Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Health Transition”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,459 records · Page 81Linked to original sources
PubMed2000

A micropapillary variant of transitional cell carcinoma arising in the ureter.

A 79-year-old woman was evaluated for a ureteral stricture related to laser ablation of a tumor 6 months earlier at another institution. A ureteroscopic examination revealed an exophytic papillary tumor that was resected and examined histologically. The tumor was characterized by delicate papillae with thin stromal cores and numerous secondary micropapillae lined by small cuboidal to low columnar cells with uniform low-to-intermediate-grade nuclei, reminiscent of a serous borderline tumor of müllerian origin. The cell linings were 1 to 4 layers thick; mitotic figures were easily identified. The underlying stroma appeared edematous and contained scattered chronic inflammatory cells. No invasion was identified. After ascertaining that the patient had no known gynecologic neoplasm, the differential diagnoses considered included papillary nephrogenic adenoma, clear cell carcinoma, and the recently described entity of micropapillary transitional cell carcinoma. Because of the striking resemblance to serous carcinoma and the presence of significant mitotic activity, this case was felt to represent a case of micropapillary transitional cell carcinoma (World Health Organization grade 1 to 2) occurring in the ureter. To our knowledge, this tumor had some unique features (no areas of grade 3 nuclei or invasion) that have not been reported in tumors occurring in the urinary bladder. The transitional cell nature of the tumor cells was supported by the immunohistochemical staining pattern. The anatomic distribution of micropapillary transitional cell carcinoma is now expanded to include the ureter, and this tumor should be considered in the differential diagnosis for papillary lesions occurring in the ureter.

Aged↗
PubMed1991

[Problems of rehabilitating reconvalescents at industrial enterprises with a new economic mechanism].

The paper deals with the problem of rehabilitation of reconvalescents working at industrial enterprises. The most complicated and inadequately elaborated issues of this problem are those of rational employment and labour prognosis for reconvalescents. The so-called workshops of health established at industrial enterprises promoted the reduction in disease relapses, the decrease of disability and improvement of workers' health, however, with the transition to new economic methods of management many enterprises ceased to function. The well-grounded research findings are provided which are confirmed by the data of surveys on the problem of necessity to preserve or reconstruct the workshops of health on the new economic basis taking into account the interests of all workers.

Adult↗
PubMed2000

An effective transitional duty program: successful program.

The role of the employee health nurse practitioner/case manager in management of the Transitional Duty Program is pivotal to the program's success. Clearly articulated policies and procedures are used to support the Transitional Duty Program. Use of the transitional duty employee can produce financial benefits and improve employee morale. An effective Transitional Duty Program must successfully balance the needs of the employee with the needs of the organization.

Persons with Disabilities↗
PubMed1996

Youth with chronic conditions and their transition to adulthood. Findings from a Finnish cohort study.

OBJECTIVE: To explore the effect of chronic health conditions in adolescence on eventual transitional paths and young adult functioning in a cohort of Finnish youths. DESIGN: Survey in school at age 16 years followed by postal questionnaire at age 22 years. METHODS: Youths who had reported persistent chronic conditions at ages 16 and 22 years were compared with peers without chronic health conditions, using two-way analysis of variance for continuous outcomes and logistic regression models for dichotomous outcomes, adjusting for socioeconomic differences. MAIN OUTCOME MEASURES: Health status, chronic conditions, personal characteristics (including self-esteem), health behavior, education, family background, personal relations, and depression. RESULTS: Adolescents with chronic health conditions attained levels of psychosocial well-being, education, and marriage or dating as young adults similar to their peers without chronic conditions. Most of them experienced a successful transition to adulthood. Females with chronic conditions were more likely than women without chronic conditions to have moved away from their family of origin and to be living with a spouse or steady partner. Our findings also suggest that males with chronic conditions from white-collar family backgrounds may be at increased risk for symptoms of depression in early adulthood. Youths with chronic conditions had similar rates of nicotine and alcohol consumption as their healthy peers. CONCLUSION: Our findings suggest that in this cohort, most adolescents with common chronic conditions had a successful transition to adulthood.

Adolescent↗
PubMed2002

Impact on health authorities of the introduction of primary care groups and trusts.

