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PubMed2006

Development assistance for health in central and eastern European Region.

OBJECTIVE: We aimed to quantify development assistance for health to countries of central and eastern Europe and the Commonwealth of Independent States (CEE-CIS). METHODS: We used the International Development Statistics database of the Organisation for Economic Co-operation and Development and the database on development assistance for health compiled for the Commission on Macroeconomics and Health to quantify health development assistance to the region, compared to global and overall development assistance. We based our analysis on standard health indicators, including child mortality, life expectancy at birth and health expenditures. FINDINGS: Although total development assistance per capita to CEE-CIS was higher than that for most other regions of the world, development assistance for health was very low compared to other countries with similar levels of child mortality, life expectancy at birth and national expenditures on health. CONCLUSION: The allocation of development assistance for health on a global scale seems to be related far more to child mortality rather than adult mortality. Countries of CEE-CIS have a high burden of adult morbidity and mortality from non-communicable diseases, which does not appear to attract proportionate development assistance. Levels of development assistance for health should be determined in consideration of the region's particular burden of disease.

Child↗
PubMedDate not supplied

Thailand mental health country profile.

Thailand, a constitutional monarchy, has undergone a rapid shift in its demography and economy in last two decades. This has put a great burden on the health services, including mental health care of the country. The current emphasis of the Ministry of Public Health is to change its role from health care provider to policymaker and regulator of standards, and to provide technical support to health facilities under its jurisdiction as well as in the private sector. The Department of Mental Health, established in 1994, has laid down a mental health policy that aims to promote mental health care within the community with the help of people's participation in health programmes. Focus has been placed on developing suitable and efficient technology by seeking cooperation both within and outside the Ministry of Public Health. Consequently, the Department of Mental Health has been receiving increasing budgetary allocations. Since there is a paucity of trained manpower, the emphasis is being laid on the utilization of general health care for mental health care. Some of the specific interventions are community services, prison services, psychiatric rehabilitation, and use of media in mental health operations. There have been active efforts towards international cooperation for developing technologies for specific programmes. Private and non-governmental organizations are supported and encouraged to provide mental health care to the marginalized sections of society. Efforts have also been made by the Department of Mental Health to inspect and raise the efficiency of its operations to result in quality service.

Community Mental Health Services↗
PubMed2006

Attentional bias to angry faces using the dot-probe task? It depends when you look for it.

A number of studies using the dot-probe task now report the existence of an attentional bias to angry faces in participants who rate highly on scales of anxiety; however, no equivalent bias has been observed in non-anxious populations, despite evidence to the contrary from studies using other tasks. One reason for this discrepancy may be that researchers using the dot-probe task have rarely investigated any effects which might emerge earlier than 500 ms following presentation of the threat-related faces. Accordingly, in the current study we presented pairs of face stimuli with emotional and neutral expressions and probed the allocation of attention to these stimuli for presentation times of 100 and 500 ms. Results showed that at 100 ms there was an attentional bias towards the location of the relatively threatening stimulus (the angry face in angry/neutral pairs and the neutral face in neutral/happy pairs) and this pattern reversed by 500 ms. Comparisons of reaction time (RT) scores with an appropriate baseline suggested that the early bias toward threatening faces may actually arise through inhibition of the relatively least threatening member of a face pair rather than through facilitation of, or vigilance towards, the more threatening stimulus. However the mechanisms governing the observed biases are interpreted, these data provide evidence that probing for the location of spatial attention at 500 ms is not necessarily indicative of the initial allocation of attention between competing emotional facial stimuli.

Adult↗
PubMed2006

[Vocational rehabilitation in transition--challenges and perspectives].

