBJECTIVES: This paper investigates the association between job characteristics and work disability among men and women in older working ages in the United States. We examine whether the association persists when controlling for major chronic disease experience. We also address whether job characteristics are ultimately associated with the receipt of disability benefits. METHODS: Data are from the Health and Retirement Survey and are nationally representative of noninstitutionalized persons 51-61 in 1992. Disability onset is estimated using a hazard modeling approach for those working at wave 1 (N = 5,999). A logistic regression analysis of disability benefits is based on a risk set of 525 persons who become work-disabled before the second interview. RESULTS: Women's disability onset and health problems appear less related to job characteristics than men's. For men, work disability is associated with stressful jobs, lack of job control, and environmentally hazardous conditions but is not associated with physical demands. Participation in disability benefit programs among those with work disability is unrelated to most job characteristics or health conditions. CONCLUSIONS: Understanding of the differing process to work disability for men and women and the relationship between work and health by gender is important for current policy development.

Persons with Disabilities↗
PubMed2000

[Sex role and sports].

Gender inequality in all areas of life remains a global problem despite efforts over the past twenty years in particular to address the situation. In physical activity and sport the inequality between women and men is particularly pronounced in almost all countries, although it differs in degree. Two of the main reasons why inequality between women and men physical activity and sport is more extreme than in many other areas of social life are the result of the close association between the attributes required for sport and those associated with traditional concepts of stereotypical, hegemonic masculinity, and a lack of understanding of the difference between sex and gender. In sport and physical activity physical differences between men and women have been confused with socially constructed differences i.e. physical differences have been confused with gender differences, and this confusion has been used to justify women's lesser and limited participation at all levels. To achieve equality between women and men in physical activity and sport it will be essential that gender is identified and understood as a socially constructed and fluid concept which is a product of the relations between women and men. The fact that women bear children or are generally less physically powerful than men is not sufficient to justify why it is not considered appropriate for women to participate in certain forms of physical activity or why their participation is less valued than the participation of men. An understanding of gender and of the construction of gender relations is an important pre-requisite to addressing the inequality between women and men in physical activity and sport and in developing policies and programs which include, and are of equal benefit to both sexes. While more research on the benefits of participation in physical activity is needed, there is currently sufficient information available to identify the health related and social value of participation to both women and men. What is now needed to ensure equality between women and men in physical activity and sport is the adoption of a gender-relations approach to policy and program planning by governments, civil society and specifically by those "experts" in the field who have the power to advocate and to influence decision makers at all levels.

Female↗
PubMed2003

Depleting fish resources, declining fishing communities, and the state revitalization project in Korea.

This paper reviews recent declines in fish resources and fishing communities in Korea, evaluates major factors of declines, and examines a subsequent community-based revitalization project. Factors leading to depleting fish resources include global regulations, technological advances in fishing, national economic development policies, land reclamation projects, and pollution. The negative economic and societal impact of depleting fish resources is addressed using demographic and income levels of the communities. In response, the state initiated revitalization projects and invested in local fishing cooperatives promoting community-based management. The result has been less than effective as it led to mismanagement of investment and created an attitude of dependence on the government for financial assistance.

Animals↗
PubMed2006

Multi-criteria assessment of tensions in resource use at continental scale: a proof of concept with Australian rangelands.

The purpose of this study was to help to inform policy development for the Australian rangelands, and provide a proof of concept for application of a multi-criteria analysis approach to assessment of competing resource use at continental scale. The study aimed to identify and locate key natural resource and agricultural production assets in the rangelands, define a number of measures of potentially threatening processes, and use a multi-criteria approach to identify areas where threatening processes, agricultural production problems, or valuable natural resources coincided. The analysis used 35 readily available, continental spatial data layers at 5-km pixel resolution ranked from 1 (low) to 5 (high) under three themed groupings: natural resource base, production base, and threatening processes. These measures were aggregated into composite indicators to define attributes such as environmental sensitivity and total grazing pressure. The composites were then compared in a two-way analysis to explore particular interactions between threatening processes such as pastoralism and mining, and the condition of production and natural resource assets. These interactions were defined as "tensions" for purposes of this analysis. Example "tensions" included the association of high grazing intensity with areas of high environmental sensitivity, indicating a risk of land degradation under adverse climatic conditions. A summary of patterns of tension was obtained by extracting area proportions of high-tension classes for selected Natural Heritage Trust Regions, which are a basis for Australian Government funding of improved environmental management. The study provides a basis for further examination of trade-offs in the use of natural assets, opportunities for improved productivity and sustainability, and social and economic implications.

Agriculture↗
PubMed2001

Environmental indices in irrigation management.

Irrigation management calls for objective criteria capable of representing the economy, reliability, and productivity of irrigation systems. These criteria must be compatible with long-term sustainability and conservation goals. The criteria representing the above goals are the economic effect of management on yield reduction, economic effect, and reliability referring to plant growth and operation of the network. In this study environmental indices are introduced to express the above criteria in quantitative terms. The inclusion of these indices at the farm and network level create a multicriteria framework for decision-making based on composite programming. An experimental study was conducted during the irrigation periods of 1989 and 1990 in Chania, Greece, concerning water delivered to 40 experimental plots, soil moisture content at the rootzone, and irrigation system operational failures. The data collected in real time were used for the calculation of the corresponding environmental indices. The variation in time and space is high and resulted in up to 62% of yield loss and low system performance (up to 7% of system temporal reliability). The study indicated that environmental indices could be incorporated to select alternatives and also to develop policies on water delivery. The final decision involves a trade-off analysis between cost of application and desired system performance. Measures of both primary objectives can be obtained using environmental indices that represent system operation aggregation at its basic levels (on farm and network).

