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At least 1,423 records · Page 79Linked to original sources
PubMed2005

Planning for PPM-DOTS implementation in urban slums in Kenya: knowledge, attitude and practices of private health care providers in Kibera slum, Nairobi.

SETTING: Kibera, the largest slum in Nairobi, Kenya. OBJECTIVE: To determine the tuberculosis (TB) knowledge, attitude and practices (KAP) of private health care providers (PHCPs) to identify their training needs and willingness to participate in a National Leprosy and Tuberculosis Control Programme (NLTP) guided TB control effort in the slum. DESIGN AND METHODOLOGY: A cross-sectional survey. The KAP of PHCPs was assessed using an interviewer administered questionnaire. RESULTS: Of 75 PHCPs interviewed, the majority (96.0%) were paramedics; 51 (77.1%) did not consider sputum smear microscopy crucial in patients presenting with prolonged cough or when a chest X-ray was suggestive of TB; of 29 (38.7%) who indicated familiarity with the drugs used in TB treatment, 20 (58.5%) would have chosen the NLTP-recommended regimens for the treatment of the various types of TB; 16 (21.3%) PHCPs indicated that they treated TB, six (37.5%) of whom were not familiar with anti-tuberculosis drug regimens. All the PHCPs referred TB suspects to the public sector for diagnosis. CONCLUSION: This study reveals a significant gap in TB knowledge among the PHCPs in Kibera slum. However, given appropriate training and supervision, there is potential for public-private mix for DOTS implementation in this setting.

Allied Health Personnel↗
PubMed2004

Socio-demographic characteristics and clinical features among patients attending a private paediatric dental clinic in Nairobi, Kenya.

OBJECTIVES: To evaluate the socio-demographic characteristics, chief complaints and clinical presentation of children attending a private dental clinic in Nairobi, Kenya. DESIGN: A retrospective survey of dental clinic records. SETTING: A private dental clinic in Nairobi, Kenya. SUBJECTS: All patients aged 0-18 years who were first-time attenders at the dental clinic during a three year period. RESULTS: The records of 800 patients were examined, comprising 395 males and 405 female children. The average age was 7.2 years (95%CI, 6.9-7.4). Referral to the clinic for treatment was mostly by self (81.4%). Most patients (57.9%) were self-sponsored for their dental treatment. Majority of the patients attending (86.8%) did not clinically have any underlying medical conditions. The major complaints for most patients were dental decay (27.4%) and dental pain (21.6%). Very few children (7.6%) attended for dental check-up. Five hundred and forty nine (68.6%) of the children suffered from dental decay while 294 (36.8%) suffered from gingivitis. The average number of teeth decayed was 4.02, SD +/- 2.4 (95% CI 3.8-4.2). Most carious lesions occurred in the younger children. There was a significant increase in the occurrence of decay over the three year period of the study. Significantly higher levels of gingivitis was observed in the prepubertal and pubertal age group. Attendance for traumatic injuries was relatively low with only 46 (5.8%) children reporting traumatic injuries to their dentitions. Most traumatic injuries involved the anterior teeth as a result of falls. Treatment given at the first visit was mainly restorative (28.6%) followed by dental extractions (25.4%). CONCLUSION: The average are of patients attending the clinic was 7.2 years. Interdisciplinary referral was low since most patients were self-referred and self sponsored for treatment. Dental caries was prevalent, necessitating a high demand for restorative treatment. Although gingivitis was less prevalent, it was significant among children in the prepubertal years.

Adolescent↗
PubMed2003

[Guidelines of the OIE (world organisation for animal health) for the organisation of Veterinary Services and their relations with private-sector partners, with particular reference to developing countries].

Developing countries are being confronted with changes in the international rules governing trade in animal products. At the same time, state control over Veterinary Services, which has been in place for many years, is gradually giving way to private-sector involvement. In light of these developments, the International Animal Health Code (the Code), must ensure that it includes guidelines that take into account the new role of private-sector professionals. Integrating these professionals into the national networks of Veterinary Services is vital for the improvement of the services. Moreover, the situation in the field in developing countries has at times given rise to the emergence of 'alternative' methods of veterinary care, whose uncontrolled development may be an obstacle to achieving the required levels of service provision. It is recommended that countries shun apparently attractive short-term solutions, and adapt their national legislation to allow for the gradual reform of their Veterinary Services, pursuant to international standards.

Animals↗
PubMed2005

Evaluation of annual exposure to noise among private farmers on selected family farms of animal production profile.

