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PubMed1999

Legal and ethical perspectives on delivery of reproductive and sexual health services in the countries of eastern Europe and the CIS (countries with economies in transition, Europe).

International human rights conferences have repeatedly declared that reproductive and sexual health and choice are human rights entitled to protection and respect. This is no less true in the countries of Eastern Europe and the New Independent States (NIS). It was widely believed that the dissolution of the former Soviet Union and of Communist rule in Eastern Europe would lead to conditions of greater freedom, health and prosperity and to a time of greater respect for reproductive health and rights of choice. In fact, that has not happened; in some respects, the situation in these countries is now worse than before. This article examines the current state of reproductive and sexual health in these countries and several of the reasons why conditions, generally speaking, have not improved since the transition. It closes by identifying some suggestions for positive change and some resources for reproductive health advocacy in these countries.

Adolescent↗
PubMed2006

Health-risk behaviors and health promotion in adolescent and young adult cancer survivors.

A diagnosis of cancer during adolescence, a period characterized by experimentation and risk-taking behaviors, has the potential to derail critical developmental tasks required for successful transition into adulthood. Health professionals caring for adolescents and young adults have an opportunity to influence behavioral practices by correcting knowledge deficits, addressing factors that enhance the survivor's sense of vulnerability to health problems, and providing personalized health counseling that encourages the practice of health promoting behaviors. The approach to health counseling in childhood cancer survivors should consider their unique educational needs related to their cancer experience. Previous investigations of adolescent and young adult survivor health behavior indicate that survivors perceive themselves as more vulnerable to health problems than their peers without cancer and recognize a need to protect their health. However, these perceptions of health vulnerability do not always correlate with health promoting behavioral practices, suggesting that factors other than health perceptions should be investigated to motivate behavioral change. Very few studies have been undertaken to prospectively evaluate the effectiveness of health promotion programs in adolescent and young adult survivors of cancer. The scarcity of knowledge in the issue of health promotion after childhood cancer underscores the need for more research to define 1) the optimal timing of health counseling; 2) the influence of developmental status and neurocognitive function; 3) the most effective methods and venues for health education; 4) the feasibility and cost-effectiveness of health promotion strategies; and 5) psychosocial and economic impediments to practice of healthy behaviors.

Adolescent↗
PubMed2002

Health sector reform in South Asia: new challenges and constraints.

In early 1990s, Jamison, Mosley and others concluded that a profound demographic and consequent epidemiological transition is taking place in developing countries. According to this classical model, by the year 2015, infectious diseases will account for only about 20% of deaths in developing countries as chronic diseases become more pronounced. These impending demographic and epidemiological transitions were to dominate the health sector reform agenda in developing countries. Following an analysis of fertility, mortality and other demographic and epidemiological data from South Asian and other developing countries, the paper argues that the classical model is in need of re-evaluation. A number of new 'challenges' have complicated the classical interplay of demographic and epidemiological factors. These new challenges include continuing population growth in some countries, rapid unplanned urbanization, the HIV/AIDS pandemic in Sub-Saharan Africa (and its impending threat in South Asia), and globalization and increasing marginalisation of developing countries. While the traditional lack of investment in human development makes the developing countries more vulnerable to the vicissitudes of globalization, increasing economic weakness of their governments forces them to retreat further from the social sector. Pockets of poverty and deprivation, therefore, persist giving rise to three simultaneous burdens for South Asia and much of the rest of the developing world: continuing communicable diseases, increasing burden of chronic diseases, and increasing demand for both primary and tertiary levels of health care services. While these complex factors, on the one hand, underscore the need for health sector reform, on the other, they make the task much more difficult and challenging. The paper emphasizes the need to revisit the classical model of demographic and epidemiological transition. It is argued that the health sector in developing countries must be aware of and effectively address these 'new challenges'. Although it has included data from many developing countries, the focus is primarily on South Asia.

Bangladesh↗
PubMed2002

Health manpower planning in Slovenia: a policy analysis of the changes in roles of stakeholders and methodologies.

A heightened awareness about medical manpower issues can be observed in countries that are in a state of political, economic, and social transition. Slovenia entered the transition process in 1989 and became an independent country in 1991. Transition and independence influenced its health care in several ways. It changed the health care system and its financing (by introducing a Bismarckian style of social insurance). It then redistributed power from the Ministry of Health to several stakeholders. A major change occurred in the labor market in health care when the flow of health professionals from the newly independent countries greatly decreased. The decrease was partly due to the consequences of the war in the Balkans and partly due to independent labor legislation in Slovenia. Transitional changes brought new stakeholders to the scene, with a resulting redistribution of responsibilities for health manpower policies and the use of various methodologies. This policy analysis offers a detailed description of the contextual framework, quantitative data on medical manpower development, and, most important, interviews with representatives of the key stakeholders and study of relevant policy documents. We conclude that all stakeholders underpin the need for a structured approach toward health manpower planning in the form of a more coherent system of planning, decision making, and control. A compromise on mutual responsibilities between the less dominant Ministry of Health and the two new powerful stakeholders, the Health Insurance Institute of Slovenia and the Medical Chamber of Slovenia, seems necessary.

