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PubMed1994

[Congenital toxoplasmosis, evaluation of the prevention policy].

OBJECTIVES: This study was performed to assess the effect of a prevention programme against congenital toxoplasmosis conducted as part of the French health policy developed in the Rhône department. METHODS: A descriptive epidemiological survey was conducted in 1991 including 806 post-partum women who were hospitalized in 22 maternities in the Rhône department. RESULTS: Forty-nine percent of the women had negative serology tests. French legislation requiring detecting non-immunized women at diagnosis of pregnancy was applied satisfactorily by the attending physicians. Inversely, women at risk were insufficiently informed: only 17% of the women at risk were aware of the three main routes of contamination; 63% believed vaccination is possible and 11% though they had been vaccinated. Deficient information was probably the cause of poor compliance to preventive measures as observed in this sample: only 17% of the serologically negative women stated they had applied anti-toxoplasmosis prophylaxy measures. CONCLUSION: Women at risk must be informed to convince them to modify their behaviour during pregnancy. The role of the attending physician and biologist is of major importance.

Adult↗
PubMed1994

Casemix--an AMA perspective.

The introduction of casemix payment systems into Australia's public hospitals is an inevitability which the Australian Medical Association has now begun to address. A greater involvement of clinicians in the design and implementation of casemix can add substantial quality to these systems. However, there is concern that a proliferation of separate casemix systems may be contrary to overall health policy developments and that governments will not understand the limits of casemix. Recent attempts to include medical payments within a casemix payment system in the private sector faced our united opposition. Finally, special care needs to be taken to ensure that the introduction of a casemix payment system does not further disadvantage access to high quality health care for Aborigines.

Australia↗
PubMedDate not supplied

1992 Ontario Survey of Public Health Nurses: perceptions of roles and activities.

A survey of public health nurses (PHNs) who work in official public health units in Ontario was undertaken to determine whether their perceptions of their roles and activities concurred with a 1990 Canadian Public Health Association report which describes the roles and qualifications of public health nursing in Canada. The survey questionnaire was completed by 1,849 PHNs in all 42 public health units (response rate = 85%). About one tenth of the PHNs reported no activity as a caregiver/service provider. Most PHNs reported being active in the roles of educator/consultant, social marketer, and facilitator/communicator/collaborator. The community developer, policy formulator, research/evaluator, and resource manager/planner/coordinator roles were less frequently performed, however, increased activities in such roles were expected in the future. Nurses said that they needed further preparation to perform the latter roles. These results have implications for deployment of PHNs as Ontario's health system shifts to community health and health promotion.

Community-Institutional Relations↗
PubMedDate not supplied

Personal, home and community safety promotion with community-dwelling elderly persons: response to a public health nurse intervention.

Public health clients aged 65 years and older were randomly allocated to receive an intervention by a public health nurse during a home visit, promoting either safety behaviours or influenza immunization. Sixty-eight clients reported making a total of 103 safety changes, with almost equal proportions making changes in the safety and influenza groups (21.9% vs. 18.3%). A higher percentage of males (25.0%) than females (17.3%) reported making safety changes following the intervention. Further research should focus on the effectiveness of safety promotion strategies which are expanded to include seniors participation, policy development and community planning and design.

Activities of Daily Living↗
PubMed1994

Legal considerations for document delivery services.

Health sciences libraries that provide fee-based information services must consider and develop policies and procedures for complying with legal requirements. This paper reviews the provisions of copyright law that pertain to document delivery, including two court decisions concerning copyright. Also discussed are recent actions by publishers to reinforce their view of libraries' responsibilities for royalty fees for articles copied and their use of licenses to impose additional restrictions on the use of and reproduction of materials.

Copyright↗
PubMed1993

EUROHEALTH Programme.

The countries of central and eastern Europe (CCEE) and the newly independent states (NIS) of the former USSR are undergoing rapid and profound change, and assistance from the international community has lacked a common focus. In late 1990, the WHO Regional Committee for Europe created the EUROHEALTH programme to try to meet the urgent and medium-term needs of the CCEE/NIS for technical, managerial and material resources within the framework of the long-term regional strategy for health for all. The programme's strategy includes making collaborative agreements with each of the CCEE/NIS, raising funds and coordinating tripartite assistance with a wide variety of international organizations. The Regional Office for Europe has changed to support the EUROHEALTH programme by establishing a Country Health Development department, and an information clearing-house to track assistance to the NIS so it can be provided more efficiently. The programme's work has created a flow of information and better coordination of cooperation between all the organizations working in the health sector in the CCEE/NIS. The most important EUROHEALTH activities in 1992-1993 have focused on: relieving shortages of vaccines and medical equipment, developing health policy and developing programmes on such issues as health service reform, human resources, noncommunicable diseases, maternal and child health, AIDS and environment and health. The EUROHEALTH programme is a pragmatic and highly appropriate approach to the CCEE/NIS; its main need is for more funding to enable it to meet countries' needs more precisely and to cooperate more effectively with other organizations.