The National Tracker Survey of Primary Care Groups (PCGs) and Trusts (PCTs) in the UK has provided evidence about how PCGs and Health Authorities managed the transition to PCTs. This was a major challenge for both organizations. Devolution of responsibilities was dependent on the capacity and readiness of PCGs to take on their new roles. The development of good working relationships between the principal parties was critical to this process. Health Authorities started to let go and all put in place basic mechanisms for holding PCGs to account in their first year. However, a number of PCGs regarded their Health Authority as authoritarian. Most Health Authorities were found to have started to provide information to support PCGs in their core functions, but resources were frequently problematic. It will be important for Health Authorities and PCG/Ts to negotiate a shared view of their respective roles and responsibilities. The future role of Health Authorities in providing strategic leadership for their local health economies was not sufficiently well defined or understood.

Efficiency, Organizational↗
PubMed2005

Healthons: errorless healthcare with bionic hugs and no need for quality control.

Errorless, invisible, continuous and infrastructure-free healthcare should become our goal. In order to achieve that goal, we need to rapidly move from current episodic and emergency-driven "healthcare delivery system" to an intelligent and extelligent health environment. That requires introduction of distributed affective Intelligent Caring Creatures (ICCs) consisting of healthons. Healthons are tools combining prevention with diagnosis and treatment based on continuous monitoring and analyzing of vital signs and biochemistry. Unlike humans, who posses only two or three dimensions of thinking, healthons can assure errorless health because of their adaptability, flexibility, and multidimensional reasoning capability. ICCs can do "the right thing" based on (1) state-of-art medical knowledge, (2) data about emotional, physiological, and genetic state of a consumer and (3) moral values of a consumer. The transition to the intelligent health environment based on ICCs requires the solutions to many currently unsolved healthcare problems. This paper lists the unsolved problems (by analogy to mathematical unsolved problems list) and explains why errorless healthcare with bionic hugs and no need for quality control is possible.

Artificial Intelligence↗
PubMed1994

Health seeking behaviour and self-treatment for common childhood symptoms in rural Guatemala.

This study was conducted in the Guatemalan highland department of Sacatepequez, in a sample of 146 rural women insured by the Social Security system. It examined their health care behaviour when their children presented common childhood symptoms such as diarrhoea, fever, cough and worms. The mothers generally sought help and treatment advice from an older woman in the family, and did so more often for diarrhoea (82%) and fever (64%) than for cough (43%) or worms (28%). Obtaining advice in a pharmacy or from a drug seller ranked second (range: 8%-38%, depending on the symptom), before the procurement of professional help at a medical service (range: 8%-23%). Traditional healers were hardly consulted (range: 0%-3%). In the case of self-treatment the women predominantly relied on Western drugs: around 80% in diarrhoea and fever, and above 50% in cough. Herbs and traditional external remedies were little used, except in cough (27% herbs) and worms (58% external remedies). None of the mothers reported ORS as home treatment for diarrhoea. Problems of geographical or financial accessibility could not explain the low utilisation of the Western health care system. The acceptability of public services, however, was poor. Largely because the Social Security clinic did not prescribe the "potent" modern drugs mothers preferred for the treatment of childhood symptoms--at least, not for uncomplicated illness episodes. Women hence turned to the--partially informal--private sector, which unabashedly responds to their demands. Clear away the discrepancy between the "rational" needs perceived by the official health sector and the demands of the population is one of the bigger challenges to health care planning in transitional communities such as the one studied.

Adult↗
PubMed2004

Cost effectiveness of memantine in Alzheimer's disease: an analysis based on a probabilistic Markov model from a UK perspective.

