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PubMed2000

Evidence for dental caries decline among children in an East European country (Hungary).

In Central and Eastern Europe oral health systems are in transition due to the economic and political changes. The aim of the present study was to highlight the long-term trend in dental caries prevalence of Hungarian children. A WHO National Pathfinder Survey of oral health status was conducted in 1996 which included 6-year-olds (n = 900) and 12-year-olds (n = 900). Similar surveys were performed in 1985 (age 6-7, n = 895; age 12, n = 893) and in 1991 (age 5-6, n = 898; age 12, n = 898) and the surveys were based on the same sites and examination criteria. Clinical data were collected by trained dental examiners according to the WHO Basic Methods. In 1996, 73% of 5-6-year-olds and 84.5% of 12-year-olds were affected by dental caries. At age 5-6 the mean dmft was 4.5 and at age 12 the DMFT was 3.8. In both groups, the d/D-components were high (5-6 years: dt/dmft = 89%; 12 years: DT/DMFT = 45%). For children aged 5-6, the mean caries experience increased from 1991 (3.7 dmft) to 1996 (4.5 dmft) (P<0.01) whereas DMFT of 12-year-olds declined from 5.0 in 1985 and 4.3 in 1991 (P<0.01). The differences in caries experience by urbanization level were reduced over time. In 1996, 72% of 12-year-olds had gingival bleeding (CPI scores 1+2), and 23% had moderate/severe malocclusion. In conclusion, in order to meet the need for dental care in schoolchildren in Hungary health authorities are encouraged to revitalize the school dental services. Implementation of community-based health promotion is needed to control oral disease in Hungarian children.

Child↗
PubMed2001

Intravenous-to-oral transition therapy in community-acquired pneumonia: the INOVA Health System experience.

Economic pressures on the delivery of health care have necessitated a focus on reducing costs and resource utilization while maintaining or improving the quality of care. A growing consensus holds that switching from intravenous to oral therapy is a cost-effective and clinically sound approach for a significantly large group of patients with community-acquired pneumonia (CAP). Drug utilization studies within the INOVA Health System revealed that levofloxacin is a cost-effective alternative to ciprofloxacin in infectious disease and that use of risk prediction criteria can reduce inappropriate hospitalizations for CAP, thereby reducing costs. In addition, the INOVA experience demonstrates that the strategy used to implement new antibiotic regimens such as switch-therapy regimens is an important factor in cost reduction: a therapeutic interchange mandate is more successful than standard educational techniques in changing treatment patterns.

APACHE↗
PubMedDate not supplied

[Evolution and revolution in health].

For the past several years, Mexico has experienced vast transitions which have had an effect on the state of health and the form in which its inhabitants are adequately cared for. The transitions--demographic, epidemiological, cultural/educational, economic, social, and political--show us how changes in the area of health come about. These can be grouped into two categories: (1) a new look at health care and (2) the accelerated progress in biomedical investigation. With regard to health care, the changes are directed towards a preventative emphasis rather than a curative one. This leads us to structural and functional redefinitions of health services. The government, since the past century, has put several experiments into practice (for the purpose of protecting vulnerable groups) by establishing institutions that have served as a foundation for the National Health System. These efforts intend to offer to everyone equal opportunities for the enjoyment of health. The second category shows the accelerated pace of biomedical research and its resulting beneficial achievements. It is now possible to offer better attention with more specific diagnosis and more efficient therapeutic measures.

Culture↗
PubMedDate not supplied

An "All-American" health reform proposal.

Reforming the U.S. health care system is frequently thought of in absolutist terms: managed competition versus rate regulation; federal versus state administration; and business mandates versus individual insurance purchases. While these choices must be resolved over the long run, the transition to a new health care system will take several years and require more flexible solutions. The "All-American" Deal offers just that. It requires individual households to be insured and allows businesses to voluntarily offer health insurance; relies on the federal income tax system to collect income-based premiums and transfer funds to states through risk-adjusted payments; and lets states manage the disbursement of funds for uninsured residents.

Budgets↗
PubMedDate not supplied

[Education of psychologists and their role in primary health care].