The aim of the study was the recognition and evaluation of annual exposure to noise among private farmers on family farms of animal production profile. The study covered 16 family farms using arable land of the size of 14-50 ha (25.8 ha on average), equipped with agricultural tractors (working with a set of agricultural machines), machines for the production of fodder, workshop machines and woodworking saws. Based on the precise working time schedules concerning agricultural activities and dosimetric measurements conducted during the whole year, two acoustic parameters were determined: total exposure in individual months and equivalent daily exposure. The study showed that the highest values of the total monthly exposure to noise occurred in two summer-autumn months (August, October) and during four winter-spring months (January, March, and May, June). High values of the total exposure observed in the summer-autumn season result from the performance of intensive field and transport work activities, with prolonged duration of work and a large number of workdays in these months. The occurrence of high total values of the total exposure in winter-spring months, however, is associated with logging wood for winter (saws) and intensive repair work activities. In the seasons of the year analysed, high values of equivalent daily exposure were obtained, within the range: 4.20-4.86 Pa(2) x h. The average value of this parameter for the whole year reached the value: 3.61 Pa(2) x h (standard exceeded 3.6 times). This value is equivalent to the mean level of exposure to noise equal to 90.5 dB. In consideration of the moderate accuracy of mean values obtained and small degree of variability of the results, the data acquired in this study may be used in practice by proper State services for the evaluation of noise risk among private farmers specializing in animal production.

Agricultural Workers' Diseases↗
PubMed2005

Diabetes control and complications in private primary healthcare in Malaysia.

This Diabcare-Asia project was initiated to study the status of diabetes care and prevalence of diabetic complications in Asia and this study was done to evaluate the above in primary private healthcare in Malaysia. A total of 49 private clinics participated in this study from which a total of 438 patients were included and analysed. The majority of patients (96.5%) had type 2 diabetes mellitus and 81.4% had BMI > or =23 kg/m2. Only 12.0% of the patients had their HbA1c measured in the preceding 12 months. As for glycaemic control only 20% of the patients had HbA1c <7% and 11% had FPG < 6.7 mmol/L. As for lipid levels, only 12.3% of the patients had total cholesterol < 4.8 mmol/L; 30.9% had HDL-cholesterol > 1.2 mmol/L and 49.8% had triglycerides < 1.7 mmol/L. Despite the high proportion of patients having dyslipidaemia. only 12.4% of the patients were on lipid lowering therapy. As for blood pressure, 55.9% of the patients had systolic pressure > or =140 mmHg and 40.9% had diastolic pressure > or =90 mmHg. However, only 32.4% of the patients were on antihypertensive medication. Only 37.4% of the patients admitted to adhering to diabetic diet regularly and 32.0% exercised regularly. As for glucose monitoring only 6.9% of the patients did home blood glucose monitoring and 6.2% did home urine glucose. There was also a high complication rate with the commonest being neuropathy (30.1%) followed by background retinopthy (23.5%), albuminuria (22.9%) and microalbuminuria (20.4%). In conclusion, the majority of diabetic patients treated at the primary care level were not satisfactorily controlled and this was associated with a high prevalence of complications. There is an urgent need to educate both patients and health care personnel on the importance of achieving the clinical targets and greater effort must be made to achieve these targets.

Diabetes Complications↗
PubMed2005

Leadership, management and technical lessons learnt from a successful public-private partnership for TB control in Nepal.

BACKGROUND: There is considerable interest in involving private practitioners (PPs) in tuberculosis (TB) control, but little experience. OBJECTIVE: To describe and discuss leadership, management and technical lessons learnt from the successful implementation of a public-private partnership (PPP) for TB control in Nepal. METHODS: Description and discussion of implementation of the PPP is based on feedback from the working group charged with developing the PPP, PPs involved in diagnosis and referral, NGOs providing direct observation of treatment and tracing of late patients, and members of the Nepal National TB Programme. FINDINGS: The process of building the partnership was slow and demoralising, yet with perseverance partners gradually increased their involvement and commitment to the PPP. Leadership was needed to foster communication and openness between partners. It was not necessary to involve all PPs: many patients bypassed PPs and went directly to the free DOTS centres. CONCLUSION: An understanding of issues that arose during development of the Lalitpur PPP may assist assessment of the feasibility of PPPs in other settings, and increase the likelihood of successful implementation. The wider literature on partnerships may be useful to further inform the development of PPPs for health in developing countries.

Antitubercular Agents↗
PubMed2005

Efficacy of halogen photopolymerization units in private dental offices in Toronto.

