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PubMed2002

Towards a comparative analysis of health systems reforms in the Asia-Pacific Region.

The paper will review a representative selection of health systems reforms throughout the Asia-Pacific region to summarise the regional experience, identify the key lessons learnt from innovative health reforms and propose policy recommendations for sustainable health systems development. Broad descriptive trends of health systems reforms will be compared across the Asia-Pacific region within the context of rapid demographic, health and socio-economic development. More specifically, the study will address the following questions: 1. What are the main features of innovative health systems reforms? 2. How have these reforms affected the health systems? 3. Are there lessons and other implications from these reforms? A common conceptual framework to compare health systems reforms is adopted, using a standardised format to report data of national health systems. A classification of health systems is constructed by categorising them according to the level of development of their respective economies: 1) Developed 2 )High Performing 3) Newly Industrialising 4) Transitional, and 5) Developing. A typology of common issues, challenges and responses are generalised for these health systems at different stages of socio-economic development of individual countries. Evaluative criteria are proposed to compare the long-term effects of these reforms on national health systems in terms of efficiency, equity, quality and sustainability.

Asia, Southeastern↗
PubMed2004

The nutrition transition: an overview of world patterns of change.

This paper examines the speed of change in diet, activity, and obesity in the developing world, and notes potential exacerbating biological relationships that contribute to differences in the rates of change. The focus is on lower- and middle-income countries of Asia, Africa, the Middle East, and Latin America. These dietary, physical activity, and body composition changes are occurring at great speed and at earlier stages of these countries' economic and social development. There are some unique issues that relate to body composition and potential genetic factors that are also explored, including potential differences in body mass index (BMI)--disease relationships and added risks posed by high levels of poor fetal and infant growth patterns. In addition there is an important dynamic occurring--the shift in the burden of poor diets, inactivity and obesity from the rich to the poor. The developing world needs to give far greater emphasis to addressing the prevention of the adverse health consequences of this shift to the nutrition transition stage of the degenerative diseases.

Body Composition↗
PubMedDate not supplied

[Intra-urban mortality differentials in Belo Horizonte, Minas Gerais State, Brazil, 1994: revisiting the debate on demographic and epidemiological transitions].

Demographic and epidemiological transition models have seldom been debated within the Brazilian scientific community. This study aims to critically review the studies based on such transition models, analyzing their contributions and limitations for health research in Brazilian cities. Data from the city of Belo Horizonte were used to illustrate the theoretical issues raised in this paper. A total of 10,558 death certificates from 1994 were classified according to underlying cause of death and place of residence (75 geographical areas). Areas were classified according to the proportion of heads of households with low formal education. Population age structures and age- and sex-adjusted mortality rates in the areas were compared. Mortality rates indicate that Belo Horizonte is experiencing a multiple and unequal epidemiological transition process. In the poorer areas, infectious diseases have been replaced by homicides as cause of death in adulthood. The findings suggest that large Brazilian cities have mortality patterns that vary according to social and economic differentials.

Adolescent↗
PubMed2003

New options for health care policy and health status insurance: citizens as customers.

Health education and health literacy programs have implications on health care policy and health care status insurance. There are many benefits of a transition from disease management to a health care system, which includes priorities in prediction, prevention, and health education. Health care and disease management could best be implemented by multiple-tier, market-oriented models of universal coverage allowing for competition among health status insurers and educational, pharmaceutical, nursing, and other health service providers. Promotion of health literacy will allow citizens to become educated customers and consumers of health care services. Internationally, health literacy might narrow the gap between economically richer and poorer countries.

Delivery of Health Care↗
PubMed2004

Use of risk assessment in attaining and maintaining oral health.