This paper takes as its basis the concept of comprehensive health care. The need to try out complementary approaches to health care is emphasized in order to ameliorate the effects of the epidemiological transition. The approach of Primary Health Care as a basic strategy is also presented. The importance of applying health system population approach to health care is also analyzed. A number of health care alternatives are presented in order to stabilize the health of a community. Within these alternatives the training of human resources with a focus on prevention as well as the curative approach are presented. The role that the psychologist plays within the comprehensive health care is also described. Also the authors describe an innovative training program directed to Psychologists at this stage, that integrates a Master on Public Health with emphasis in mental health with a residence program in Comprehensive Health Care as an option to contribute to replicate the alternatives of care presented in the paper. Finally, the programs and their advances are presented.

Curriculum↗
PubMed1999

Equity in health and health care: the Chinese experience.

This paper examines the changes in equality of health and health care in China during its transition from a command economy to market economy. Data from three national surveys in 1985, 1986, and 1993 are combined with complementary studies and analysis of major underlying economic and health care factors to compare changes in health status of urban and rural Chinese during the period of economic transition. Empirical evidence suggests a widening gap in health status between urban and rural residents in the transitional period, correlated with increasing gaps in income and health care utilization. These trends are associated with changes in health care financing and organization, including dramatic reduction of insurance cover for the rural population and relaxed public health. The Chinese experience demonstrates that health development does not automatically follow economic growth. China moves toward the 21st century with increasing inequality plaguing the health component of its social safety net system.

Adolescent↗
PubMed2003

[The epidemiologic transition of the adolescents in Mexico].

OBJECTIVE: To identify the health status of adolescents in Mexico in their demographic, social and economic context. MATERIAL AND METHODS: A literature search and review of vital statistics, and opinion surveys were performed in order to asses the impact of the epidemiologic transition on the availability and priority of health services for adolescents. The Omran epidemiologic model was used to classify the demographic, social and economic characteristics of Mexican adolescents in efforts to define their impact on the epidemiologic transition of this age group. RESULTS: Demographic data are presented in the perspective of the epidemiologic transition which permit us to make inferences on the social conditions, growth patterns and health needs of this age group in Mexico. Data are presented regarding the demand and availability of health services, the impact of education and employment opportunities and the role of family and the economy on their well being. Other important aspects presented include the role of education on the sexual and reproductive health of adolescents and the threat of the AIDS pandemic in this age group. CONCLUSIONS: These findings reveal a sequence of variables that can no longer be addressed in the traditional problem oriented approach and strongly suggest a need to profile the health needs of adolescents in an integrated, holistic fashion with emphasis in health promotion and healthy life styles to favor their integral, just and equitable development, and also help focus the societal response in an integrated manner.

Adolescent↗
PubMed2003

Psychiatric care of suicides in Hong Kong.

BACKGROUND: Though psychiatric patients have high suicidal risks, relatively little is known about the pattern of psychiatric care they received, especially in a non-Western setting. METHODS: Territory-wide record linkage study of computerised psychiatric records of suicide cases according to coroner's verdicts. RESULTS: Only 1/4 of the suicide population received psychiatric care in Hong Kong. These patient suicides differed from general population suicide in the distribution of sex, age, and suicide methods. Suicides are more common during the periods of in-patient care and immediately post discharge. Among these patient suicides, recent contacts with psychiatrists before their lethal acts were common. LIMITATIONS: Proportion of patients that received psychiatric care could be underestimates because private psychiatric patients and persons who immigrated were not counted. No clinical data are available from the record linkage. CONCLUSIONS: A wider coverage of psychiatric care to the suicidal population is required through improved accessibility and public health education. A smooth transition of care after discharge, active case tracing, and improved in-patient care should be considered.

Adolescent↗
PubMed2005

In search of financial viability: hospital-based v. freestanding home care.

In the continually changing and perpetually unpredictable nature of Medicare and Medicaid reimbursement, many hospitals and health care systems are rethinking their relationships with their affiliated home care and hospice programs. As the books of many of these programs show an increasing amount of red ink, many hospitals are spinning off their home care and hospice services into independent entities with their own individual operating structures. This article provides insight into one health care system's transitioning of its home care services into a freestanding entity.