PURPOSE: Light units used for polymerization of resin composites are subject to deterioration with age, and frequent maintenance is required to maintain optimal efficacy. This study examined the efficacy of quartz-tungsten-halogen light units in private dental offices in Toronto for polymerization of resin composites. MATERIALS AND METHODS: One hundred dental offices met all selection criteria and agreed to participate in the study. The light intensity was determined for a total of 214 light units. Disk-shaped specimens, 2.5 mm thick, were made from 2 resin composites (Charisma, Heraeus Kulzer; Point 4, Kerr Corp) and were subjected to photopolymerization: Charisma for 20 seconds (99 units) and Point 4 for 20 and 40 seconds (all 214 units). Knoop hardness values for the upper and lower surfaces of each specimen were determined, and relative hardness values (hardness of lower surface/hardness of upper surface x 100) were calculated. Data were analyzed using descriptive statistics, t-tests, 1-way analysis of variance, and simple and multiple linear regression (a = 0.05). RESULTS: The light intensity of the individual units varied widely, from 120 to 1,000 mW/cm2. Surface hardness and relative hardness were significantly (p < 0.05) and positively associated with light intensity, and wide ranges in surface hardness and relative hardness values were observed. Mean relative hardness ranged from 34.8% to 57.7%. CONCLUSIONS: Light polymerization units in private dental offices displayed a wide range in light intensity, and many had below-recommended levels. Of the resin composite specimens polymerized for 40 seconds with each of the 214 light units, only 10% reached the desired relative hardness of at least 80%. A positive linear relationship was found between light intensity and relative hardness. Increased exposure time resulted in a significant increase in relative hardness. Also, relative hardness was found to be dependent on the brand of composite material used. Dentists should regularly monitor the condition of light units and replace deteriorating parts.

Analysis of Variance↗
PubMed1992

Private patients' perceptions of nursing practice in the National Health Service.

A study of private patients (n = 649) was carried out in Wessex Region in January 1991 to discover why patients decide to go private rather than use the NHS for in-patient treatment. Relatively few patients complained of the attitudes of nurses in the NHS, but just over one third mentioned nursing as a significant problem in the NHS and, of this group, over half were critical of nurses' attitudes. Further analysis revealed that these perceptions were not based on direct experience (of those who said that nursing was a problem, only 5 per cent had been NHS in-patients since 1985), but alarm about the public image of nursing remains.

Adult↗
PubMed2005

Intervention studies on rational use of drugs in public and private sector in Nepal.

In developing countries, inappropriate, inefficient and ineffective use of pharmaceuticals have resulted into the poor health and medical cares for the community people. For improving the situation, various interventions have been tested and proved effective in different settings. In Nepal also, various strategies have been tested and found effective to improve the prescribing and dispensing practices. This paper has examined the process and results of different studies. The educational intervention, the training has not been effective in improving the prescribing practices but has limited effect on dispensing practices in the public sector. However, it becomes effective in improving prescribing practices if combined with a managerial intervention e.g. peer-group discussion. In private sector, training alone is effective in changing the drug recommendation practices of retailers. But none of interventions have been found to be effective in improving dispensing practices. After examining the effectiveness of different interventions, training combined with peer-group discussion is recommended for piloting in all Primary Health Care (PHC) outlets of a district to improve the prescribing practices. For improving the dispensing practices in both public and private sector, additional studies have to be carried out using different strategies.

Child, Preschool↗
PubMed2005

Dollars and sense. Is there a better way to determine private surgical fees in New Zealand?

In New Zealand, private insurers reimburse surgeons on a fee-for-service basis. Ideally, the level of reimbursements should reflect competitive market prices. Due to concerns such a market does not exist, other countries have adopted Relative Value Scales (RVS) to estimate a fair reimbursement level for different procedures. No such scale exists in New Zealand for surgeons, but it does for anaesthetists. This study compares reimbursements to surgeons and anaesthetists from private insurers using data from 3186 procedures performed between 1996 and 2002. We calculate an implicit hourly rate of reimbursement and compare the level of reimbursement between procedures and the variance of reimbursements within procedures for surgeons and anaesthetists. The results suggest that there are significantly greater deviations in average reimbursements between procedures for surgeons than for anaesthetists. Furthermore, the variability of reimbursements is greater for reimbursements to surgeons within specific procedures. While the results do not necessarily imply that surgical reimbursements are inconsistent with underlying market rates, the results are consistent with the hypothesis that anaesthetist's fees show greater stability because of the existence of a RVS. We conclude by discussing what would be required to implement a RVS for surgical fees in New Zealand.