Europe↗
PubMed1994

Role function and mental health in postpartum working women: a pilot study.

1. Postpartum women have unique needs warranting study due to competing perspectives on the duration and time needed for recovery after childbirth. 2. This pilot study tests measures of role function and mental health in a sample of 26 women returning to work within 6 months of childbirth. 3. The study did not reveal decrements in mental health among subjects, but did reveal limitations to functional status. The results also suggested that the adapted measure of role function, and the measure of mental health, are reliable and have some preliminary evidence of construct validity in this population. 4. The results of the study have implications for occupational health nursing practice, including worker assessment and family policy development, and serve as a resource for measuring health outcomes in workers.

Female↗
PubMed1994

Human immunodeficiency virus infection. American College of Physicians and Infectious Diseases Society of America.

Knowledge about the epidemiology, diagnosis, and treatment of human immunodeficiency virus (HIV) infection gained since 1988 has necessitated an update of our previously published policies. Important advances have been made in the treatment of HIV infection and AIDS, resulting in a prolongation of the symptom-free period. Transmission of HIV infection from a dentist to several of his patients is believed to have occurred. Heterosexual transmission of HIV infection is increasing in importance. This statement emphasizes the ethical imperative to care for all patients; the need for health care professionals to adhere scrupulously to universal precautions because of the low but definite risk for transmission of HIV in the health care setting; the expanded recommendations for HIV testing to identify infected persons as early as possible; and the need for national leadership in public education, public policy development, and health care funding.

Ethics, Medical↗
PubMed1994

Core public health functions and state efforts to improve oral health--United States, 1993.

Since the 1988 Institute of Medicine report on the future of public health (1), state health agencies (SHAs) have focused on the role of the core functions of public health (i.e., assessment, policy development and assurance) in improving health in the United States. Oral diseases and conditions are among the most prevalent and preventable chronic health problems in the United States (2). Through use of the core functions as a guideline to identify basic public health practices integral to oral health, SHAs can improve oral health in the United States. To assess the level of involvement among SHAs with core public health functions related to oral health, in January 1994 the Association of State and Territorial Dental Directors (ASTDD) conducted a survey of SHAs in the 50 states and the District of Columbia. This report summarizes the survey findings.

Humans↗
PubMed1994

Investigating narcotic diversion.

Management is responsible for developing policies and procedures not only for handling of narcotics but also for investigating and intervening in drug-related incidents. Both nurse managers and peers often feel ill-prepared to deal with drug impairment. Nurses who suspect a peer of substance abuse should notify the manager, who must cross-check all medication documentation and look for the many tell-tale signs of narcotic diversion. If sufficient evidence is discovered, the nurse must be confronted and directed to some type of peer assistance or other recovery program.

Drug and Narcotic Control↗
PubMed1993

Case management in two long-term-care populations: a synthesis of research.

This article synthesizes case management research for two long-term care populations and compares the implications for practice, program, and policy development. The two populations are chronically mentally ill adults and functionally limited older adults. The findings are a synthesis of 137 empirical investigations of case management. The synthesis distinguishes three major variables related to case management for these populations: (a) the goals or outcome variables for case management may affect the timing of case management services and the course of care for each population; (b) the availability and function of informal supports is developmentally different for the two groups; and (c) there is a need for varying constellations of services for different long-term-care populations.

Activities of Daily Living↗
PubMed1994

Patient satisfaction surveys as a market research tool for general practices.

BACKGROUND: Recent policy developments, embracing the notions of consumer choice, quality of care, and increased general practitioner control over practice budgets have resulted in a new competitive environment in primary care. General practitioners must now be more aware of how their patients feel about the services they receive, and patient satisfaction surveys can be an effective tool for general practices. AIM: A survey was undertaken to investigate the use of a patient satisfaction survey and whether aspects of patient satisfaction varied according to sociodemographic characteristics such as age, sex, social class, housing tenure and length of time in education. METHOD: A sample of 2173 adults living in Medway District Health Authority were surveyed by postal questionnaire in September 1991 in order to elicit their views on general practice services. RESULTS: Levels of satisfaction varied with age, with younger people being consistently less satisfied with general practice services than older people. Women, those in social classes 1-3N, home owners and those who left school aged 17 years or older were more critical of primary care services than men, those in social classes 3M-5, tenants and those who left school before the age of 17 years. CONCLUSION: Surveys and analyses of this kind, if conducted for a single practice, can form the basis of a marketing strategy aimed at optimizing list size, list composition, and service quality. Satisfaction surveys can be readily incorporated into medical audit and financial management.

Adolescent↗
PubMed1993

Nurse participation in ethical decision making in the clinical setting.

