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PubMed2003

Plain radiographic surveillance of abdominal aortic stent-grafts: the Liverpool/Perth protocol.

PURPOSE: To present a protocol for plain radiographic surveillance of abdominal aortic stent-grafts that addresses the main variables in need of standardization: (1) patient position, (2) radiographic centering point, and (3) focus-to-film distance. TECHNIQUE: Our policy is to perform baseline anteroposterior and lateral films following endoluminal grafting and repeat the studies annually. These are the most important films to assess migration and component separation; supplementary right and left posterior oblique radiographs may help identify wireform fractures. It is best to perform radiography before computed tomography if both tests are scheduled for the same day, as excretion of intravenous contrast opacifies the renal collecting systems and interferes with radiographic analysis. CONCLUSIONS: Evaluation of the radiographs depends on the design of the stent-graft, so it is important to understand graft construction and the position of the radiopaque markers to best assess changes on follow-up films.

Aortic Aneurysm, Abdominal↗
PubMed2005

For work and for school: internal migration of Canada's rural nurses.

Using data from the Registered Nurses Database and a recently conducted national survey, this study examined the internal migration patterns of Canadian-educated rural RNs. Inter-provincial migration rates, ranging from 11% to 27% depending on the database used, mask much wider variations in sub-provincial movement rates, which are particularly relevant when considering the provision of nursing services in rural and remote communities. Rural RNs are more likely to migrate if they are female, older, working in nursing stations, and living in remote communities. A majority of RNs whose migration is associated with going to school after their initial nursing education do not return to the jurisdiction where they were first registered. Targeted migration studies are needed to fully understand both the detailed patterns and the predictors of such movements in order to better assess recruitment and retention policies and to enhance our overall health human resources planning models.

Adult↗
PubMed1992

Methods for assessing the impact of temporary labour emigration.

The author analyzes temporary labor migration and its impact on economic development in developing countries. "The paper presents four methods...namely partial sectoral analysis by regression computations, cost-benefit analysis, social accounting matrices, and computable general equilibrium models. It considers their respective advantages for different ends, questions, and policy goals, and explains their data requirements." A comment by Mohammad Afzal is included (pp. 1,237-9).

Demography↗
PubMed2004

Screening for prostate cancer: updated experience from the Tyrol study.

The aim of the Tyrol study was to monitor the impact of screening in a natural experiment by comparing prostate cancer mortality in Tyrol, where prostate-specific antigen (PSA) testing was introduced at no charge, with the rest of Austria, where it was not strictly organized and not free of charge. In 1993, PSA testing was made freely available to men between the ages of 45 and 75 years in the Federal State of Tyrol, Austria. At least 70% of all of the men in this age range have been tested at least once during the first 10 years of the study. Initially, only total PSA was measured, but free PSA measurement was added in 1995. Since 2001, complexed PSA also has been measured. Digital rectal examination was not part of the screening examination. Significant migration to lower clinical and pathological stages has been observed since the introduction of this screening program. These findings are consistent with the hypothesis that the policy of making PSA testing freely available, and the wide acceptance by men in the population, is associated with a reduction in prostate cancer mortality in an area in which urology services and radiotherapy are available freely to all patients. It is our opinion that most of this decline is likely a result of aggressive downstaging and successful treatment and that any contribution from detecting and treating early cancers will become apparent in the years to come.

Aged↗
PubMed1979

Providing health and social services to illegal alien families: a dilemma for community agencies.

Proposals for dealing with illegeal migration from Mexico to the United States generally do not recognize it as an international social problem. The proposals also present contradictory solutions. Amnesty, a humanitarian policy, is being suggested as well as increased restrictions and punishments, a policing policy. However, in the absence of a comprehensive national policy, community social and health care programs must provide services to illegal aliens. This article attempts to document some of the issues that illegal immigration presents for community agencies.

Child Health Services↗
PubMed1990

Labour migration and the single European market: a synthetic and prospective note.

"The present paper is an attempt to analyse and forecast the following major issues relating to migration in Europe after 1992: (i) the evolution and structure of intra-European flows in the forthcoming single European market; (ii) the integration, after 1992, of established immigrant communities, including ethnic minorities and second generation groups; (iii) future immigration from non-EC member states.... The article explains that, in addition to policy-related mutations inherent in the completion of the internal market, other factors (demographic changes and insufficient enrolment of national graduate students in key disciplines) and issues (emergence of atypical groups such as second generation and Eastern European migrants), are due to generate new patterns and modified interests in European labour migration after 1992."