Anesthesiology↗
PubMedDate not supplied

Costs and benefits of private finance initiative schemes.

The private finance initiative (PFI) is the biggest building programme in the history of the NHS. It aims to raise the quality of health care facilities by utilising the skills and expertise of companies in the private sector. This article outlines what PFI involves, how it works and the benefits to the NHS in raising the quality of health care facilities.

Cost-Benefit Analysis↗
PubMed2006

Health care financing and public responses: use of private insurance in Western Australia during 1980-2001.

OBJECTIVES: The aim was to identify and explain trends and cut points in payment classification (privately insured or otherwise) for episodes of hospitalisation in Western Australia. METHODS: Hospital morbidity data from 1980 to 2001 were used to produce trend lines of the proportion of hospital separations in each payment category in each year in age and clinical subgroups. RESULTS: The most significant changes in payment classification over time were found in all groups between 1980 and 1984, corresponding to a period when free public hospital care in Australia was abolished (Sep 1981 to Feb 1984). The trend associated with this policy change rebounded significantly just before the introduction of Medicare in 1984. These observations were consistent over all age groups except in the oldest group (70+ years). This trend was more pronounced for the surgical subgroup compared with other broad clinical categories. More recently, a trend towards increasing public episodes was reversed from 2000 following introduction of incentives for private health cover and sanctions against deferred uptake in younger people. CONCLUSION: The public appeared to adopt a short-term crisis reaction to major policy change but then reversed towards past patterns of behaviour. The implications for policy makers include the need to understand the underlying culture of the population; to realise that attitudes become fixed as people age; and to recognise the difference in the effectiveness of incentive- and deterrent-based policies.

Adolescent↗
PubMedDate not supplied

[Comparative analysis of nutritional status, food intake and length of hospitalization considering two hospitals: public versus private].

INTRODUCTION: To assess the nutritional status of hospitalized patients is important for the prevention of hospital malnutrition and planning of nutritional intervention. OBJECTIVE: To comparatively analyze the nutritional status of patients admitted to two hospitals, one public and another private, caring for populations with different socioeconomic profiles. CASE STUDY AND METHODS: This was a prospective study and samples were collected from patients of two hospitals, one public (PUH) and another private (PRH), which respectively represent the underprivileged and the more affluent populations. The analysis considered 51 patients from the PUH, aged between 53.9 +/- 15.6 years and 51 from the PRH, aged between 55.0 +/- 13.9 years, paired and grouped according to the following diseases: neoplasia (n+25), digestive tract disorders (n+11) and others (n+15). The statistical analysis was made by means of the T-Student test to compare PUH and PRH variables with p < 0.05, as well as to compare different variables in the same hospital, with p < 0.05; p < 0.01; p < 0.005 and p < 0.001. RESULTS: There were no statistical differences when the variables evaluated in both hospitals were compared, except for the length of hospitalization of patients with digestive tract disorders, which was longer for HPR. Upon hospitalization, 21.0% and 17.6% presented a body mass index (BMI) indicative of malnutrition. The patients with neoplasias presented current weight (CW) lower than habitual weight (HW). Both the patients with neoplasias and those with digestive tract disorders presented insufficient energy consumption in the period before hospitalization (p < 0.05). A negative correlation was found between the length of hospitalization and the current weight/habitual weight ratio (r = 0.194, 0 < 0.05, n = 102) and BMI (r=-0.186, p < 0.05, n = 102), according to Pearson's coefficient. CONCLUSION: The similarity of nutritional conditions found points to similarity of nutritional status for patients of both institutions and reflects the changes in the nutritional status of the population. The nutritional intervention should consider the nutritional needs of the population assisted.

Eating↗
PubMed2005

[Comparative analysis of occupational hearing loss risk among private farmers with reference to decision-making criteria contained in the cabinet ordinances (current and previous)].