The present article outlines the challenges in occupational rehabilitation arising from the successive erosion of the financial foundations of the welfare system, from changes in industry as well as in health, education and labour-market policy. Five perspectives are discussed to design and develop strategies in occupational rehabilitation. Among these are: (1) Rehabilitation in companies is mostly based on miscarried efforts to prevent separation. The discontinuance and the re-integration in a position or in a company have therefore to be regarded as an interlocking process between vocational training centre, social insurance agencies and employers; (2) Regional vocational rehabilitation centres with the objective to promote participation in work life may advance to institutionalized junctions to connect the rehabilitation landscape and would represent the logistic context; (3) The development of participation benefits should mainly be directed towards individualized allocation of resources as well as the possibility of direct transfer to work in close cooperation with employers; (4) Structural solutions and process-innovation could be supported by application-orientated research; (5) A new consensus to assign future tasks and objectives should be defined among the responsible bodies and service organisations involved in occupational rehabilitation.

Persons with Disabilities↗
PubMed1994

An evidence-based approach to evaluating and improving clinical practice: implementing practice guidelines.

Clinical practice guidelines can improve health care outcomes, but they are only as effective as their implementation. We present a framework for implementing practice guidelines that begins by identifying the forces driving and restraining the adoption of the guideline. Strategies for changing physician behavior that strengthen the driving forces and weaken the restraining forces can then be incorporated into a comprehensive implementation program. Nine strategies for changing physician behavior are presented, based on a review of the literature and organizational experience at Group Health Cooperative of Puget Sound. In designing an implementation strategy, it is essential that the resources allocated to implementation are commensurate with the improvement in outcomes expected from the successful implementation of the guideline. All implementation programs should include plans for measuring outcomes to allow for continuing improvement. Guideline implementation, evaluation and improvement efforts are most likely to be successful when they are part of an explicit, evidence-based process for evaluating and improving clinical practice.

Decision Making↗
PubMed1989

Canadian experiences with AIDS and HIV infection.

Canada's first AIDS case was diagnosed in 1978, and a total of 2,003 cases had been recorded up to 19 September 1988. Nationwide, 82% of those afflicted have been homosexual or bisexual men, 5% have been immigrants from endemic regions, and 4.6% have been recipients of blood or blood products. Estimates of Canadians infected with HIV range from 10,000 to 50,000. A system of voluntary testing of individuals, combined with anonymous screening of populations for epidemiologic purposes, comprises the HIV testing program in Canada. Most major cities have volunteer AIDS support committees conducting education, advocacy, and support activities; Can$48 million has been allocated to educate the public about AIDS over the next five years. Research and international cooperation are also receiving increased priority and funding.

AIDS Serodiagnosis↗
PubMed1988

[Clinical study of postoperative infection of gastrointestinal cancer. Randomized study of preventive efficacy of cefmetazole versus cephalothin in postoperative infection of gastric and colorectal cancer].

Effectiveness of prophylactic administration of cefmetazole (CMZ) (A) for postoperative infection was compared with that of cephalothin (B) using patients undergoing resection of gastric cancers or colorectal cancers as subjects in cooperation with 19 major hospitals in the Tohoku districts. Using the envelope method, each hospital allocated, at random, patients with each organ removed into groups A and B. Either drug was administrated at 4 g/day (in 2 divided doses) for 7 days. Registered patients with gastric cancers amounted to 114 in group A and 113 in group B; those with colorectal cancers were 63 each in groups A and B. As to background factors, advanced cancers were found more in group A with gastric cancers, and operations took more time on the average in this group; however, there were no significant differences in other factors between the 2 groups with gastric cancers and in the all factors between A and B groups with colorectal cancers. Rates of ineffective prophylaxis judged by physicians in charge were 3.9% and 21.0%, respectively, in groups A and B with gastric cancers, and 5.0% and 20.7%, respectively, in groups A and B with colorectal cancers. Rates of ineffective prophylaxis determined by committees were 16.7% and 31.0% among the former, and 8.3% and 29.3% among the latter, respectively. Ineffectiveness rates in group A with gastric cancers or colorectal cancers were significantly lower in all the evaluations, and CMZ was, therefore, comfirmed to have stronger efficacy.

