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PubMed1991

Services for families of alcoholics: a national survey of Veterans Affairs treatment programs.

Directors of 70 (75% response rate) inpatient and 51 (54% response rate) outpatient alcoholism treatment programs run by the Department of Veterans Affairs (VA) returned questionnaires about patient and program characteristics and the extent of use of family-focused treatment modalities. Referrals to Al-Anon for spouses and to Alateen for teenage children were by far the most frequently provided services. Conjoint couples therapy was the type of direct service provided most frequently. Couples group therapy for outpatient programs and spouse education groups for inpatient programs were the next most frequently used. Family therapy was not used frequently. The majority of programs did not offer services directed at the individual needs of spouses, such as individual or group therapy and educational groups. Finally, services to children of alcoholics were nearly nonexistent being limited to referral of teenage children to Alateen. Marital and family services other than referral to Al-Anon and Alateen and conjoint couple interviews in inpatient programs were provided to fewer patients than those eligible for the services. The extent of family services offered bore little or no relationship to program characteristics (e.g., funding level, staffing pattern) but was related to patient characteristics. Programs with more middle-aged, employed, high school (or better) educated, married veterans made greater use of family-focused modalities. The results suggest the VA needs to develop policy guidelines for the type and intensity of marital and family services their programs should provide with specific determination of what responsibility, if any, VA programs have to the children living with the alcoholic veterans treated in these programs.

Adult↗
PubMed2003

Consent for emergency medical services for children and adolescents.

Pediatric patients frequently seek medical treatment in the emergency department (ED) unaccompanied by a legal guardian. Current state and federal laws and medical ethics recommendations support the ED treatment of minors with an identified emergency medical condition, regardless of consent issues. Financial reimbursement should not limit the minor patient's access to emergency medical care or result in a breach of patient confidentiality. Every clinic, office practice, and ED should develop policies and guidelines regarding consent for the treatment of minors. The physician should document all discussions of consent and attempt to seek consent for treatment from the family or legal guardian and assent from the pediatric patient. Appropriate medical care for the pediatric patient with an urgent or emergent condition should never be withheld or delayed because of problems with obtaining consent. This statement has been endorsed by the American College of Surgeons, the Society of Pediatric Nurses, the Society of Critical Care Medicine, the American College of Emergency Physicians, the Emergency Nurses Association, and the National Association of EMS Physicians.

Adolescent↗
PubMedDate not supplied

[Health institutions and physicians' self-care].

OBJECTIVE: To analyze how self-care of health workers is influenced by their professional training and institutional setting. MATERIAL AND METHODS: This study took place from March 2000 to February 2001 in a health center, a general hospital, and a health research institute. Qualitative in-depth interviews were used to collect data. Four in-depth interviews were conducted among physicians at the study sites: two to primary care physicians and two to secondary care physicians. RESULTS: Study findings show that physicians face barriers to self-care. Secondary care physicians were particularly affected by long work journeys and multiemployment. The main difficulties were associated with stress, nutrition, rest, and recreational activities. Physicians did not regularly have medical check-ups and would often simply consult with their colleagues in "hallway checkups" when they were afflicted by an illness. The physicians coincided in their recommendation that the health institutions should develop policies, programs, guidelines, and facilities to promote self-care among health workers. CONCLUSIONS: Health institutions are not designed or organized to promote self-care among their personnel. In the case of secondary care physicians, the organizational structure often prevents them from engaging in healthy activities. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Adult↗
PubMed2001

An ecosystem approach to health and its applications to tropical and emerging diseases.

Disease and health outcomes occur within a complex socio-ecological context characterized by feedback loops across space and time, self-organization, holarchies, and sudden changes in organization when thresholds are reached. Disease control programs, even if they are successful, may undermine health; conversely, programs in agriculture and economic development designed to improve health may simply alter disease patterns. A research and development strategy to promote sustainable health must therefore incorporate multiple scales, multiple perspectives, and high degrees of uncertainty. The ecosystem approach developed by researchers in the Great Lakes Basin meets these criteria. This has implications for community involvement in research, development policies, and for understanding and controlling tropical and emerging diseases. Even if unsuccessful in achieving specific outcome targets, however, the requirements of this approach for open and democratic communication, negotiation, and ecological awareness make its implementation worthwhile.

Agriculture↗
PubMed1976

Nursing assessment in industry.

