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PubMed1994

Health care of the disabled adolescent.

With improved diagnostic techniques and medical advances, increasing numbers of children with disabilities are living longer and healthier lives. During adolescence, those with chronic health problems are at increased risk of various psychological difficulties, culminating in the challenge of transition to adult health services. This review explores these issues as well as how related medical care is funded. The long-term outcome for adolescents with disabilities is favorable.

Adolescent↗
PubMedDate not supplied

[Health policy polarization in Mexico].

In the last 17 years, health policy in Mexico has been shifted from a conception of integrated health care and a gradually extended coverage as a major responsibility of the State and health care public institutions, to in the one hand, a very active promotion of market and private profit in health services and in the other, poverty relief programs. In this paper we identify different periods corresponding to the last three presidential terms. Each clearly represent different stages of health sector reform: transitional (1982-1988), mercantilisation and poverty relief (1988-1994) and, strengthening of the so called health markets (1994-2000). The analyzed transformation is part of the set of secondary reforms subordinated to the structural adjustment and the economic and social megaprojects imposed by the international financial institutions.

Health Policy↗
PubMed1996

[Transition of the roles and mandates of public health professionals].

There is a call for a new intervention paradigm that integrates all dimensions of physical, political and economic environments that might impact on health. The Ottawa Charter, the Global Plan for Health Promotion and the Health and Welfare Policy to mention a few, suggest that public health agents broaden their roles and their mandates. From health educators, they are now being asked to not only continue to favour the development of personal skills, to help create supporting environments, to reorient health services, to reinforce community action, as well as elaborate health public policies but to also become consensus builders towards this new paradigm. This article discusses the transition of the role and mandate of the individual health professional. In order to do so, the article traces the practice of the health professional beginning at the end of the 1970's and compares it to that of 1996 looking at the following dimensions: roots, objectives, place of activity, favoured strategies and approaches. Furthermore, it will try to identify new obstacles in health promotion. Finally, it will underline the new challenges for public health near the year 2000.

Health Personnel↗
PubMed2004

Assessment of possible impact of a health promotion program in Korea from health risk trends in a longitudinally observed cohort.

BACKGROUND: Longitudinally observed cohort data can be utilized to assess the potential for health promotion and healthcare planning by comparing the estimated risk factor trends of non-intervened with that of intervened. The paper seeks (1) to estimate a natural transition (patterns of movement between states) of health risk state from a Korean cohort data using a Markov model, (2) to derive an effective and necessary health promotion strategy for the population, and (3) to project a possible impact of an intervention program on health status. METHODS: The observed transition of health risk states in a Korean employee cohort was utilized to estimate the natural flow of aggregated health risk states from eight health risk measures using Markov chain models. In addition, a reinforced transition was simulated, given that a health promotion program was implemented for the cohort, to project a possible impact on improvement of health status. An intervened risk transition was obtained based on age, gender, and baseline risk state, adjusted to match with the Korean cohort, from a simulated random sample of a US employee population, where a health intervention was in place. RESULTS: The estimated natural flow (non-intervened), following Markov chain order 2, showed a decrease in low risk state by 3.1 percentage points in the Korean population while the simulated reinforced transition (intervened) projected an increase in low risk state by 7.5 percentage points. Estimated transitions of risk states demonstrated the necessity of not only the risk reduction but also low risk maintenance. CONCLUSIONS: The frame work of Markov chain efficiently estimated the trend, and captured the tendency in the natural flow. Given only a minimally intense health promotion program, potential risk reduction and low risk maintenance was projected.

Journal Article↗
PubMed2003

Do parents really matter? Child health and development in Spain during the demographic transition.

Linked life histories of children and of their parents living in Aranjuez (Spain) between 1870 and 1950 are used to assess the health and well-being of children in terms of the survival status of their parents. The loss of a mother leads to dramatic increases in the mortality of young children, especially during the first 2 years of life, while the loss of a father has a rather limited negative impact. Over time the relative importance of the loss of a mother increases sharply, thus affording strong, albeit indirect, evidence of their role for mortality reduction during the demographic transition. Heights of military conscripts are used to assess other elements of health unrelated to survival. Results suggest that orphans were noticeably shorter than non-orphans. Over time this effect diminishes thanks to increasingly effective public assistance for orphans.

Child↗
PubMed2002

Menopausal transitions, symptoms and country of birth: the Australian Longitudinal Study on Women's Health.