BACKGROUND: Clinical trials with memantine, an uncompetitive moderate-affinity NMDA antagonist, have shown improved clinical outcomes, increased independence and a trend towards delayed institutionalisation in patients with moderately severe-to-severe Alzheimer's disease. In a randomised double-blind, placebo-controlled, 28-week study conducted in the US, reductions in resource utilisation and total healthcare costs were noted with memantine relative to placebo. While these findings suggest that, compared with placebo, memantine provides cost savings, further analyses may help to quantify potential economic gains over a longer treatment period. OBJECTIVE: To evaluate the cost effectiveness of memantine therapy compared with no pharmacological treatment in patients with moderately severe-to-severe Alzheimer's disease over a 2-year period. METHODS: A Markov model was constructed to simulate patient progression through a series of health states related to severity, dependency (determined by patient scores on the Alzheimer's Disease Cooperative Study-Activities of Daily Living [ADCS-ADL] inventory and residential status ('institutionalisation') with a time horizon of 2 years (each 6-month Markov cycle was repeated four times). Transition probabilities from one health state to another 6 months later were mainly derived from a 28-week, randomised, double-blind, placebo-controlled clinical trial. Inputs related to epidemiological and cost data were derived from a UK longitudinal epidemiological study, while data on quality-adjusted life-years (QALYs) were derived from a Danish longitudinal study. To ensure conservative estimates from the model, the base case analysis assumed drug effectiveness was limited to 12 months. Monte Carlo simulations were performed for each state parameter following definition of a priori distributions for the main variables of the model. Sensitivity analyses included worst case scenario in which memantine was effective for 6 months and one-way sensitivity analyses on key parameters. Finally, a subgroup analysis was performed to determine which patients were most likely to benefit from memantine. Informal care was not included in this model as the costs were considered from National Health Service and Personal Social Services perspective. RESULTS: The base case analysis found that, compared with no treatment, memantine was associated with lower costs and greater clinical effectiveness in terms of years of independence, years in the community and QALYs. Sensitivity analyses supported these findings. For each category of Alzheimer's disease patient examined, treatment with memantine was a cost-effective strategy. The greatest economic gain of memantine treatment was in independent patients with a Mini-Mental State Examination score of > or =10. CONCLUSION: This model suggests that memantine treatment is cost effective and provides cost savings compared with no pharmacological treatment. These benefits appear to result from prolonged patient independence and delayed institutionalisation for moderately severe and severe Alzheimer's disease patients on memantine compared with no pharmacological treatment.

Aged↗
PubMed2001

Risk behaviours and self rated health in Russia 1998.

OBJECTIVES: As self rated health and mortality represent different dimensions of public health and as risk behaviours have been closely related to mortality, we wanted to examine whether (poor) self rated health on the one hand and risk behaviours on the other can be attributed to different causes. METHODS: The Taganrog household survey (1998) was conducted in the form of face to face interviews and included 1009 people and their families. To estimate health differences and differences in risk behaviours between groups, logistic regressions were performed. RESULTS: In Taganrog between 1993/94 and 1998, changes in self rated health seem to have been much more dramatic than changes in smoking and different in direction from changes in heavy alcohol consumption. Moreover, self rated "poor" health was especially common among those whose economic situation was worse in 1998 than 10 years before. However, having a poorer economy during the period 1988-1998, does not seem to have affected drinking or smoking habits significantly. CONCLUSIONS: Self rated health seems to be closely related to three indicators of economic circumstances. Risk behaviours are probably important for the poor state of public health in Russia, but may be less sensitive to the economic aspects of the transition than is self rated health.

Adult↗
PubMed1992

Gender, marital status and the social control of health behavior.

Mortality rates are lower for married individuals than they are for unmarried individuals, and marriage seems to be even more beneficial to men than women in this regard. A theoretical model of social integration and social control is developed to explain why this may occur. Drawing from this model, I hypothesize that marriage may be beneficial to health because many spouses monitor and attempt to control their spouse's health behaviors. Furthermore, the provision, receipt, and consequences of these social control efforts may vary for men and women. These hypotheses are considered with analysis of a national panel survey conducted in 1986 (N = 3617) and 1989 (N = 2867). Results show that: (1) marriage is associated with receipt of substantially more efforts to control health for men than women, (2) those who attempt to control the health of others are more likely to be female than male, (3) there is some support for the social control and health behavior hypothesis among the married, and (4) the transition from married to unmarried status is associated with an increase in negative health behavior while the transition from unmarried to married status seems to have little effect on health behavior. A theoretical explanation is developed to explain these marital status differences.

Adult↗
PubMed2005

HIV-related issues and concerns for imprisoned persons throughout the world.

PURPOSE OF REVIEW: To summarize articles related to HIV/AIDS and correctional populations that were published from January 2004 through March 2005. In all, 43 empirical and seven non-empirical articles are summarized, about two-thirds of which are focused on correctional populations in the USA. The majority of the studies were descriptive; only two articles presented evaluation data for HIV prevention interventions. RECENT FINDINGS: Published studies during the review period documented elevated rates of HIV, STIs, and hepatitis among correctional populations--often associated with injection drug use, mental illness, and infectious-disease co-morbidity. These studies highlighted a global public-health need for comprehensive HIV risk-reduction programs that address not only disease prevention but also the factors enabling disease transmission. Research further demonstrated the detrimental effects of release from prison on medication adherence and disease progression among HIV-positive people, underscoring the need for transitional treatment and health-care services. SUMMARY: HIV-related research is urgently needed to document the global scope of HIV disease prevalence and correlates among incarcerated populations, to examine the impact of incarceration and release from prison on HIV risk behavior, to identify optimal treatment programs for HIV-positive individuals, and to rigorously evaluate HIV risk-reduction interventions for incarcerated people--particularly those focused on the period of community re-entry. Finally, research and activism are needed to impact structural factors impeding HIV-prevention efforts with correctional populations.