The cost of health care is increasing rapidly. A transition from the "repair" to a "wellness" model of oral health care that minimizes the occurrence of disease and the need for complex treatment may reduce costs and improve oral health. Quantification of risk is essential for successful use of the wellness model. Subjective risk assessment by expert clinicians is too variable to be useful in clinical decision making. However, user-friendly Internet-based technology has been developed that provides a consistently accurate and valid quantified risk assessment for periodontitis, as well as a quantified measure of disease severity and extent. The numeric information helps clinicians and patients make diagnoses and generate individual, needs-based treatment plans. This technology enables successful application of the wellness model of care in day-to-day dental practice. Use of the wellness model may result in more uniform and accurate periodontal clinical decision making, improved oral health, less need for complex periodontal therapy, lower oral health care costs, and improved clinician productivity and income.

Adult↗
PubMed2005

The effects on employment and wages when working mothers lose Medicaid.

This study examines the importance of health insurance in promoting employment and wage growth for prime-age mothers. Many mothers on welfare and other low-income mothers are eligible for Medicaid, but as they move up the job ladder, they lose eligibility. Losing work supports limits mothers' ability to stay employed: mothers who make this transition into employer-provided health insurance are nine times more likely to stay employed than mothers who leave Medicaid without this benefit. However, few mothers make the transition from Medicaid to employer-provided health insurance--not because they lack employment but because they do not find jobs that offer health insurance. Between the beginning of 2002 and the end of 2003, 37.2 percent of those on Medicaid left the program, but fewer than a quarter (23.4 percent) of those had employer-provided health insurance.

Adult↗
PubMed1990

Navajo childbirth in transition.

For the Navajo Indians, the transition from home-centered childbearing practices based on religious ritual to biomedically directed childbirth in hospitals was completed over a relatively short time in the middle decades of this century. For Anglo-American society, the acceptance of medically oriented childbirth occurred during an equally short period earlier in the century. The transition was driven for both by many common factors. For Navajo women it was additionally influenced by the social and economic changes that affected the Reservation following the beginning of the Second World War. This paper examines the changes in Navajo childbearing practices and, for comparison, those of the dominant American society. It reviews factors that permitted the acceptance of biomedical childbirth by Navajo women and explores the health implications of the transition.

Delivery, Obstetric↗
PubMed1992

Some current factors restricting the potential of private general practice.

This background paper focuses on two or three aspects which, in the writer's opinion, are crucial to the healthy development of general dental practice, although the rapidly progressing health reforms have already altered the relevance of some comments made. The first aspect is equitable access, especially for the financially disadvantaged in this time of economic recession. The ability and inclination of providers to treat the financially disadvantaged has not currently been matched by the political will of funders, even though an effective system could simply be organised. Access problems also apply to the elderly. A smooth transitional system of oral health care should exist for every aging patient, whether economically, physically, and mentally healthy, or in a state of total dependence, and this should be an integral part of general dental practice management. Generally it is not. Secondly, the fragmentation of the New Zealand dental workforce, and the lack of a real team approach have hindered the logical development of oral health services and prevented many possible options from being offered. Dialogue to reduce the fragmentation must continue, hopefully to a successful conclusion. Perhaps the catalyst for meaningful change may be contained in the current health reforms. Certainly opportunities for change have been clearly signalled.

Dental Auxiliaries↗
PubMed1986

Use of health care services by children and diagnoses received during presumably stressful life transitions.

Transition periods in the lives of children are potentially stressful and might therefore be associated with adverse changes in children's physical or emotional health. The computerized medical records of 1,521 children continuously enrolled in a prepaid health plan for 6 years were analyzed to identify if such a trend was present. The overall rates of children's health care use steadily decline with increasing age until early adolescence, at which time girls' rates modestly increase and boys' continue to decline. However, the prevalence of diagnoses for which an emotional basis may be presumed increases markedly during two major transitional periods: (1) early elementary school and (2) early adolescence. During both periods, there are notable differences between boys and girls with regard to rates and temporal patterns. Girls do not demonstrate the same increased rates during elementary school years as do boys. The study provides evidence from population-based data that for some children early school years and adolescence are times of increased stress. Children who are once diagnosed as having an emotional problem, presumably related to stressful life transitions, tend to continue having similar difficulties.

Acute Disease↗
PubMed1998

Home health nurses' initial experiences with wireless, pen-based computing.