In order to be able to offer nursing service to industry, a community health agency must have some knowledge of the industry and the daily problesm faced by both management and worker. The nursing process can serve as a framework for the gathering of necessary information and planning of sound care. The five-step nursing process, which includes assessment, diagnosis, planning, implementation and evaluation, is discussed and annotated model Assessment Guide for Nursing in Industry is given (Appendix A). The six areas from which information should be gathered when assessing an industry are the following: I. The community in which the industry is located: II. The industry, its historical development, policies, and projections; III. The plant or physical structure; IV. The working population; V. The industrial process of the plant; VII. The existing health program. Once the assessment is completed and a diagnosis formulated, services can be offered based on specific, defined needs.

Humans↗
PubMed1994

CDC's consensus set of health status indicators: monitoring and prioritization by state health departments.

A survey assessed the extent to which state health departments monitor and prioritize the Centers for Disease Control and Prevention's consensus set of health status indicators. A response rate of 100% was obtained. Although mortality indicators are often monitored, only 75.5% of the states monitor work-related injury deaths. Most states monitor the incidence of acquired immunodeficiency syndrome, measles, tuberculosis, and syphilis. Low birthweight, births to adolescents, and lack of prenatal care are monitored in nearly all states and are considered high-priority problems. Only 46.9% of states are monitoring poor air quality, and only 58.8% are monitoring childhood poverty. Survey results suggest a need for standardized assessment of indicators for policy development and program planning.

Adolescent↗
PubMed1998

The globalization of public health, I: Threats and opportunities.

The globalization of public health poses new threats to health but also holds important opportunities in the coming century. This commentary identifies the major threats and opportunities presented by the process of globalization and emphasizes the need for transnational public health approaches to take advantage of the positive aspects of global change and to minimize the negative ones. Transnational public health issues are areas of mutual concern for the foreign policies of all countries. These trends indicate a need for cross-national comparisons (e.g., in the areas of health financing and policy development) and for the development of a transnational research agenda in public health.

Global Health↗
PubMed2002

The community-oriented primary care experience in the United kingdom.

The UK National Health Service has long delivered public health programs through primary care. However, attempts to promote Sidney Kark's model of community-oriented primary care (COPC), based on general practice populations, have made only limited headway. Recent policy developments give COPC new resonance. Currently, primary care trusts are assuming responsibility for improving the health of the populations they serve, and personal medical service pilots are tailoring primary care to local needs under local contracts. COPC has yielded training packages and frameworks that can assist these new organizations in developing public health skills and understanding among a wide range of primary care professionals.

Behavioral Risk Factor Surveillance System↗
PubMedDate not supplied

Analysis of irrigation systems using sustainability-related criteria.

Sustainable agricultural development as a desired goal in irrigation management is a result of recent public awareness of the scarcity of water for food production. In order to incorporate sustainability-related criteria in the analysis of irrigation systems, the present study aims at introducing environmental indices that represent irrigation water conservation and satisfactory production and income for farmers under stress conditions. An experiment was conducted in Chania, Greece, during the irrigation periods of 1989 and 1990. The irrigation water delivered to 40 experimental plots and the relevant soil moisture content at the root zone were recorded. The data, collected in real time, were used for the calculation of the corresponding environmental indices. The variation of indices in time and space was high, and demonstrated that up to 13% of water was delivered to crops, 82% was yield loss, and 84% was economic return. The study indicated that environmental indices could be easily computed by means of routinely collected data, and could also be incorporated into decision-making approaches, such as compromise programming, in order to develop policies for irrigation water allocation.

Agriculture↗
PubMedDate not supplied

Soil quality at a national scale in New Zealand.

New Zealand is a signatory to international conventions on environmental performance, and soil quality information is needed for reporting both at a national and regional level. Soil quality was measured at 222 sites in five regions of New Zealand (12 soil orders and 9 land-use categories). Topsoil (0-100 mm) properties measured were total carbon and nitrogen, potentially mineralizable N, pH, Olsen P, cation exchange capacity, bulk density, total porosity, macroporosity, and total available and readily available water. Our objectives were to gauge the representativeness of the sample, determine the contribution from land use or soil order to variability, rationalize the data set, and identify concerns for long-term sustainable land use. Soil and land use combinations were both under- or overrepresented in the data set compared with national distribution. Soil order and land-use categories explained 55 to 76% of the variance in soil properties. Total C contents of pastures were comparable with indigenous forest soils, but pastures were less acidic and with higher N and P contents. Plantation forests had characteristics similar to indigenous forests on comparable soils. Cropland soils comprised <1% of the national land cover and generally had high inorganic fertility and low organic matter, with evidence of compaction. Seven characteristics (total C, total N, mineralizable N, pH, Olsen P, bulk density, and macroporosity) explained 87% of the total variability. The findings are being used by monitoring agencies to raise awareness about soil quality in the wider community, set land management guidelines, and develop policies.