Journal Article↗
PubMed1992

Transition from the hospital to the community: small group program.

1. Clients in a psychiatric hospital often experience loss of control over their lives and dissatisfaction with their quality of living. A small group rehabilitation program can counteract the effects of institutionalization and restore a sense of mastery to chronic psychiatric clients. 2. The therapeutic nurse-client relationship provides consistency and stability for clients who must cope with the stress of the mental health system and the transition to a community setting. 3. The program strives to restore individuals' self-confidence and dignity, improve their quality of life, and decrease the frequency and length of hospitalization.

Activities of Daily Living↗
PubMed2002

Health care for the elderly in Chile: a country in transition.

Chile's demographic and epidemiological transitions are among the most advanced in Latin America. This article documents the new importance of chronic disease and conditions that significantly affect the quality of life of the older population, noting that primary care-sensitive conditions such as poor vision, hearing, and dental care are among the most common unmet health needs of the older population. An overview of the health care system in Chile shows that it is a mixed public-private system in both insurance and provision, but the organization of the system forces most elderly persons into the public system. The dominance of the public system in the care of the aged has the potential to improve the organization and delivery of needed services, but up to now health care for older persons has not been a top priority compared to broader macro system issues. We discuss directions that Chile could take within its current economic and institutional structure that would make it more responsive to the aging population.

Aged↗
PubMed1998

The collision of economics and politics in Medicaid managed care: reflections on the course of reform in Maryland.

One of the most dynamic areas of health policy is the transition of Medicaid programs to managed care and market competition. Maryland has been a leader in this trend, initiating three different systems of managed care for the Medicaid population during the 1990s as it searched for an ideal plan. The Maryland experience illustrates the complex new demands that policy makers are facing. Health plans are expected not only to deliver budgetary savings, but also to improve the quality of their services and guarantee a place for safety-net providers in their delivery systems. As a result, there is a sizable gap between the original savings projected for the new Maryland system and its actual capacity for cost containment. The apparent collision between economic assumptions and political realities, however, may point the way to a constructive synthesis--a form of managed care that balances economy with important community, professional, and personal values.

Child↗
PubMed2004

Frequent attenders in family practice in Croatia: retrospective study.

AIM: To determine the number of "frequent attenders" in family practice offices in Croatia according to the number and proportion of frequent attender visits in the total number of visits, and to follow up the frequent attenders and the number of visits they made over a period of three years. METHODS: The retrospective study involved 8 family practice offices in Northern Croatia. The number of visits to family practice was determined for 4,312 patients aged over 18 years. There were 1,826 men (42.3%) and 2,486 (57.7%) women. The follow up period lasted from January 1, 1997 to December 31, 1999. The borderline value that divided the frequent from non-frequent attenders was the value at the third quartile of the number of visits in a single age-sex group of patients. RESULTS: We recorded a total of 58,088 visits of patients older than 18 years to 8 family practice offices in the three-year period. In 1997, out of 4,312 patients who made a total of 17,938 visits, 944 (22%) frequent attenders made 11,257 (63%) visits. In 1998, there were a total of 20,350 visits made, with 966 (22%) frequent attenders making 12,145 (60%) visits. In 1999, a total of 20,725 visits were made, with 988 (23%) frequent attenders making 12,259 (59%) visits. The differences in the distribution of frequent vs non-frequent attenders according to age and sex were not statistically significant in any of the three study years (chi-square, p=0.727). Older men and older women were not more often frequent attenders than younger men and younger women, respectively. Out of 4,312 patients, 1,714 (40%) were frequent attenders in one of the three study years. Of these, 884 (21%) were frequent attenders in one year, 476 (11%) in two years, and 354 (8%) in all three subsequent study years. Out of 4,312 patients, 1,762 (41%) patients in 1997, 1,139 (26%) in 1998, and 1,116 (26%) patients in 1999 did not make a single visit to a family physician. CONCLUSION: Frequent attender visits make a great proportion of the total number of visits to family practice offices in Croatia, a country with a health care system in transition. Eight percent of patients remained being frequent attenders during all three study years.