OBJECTIVE: To assess differences among the menopausal transitions and symptoms experienced by women participating in the Australian Longitudinal Study on Women's Health, according to their countries of birth. METHODS: Data from 8,466 women aged 45-50 in 1996, who responded to surveys in 1996 and 1998 and had not had a hysterectomy, were analysed. Women were categorised by country of birth and cross-sectionally by menopausal status at Survey 1 and 2, as well as longitudinally by transition through menopause between Surveys 1 and 2. Four endocrine-related and 10 general symptoms were assessed. RESULTS: Women bom in Asia were twice as likely as Australian-bom women to be post-menopausal at Survey 1, twice as likely to become post-menopausal between surveys, less likely to remain peri-menopausal, and less likely to report hot flushes and night sweats. Odds ratios for each symptom at Survey 2 were near unity for all country of birth groups compared with Australian bom women, with or without adjustment for symptoms at Survey 1, menopausal transition category, behaviour, lifestyle and demographics. CONCLUSIONS: Asian-born women entered menopause earlier and passed through it more quickly, but once this was taken into account all women showed the same prevalences of symptoms. There may be differences between ethnic groups that influence the timing of menopause, but the subjective experience appears similar. IMPLICATIONS: The timing of menopause may be affected by biological or dietary differences. Asian-bom women's lower reported prevalence of symptoms may be explained by a more rapid peri-menopausal transition. With increasing numbers of Asian-Australian women reaching menopause, an understanding of country-of-birth differences has implications for public health.

Asia↗
PubMedDate not supplied

Innovations in community-based nursing education: transitioning faculty.

The health-care climate is changing rapidly and in ways that challenge the abilities of professionals who provide health care. Nursing educators are preparing professional nurses who can think critically, use sound clinical judgment, and participate as full partners in shaping health-care delivery and policy. Therefore, many schools of nursing, including five schools of nursing whose experiences are synthesized in this article, are revising their curricula to a community-based nursing perspective. Strategies to assist faculty in the transition to a community-based nursing curriculum include using change theory, creating a supportive environment, reducing tension and isolation, and evaluating. Potential challenges during transition include addressing grief and loss, overcoming the tedium of curricular development, moving the revision along while allowing opportunities for faculty input and consensus building, exploring alternative pedagogies, managing faculty workload and qualification issues, and preparing for transition. Outcomes include a more complete understanding of the community client as a partner in the delivery of health care, increased visibility and role modeling to potential future candidates for health careers, cultural transformations within a university, and promotion of the overall health of a community.

Adaptation, Psychological↗
PubMed1991

[Restructuring of teaching of social hygiene and public health administration based on students' opinion].

This is a continuation of the issue discussed in the article by Academician Yu. P. Lisitsyn and assistant Professor L. G. Perekopskaya "On the restructuring of teaching in social hygiene and public health administration" ("Soviet Public Health", 1990, No. 1). 75.6 percent of students from the Rostov Medical Institute participating in the anonymous survey stressed that the training in social hygiene and public health administration should be preceded by fundamental training in clinical subjects which they considered advisable to study during the fifth and sixth year of training. The students considered it necessary to get specialists in applied public health more widely participate in the teaching process. The issues are raised of the status, clinical bases and material and technical supply of chairs of social hygiene and public health administration. It is considered necessary to provide for a series of lectures on social hygiene and public health administration during the sixth year of training. The students displayed a keen interest in the transition of public health services to the new economic mechanism. The students consider it advisable to study the practice of developed countries in the field of population's health protection. An issue is raised of the necessity to integrate the teaching of social hygiene and public health administration with clinical chairs.

Education, Medical, Undergraduate↗
PubMed2002

Transitions through postacute and long-term care settings: patterns of use and outcomes for a national cohort of elders.

OBJECTIVES: Despite the large number of elders using postacute and long-term care services, there is little information about transitions through different settings or the impact of transitions on elders' health. This gap in knowledge is addressed by analyzing the use of postacute and long-term care settings during a 2-year interval by a nationally representative cohort of elders. METHODS: A 2-year longitudinal record of the use of short-stay hospitals and postacute and long-term care settings was constructed for all respondents to the 1994 National Long Term Care Survey age 65 or older in 1992. Indicators of potential transition problems include emergency room visits, potentially avoidable hospital stays, and return to an institutional setting following discharge to the community. RESULTS: Almost 18% of elders, 4.9 million persons, were admitted to or discharged from a study setting between 1992 and 1994. A sizable number of these elders (22.4%) had subsequent health care use, suggesting a possible transition problem. Transitions from acute care hospitals to paid home care represent 20.8% of all transitions and are followed by relatively high rates of potential problems. CONCLUSIONS: This study provides new information on patterns of postacute and long-term care use and the types of transitions most likely to be followed by potential problems. The results suggest three broad strategies for improving the outcome of transitions through postacute and long-term care settings.