Eight home health nurses from the Visiting Nurse Service of New York participated in a focus group discussion after their initial experiences using wireless, pen-based computing in the inner-city, home care environment. Transcripts of the nurses' responses to open-ended questions were analyzed and central themes were found, following the method of concept analysis described by Strauss and Corbin (1990). The central concepts were "Readiness," "A thousand pounds on my back," "Call for support," "Problems with transmission," "Using the computer as an assistant," "Nurses discovered glitches," and "Everybody has to have a computer." These themes reflected the nurses' initial experiences with the wireless computers and also revealed their concerns. This article will describe these themes and will discuss the implications of current improvements in wireless computing for health care. The focus group themes aided in understanding how this group of experienced home health nurses began to transition from handwriting on several different forms to checking-off items on a small, hand-held computer screen, from innovating methods to communicate when telephones were not available, to using a wireless computer to send and receive data involved in the patient admission process

Attitude of Health Personnel↗
PubMed1992

Yes, the market can curb health costs.

Memo to Clinton's transition team: forget those tough expenditure ceilings you're considering. Look instead at what managed competition is already accomplishing.

Competitive Medical Plans↗
PubMed1998

Socioeconomic factors, perceived control and self-reported health in Russia. A cross-sectional survey.

Russia has the lowest life expectancy among industrialised countries, but little is known about other health outcomes and determinants of health in the Russian population. Here we report a cross-sectional study in a national sample of the Russian population of social and psychosocial determinants of two self-reported health indicators: self-rated health (shown to predict mortality in prospective studies) and physical functioning (validated against more objective health measures). A multi-stage sample of the Russian population aged 18 years and more was interviewed (n=1599, response rate 66%). The questionnaire included political attitudes, social and economic circumstances, psychosocial factors, smoking, alcohol consumption, self-rated health and physical functioning (from the SF36 instrument). Scores of perceived control over life and over one's health were calculated from 6 and 3 questions, respectively. Data were analysed in logistic regression for two dichotomised outcomes: poor self-rated health (worse than average) and low physical functioning (less than 60% of maximum). Overall, 25% of subjects rated their health as worse than average; this is substantially more than in western countries. Perceived control over life was strongly related to both outcomes; age- and sex-adjusted OR for 1 standard deviation increase in control were 0.60 (95% CI 0.52-0.69) for poor self-rated health and 0.67 (0.57-0.81) for low physical functioning. Adjustment for a battery of other factors reduced these estimates only slightly. Associations between control over one's health and both outcomes were also significant, but weaker and attenuated in multivariate models. Material deprivation was also strongly related to both outcomes. Education was inversely related to self-rated health, and unmarried men reported poor physical functioning substantially more often. Subjects not approving the economic changes reported poorer health but this association was removed by adjustment for socioeconomic factors and control. Subjects who could not rely on informal social structures when in problems reported worse health; this effect largely persisted in multivariate analyses. These results are consistent with the hypothesis that poor health status in Russia is related to dysfunction of social structures, socioeconomic deprivation, and lack of perceived control. The absence of informal social networks, vital for maintaining general welfare, seems to affect adversely self-rated health. Deprivation and low perceived control may be important mediators between the broad social environment and health in populations undergoing transition and can provide a useful framework for many biological and behavioural factors. Prospective studies are needed to address the issue of temporality and reporting bias, the major problems in interpreting these findings.

Activities of Daily Living↗
PubMed2001

Extending the Aberdeen Back Pain Scale to include the whole spine: a set of outcome measures for the neck, upper and lower back.