Health Care Coalitions↗
PubMed2004

Potential future studies on the nutritional status among indigenous peoples in Alaska and the Russian Far East: preliminary assessment of the Social Transition in the North data set.

OBJECTIVE: The purpose of this assessment is to examine the nutrition-related health data collected during the Social Transitions of the North (STN) study for understanding cultural differences between nations and the impact on nutritional status. METHODS: The nutrition data in the STN study was collected in two regions of Alaska (Northwest Arctic and the Aleutian Islands) and in two regions of the Russian Far East (Kamchatka and Chukotka). The health questionnaire explored several factors that may contribute to identifying the nutritional status of the study populations. These factors were appetite, weight, subsistence food consumption, vitamin or mineral supplements use self-perception of health, special diets, and number of meals consumed with relatives. RESULTS: US populations were heavier than the Russian population (p = 0.0001). Both the Alaskan and Russian populations are frequent users of subsistence foods. The US respondents reported consuming 75% or more of the total protein as subsistence protein more often (40%) than the Russian respondents (25%). CONCLUSION: US respondents perceive themselves as healthier than their Russian counterparts. The US respondents consumed greater amounts of subsistence foods in general, and more of their diet over the year is made up of Native protein.

Adult↗
PubMed1997

Gastrointestinal transit and prolonged ambulatory colonic motility in health and faecal incontinence.

BACKGROUND: Colonic motor function has not been studied in the ambulatory setting over a prolonged period in the unprepared state. Furthermore, the disturbance of this function in patients with faecal incontinence is unknown. AIM: To study colonic function over two to three days in the ambulatory, unprepared state in health and in patients with idiopathic faecal incontinence. METHODS: Six healthy women and six women with faecal incontinence and a structurally intact anal sphincter ingested a dual radioisotope meal, and had a six sensor, solid state manometric probe colonoscopically inserted into the left colon. Scanning was performed until radioisotope left the gut and pressure was recorded for a median of 44 hours. RESULTS: Three of six patients showed abnormal gastric emptying. Patients showed no disturbance of colonic radioisotope transit. Controls had a median of 12, whereas patients had a median of 16, high amplitude propagated waves per 24 hours. In three patients urge incontinence was associated with high amplitude (up to 500 cm water) propagated waves which often reached the rectum. These high pressure waves were identical to those occurring in healthy subjects, the only difference being the lack of adequate sphincter response. Passive incontinence was not associated with colonic motor activity. Defaecation in all subjects was associated with identical propagated waves, and distal movement of 13% (median) of right colonic content and excretion of 32% from the left colon and rectum. The urge to defaecate was associated with either propagated waves (45%) or non-propagated contractions (55%). Rectal motor complexes were recorded in both groups of subjects, but similar rhythmic activity was also recorded in the sigmoid and descending colon. CONCLUSIONS: Normal colonic function consists of frequent high pressure propagated waves. Rhythmic activity occurs both proximal to and in the rectum. Defaecation is characterised by high pressure propagated waves associated with coordinated anal sphincter relaxation. Patients with faecal incontinence may have a widespread disturbance of gut function. Urge incontinence, an urge to defaecate, and defaecation can all be associated with identical high amplitude propagated pressure waves.

Aged↗
PubMed2000

Hans Castorp's journey-to-knowledge of disease and health in Thomas Mann's The Magic Mountain.

The paper examines Thomas Mann's novel, The Magic Mountain, to show how imaginative literature can enhance our understanding of health in place. The story centers on the experiences of Hans Castorp, a young bourgeois German, at a tuberculosis sanatorium in the Swiss Alps. Three themes are examined: (1) how knowledge about illness and health, death and life, is gained; (2) how knowledge is arrived at through a dialectical process which reconciles seeming opposites; and(3) how new knowledge is gained through making transitions. Lessons for health geography are drawn from analysis of the three themes.

Adaptation, Psychological↗
PubMed1992

Diabetes mellitus in the transition to adulthood: adjustment, self-care, and health status.

