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PubMedDate not supplied

[Local health systems: a transition of the organized social response].

This paper discusses the transition of the organized social response in health with emphasis on local health systems. After reviewing a few basic definitions (health system, local health system, health care system, institutional system of health services), the author discusses the health transition (transition of the concept health-disease, technological transition, epidemiological transition, demographic transition, health care system transition) and the importance attributed to local health systems in Mexico.

Delivery of Health Care↗
PubMed1991

International health in transition.

The need for a transition towards a new concept of international health is emphasized and a paradigm for making the transition is proposed. The challenge of building a vigorous intellectual and academic tradition of international health which supports its efforts to generate knowledge and leads to its practical application is recognized and addressed. It is argued that the development of such an intellectual field is based on four elements: conceptual base, production base, reproduction base, and utilization base. The Unit for International Studies in Public Health (UISPH) of Mexico is presented as one example of efforts to consolidate an academic tradition in this field.

Education, Medical↗
PubMed2006

[Transition in health care from youth to adulthood for disabled people].

Most children born with a chronic health condition or disability are expected to live more than 20 years. Health care is provided for these children in paediatric units until they are 18 years old, and the transition to the adult health care system is difficult because of poor collaboration between specialists and families who sometimes wonder if the adult specialist will be competent, although young disabled people need specialised follow-up. This report discusses U.S. and English models in the transition in health care. Coordination between paediatricians and adult services is necessary. The neuromuscular disorders clinic is cited as an example.

Adolescent↗
PubMed2006

The diagnosis of breast cancer: transition from health to illness.

PURPOSE/OBJECTIVES: To gain a better understanding of the common meanings and shared experiences that women encounter after a diagnosis of breast cancer. RESEARCH APPROACH: Qualitative using Heideggerian hermeneutics. SETTING: Tertiary breast care center in suburban Buffalo, NY. PARTICIPANTS: Purposive, convenience sampling recruited 30 women. METHODOLOGIC APPROACH: Secondary analysis on tape-recorded interviews of women receiving their last cycle of chemotherapy. Narratives were interpreted using the seven-stage hermeneutic process. MAIN RESEARCH VARIABLES: Life experiences, shared meanings, and perceptions. FINDINGS: Four themes emerged: Changing Health Overnight, Erasing of a Former Self, Appraising of Illness, and Approaching the Future Now What? The constitutive pattern was transitioning from health to illness. CONCLUSIONS: Women experience a precipitous change in their lives after a diagnosis of breast cancer. How they mentally and emotionally approached diagnosis and treatment affected their symptom experience and outcomes. INTERPRETATION: This study provides oncology nurses with the awareness that beyond physical symptoms, women experience profound and precipitous emotional transformation following a diagnosis of breast cancer. It gives meaning to the devastation and symptom distress women experience that may be lessened if they are given adequate information and support. Women in the study who approached diagnosis and treatment more positively better incorporated the breast cancer process into their lives and better managed the side effects of treatment.

Adaptation, Psychological↗
PubMed2004

Health care transitions for adolescents with congenital heart disease: patient and family perspectives.

Advances in medical management and surgical treatment have improved the longevity and quality of life for patients with CHD. However, meeting the health care needs of this growing population has not kept pace with the advances in technology. Adolescents with CHD are caught between both childhood and adulthood and pediatric and adult cardiology. As health care providers develop strategies to meet the special health care transition needs of this group, patient and family perspectives must be understood and included in the transition plan if one is to develop meaningful interventions. Assessment and recognition of the developmental changes occurring for both adolescents and their families and the impact of chronic illness on these changes are critical if transition is to be successful. Expectations,individual biases, and negative stereotypes need to be recognized and reframed if one is to establish an empathetic, positive, and trusting relationship with patients and their families. Greater sensitivity also needs to be given to the shifting roles, responsibilities, and inherent losses that occur with transition. Nurses have a key role in guiding patients and families toward adult, independent self-care by helping them identify and use their talents and resources as they move toward achieving their goals and dreams for the future.