Agriculture↗
PubMed1990

Rational limits for drug impurities.

The United States Pharmacopeia (USP) has developed policies on drug substance purity and organic volatile impurities. This paper will include the historical background and the scientific basis of these policies and will give several examples of how they are reflected in the tests that are included in USP monographs. Data on the types of analytical methods used in assessing the purity of compendial articles will also be presented.

Chemical Phenomena↗
PubMed1997

Factors affecting quality of life of the Korean aged stroke patients.

Among the most prevalent disabling diseases of old age, stroke is the leading chronic condition in Korea. The physical and psychosocial complications of a stroke can result in serious limitations on all aspects of one's life that affect overall quality of life. This study examines the relative importance of and interactions among factors which affect the quality of life of 119 stroke patients aged sixty-five and older in Korea. The model uses family support, personality (specifically hardiness), economic status, and physical functioning as independent variables, and quality of life as a dependent variable. The results of this study suggest that physical functioning and physical care by the family are important factors influencing quality of life of the aged stroke patients. Hardy personality is negatively associated with financial support and physical care by the family. These findings have several implications for policy development, clinical practice, and future research in this area.

Aged↗
PubMed1976

Evaluation of health care quality by consumers.

Ideological and conceptual issues arising out of the involvement of consumers in health care quality determination are identified. Historically and currently, criteria and procedures for quality review and assessment have reflected the values and interests of the professional providers of health care. This perspective restricts the role of the consumer to that of either a nonparticipant or a data source, at best. If the social values and merits for health care provision of consumer involvement in quality determination are to be realized, then this perspective will need to be modified, and our knowledge base of consumer criteria of health care quality will need to be enlarged. Although the perspectives of probiders and consumers are thought to the antagonistic, they may not, in fact, be so. Some suggested areas of needed research, necessary to policy development and implementation, are offered.

Consumer Behavior↗
PubMed1987

Race, socioeconomic status, and the subjective well-being of older Americans.

Causal examination of factors influencing life satisfaction among older Americans can provide knowledge important to social policy development. Using rotated factor analysis, this study isolates two dimensions of life satisfaction, labeled happiness and morale, using data from the 1981 Harris survey on aging. Race, SES characteristics, and the two intervening variables of self-assessed health status and problems experienced are tested through path analysis on the two attributes of life satisfaction. Most of the effects of race and SES are mediated by self-assessed health status and problems experienced, and these two intervening variables are the strongest direct predictors of happiness and morale. Of particular significance are results which demonstrate that racial background has a strong influence on problems experienced, and that education is more influential than income on the life satisfaction factors tested in this study.

Adult↗
PubMed1989

The use of constant observation in general hospitals.

This study reports data describing a population of general hospital patients whose behavioral management required the use of constant observation (CO). In this retrospective chart review, the mean number of days of CO per patient was 3.8, with a median of 2.0 and a standard deviation of 14.8. The longest number of days of CO was twenty-four. The types of patients placed on CO included medically complicated suicide attempters, male trauma patients with personality disorder and substance abuse, elderly patients with delirium, patients in delirium tremens, and medical patients with concurrent severe psychiatric disorders. The majority of patients on CO had no psychiatric history. The clinical data presented provide a basis for policy development, as well as recommendations for financial and medicolegal management of this population.

Adult↗
PubMed2026

Targeted Next-Generation Sequencing for Improved Clinical Outcomes in People Living With Rare Diseases in Global South: Protocol for a Systematic Review and Meta-Synthesis.