Aged↗
PubMed2000

Dental caries in schoolchildren of an Estonian and a Danish municipality.

OBJECTIVES: The objectives of the study were to describe the prevalence rate and the severity of dental caries in Estonian schoolchildren aged 7 and 12 and to compare the findings with those of Danish children. DESIGN: Cross-sectional surveys in Estonia and Denmark, clinical oral examinations of children in 1997. SAMPLES AND METHODS: In Estonia, 195 children aged 7 and 215 children of age 12 were selected in the municipality of Tartu in schools identified for oral health promotion projects. In Denmark, the study included 637 7-year-olds and 642 12-year-olds living in the municipality of Horsens and served by the Public Dental Health Service for children. All children in the two countries were examined by calibrated dentists for dental caries according to the Recording System for the Danish Public Dental Health Service. RESULTS: At age 7, 83.8% of Estonian children had dental caries (7.7 dmfs) against 62.1% of Danish children (5.3 dmfs). At age 12, the mean caries experience was 2.1 DMFS in Estonia against 1.3 DMFS of the Danish children. Most of the caries indices were due to the high d/D components and approximal caries was prominent. In the study area in Estonia, the content of fluoride in drinking water was optimal (0.8-1.5 p.p.m.) whereas the level of fluoride was low in the Danish municipality (0.2 p.p.m.). CONCLUSION: In the Baltic states, the oral health systems are in transition. For the continuous improvement of oral health in childrens' reorientation of services should consider implementation of community-based oral health promotion and the schools provide an excellent setting for preventive oral care.

Cariostatic Agents↗
PubMed2003

Health outcomes following treatment for six months with once daily tiotropium compared with twice daily salmeterol in patients with COPD.

BACKGROUND: A study was undertaken to record exacerbations and health resource use in patients with COPD during 6 months of treatment with tiotropium, salmeterol, or matching placebos. METHODS: Patients with COPD were enrolled in two 6-month randomised, placebo controlled, double blind, double dummy studies of tiotropium 18 micro g once daily via HandiHaler or salmeterol 50 micro g twice daily via a metered dose inhaler. The two trials were combined for analysis of heath outcomes consisting of exacerbations, health resource use, dyspnoea (assessed by the transitional dyspnoea index, TDI), health related quality of life (assessed by St George's Respiratory Questionnaire, SGRQ), and spirometry. RESULTS: 1207 patients participated in the study (tiotropium 402, salmeterol 405, placebo 400). Compared with placebo, tiotropium but not salmeterol was associated with a significant delay in the time to onset of the first exacerbation. Fewer COPD exacerbations/patient year occurred in the tiotropium group (1.07) than in the placebo group (1.49, p<0.05); the salmeterol group (1.23 events/year) did not differ from placebo. The tiotropium group had 0.10 hospital admissions per patient year for COPD exacerbations compared with 0.17 for salmeterol and 0.15 for placebo (not statistically different). For all causes (respiratory and non-respiratory) tiotropium, but not salmeterol, was associated with fewer hospital admissions while both groups had fewer days in hospital than the placebo group. The number of days during which patients were unable to perform their usual daily activities was lowest in the tiotropium group (tiotropium 8.3 (0.8), salmeterol 11.1 (0.8), placebo 10.9 (0.8), p<0.05). SGRQ total score improved by 4.2 (0.7), 2.8 (0.7) and 1.5 (0.7) units during the 6 month trial for the tiotropium, salmeterol and placebo groups, respectively (p<0.01 tiotropium v placebo). Compared with placebo, TDI focal score improved in both the tiotropium group (1.1 (0.3) units, p<0.001) and the salmeterol group (0.7 (0.3) units, p<0.05). Evaluation of morning pre-dose FEV(1), peak FEV(1) and mean FEV(1) (0-3 hours) showed that tiotropium was superior to salmeterol while both active drugs were more effective than placebo. CONCLUSIONS: Exacerbations of COPD and health resource usage were positively affected by daily treatment with tiotropium. With the exception of the number of hospital days associated with all causes, salmeterol twice daily resulted in no significant changes compared with placebo. Tiotropium also improved health related quality of life, dyspnoea, and lung function in patients with COPD.