Adaptation, Psychological↗
PubMed2004

Marital status, marital transitions, and health: a gendered life course perspective.

We work from a life course perspective to assess the impact of marital status and marital transitions on subsequent changes in the self-assessed physical health of men and women. Our results suggest three central conclusions regarding the association of marital status and marital transitions with self-assessed health. First, marital status differences in health appear to reflect the strains of marital dissolution more than they reflect any benefits of marriage. Second, the strains of marital dissolution undermine the self-assessed health of men but not women. Finally, life course stage is as important as gender in moderating the effects of marital status and marital transitions on health.

Adult↗
PubMed2005

Mass transit infrastructure and urban health.

Mass transit is a critical infrastructure of urban environments worldwide. The public uses it extensively, with roughly 9 billion mass transit trips occurring annually in the United States alone according to the U.S. Department of Transportation data. Its benefits per traveler include lower emissions of air pollutants and energy usage and high speeds and safety records relative to many other common modes of transportation that contribute to human health and safety. However, mass transit is vulnerable to intrusions that compromise its use and the realization of the important benefits it brings. These intrusions pertain to physical conditions, security, external environmental conditions, and equity. The state of the physical condition of transit facilities overall has been summarized in the low ratings the American Society of Civil Engineers gives to mass transit, and the large dollar estimates to maintain existing conditions as well as to bring on new improvements, which are, however, many times lower than investments estimated for roadways. Security has become a growing issue, and numerous incidents point to the potential for threats to security in the US. External environmental conditions, such as unexpected inundations of water and electric power outages also make transit vulnerable. Equity issues pose constraints on the use of transit by those who cannot access it. Transit has shown a remarkable ability to rebound after crises, most notably after the September 11, 2001 attacks on the World Trade Center, due to a combination of design and operational features of the system. These experiences provide important lessons that must be captured to provide proactive approaches to managing and reducing the consequences of external factors that impinge negatively on transit.

Air Pollution↗
PubMed1991

[The epidemiologic transition in Latin America].

The concept of health transition is considered to include two interrelated processes: transition of health care and epidemiological transition. The latter encompasses three basic processes: (a) replacement of the common infectious diseases by noncommunicable diseases and injuries as the leading causes of death; (b) a shift in peak morbidity and mortality from the young to the elderly; and (c) change from a situation in which mortality predominates in the epidemiological panorama to one in which morbidity is dominant. Latin America is characterized by a heterogeneous health profile in which different countries are in various stages of epidemiological transition. However, in most of them, the transition experience is unlike that of the developed countries and is distinguished by: (a) a simultaneous high incidence of diseases from both the pre- and post-transitional stages; (b) a resurgence of some infectious diseases that had previously been under control; (c) a lack of resolution of the transition process, so that the countries appear to be caught in a state of mixed morbidity; (d) a peculiar epidemiological polarization, not only between countries but also in the different geographical areas and between the various social classes of a single country. This experience is called a "prolonged polarized model."

Adolescent↗
PubMed2003

Straddling the pathway from paediatrician to mainstream health care: transition issues experienced in disability care.

OBJECTIVE: To identify the strengths and limitations of health care and related services provided to young adults with a disability during the period of transition from the care of a paediatrician to the mainstream health system. DESIGN: A descriptive design was used to address the study objectives. SETTING: Barwon and south-western region of Victoria. SUBJECTS: Twelve focus group discussions, with young adults with a disability, carers of young adults with a disability and health care service providers. Each focus group involved eight to 10 participants. RESULTS: The findings revealed a number of problems with the transition period. All participants acknowledged the supportive, coordinating role of the paediatrician. In the absence of this type of role, carers felt they lacked the knowledge and support to manage the adolescent with a disability. Communication problems between all service providers were identified as being problematical. The general lack of continuity of care between providers made it difficult for individuals to negotiate the transition period and increased the burden of care on carers. CONCLUSION: There is a need for policy makers to address these transition problems and develop appropriate services that improve the situation for young adults with a disability and their carers.