Many therapists treat the spine as a 'functional unit', but suitable condition-specific outcome measures for the whole spine are not available. One of the most rigorously tested measures for back pain related health status is the Aberdeen Back Pain Scale, but it is only suitable for the lower back. The Aberdeen Back Pain Scale was extended to create a set of interlocking outcome measures for the neck, upper and lower back. Questions in these extended outcome measures had to fulfil a series of psychometric criteria before being accepted into the final questionnaires. This involved response frequency, item-total correlation and principal component analysis. The final questionnaires were tested for reliability, criterion and construct validity, responsiveness and acceptability, on patients attending a primary care musculoskeletal clinic. One question was discarded from all three sets of questionnaires and a further question was removed from the neck questionnaire. Baseline scores approximated to normal distributions. Although not completely reproducible, they were internally consistent, so showed evidence of reliability. They were highly correlated with the SF-12 and their mean scores changed according to whether their health status, measured by a transition question, improved, stayed the same or worsened. Modified standardised response means showed large changes when health status improved and moderate-sized changes when health status worsened. Patients made few adverse comments about the questionnaires and found them acceptable. The Extended Aberdeen Spine Pain Scales for neck, upper and lower back pain, showed evidence of reliability, validity, responsiveness and acceptability. They can be used for single regions of the spine or combined as clinically necessary. They are particularly recommended for primary care patients.

Adult↗
PubMedDate not supplied

PNP roles and interventions with children with special needs and their families.

Pediatric nurse practitioners (PNPs) can create excellent professional roles caring for children with special health care needs (CSHCN) and their families. Children with chronic conditions represent an estimated 31% of the US population younger than 18 years (approximately 20 million children in 1988). Five percent of all children who have multiple special needs account for approximately 40% of all pediatric health care expenditures. Skill building is needed for PNPs who have traditionally focused on wellness and common acute illnesses in primary care settings. Role theory and research can guide PNPs in creating roles and interventions to improve the health, safety, and developmental outcomes for CSHCN and their families. Two roles are described, with examples of specific nursing interventions. Assisting child care centers to serve children and families with special needs is an ideal role for PNPs who have knowledge of health and regulatory issues. Another important PNP role is working with adolescents with special health care needs as they transition from pediatric to adult care. Many resources (such as those from the Maternal and Child Health Bureau) are available to assist PNPs to create new roles and interventions for CSHCN and their families.

Adolescent↗
PubMed1997

Business prospective: a complement to a successful public health agenda.

Business planning is an analytical and practical exercise that will help better understand your organization's position and capabilities with regard to the competitive market place. This clarification will help set direction referencing an organization's mission, alternative service delivery options and managed care network opportunities. The Bergen County Department of Health is an organization in transition, building capabilities and credibility to assume leadership responsibilities in the development of a sustained Public Health infrastructure. In addition, the department is attuned to the changing health care industry's responsibility and incentives, is actively pursuing appropriate service delivery roles as a complement to the county-wide community health system capacity.

Commerce↗
PubMed1994

[The epidemiological transition in Latin America].

The changes in health conditions that have occurred in most of the countries of Latin America in the second half of the twentieth century are analyzed. "This paper analyzes the main mechanisms involved in the epidemiologic transition, which are: changes in risk factors, fertility decline and improvements in health care technology." The authors use a mortality profile ratio, obtained by dividing the mortality rate due to infectious and parasitic diseases over the mortality rate due to cardiovascular diseases and neoplasms, to analyze trends in 15 countries. "Three distinct groups can be recognized. Each of them represents a different transitional experience. Such experiences are discussed in detail, including a new 'protracted polarized model' of the epidemiologic transition, which characterizes several Latin American countries. Finally, evidence is provided to illustrate the relationship among economic development, fertility change, and mortality profiles." (SUMMARY IN ENG)

Birth Rate↗
PubMed1977

Health norms in pregnancy.

A study was conducted on a sample of pregnant women. The study had two aims: to develop a method of measuring social expectations (norms) and to find out how far women conform in their behaviour to these norms. The areas of behaviour were smoking, exercise, diet, alcohol, and medication. Pregnancy was found to be appropriate for this study because of the high degree of formalisation that this state enjoys in our society. The methods used for measuring norms in this study are an improvement on earlier methods, but further refinements are needed. The findings show that women generally do conform to the social expectations and that their behaviour is in accordance with three types of norms--that is, general, specific, and transitional. The implications for health education interventions are discussed.

Alcohol Drinking↗