Bacterial Infections↗
PubMed1985

The results after 20 months of a study testing the efficacy of a weekly fluoride mouthrinsing program.

The purpose of this study was to determine the efficacy of weekly mouthrinsing with a 0.2 percent NaF solution in first-grade children living in a non-fluoridated community. Children in the control group were also participants in a randomized clinical trial to evaluate the efficacy of semiannual fluoride varnish treatments. Children allocated to the mouthrinse group attended school at three of the 17 area schools where the varnish study was occurring. Random allocation of children into the treatment group was considered impractical because of potential problems of teacher cooperation and compliance. The same two standardized examiners examined all participants, and were blind to group assignment for all children. After two academic years, or approximately 72 weeks of rinsing, 178 and 247 children remained in the treatment and control groups, respectively. The control group experienced a mean caries rate of 2.02 surfaces over 20 months, while the treatment group demonstrated an increment of only 1.33 surfaces, representing a savings of about 0.34 surfaces per year or a reduction in DMFS of 34.2 percent. Surface-specific incremental reductions after 20 months were 0.35, 0.19, and 0.14 for the occlusal, buccal, and lingual surfaces, respectively. The proximal increment was too small to draw any meaningful conclusions. In the primary dentition, the treatment and control dfs increments were 0.74 and 1.74, respectively. This reduction represents a savings of one-half surface increment per year, or a reduction of 57.5 percent.

Child↗
PubMed1998

[Role of school lunch in primary school education: a trial analysis of school teachers' views using an open-ended questionnaire].

We tried to analyze synthetically teachers' view points associated with health education and roles of school lunch in primary education. For this purpose, a survey using an open-ended questionnaire consisting of eight items relating to health education in the school curriculum was carried out in 100 teachers of ten public primary schools. Subjects were asked to describe their view regarding the following eight items: 1) health and physical guidance education, 2) school lunch guidance education, 3) pupils' attitude toward their own health and nutrition, 4) health education, 5) role of school lunch in education, 6) future subjects of health education, 7) class room lesson related to school lunch, 8) guidance in case of pupil with unbalanced dieting and food avoidance. Subjects described their own opinions on an open-ended questionnaire response sheet. Keywords in individual descriptions were selected, rearranged and classified into categories according to their own meanings, and each of the selected keywords were used as the dummy variable. To assess individual opinions synthetically, a principal component analysis was then applied to the variables collected through the teachers' descriptions, and four factors were extracted. The results were as follows. 1) Four factors obtained from the repeated principal component analysis were summarized as; roles of health education and school lunch program (the first principal component), cooperation with nurse-teachers and those in charge of lunch service (the second principal component), time allocation for health education in home-room activity and lunch time (the third principal component) and contents of health education and school lunch guidance and their future plan (the fourth principal component). 2) Teachers regarded the role of school lunch in primary education as providing daily supply of nutrients, teaching of table manners and building up friendships with classmates, health education and food and nutrition education, and developing food preferences through eating lunch together with classmates. 3) Significant positive correlation was observed between "the teachers' opinion about the role of school lunch of providing opportunity to learn good behavior for food preferences through eating lunch together with classmates" and the first principal component "roles of health education and school lunch program" (r = 0.39, p < 0.01). The variable "the role of school lunch is health education and food and nutrition education" showed positive correlation with the principle component "cooperation with nurse-teachers and those in charge of lunch service" (r = 0.27, p < 0.01). Interesting relationships obtained were that teachers with longer educational experience tended to place importance in health education and food and nutrition education as the role of school lunch, and that male teachers regarded the roles of school lunch more importantly for future education in primary education than female teachers did.

Adult↗
PubMed1985

Metoprolol in acute myocardial infarction (MIAMI). A randomised placebo-controlled international trial. The MIAMI Trial Research Group.