Adolescent↗
PubMedDate not supplied

Early cardiovascular changes in 10- to 15-year-old stunted children: the Transition and Health during Urbanization in South Africa in Children study.

OBJECTIVE: Early changes in vascular function could be associated with stunting, which may contribute to the development of cardiovascular diseases in later life. In this study we tested the hypothesis that stunting may be related to changes in cardiovascular function in African children ages 10 to 15 y. METHODS: In the Transition and Health during Urbanization in South Africa in Children study, the health status of children in the North-West Province of South Africa was studied. It was an epidemiologic, cross-sectional study in which 583 black non-stunted and 192 stunted children (stature below the fifth percentile for age) of both sexes ages 10 to 15 y were recruited from 44 schools. Blood pressure was monitored with the Finapres (finger-arterial pressure) apparatus and by means of the Fast Modelflo software program; measurements for systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, heart rate, cardiac output, stroke volume, total peripheral resistance, and arterial compliance were obtained. Dietary intake data were collected with a 24-h dietary recall questionnaire. Nutrient coding was the same for all recalls and macro- and micronutrients were calculated. Anthropometric measurements were done according to standard methods. RESULTS: There were no significant differences in systolic blood pressure and diastolic blood pressure between stunted and non-stunted children after correction for body mass index and heart rate. Stroke volume, arterial compliance, and cardiac output were significantly lower and total peripheral resistance was significantly higher in stunted children than in non-stunted children. No significant differences in dietary intake could be detected, although dietary intakes were slightly lower in the stunted children. CONCLUSIONS: We found that compliance, a marker of vascular function, is significantly lower in stunted children. Stunting was related to early changes in cardiovascular function in African children ages 10 to 15 y.

Adolescent↗
PubMed2003

Quality-of-life outcomes with laparoscopic vs open cholecystectomy.

BACKGROUND: Few studies have assessed the health outcomes of patients who underwent cholecystectomy. The goal of this study was to evaluate the health-related quality-of-life (HRQoL) improvement of patients undergoing laparoscopic versus open cholecystectomy. METHODS: A prospective observational study was performed of consecutive patients on waiting lists to undergo cholecystectomy for nonmalignant disease in six hospitals. Patients were asked to complete two questionnaires that measure (HRQoL)-the SF-36 and the Gastrointestinal Quality of Life Index (GIQLI)-before the intervention and 3 months later. RESULTS: Improvement after surgery, measured by the SF-36 and GIQLI, was similar for both surgical techniques. The SF-health transition item showed a perception of worse health, compared to 1 year previously, for those who underwent open surgery and complications were also higher. CONCLUSIONS: HRQoL improvement at 3 months was relevant and similar for both surgical techniques, although the health transition perception was worse for those who underwent open surgery.

Cholecystectomy↗
PubMed1991

Colonic motility and transit in health and ulcerative colitis.

Preprandial and postprandial colonic motility and transit (scintigraphy), with respect to the splenic flexure, were studied in 10 patients with ulcerative colitis and in 9 healthy subjects. The healthy subjects had a postprandial increase in intraluminal pressure that was significantly (P less than 0.03) greater in the descending colon than in other regions of the colon. In ulcerative colitis, the pressure was decreased in all regions compared with healthy subjects, with no significant pressure gradient among different regions. In normal subjects, transit was quiescent during fasting; eating stimulated both antegrade and retrograde transit. In ulcerative colitis, transit was variable before as well as after the meal. Both healthy subjects and patients with ulcerative colitis had more rapid emptying from the splenic flexure into the sigmoid than into the transverse colon. More frequent, low-amplitude, postprandial propagating contractions occurred in ulcerative colitis (P less than 0.05) than in healthy subjects. Propagating contractions were always antegrade and caused a rapid movement of the tracer into the sigmoid. In conclusion, ulcerative colitis is characterized by (a) decreased contractility, (b) increased low-amplitude propagating contractions, and (c) variable transit. These disturbances may accentuate the diarrhea in ulcerative colitis.