Home Care Services↗
PubMed2000

Lumbosacral transitional segments: classification, prevalence, and effect on disk height.

OBJECTIVE: To determine the rate of lumbosacral transitional segments among chiropractic practice settings and to determine if this anomaly would affect the height of the lumbosacral disk. STUDY DESIGN: Retrospective review of radiographs. SETTING: Los Angeles College of Chiropractic outpatient clinic and a private chiropractic office. SAMPLES: A total of 20 lumbar series with lumbosacral transitional segments from a private chiropractic office, 47 lumbar series with lumbosacral transitional segments, and 60 age- and sex-matched control series from a college clinic. RESULTS: A total of 2.3% of 882 lumbar series at the private chiropractic office and 6.5% of 786 lumbar series at the Whittier Health Center showed lumbosacral transitional segments of types II, III, or IV. The L5-S1 intervertebral disk height was significantly smaller in patients with lumbosacral transitional segments compared with those without (ie, 11% vs 19% of total lumbar disk height, respectively). When bilateral bony fusion of L5 to the sacrum was present, the L5-S1 disk height was significantly smaller than that without bony fusion (ie, 8% vs. 12% to 14% of total lumbar disk height, respectively). CONCLUSIONS: We conclude that the rate of occurrence of lumbosacral transitional segments is low in chiropractic practice. In the presence of lumbosacral transitional segments, especially when there was bony fusion, the lumbosacral intervertebral disk was significantly narrower than the upper lumbar disks, which should not be considered as disk degeneration or displacement. The type of lumbosacral transitional segment present also showed a significant effect on the height of the lumbosacral disk.

Adolescent↗
PubMed2005

A course on the transition to adult care of patients with childhood-onset chronic illnesses.

Children with special health care needs born today have a 90% chance of surviving into adulthood, making their transition to adult systems of care an issue that will affect almost all physicians. However, many adult generalists and specialists are not familiar with the management of chronic diseases that begin in childhood. While the public health system has made transition to appropriate adult care a priority, and many specialty organizations have endorsed this concept, there are no published studies addressing how the concept of transition can be taught to medical students or residents. The authors describe a one-week course for medical students, begun in 2001 at their institution, that addresses the transition for youth with special health care needs, emphasizing patient and family-centered care, cultural competence, and decision making in end-of-life issues. Cystic fibrosis, a common genetic disease with increasing life expectancy, is used as the model for the course. Involvement of interdisciplinary faculty, interviews with youth with special health care needs and family caregivers, readings from academic and nonacademic literature, and group discussions are presented as teaching methods. Key insights based on experience with the course are the need to include the voices of patients and families, the use of faculty from various professions and specialties to model interdisciplinary care, and the insight that problems specific to transition offer into contemporary health care financing. Future studies should measure the impact of such courses on students' knowledge of transition issues, and determine essential information required for physicians in practice.

Adolescent↗
PubMed1996

Case management: meeting the needs of chronically ill patients in an HMO.

Primary care staff education plays a critical role in a health plan making a transition from a case management model to a model that emphasizes close care coordination for chronically ill patients with multiple care needs. Multidisciplinary teams can help refine the system to have a positive impact on care across diverse settings: Health Plan of Nevada found that such training aids staff in identifying at-risk individuals and in developing plans for preventive health screening activities, medication compliance, and needs assessment.

Activities of Daily Living↗
PubMedDate not supplied

The relationship between depression and emerging adulthood: theory generation.

Depression during the transition from late adolescence to young adulthood is a major mental health concern. Developmental theories addressing this transition, also called emerging adulthood, are few, and fewer yet are theories addressing mental health or psychopathology during this period. This article establishes the legitimacy of emerging adulthood as a unique developmental period and attempts to generate directions for theory development by merging theories of depression and development at the point of emerging adulthood. This article concludes with a theoretical discussion and application of this process in research and practice.

Adaptation, Psychological↗