Croatia↗
PubMed2003

Treatment of pulmonary arterial hypertension: a preliminary decision analysis.

STUDY OBJECTIVE: New therapies for pulmonary arterial hypertension (PAH) improve functional status, quality of life (QOL), and survival. Clinicians must chose between very different therapies without the availability of comparison studies. We constructed a "virtual" clinical trial to help inform these treatment choices. DESIGN: We compare key outcomes related to survival, costs, and QOL using a Markov-type decision model to estimate the expected outcomes and costs for PAH patients treated for 1 year with bosentan and treprostinil compared to patients treated with epoprostenol, as well as patients treated with bosentan compared to those treated with treprostinil. The allowed transitions in the model were between World Health Organization functional class I to IV and death. Transition probabilities were based on observed transitions for bosentan. Treatment effect was estimated using 6-min walk data for treprostinil and epoprostenol. Utilities were calculated from estimated EuroQol health states. Cost was estimated from average wholesale price and Medicare reimbursement data. The effects of changing values of input variables on the key outcomes were calculated. RESULTS: Treatment with bosentan compared to treatment with either epoprostenol or treprostinil was less costly and resulted in a greater gain in quality-adjusted life years (QALYs). Conversely, treprostinil was significantly more expensive than epoprostenol, without an appreciable gain in QALYs. These findings were not substantially affected by the reasonable adjustments of transition probabilities, utility values, or tachyphylaxis to epoprostenol. CONCLUSION: Treatment with bosentan is more cost-effective than treatment with either treprostinil or epoprostenol. In addition, a net improvement in quality-adjusted survival may be expected.

Antihypertensive Agents↗
PubMed2002

Effects of vaccination prior to transit and administration of florfenicol at time of arrival in a feedlot on the health of transported calves and detection of Mannheimia haemolytica in nasal secretions.

OBJECTIVE: To determine effects of vaccination prior to transit and prophylactic administration of florfenicol at time of arrival at a feedyard on health of cattle and colonization of the nasopharynx by Mannheimia haemolytica (MH). ANIMALS: 121 steers from Tennessee and 84 steers from New Mexico. PROCEDURE: Half of the steers were vaccinated before transport to a feedyard. Steers from Tennessee were vaccinated with MH bacterin-toxoid, and steers from New Mexico were vaccinated intranasally with modified-live leukotoxin-deficient MH. Half of the vaccinates and nonvaccinates were randomly selected to receive florfenicol on arrival at the feedyard. Steers were observed daily for respiratory tract disease (RTD). RESULTS: Administration of florfenicol at time of arrival reduced the incidence of RTD, delayed the interval before onset of RTD, and reduced the incidence of MH colonization of the nasopharynx for at least 4 days, but vaccination did not have any effect. Vaccination elicited an increase in serum antibody titers to MH. Administration of florfenicol at time of arrival reduced the development of serum antibody titers in intranasally vaccinated steers and both groups of nonvaccinated steers, but intranasal vaccination did not affect colonization by wild-type MH. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of florfenicol at time of arrival decreased the incidence of MH organisms in the nasopharynx and delayed the onset of RTD. Prophylactic use of suitable antibiotics is likely to reduce the incidence of acute RTD in calves for several days after arrival at feedyards, which is the period when they are most susceptible to infectious organisms.

Animals↗
PubMed1998

Stress and job satisfaction among social workers, community nurses and community psychiatric nurses: implications for the care management model.

The introduction in April 1993 of new arrangements for assessment and care management following the NHS and Community Care Act 1990 (Department of Health 1990a) heralded a period of major transition for front-line workers in the health and social services. Policy expectations for the development of the purchaser/provider split and the 'new managerialism' have posed unprecedented ideological, organizational and professional challenges. Two years after the full implementation of the reforms a postal survey of the experiences of care managers about policy and practice changes was undertaken in Wales. This paper focuses on the stresses and satisfactions of care management practice among three distinct groups of front-line workers: social workers, community nurses and community psychiatric nurses. The results of multiple regression analyses, corroborated by qualitative data, implicate an increased workload in general and administrative work in particular, combined with reduced opportunities for client contact, as the main sources of stress. Being able to control or shape those factors impinging on the experience of stress and job satisfaction appears to lie at the heart of the dilemma. Practice and policy implications are considered.

Journal Article↗