Acculturation↗
PubMed2001

Is globalization good for your health?

Four points are made about globalization and health. First, economic integration is a powerful force for raising the incomes of poor countries. In the past 20 years several large developing countries have opened up to trade and investment, and they are growing well--faster than the rich countries. Second, there is no tendency for income inequality to increase in countries that open up. The higher growth that accompanies globalization in developing countries generally benefits poor people. Since there is a large literature linking income of the poor to health status, we can be reasonably confident that globalization has indirect positive effects on nutrition, infant mortality and other health issues related to income. Third, economic integration can obviously have adverse health effects as well: the transmission of AIDS through migration and travel is a dramatic recent example. However, both relatively closed and relatively open developing countries have severe AIDS problems. The practical solution lies in health policies, not in policies on economic integration. Likewise, free trade in tobacco will lead to increased smoking unless health-motivated disincentives are put in place. Global integration requires supporting institutions and policies. Fourth, the international architecture can be improved so that it is more beneficial to poor countries. For example, with regard to intellectual property rights, it may be practical for pharmaceutical innovators to choose to have intellectual property rights in either rich country markets or poor country ones, but not both. In this way incentives could be strong for research on diseases in both rich and poor countries.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Primary-care--physician supply: policy analysis on the state level.

OBJECTIVE: To describe a method for policy analysis on the state level for understanding frequently overlooked determinants of the current status and dynamics of primary-care-physician supply. DESIGN: The method used is systems analysis. The approach takes account of the changing interstate migration, tracking the professional origins of physicians, their uneven age distribution, and the considerable time delays in the system. The forecasting mathematical model consists of the physician-aging submodel, the undergraduate and graduate medical education submodel, and the migration subsystem. SETTING: The necessary data were restored fully from the Virginia Board of Medicine archive database. RESULTS: The analysis shows the outstanding importance of out-of-state migration for the state of Virginia: approximately two thirds of primary-care physicians are out-of-state medical graduates. In the next decade, the attrition of primary-care physicians will start to increase steadily because of the prominent bulge in the physician age distribution. Similar bulges were observed in the age distributions for some other states. CONCLUSIONS: The method reveals the underlying mechanisms and principles of physician work-force reproduction. It may show which goals are feasible, and it may be used in any state for the research necessary for rational policy formulation.

Age Distribution↗
PubMed1999

Ageing in rural China: impacts of increasing diversity in family and community resources.

The majority of China's population lives in rural areas and a pattern is emerging of very uneven provision of support for rural elderly people. Local economic conditions and broad demographic trends are creating diversity in the ability both of rural families to care for their elderly kin and in the capacity of communities to support their elderly residents and family carers. In part as a consequence of China's population policy and the 'one-child policy', future Chinese families will have fewer members and be 'older', but they will continue to be regarded emotionally and in policy as the main source of economic and social support for the elderly. The increasing involvement of women in the paid workforce and the changing geographical distribution of family members resulting from work-related migration, are reducing the ability of families to care for their elderly relatives. The availability of resources other than the family for the care of older persons therefore becomes a key issue. Communities in more prosperous, modernising rural areas are often able to provide their elderly residents with welfare and social benefits previously found almost exclusively in urban areas. However, in poorly developed rural areas, provision is either very patchy or non-existent and the local economy cannot support expansion or improvement. A case study in Zhejiang Province illustrates the favourable provision for ageing in a prosperous modernising rural community, in which entitled elderly residents are provided with an impressive array of financial and social benefits. The paper concludes with a consideration of the policy implications of the growing differentiation of the social and economic capacity of rural communities to support their elderly members.

Journal Article↗
PubMed2002

Community self-help and the homeless poor in Latin America.