Adult↗
PubMed1987

The high risk infant: transitions in health, development, and family during the first years of life.

Greater numbers of preterm, low birth weight ("high risk") infants are surviving than ever before. It has become increasingly important for physicians and other health care professionals to become familiar with the many real and potential problems seen in this population of children during the first years of life and beyond. The residue of illnesses that are presented in the neonatal intensive care nursery and major health vulnerabilities of the early years are discussed in this article. Normal variations in neurodevelopmental patterns unique to preterm infants and neurodevelopmental disabilities which have a higher prevalence in this population are presented. The impact of a high risk infant on the family unit is described. Finally, resources and interventions available to the child, family, and health care provider during and following the transition from the hospital to home are reviewed.

Child↗
PubMedDate not supplied

[Evaluation of health-related quality of life in hospitalized schizophrenics].

Health related quality of life was evaluated in 40 schizophrenics from day hospital at admission, during the treatment and after 8 weeks. In contrast to the psychopathology which significantly decreased after 4 weeks already, the improvement of quality of life was found to be significant only at the discharge from day hospital. The quality of life did not correlate with the severity of schizophrenic symptoms. The older and more frequently hospitalized patients were, the less favorably they evaluated the quality of life. Patients professionally disabled were also less pleased with their quality of life. All quality of life domains improved after treatment with the exception of physical functioning and reported health transition. Physical functioning, role-physical, general health and mental health correlated inversely with severity of schizophrenia after treatment. There was no correlation between clinical improvement after treatment and quality of life domains. The higher was the patients' educational level the better they evaluated their vitality, social functioning and reported health transition.

Adult↗
PubMed1998

Life transitions and health insurance coverage of the near elderly.

OBJECTIVES: This study addresses three issues. (1) What are demographic wealth, employment, and health characteristics of near-elderly persons losing or acquiring health insurance coverage? Specifically, (2) what are the effects of life transitions, including changes in employment status, health, and marital status? (3) To what extent do public policies protect such persons against coverage loss, including various state policies recently implemented to increase access to insurance? METHODS: The authors used the 1992 and 1994 waves of the Health and Retirement Study to analyze coverage among adults aged 51 to 64 years. RESULTS: One in five near-elderly persons experienced a change in insurance coverage from 1992 to 1994. Yet, there was no significant change in the mix of coverage as those losing one form of coverage were replaced by others acquiring similar coverage. CONCLUSIONS: Individuals whose health deteriorated significantly were not more likely than others to suffer a subsequent loss of coverage, due to substitution of retiree or individual coverage for those losing private coverage and acquisition of Medicaid and Medicare coverage for one in five uninsured. State policies to increase access to private health insurance generally did not prevent individuals from losing coverage or allow the uninsured to gain coverage. Major determinants of the probability of being insured were education, employment status of person and spouse, and work disability status. Other measures of health and functional status did not affect the probability of being insured, but had important impacts on the probability of having public coverage, conditional on being insured.

Death↗
PubMed2004

Health care transition in congenital heart disease: the providers' view point.

Unfortunately, despite recommendations for educational training of ACHD health care providers and the goal to create regional ACHD centers, current needs still far outweigh appropriate available services. From a practical standpoint, we will need to work from our current models of health care delivery, which vary because of geographic and institutional issues and the availability of appropriate resources, toward the ideal goal of regional ACHD centers. Successful transition of adolescents and adults with CHD requires collaboration and planning between the pediatric health care team and the ACHD health care team. Good communication and an atmosphere of mutual respect are essential. All members of the ACHD health care team need to be committed to improving the process of transition for the adolescent and adult with CHD. The advanced practice nurse (CNS or ARNP) from both the pediatric program and the adult program are often key players in this process. As ACHD health care providers, we must work toward decreasing barriers to care and become organized advocates for our patients. Ultimately, our goal is not only to provide a smooth transition from one model of care to another, it is to create a health care delivery system that will maximize the lifelong potential and function of adults with congenital heart disease.

Adolescent↗