Agriculture↗
PubMed1997

Long Profile Evolution of a Mountain Stream in Relation to Gravel Load Management: Example of the Middle Giffre River (French Alps)

/ Since the 1970s, many French riverbeds have been incised by more than 1 m. This generalized phenomenon, apparently irreversible, is rightly considered as alarming. However, our study of the Giffre, a sixth-order high-energy river draining an intramountain plain in the northern French Alps, leads us to qualify this general opinion. Although the Giffre underwent considerable incision as early as the 1960s (-1.16 m between 1912 and 1988, for a total sediment loss of 2 x 10(6) m3) following extensive gravel extraction from the channel, this evolution appears to be reversed today, showing that this river is capable of rehabilitating itself. The watershed supplies the river with 50,000 m3/yr of material and part of this load (30,000 m3/yr) is extracted. Although it is theoretically possible to reverse this phenomenon, it is unacceptable for the local economy as man-made installations unadapted to flooding were developed along the river during the period of incision. Today, the development policy is in conflict with the maintenance and the preservation of natural sediment transport and deposition.KEY WORDS: Bed incision; Gravel load management; Giffre River; France

Journal Article↗
PubMed1999

Biological monitoring values for occupational exposure: a United Kingdom perspective.

Policy developments in the United Kingdom have been aimed at facilitating the appropriate use of biological monitoring. Recent initiatives have established clear criteria for the interpretation of biological monitoring results, and new guidance that deals with the ethical and practical issues involved in operating an effective biological monitoring programme has been promulgated. The United Kingdom now has a system of non-statutory biological monitoring guidance values. There are two types, the health guidance value and the benchmark guidance value. Over a number of years, biological monitoring programmes have shown that they help in reducing exposure by regular monitoring and demonstrating adequate control.

Environmental Monitoring↗
PubMed2001

Cancer patient education in Iran: a descriptive study.

Abstract. This study was carried out to examine the status of cancer patient education in Iran. Using the Multinational Association of Supportive Care in Cancer's (MASCC) patient education questionnaire, 310 individuals - a sample of heterogeneous cancer patients ( n=167) and their relatives ( n=143) - were enrolled in the study. The pooled results indicated that only 15% of respondents believed more than 80% of cancer patients were told of their diagnosis. In contrast, 30% of respondents thought less than 20% of patients knew their cancer diagnosis. When asked, "Were you given written materials about (i) cancer, (ii) treatment, and (iii) symptom management", the vast majority of respondents said "No" (91%, 87%, and 87%, respectively). When respondents were asked, "Would you like to learn more about cancer and treatments", 97% said "Yes". Most respondents indicated the need for information on the treatments available (27%) and general information about cancer (20%); most had sought information from health professionals (31%), other cancer patients and friends (29%), and television (22%). Finally, it was found that concern about patients' depression (17%), lack of printed materials (13%), the idea that it was better for patients not to know (12%), and families' requests not to tell the patient (11%) were the most frequently stated barriers to or reasons for restricted cancer patient education. The findings of the study suggest that cancer patient education in Iran is very poor and there is an urgent need to develop policy guidelines on disclosure of cancer diagnoses and patient education.

Adult↗
PubMed2006

Factors associated with gamblers: a population-based cross-sectional study of South Australian adults.

OBJECTIVE: To determine, using a random telephone survey, the prevalence of various gambling activities among South Australian adults, the prevalence of adult problem gamblers using the South Oaks Gambling Screen (SOGS) instrument, and to examine the problem gamblers by demographic and health-related risk factors. METHOD: A random representative sample of South Australian adults selected from the Electronic White Pages. Overall, 6045 interviews were conducted (73.1% response rate) using Computer Assisted Telephone Interviewing (CATI) technology. RESULTS: Overall, 75.6% (95% CI: 74.5-76.7) of respondents had participated in at least one gambling activity during the last 12 months and 2.0% (95% CI: 1.7-2.4) were identified to be problem gamblers. A wide range of factors was associated with problem gambling at a univariate level, when compared to frequent gamblers. The logistic regression analysis highlighted that problem gamblers were more likely to speak a language other than English, be employed part time and a smoker when compared to frequent gamblers. Problem gamblers were also more likely to have a mental health condition (according to the Kessler 10), have had suicidal thoughts and know of services for gambling problems. CONCLUSION: There is a wide range of characteristics associated with problem gambling in South Australia. All of these factors need addressing during policy development to assist problem gamblers.

Adult↗
PubMed2005

The need for care coordination among children with special health care needs in Illinois.

OBJECTIVES: The objectives of this study were: 1) to estimate the need for care coordination among children with special health care needs (CSHCN) in Illinois, 2) to assess the need for care coordination among CSHCN in Illinois by sociodemographic, condition-related, and access to care factors, and 3) to discuss approaches for meeting the need for care coordination. METHODS: The study included 745 Illinois families interviewed as part of the State and Local Area Integrated Telephone Survey (SLAITS) of CSHCN. Classifying families of CSHCN as needing care coordination was based on three survey questions. The prevalence of the need for care coordination among CSHCN in Illinois was examined overall and by sociodemographic characteristics, descriptors of the child's health condition, and measures of access to services. Multivariable modeling was carried out to jointly assess these factors and the need for care coordination. RESULTS: In Illinois, 25.2% of CSHCN families reported a need for care coordination. Condition severity, need for supplementary/ancillary services, lack of insurance coverage and inadequate communication among providers were significantly associated with the need for care coordination (OR = 1.14, OR = 1.72, OR = 2.45, and OR = 3.08, respectively). Having a primary care provider/medical home was not associated with the need for care coordination in multivariable analysis. CONCLUSION: Coordination of health services is important for all children and all adults, but it is particularly important for children with special health care needs. The variation in the need for care coordination both within and across states underscores the need for flexibility in program and policy development for CSHCN.

Adolescent↗