Finding realistic housing solutions that are able to respond to the realities of poverty in the developing, or newly industrializing, world are frequently distinct from those suited to the developed world due to levels of poverty and differing welfare regimes. This requires a different understanding of the concept of housing and shelter for developing and developed countries. Population increase and emerging habitation patterns in parts of Latin America have required that policy-makers review traditional 'top down' approaches to the way the homeless poor are treated and how self-help or 'bottom up' schemes are increasingly seen as a sustainable way forward in providing affordable housing options to both governments and communities. Over the last decades, mass in-migration to cities has put pressure on governments to provide public housing--but two major problems arose: firstly, governments found it difficult to finance the increasing demand for public housing, and secondly, the nature of employment and the informal economy in the developing world meant that this new housing was often too costly for the urban poor, in some cases increasing homelessness still further. Recent policy developments tend to favour supporting what the poor are and have been able to achieve for themselves, with appropriate government support. Upgrading shack settlements is now recognised as a community driven and cost-effective response that can, if appropriately supported, offer an initial and sustainable solution to urban housing need by tapping into additional non-governmental sources of funding. In the absence of a major public sector housing stock to meet demand, governments are also recognising that self-help housing schemes for families able to access funding and resources offer a further innovative approach to meeting housing need. The nature of housing and shelter in the developing world requires a unique response so that it remains attainable and affordable to the poor. Neo-liberal policies, increasingly adopted in Latin America, are not able to provide suitable, sustainable and affordable housing delivery and alternatives need to be explored. This paper traces some developments in Latin American housing policy and explores some of the challenges that are faced in responding to the unique housing needs of the urban poor.

Developing Countries↗
PubMed1994

The geography of AIDS: patterns of urban and rural migration.

We sought to describe the migration patterns of patients infected with the human immunodeficiency virus (HIV) who seek health services in North Carolina. Of 390 consecutive adult patients with HIV seen at one tertiary care medical center in the southeastern United States in the summer of 1990, 340 (87%) were approached, and 325 (83%) completed surveys. Thirty-seven percent of respondents thought they had been infected and 20% were told they were infected with HIV while living outside of North Carolina. One in five patients thought they had been infected while living in a rural county and more than half now live in rural communities (population of < 50,000). Sixty percent of patients had moved to North Carolina since 1980; 61% of these were North Carolina natives. Injecting drug users were more likely than those with other modes of exposure to HIV to have been diagnosed with HIV infection out of state (34% vs 18%). Patients' reasons for moving to North Carolina included social support (88%), health reasons (54%), and better work/educational opportunities (52%). We found that most patients with HIV who seek health care services in North Carolina live in rural areas with their families, and a substantial proportion migrated in after they were diagnosed out of state. Characterizing these migration patterns is crucial for predicting the diffusion of HIV to rural areas; designing AIDS prevention strategies, education, and health service needs; and assessing federal HIV care funding policies.

Acquired Immunodeficiency Syndrome↗
PubMed2006

[Study on factors causing the delay of access to tuberculosis diagnosis and its influencing factors in migrating tuberculosis patients in Putuo district, Shanghai].

OBJECTIVE: To describe factors causing the delay of diagnosis among non-resident tuberculosis (TB) patients and to study its implications from demographic, socio-economic aspects in order to provide information to policy makers for TB control programs in Shanghai. METHODS: A historical cohort study through questionnaire interview was conducted in 146 newly diagnosed TB patients. The questionnaire covered the general information of subjects and information on patients' health care seeking experiences from the first symptom to the TB diagnosis in health facilities. Index adopted to reflect the access to TB diagnosis would include the days due to delayed diagnosis consisting the days from both patient's and doctor's responsibilities. RESULTS: The median days due to patients' delay was 19 (7-33.5) days, which was 3.8 times longer than 5 (2.5-10) days caused by doctor's. The median of total diagnostic delay was 31 (11-59) days. Female TB patients, patients with lower than annual 5000 Yuan income had an increased risk of a longer diagnostic delay with an OR of 3.226 and 11.958 relatively. Smear positive patients had a shorter delay (OR = 0.280, P < 0.05). CONCLUSION: Delayed diagnosis was mostly caused by the patients, suggesting that TB control strategy for non-residents should aim at improving the access to TB diagnosis among patients with lower income and female non-residents.

China↗
PubMed1986

New federalism and health care policy: states and the old questions.

The New Federalism that evolved under the Reagan administration tends to grant states more discretion in the implementation of health care programs. It thereby rekindles old concerns about the commitment, capacity, and progressivity of the states. This paper reviews recent policy developments and reconsiders state performance from the vantage point of the mid-1980s. While hard evidence remains elusive, a plausible case exists that any gap between the states and Washington on commitment, capacity, and progressivity has diminished. State administrative capacity in particular has probably increased. The continued presence of substantial variation among the states needs to be underscored, however. Moreover, the relentless imperative of economic development, or migration, theory sets severe limits on how far states can go in adopting redistributive measures to assure adequate medical care for the poor. Given current federal laws, the most optimistic, plausible scenario envisions the rise of a technical politics of efficiency in the states. In spite of state limitations, health policy reformers need to pay increased attention to their potential role.

Costs and Cost Analysis↗