Administration, Inhalation↗
PubMed2006

A dynamic model for estimating changes in health status and costs.

We develop an innovative method to assess total treatment costs over a finite period of time while incorporating the dynamics of change in the health status of patients. Costs are incurred through medical care use while patients sojourn in health states. Because complete ascertainment of costs and observation of events are not always feasible, some patient utilization will be incomplete and events will also be censored. A Markov model is used to estimate the transition probabilities between health states and the impact of patient variables on transition intensities. A mixed-effects model is used for sojourn costs with transition times as random effects and patient variables as fixed effects. The models are combined to estimate net present values (NPVs) of expenditures over a finite time interval as a function of patient characteristics. The method is applied to a data set of 624 incident cases of cancer. Physical functioning after cancer diagnosis was assessed periodically through structured interviews. The outcomes of interest are normal physical function, impaired physical function, or the terminal state, dead. Charges were obtained from Medicare claim files for 2 years following cancer diagnosis. For demonstration purposes, we estimate NPVs for charges incurred over 2 years by cancer site and cancer stage. Our method, a joint regression model, provides a flexible approach to assessing the influence of patient characteristics on both cost and health outcomes while accommodating heteroscedasticity, skewness and censoring in the data.

Female↗
PubMedDate not supplied

Workers' participation and their health and safety protection in China's transitional industrial economy.

Chinese workers have inherited from the Maoist era two institutions through which they may participate in workplace management--the trade union and the Staff and Workers' Representative Congress. This paper analyzes how workers have participated in the protection of their health and safety through these institutions, describing their functions, on paper, as stipulated by laws and regulations, and in practice, in a printing-machinery shareholding company, based on an in-depth case study. The impacts of these two institutions have declined with industrial economic reform, and the power of the enterprise is shifting toward management. China is confronted with serious occupational health and safety problems. It is imperative to strengthen the mechanisms that engage workers in the prevention of these problems.

Accidents, Occupational↗
PubMed1983

Health maintenance organizations--PHS. Final rule; confirmation of interim rule.

This document finalizes, without change, the interim rule published on January 12, 1983, that amends the Public Health Service regulations on Federal qualification of health maintence organizations (HMOs) to provide for greater flexibility for already existing prepaid health care delivery systems to become transitionally qualified HMOs.

Health Maintenance Organizations↗
PubMed2005

[Epidemiological aspects of the present-day demographic situation in Russia].

Study of reference rate in healthcare institutions in 1991 - 2001 demonstrated a steady growth of general mortality and disease incidence among the population (by 22.7% and 8.1%, respectively). The number of patients with acute and chronic diseases registered in 2001 was by 16.4% higher than that in 1991. These trends were characteristic of all disease classes, but the most intensive growth was observed in such classes as diseases of blood and hemopoetic organs (2.5 times), endocrinal and urogenital diseases (1.8 times). Disease incidence and general mortality among children aged 0 to 14 had grown by 25% and 33.2%, among adolescents--by 60% and 71.1%, among adults--by 5.2% and 20.3%, respectively. These negative trends in population health were accompanied by a constant growth of incapacitation rate in 1990 - 2000 (2.4 times, and 4.3 times among children and adolescents younger than 18). There is a correlation between mortality and traditionally used demographic parameters, which suggests that mortality should be recognized the key demographic parameter. In order to achieve a satisfactory level of population health and adequate demographic transition, and to develop general sanatory strategy, the State should undertake powerful, goal-seeking, society-oriented measures, including deep clinical and epidemiological study of human pathology.

Adolescent↗
PubMed2002

Illicit drug use and its health consequences in Belarus, Russian Federation and Ukraine: impact of transition.

The objective of this paper was to analyze the impact of the transition period on illicit drug use and its health consequences in Belarus, the Russian Federation and Ukraine. Available data were compiled to illustrate the trends and policy responses since 1991, when the countries had become politically independent and implemented radical changes in their social systems, which is particularly prominent in the Russian Federation and Ukraine. The transition period was associated with a rapid and dramatic increase in the supply of drugs combined with an increased demand, which was influenced by a range of social, economic and psychological factors. There was a sharp increase in negative public health consequences too. Inadequate policy responses might have had serious implications for economic and human development in the countries with a total population of more than 200 million people. The role of research to support policy responses is also discussed.

Health Status↗