A cross-sectional study of health and adjustment among 18 to 22-year-old patients with insulin-dependent diabetes mellitus (IDDM) is reported. Objectives were to examine coping with IDDM in this age group; to identify predictors of health status, treatment adherence, and health care use; and to provide a retrospective evaluation of the persistence of IDDM-specific adjustment from earlier through later adolescence. Multiple validated measures, interviews of independent informants, and biochemical assays were used to assess psychological, behavioral, and metabolic status. Patients and parents completed a retrospective measure of the patient's adjustment to IDDM during earlier adolescence. Findings (n = 81) indicated: (1) normal rates of general psychopathology but some evidence of poorer adjustment to IDDM relative to other age groups, (2) poor diabetic control and high incidence of microalbuminuria, (3) specific factors associated differentially with treatment compliance, health care use, diabetic control, and microalbuminuria among late adolescents, and (4) evidence that poor adjustment to IDDM in earlier adolescence persists into the transition to adulthood. The findings imply that late adolescents with IDDM are at risk of various unfavorable behavioral and health outcomes and that adjustment to the disease during earlier adolescence may be a predictor of subsequent health-related behavior and health status. A longitudinal study is needed to confirm these findings.

Adaptation, Psychological↗
PubMed2001

The impact of social change on child mental health in Eastern Europe.

The transition of the Eastern European countries in the past 12 years from totalitarian, communist societies to democratic societies has had a broad impact on children's mental health, both positively and negatively. This transition has not been without economic difficulties. All countries in the region experienced a significant deterioration of output that has affected the availability of commodities and services. Although recovery has been achieved in some Eastern European countries and is in progress in other countries, reversal of the cutbacks in allocations to necessary services that protect children and families may take longer to achieve. Movement toward a free market economy and greater individualism also has focused attention away from the role of society to protect and provide care for its citizens, especially the most vulnerable. On the positive side, mental health, as a concept for children and adults, comes to be appreciated only in a society that values and safeguards individual rights. Democratic process within the family, the depoliticization of mental illness, the passage of laws assuring basic children's rights, services for and public awareness about children abuse, reforms in education, the proliferation of mental health clinics and support centers, and the resumption of training of mental health professionals all set a tone to first consider, then assure, the positive development of children's mental health.

Adolescent↗
PubMedDate not supplied

Shaping the advanced practice psychiatric-mental health nursing role: a futuristic model.

As advanced practice psychiatric-mental health nursing has transitioned from earlier models of practice, elements of clinical specialist and psychiatric nurse practitioner roles are being blended to produce a new type of practitioner. The challenge of preserving mental health expertise while expanding advanced practice primary and primary mental health care competencies is addressed in several nursing education models. At New York University's Division of Nursing, faculty have designed a program around elements identified as essential to the autonomy demanded of the evolving role, knowledge, and skills basic to broad based health care and mental health care delivery with quality patient care outcomes and the competencies necessary for accountability as care providers in a changing health care delivery system. Essential elements, resources to identify them, and strategies to attain them are discussed. Approaches that promote student, clinician, and faculty development and maximize education affirm the specialty's capacity for innovation and the profession's capacity for new direction and futuristic change.

Curriculum↗
PubMedDate not supplied

Role insufficiency and role supplementation: a conceptual framework.

A theoretical basis for the diagnosis of nursing problems, centered on the concepts of role insufficiency and role supplementation, is offered. Role insufficiency is anticipated and experienced by clients during role transitions with developmental, situational, and health-illness implications. The conceptual basis of nursing intervention is role supplementation, and components, strategies, and processes of role supplementation are described. Conditions that predispose clients in the health setting to undergo role transition, conditions under which aspects of role transition may become nursing problems, and the role of the nurse in dealing with clients' role transition problems are described. A predictive and prescriptive paradigm, showing the interaction of construct components, is presented.

Communication↗
PubMed2002

Nurses in corporate America: embracing power through influence.

Executive positions in corporate America offer nurse leaders the opportunity to influence product development and services delivered to ensure that the best possible solutions are provided to health care organizations, providers, and patients. This opportunity to "make a difference" is a critical component for nurses' attraction to migrating to the business side of the health care industry. However, making the transition from leadership positions in health care delivery organizations to corporate businesses carries big challenges. A major demand is for nurse leaders to adjust from direct span of control organizational models to matrix management structures used in complex business organizations.

Altruism↗
PubMed1991

[Rural medicine and public health: the state and ways of improvement].

In connection with the publication of the article "On the rural medicine" by O. L. Sigailo in "Sovetskoye Zdravokhraneniye" 1990, No. 6, we attempted in a proper controversial way to specify some statements made in the above-mentioned paper and give our view of the above problem using our own findings. Primarily, in accordance with the data of Comprehensive Soviet Encyclopedia, a possible permissible specification of the article title was provided which would properly correspond to its contents. In this respect we expressed the opinion that publications such as this should provide a wider description of measures which would characterise the state of current rural medicine and public health. By this we mean a number of demographic indicators, the health status of different population groups, the material basis and its capacity, prospects for development, approaches to health personnel of high and medium qualification. The most important thing which we reproach the author with is the absence of clear-cut statement that the major problem of rural medicine (using the terminology of Dr. Segailo) is how to use the available health resources. And, moreover, one cannot help but express one's opinion on such vital problems as preparation for total medical survey of population, disease-caused temporary disability, the transition of public health to the new economic mechanism, insurance medicine.