BACKGROUND: Rare diseases affect many individuals and pose major challenges in diagnosis and treatment, especially in Global South countries where health care resources are limited. Targeted next-generation sequencing (NGS) has significantly advanced diagnostic accuracy and clinical care for rare diseases globally; however, its implementation and impact within the Global South context remain insufficiently studied. OBJECTIVE: This study aims to evaluate the use, clinical benefits, challenges, and implementation outcomes of targeted NGS for diagnosing and managing rare diseases in Global South populations. Specifically, it seeks to quantify the diagnostic yield of NGS, examine its influence on subsequent clinical decision-making, and identify principal barriers to, and facilitators of, the implementation of targeted NGS approaches in these contexts. METHODS: This protocol follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We will systematically search PubMed, Scopus, and Web of Science for studies published between 2005 and 2025 that report on the use of targeted NGS in Global South population with rare diseases. Two reviewers will independently perform study selection, data extraction, quality assessment, and evaluation of risk of bias by using QUADAS-2 for diagnostic accuracy studies and the risk of bias assessment tool for nonrandomized studies. Meta-analyses will be conducted to estimate pooled outcomes for diagnostic yield, with heterogeneity assessed using random effects models. Heterogeneity will be further examined through visual inspection of forest plots and by evaluating the chi-square test and I&#xb2; statistic. RESULTS: The protocol has been registered with PROSPERO (CRD420251078455). Database search or screening, data extraction, and data synthesis are planned to commence in June 2026 and conclude by September 2026. Study findings will synthesize the diagnostic yield, clinical impact, and contextual determinants influencing the implementation of targeted NGS in Global South health care settings. CONCLUSIONS: This review will provide evidence on the application, advantages, limitations, and clinical outcomes of targeted NGS for individuals affected by rare diseases in countries of the Global South. The finding will identify priorities for capacity strengthening, policy development, and future genomic research. TRIAL REGISTRATION: PROSPERO CRD420251078455; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251078455. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/85150.

Rare Diseases↗
PubMed2001

The Oregon Health Plan: predictors of office-based diabetic quality of care.

OBJECTIVE: In 1994, the Oregon Health Plan (OHP) expanded basic Medicaid insurance to residents under the federal poverty limit, adopted a prioritized limited benefits package, and converted to managed care. The quality of care in predominantly Medicaid populations with diabetes has not been previously described. In OHP enrollees, we examined predictors of diabetes care based on American Diabetes Association guidelines and described OHP diabetes care compared with national benchmarks. RESEARCH DESIGN AND METHODS: Chart abstraction and Medicaid data for 1995-1996 yielded 996 nonpregnant diabetic patients who were 18-64 years of age. Using HbA1c, lipid panel, and urine protein/microalbumin documentation ordered during the study year, we constructed a standard care (SC) index: SC for all three tests, mixed care (MC) for one to two tests, or no tests documented (NTD). RESULTS: Our sample was predominantly white, 48 +/- 11 years of age, 63% women, with 8 +/- 5 provider visits. Providers ordered HbA1c (70%), urine microalbumin/protein (57%), and lipid panel (41%) tests. Patients distributed into SC (22%), MC (62%), or NTD (16%). Thirteen variables predicted SC. Patients had a higher likelihood of SC if they were 18-24 years of age, had more clinic visits, were on insulin daily, were in several comorbid groups, were enrolled in salaried or capitated health plans, or lived in counties with more hospital beds. Four studies were used as comparable national benchmarks. CONCLUSIONS: Care provided to OHP patients with diabetes compares favorably with national benchmarks. Yet, most OHP patients with diabetes are still not achieving optimal care. Examining predictors of SC may play an important role in further policy development.

Adolescent↗
PubMed1995

Functional assessment of Chinese children with the ABILITIES index.

The diagnosis and classification of children with disabilities are persistent concerns in paediatric and habilitative services. These concerns are magnified in international contexts and restrict comparative research and policy development. Even within classifications such as mental retardation, hearing impairment and physical impairment, children can vary widely in the nature and severity of manifested conditions. In the fields of disability and rehabilitation there is a growing interest in functional measurement. Accompanying this awareness is a corresponding recognition of the value of classification approaches which are compatible with the WHO framework of the International Classification of Impairments, Disabilities, and Handicaps. This paper examines issues pertaining to the classification of children with disabilities and describes the development of the ABILITIES Index, a functional assessment measure yielding a profile of individual characteristics. The cross-cultural applicability of the measure is documented on the basis of data for children in the People's Republic of China.

Adolescent↗