The effect of metoprolol on mortality and morbidity after 15 days, was compared with that of placebo in a double-blind randomised international trial (the MIAMI trial) in patients with definite or suspected acute myocardial infarction (AMI). Treatment with intravenous metoprolol (15 mg) or placebo was started shortly after the patient's arrival in hospital within 24 h of the onset of symptoms, and then oral treatment (200 mg daily) was continued for the study period (15 days). Of the 5778 patients included, 2901 were allocated to placebo and 2877 to metoprolol. Definite AMI was confirmed in 4127 patients. There were 142 deaths in the placebo group (4.9%) and 123 deaths in the metoprolol group (4.3%), a difference of 13 per cent with 95 per cent confidence limits of -8 to +33 per cent, not statistically significant (P = 0.29). Previously recorded risk indicators of mortality were analysed in retrospect. These indicated that there was a category which showed higher risk which contained approximately 30% of all randomized patients. In these, the mortality rate in the metoprolol treated group was 29% less than in the placebo group. In the remaining lower risk categories there was no difference between the treatment groups. This subset analysis must be interpreted with caution in view of the findings from other similar studies. Positive effects were observed on the incidence of definite AMI and on serum enzyme activity in patients treated early (less than 7 h). There was no significant effect on ventricular fibrillation but the number of episodes tended to be lower in the metoprolol treated patients during the later phase (6-15 days; 24 vs 54 episodes). The incidence of supraventricular tachyarrhythmias, the use of cardiac glycosides and other antiarrhythmics, and the need for pain-relieving treatment were significantly diminished by metoprolol amongst all randomised patients. Adverse events associated with metoprolol were infrequent, expected, and relatively mild.

Aged↗
PubMed2003

Transitions between cooperative and non-cooperative responding in the 'Pigeon's Dilemma'

Two pigeons played Iterated Prisoner's Dilemma (IPD) against a simulated opponent pre-programmed to play 'Tit-For-Tat' (TFT) and 'Random' (RND) strategies. Each pigeon received differential amounts of access to food following choices of either 'cooperate' or 'defect' on a trial. After 1000 trials against TFT and 500 trials against RND, results indicated that choice allocation was optimal when the birds played against RND but was sub-optimal when the birds played against TFT. In order to determine why the pigeons responded suboptimally against TFT, a trial-by-trial analysis of the data was conducted. The analysis revealed that once a pigeon had received the 'Sucker's' payoff (S), it was more likely to defect and receive the 'Temptation' payoff (T) than to cooperate and receive the 'Reward' (R) payoff. Local reinforcement contingencies appear to determine suboptimal responding against TFT in the iterated Pigeon's Dilemma.

Journal Article↗
PubMed1994

Global bioethics.

Because there is a large agenda of work that needs to be done to help ethicists to be better able to address ethical questions in healthcare from an environmentally conscious and globally coherent point of view, Cambridge Quarterly of Healthcare Ethics is initiating this occasional column on global bioethics to provide a space to publish and discuss environmental issues in healthcare. We are initiating this section with a paper of my own outlining some broad concerns about healthcare ethics in a global context ["Casuist or Cassandra? Two conceptions of the bioethicist's role," p. 451-466] and are inviting readers to submit philosophical and multidisciplinary papers taking a global perspective on ethical issues in healthcare....

Bioethics↗
PubMed2002

Dyadic versus individual storytelling by preschool children.

A constructive model of recall and communication (D. Edwards & D. Middleton, 1986) and certain whole-word approaches to learning (C. Pontecorvo & C. Zucchermaglio, 1989) were evaluated in conjunction with an investigation of the benefits of joint storytelling on children's cognitive processes. Preschoolers (N = 36, aged 30-62 months) were prompted to compose a story, working with a classmate (during which they talked together freely and generated a mutual narrative) or individually. Findings revealed that, although dyadically generated stories were longer, containing significantly more words, propositions, and additive conjunctions, stories told by individuals contained proportionally more logically connected statements and greater use of the past tense. Moreover, compared with dyadic stories, individually generated narratives contained fewer alterations of the protagonist.

Child↗