Allied Health Occupations↗
PubMedDate not supplied

Transition to university and vigorous physical activity: implications for health and psychological well-being.

The authors investigated vigorous physical activity and psychological well-being during transition from high school to first-year university in a sample of 145 Canadian undergraduates. Participants completed retrospective measures assessing vigorous physical activity during their first 2 months at university and their last 2 months at high school as well as measures assessing psychological well-being. According to nationally recommended (US Department of Health and Human Services) standards, two thirds (66.2%) of students reported adequate levels of vigorous activity in high school, whereas significantly fewer (44.1%) met the standard during their first 8 weeks at university. One third of students were active in high school but became insufficiently active once at university; 33% were active at both times; 23% consistently fell short of recommended levels; and only 11% became active once at university. Students who had become insufficiently active reported higher levels of fatigue and lower levels of vigor compared with those who continued to be active.

Adolescent↗
PubMed1997

Grey glasses: sadness in young women.

Sadness as a developmental phenomenon in young women was discovered in a study designed to identify developmental transitions and the relationship of these transitions to mental health. Sadness is conceptualized as a pervasive feeling of disillusionment and unhappiness that influences the meaning of life events and decision-making. Field research and interpretive analysis techniques were used to observe, describe and analyse the life experiences of 25 volunteer participants. For most women in the study, sadness was found to be time-limited and perhaps had beneficial effects. Some women, however, were unable to resolve sadness and became depressed. Sadness can be an antecedent to depression. Sadness that is recognized and validated may facilitate reshaping of a woman's expectations, a form of cognitive restructuring. The transitional nature of sadness has important implications for women's mental health.

Adaptation, Psychological↗
PubMedDate not supplied

Health and home for homeless people in transition.

In recent years, increasing focus has been placed on the relation between environmental qualities and the promotion of well-being. This paper explores this relationship from an environmental psychological approach that emphasizes the broader social and physical context and the central significance of individual goals. In particular, the qualities of home and their potential value in the promotion of well-being are discussed. This paper presents a review of recent literature, followed by an empirical study of homelessness in London. A sample of 531 adults was staying in squats, hotels, hostels, and on the streets. Each setting was examined in terms of qualities of home and a general level of well-being. The results suggest that this sample experienced low levels of well-being, typical of persons experiencing such upheaval. Furthermore, there may be a positive relation between levels of well-being and home-like qualities for some homeless settings. The paper concludes that a focus on qualities of home may contribute to a broader understanding of health and well-being that values individual experience and goals.

Adaptation, Psychological↗
PubMed1994

Forming the system of health insurance in the Russian Federation.

A radical reform is being prepared in the Russian Federation health care. Its major point is a transition from tax-financed national health system to social health insurance. The paper highlights the issues of forming the system of health insurance. First, the arguments for a transition to a new model of finance are discussed. Secondly, the concept of the new model and its implementation in the context of the regional experiment are addressed. A discussion of current and expected developments focuses on two major issues: monopsony or pluralistic model of third-party purchasing? What is important for forming the market of health care provision? The major argument is that a transition from a highly integrated to a contractual model may start with regional monopsony or some version of it. A pluralistic model of third-party purchasing needs a refined regulation and may not meet health policy objectives. It is also argued that on the first stage of reform implementation forming the market of health care provision is more dependent on its regulation and management than on the market structure of health care purchasing.

Economic Competition↗
PubMed2003

Examination of risk status transitions among active employees in a comprehensive worksite health promotion program.

Most worksite health promotion programs are designed to effect risk reduction. Net changes in the prevalence of health behaviors are a combination of individuals who reduce to low-risk and those who become high-risk. It is the purpose of this study to examine overall risk status transitions, between low-risk (0-2 risks); medium-risk (3-4 risks); and high-risk (5 or more risks), within a comprehensive worksite health promotion program over the first year of the program (short-term) and after 5 years (long-term). Significant increases were demonstrated in the numbers of individuals who transitioned to lower risk status. Nearly half (0 percentage points) of the net reduction to low-risk status (+10.4 percentage points) occurred during the first year of the program. The design of health promotion programs may need to be adjusted from risk reduction in the short-term to programs that maximize retention of individuals within low-risk categories over the long-term. This program design would maximize the opportunity to obtain initial risk reduction during the first years of the program and then maximize the opportunity to maintain low-risk status in the long-term.

Adult↗