Nurses, in their day-to-day practice, are required to combine clinical expertise with skill in moral judgment. Because of the nurse's unique relationship with the patient and a collaborative practice with the physician, the nurse often is at the forefront of identifying ethical dilemmas. In addition to identification of the ethical dilemma, the nurse often actively participates in the decision-making process. Ethical decision-making models bear some resemblance to the nursing process. The nurse plays an active role in each step of assessment, planning, implementation, and evaluation. An increasing number of nurses are formally participating in ethical decision making as a member of hospital ethics committees. The three primary tasks of these committees are: (1) education; (2) policy development; and (3) case consultation. Nursing ethics committees also are being developed to address issues specific to nursing, such as nurse staffing ratios and allocation of nursing resources. Nurses can use ethical rounds or retrospective case studies to perpetuate the study of ethics at the bedside.

Decision Making↗
PubMed1993

Families with children with emotional disorders: a review of the literature.

This review identifies and explores a body of literature that correlates a child's emotional or behavioral problems with some aspect of the family and a body of literature that considers a wider ecological perspective. This literature is examined in relation to two questions: (1) What do we know about families with children with emotional disorders? and (2) How does that information help us design social policy and social work interventions for these families and their children? The hope for social work research and practice, as well as program and policy development, lies in expanding the ecological work that considers factors related to children's referral for mental health services, parents' perspectives of what they expect from mental health services, and parents' perspectives of their experiences and needs in relation to their child with emotional or behavioral problems.

Adult↗
PubMed1994

Human immunodeficiency virus (HIV) infection. American College of Physicians and Infectious Diseases Society of America.

Knowledge about the epidemiology, diagnosis, and treatment of human immunodeficiency virus (HIV) infection gained since 1988 has necessitated an update of our previously published policies. Important advances have been made in the treatment of HIV infection and the acquired immunodeficiency syndrome (AIDS), resulting in a prolongation of the symptom-free period. Transmission of HIV infection from a dentist to several of his patients is believed to have occurred. Heterosexual transmission of HIV infection is increasing in importance. This statement emphasizes the ethical imperative to care for all patients; the need for health care professionals to adhere scrupulously to universal precautions because of the low but definite risk for transmission of HIV in the health care setting; the expanded recommendations for HIV testing to identify infected persons as early as possible; and the need for national leadership in public education, public policy development, and health care funding.

AIDS-Related Opportunistic Infections↗
PubMed1993

A framework for quality assurance by professional organizations.

The Australian Diabetes Educators Association (ADEA) has undertaken policy development aimed at maintaining standards of practice and increasing professional skills. The components of a quality assurance framework have been identified and committees established to operationalize the objectives. Implementation of quality assurance projects has benefits for consumers and providers of health care. Knowledge and skills developed in the process of implementing quality assurance initiatives increase professional awareness and can be adapted to broaden practice parameters and create practice opportunities. This paper describes the approach to quality assurance developed by the committees and working parties of the ADEA that could be implemented in part or whole by professional groups seeking to ensure quality services by members.

Accreditation↗
PubMed1993

Continuing nursing education: why don't nurses go? Why don't they use what they learn?

There are barriers that block nurses from participating in continuing nursing education (CNE) and from using what they learn when they do participate. This article describes the problems nurses experience in going to, and using what they learn from, CNE. Possible causes for the barriers, and steps to take to surmount them, are discussed. This information has implications for human and financial resource management, staffing and scheduling, staff development, policy regulations, economics, and professional trends.

Adult↗
PubMed1993

Assessing the utilization of in-patient facilities in a Canadian pediatric hospital.

STUDY OBJECTIVE: To validate the pediatric appropriateness evaluation protocol (P-AEP) for use in the Canadian health care system and then to use it to assess the extent of inappropriate utilization in a Canadian tertiary care pediatric facility. METHOD: The P-AEP was applied to a 10% random sample of all general pediatric admissions during 1990 and to a sample of 547 subsequent days of care. The reliability of the P-AEP was assessed using a subsample of 72 admissions and 72 days of care. Validity was tested by comparing the P-AEP judgment on a sample of 50 admissions and 50 days of care with the subjective opinion of panels of three pediatric staff physicians. RESULTS: In the reliability test, there was a high level of agreement between the two independent observers applying the P-AEP. In validity testing, the physicians found a slightly lower rate of inappropriateness relative to the P-AEP, but the validity was good overall. In the main study, 136 of 477 admissions (29%) were found to be inappropriate. Factors associated with inappropriate admission included nonurgent or emergent admission, surgical (versus medical) cases, residence outside the Greater Vancouver area, and admission on Sundays or Mondays. Fifty-five percent of inappropriate admissions were judged necessary but premature, whereas 45% were judged medically unnecessary. Of 547 subsequent days of care, 121 (22%) were found to be medically inappropriate. Inappropriate days of care were associated with girls, Mondays, and patients older than 14 years of age. CONCLUSIONS: The P-AEP seems to be a valid and useful instrument for assessing the utilization of pediatric beds in a Canadian health care setting. Using the P-AEP made it possible to identify several service and policy developments which would help improve the efficiency of utilization at the hospital.

Adolescent↗