BACKGROUND: Noise present in the agricultural environment constitutes a significant risk for the hearing organ among private farmers. The change of the principles concerning diagnostic and decision-making procedures give rise to specific consequences of an ethical, social, medical, economic or political nature. The aim of the study was to perform a comparative analysis of the occurrence of the occupational hearing loss risk among private farmers, with reference to two different decision-making criteria. MATERIALS AND METHODS: The assessment of the state of hearing in farmers, previously carried out in a selected group of 128 people, was the major research material. A comparative analysis of hearing loss and the evaluation of the risk of occupational hearing impairment was conducted on the basis of two different decision-making criteria set forth in the Cabinet Ordinances of 2002 and 1983, supplemented with the Instruction of the Minister of Health issued in 1987. In the evaluation of hearing loss the following aspects were considered: selected age and employment duration intervals as well as selected audiometric frequencies and types of the diagnosed hearing loss (total or corrected). The analysis of occupational risk, however, was based on specified frequencies of standard-exceeding hearing loss (standard: 30 dB or 45 dB). RESULTS: The analysis showed that the total hearing loss increased with farmers' age, whereas corrected loss was not age-ndependent. An increase in hearing loss independent on the duration of employment was observed only up to 30 years of employment; beyond this period a decrease in hearing loss (total and corrected) was noted. Standard-exceeding hearing loss, according to the 1983 decision-making criterion occurred considerably more often (11 cases; 8.6%), compared to that based on the 2002 criterion (8 cases; 6.2%). CONCLUSIONS: Bearing in mind that the greater corrected hearing loss occurs among younger people, it is recommended to apply corrected hearing loss in the evaluation of the degree of hearing impairment. Due to more frequent hearing loss within the range of high frequencies (4 and 6 kHz), and to provide the required distinctiveness of speech (tone), the frequency of 4 kHz should be applied in calculations of mean values. The comparative analysis of hearing loss inclined us to presume that the 1983 diagnostic procedures and decision-making criterion (corrected values; frequencies: 1, 2 and 4 kHz, standard: 30 dB) should be reinstated to ensure a proper protection of workers against noise.

Adult↗
PubMedDate not supplied

Opportunities for nurses in a private finance initiative.

The private finance initiative is part of the government's building procurement policy, incorporating both public and private sectors. This article outlines the part nurses can play, as a clinical adviser, within a PFI project team and within particular aspects of the PFI process.

Decision Making, Organizational↗
PubMedDate not supplied

[Quality and efficacy in occupational medicine: relationship between quality, efficacy, and surveillance -- Experience of public and private facilities in Emilia Romagna].

Italian legislation concerning health and safety at work establishes minimal requirements, according to European regulations. On the other side it's compulsory for Employers to set themselves at a level "above minimal requirements" according only to technicalfeasibility. It's a duty of Control Bodies (in Italy National Health Service's Work Environment Prevention Services) to verify the respect of law's preview minimal requirements. Quality standards and application guidelines, on the contrary, require collaboration and consensus among all actors involved in the implementation of health and safety managing systems on workplaces: Control Bodies, Professional Officers (Occupational Physicians, Safety Consultants), public and private Consultant Companies working on the field of health and safety at work. In this document some Emilia Romagna Region Control Bodies guidelines are discussed, and two experiences concerning public and private Consultant Companies are presented.

Humans↗
PubMed2006

Ocular morbidity among children studying in private schools of Kathmandu valley: A prospective cross sectional study.

A prospective cross sectional study of students of two private schools was done and students were screened in detail. A total of 1816 students aged 5 to 16 years were evaluated, out of which 52.8% were males and 47.2 % were females. Among the total, 65.8% had no ocular abnormalities and 34.2% had some form of ocular disorders. Refractive error was the commonest problem seen accounting for 21.9% out of total, followed by infective disorders, which accounted for 7.2%, 3.5% of them were noted to have Orthoptic problem including various types of strabismus, 2.2% were color blind, 2.6% were found to have various other disorders. The prevalence of refractive error among private school children seems to be higher. Color blindness also seems to be prevalent among these children. This kind of school screening would help in detecting the eye problems timely and thus would reduce the ocular morbidity as well as prevent children from going blind unnecessarily.

Adolescent↗
PubMed2006

The economic burden of pervasive developmental disorders in a privately insured population.

The objective of this study was to compare health care costs and utilization in children with pervasive developmental disorders (PDDs), asthma, or diabetes. Data for this investigation were derived from a large U.S. commercial insurance plan. Total cost per child and number of outpatient claims were significantly higher six months prediagnosis and 12 months postdiagnosis for PDD (N = 470) than for asthma (N = 550) or diabetes (N = 475). Controlling for age, gender, insurance plan, and prediagnosis costs, total cost per child during the postdiagnosis period was higher for PDD than for asthma or diabetes. Privately insured children with a PDD incur significantly greater costs and utilization and significantly more outpatient services than privately insured children with diabetes or asthma.

Adolescent↗