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PubMed1992

The quality assurance-risk management interface.

Involvement with both risk management and quality assurance programs has led many authors to the conclusion that the fundamental differences between these activities are, in fact, very small. "At the point of overlap, it is almost impossible to distinguish the purposes and methods of both functions from one another." "Good risk management includes real improvement in patient care through organized quality assurance activities." The interface between a proactive risk management program and a quality assurance program is dynamic and can serve the legitimate interests of both. There is little to be gained by thinking of them as separate entities and much to be gained by sharing the lessons of both. If one thinks of risk management in terms of "risk" to quality patient care, and that "assuring quality" is the most productive type of risk management, then there is no practical reason to separate one from the other.

Emergency Service, Hospital↗
PubMed1990

Community awareness and utilization of growth chart in a semi-urban Nigerian community.

Five hundred and eighteen mothers resident in Adeta, Sawmill and Baboko Communities of Ilorin Local Government Area of Kwara State, Nigeria, were interviewed to assess their knowledge, utilization, and understanding of the growth chart. Five health facilities in the communities studied were visited to assess the availability, utilization and understanding of growth charts by health workers. Over half (53.7%) of the mothers interviewed have heard about growth charts. The level of awareness was significantly influenced by maternal age, educational status and parity (PLO.OS). Of those who have heard about growth chart, only 155 (55.8%) have it, and 150 of these (96.8%) use it regularly. One hundred and seventy four (33.6%) of all mothers, but 62.6% of those who have heard about the chart demonstrated an understanding of the markings on it. One hundred and sixteen mothers found the growth chart useful for immunization record, nutrition advice, clinic appointment dates, and assessment of developmental milestones. Two of the five health facilities visited had, and used growth charts. The health workers, however, demonstrated a clear understanding of weighing, plotting, and interpretation of the chart, and gave appropriate advice to mothers. Ways of improving growth monitoring in the community using the growth chart are suggested.

Adult↗
PubMed1991

Utilization of village health workers within a primary health care programme in The Gambia.

The utilization of Village Health Workers (VHWs) was studied in a rural area of The Gambia 3 years after the introduction of a village-based Primary Health Care (PHC) programme. Of 23 children who died from conditions treatable at village level, only five were first seen by the VHW. Fourteen were seen elsewhere in the region by staff more qualified than the first tier workers. The implications of this pattern of utilization on the lack of impact of VHWs on mortality are discussed. Only half of the non-fatal illnesses were attended to by VHWs. Reasons for this included such factors as lack of knowledge of services available, shortages of money, absence of the VHW at critical periods and social or political disputes with VHWs. Attempts must be made to tackle these fundamental problems if VHWs are to be successfully incorporated into the health services.

Cause of Death↗
PubMed1991

Microcomputer applications for primary health care in developing countries.

This article explores some ways in which computer technology can be harnessed to strengthen primary health care planning and management, make more efficient use of scare health resources, and maximize the beneficial impact on health of local, district, and national health systems in both developing and developed countries.

Cost-Benefit Analysis↗
PubMedDate not supplied

The Guadeloupean perinatal mortality audit: process, results, and implications.

In 1983, we implemented an ongoing perinatal mortality audit in Guadeloupe to identify factors underlying the current level of poor perinatal outcome and to stimulate increased provider motivation. The audit was part of an active research approach to document the specific nature of the perceived perinatal health problem, to modify provider behavior through the use of this acquired information, and, ultimately, to decrease avoidable perinatal deaths. We investigated all 320 perinatal deaths in Guadeloupe during 1984 and 1985. Nearly one-half of the perinatal deaths reviewed were determined to be related to maternal high blood pressure, maternal/fetal infection, and preterm delivery. Slightly more than one-half of the perinatal deaths were considered to be avoidable. Over the course of the audit, perinatal mortality rates exhibited a marked decline. The findings of this study support claims that perinatal audits with confidential inquiries may help effect change in perinatal health status in a population; the findings also call attention to the potential benefits of incorporating motivational incentives into these activities.

Cause of Death↗
PubMedDate not supplied

Late sequelae following laparoscopic female sterilization.

A retrospective study regarding long-term sequelae among 818 randomly selected patients undergoing elective laparoscopic tubal sterilization is presented. These procedures were carried out at the Women's Medical Pavilion in Dobbs Ferry, NY, a free-standing surgical unit, between January 1, 1980 and June 30, 1985. A questionnaire was sent to each patient's last known address and, at the same time, attempts were made to contact them by telephone; 623 patients were reached and assessed as to satisfaction with tubal ligation, any ensuing menstrual changes requiring a D&C, and/or psychological problems. Also determined was the number of patients in the series who failed to continue routine gynecological care. It was found that the incidence of dissatisfaction with the operation was 2.9%, of undesired menstrual changes, 4.8%, and of psychiatric morbidity, 8.2%. These results were also correlated with the data of our medical records. In our series, 16.9% of the women failed to continue routine gynecological care. The necessity of thorough counseling by strict guidelines and the need for follow-up are discussed.

Adult↗
PubMed1989

Identifying health problems and health research priorities in developing countries.

When we were invited to prepare this background paper on the health problems of the developing countries for the Commission on Health Research for Development, our first thought was to compile and organize available data on the causes of morbidity and mortality affecting different age groups in various populations. It soon became clear that this would not be especially useful. There are major gaps in the available data, particularly from the poorer countries and for people above 5 years of age. The data that are available are often of poor or uncertain quality, collected from unrepresentative or undefined subpopulations, and not strictly comparable due to different definitions and data-collection methods. Additionally, in the absence of agreed definitions and analytical frameworks, it is not clear what could or should be done with the data on health problems so amassed. More fundamentally, we have come to doubt whether the current array of epidemiological concepts and tools is sufficient for the task. We therefore decided that, while giving an overview of current knowledge on levels and trends of morbidity and mortality, the emphasis of this paper should be more towards concepts, methods, and data deficiencies. In Section 1, we set out definitions and frameworks for considering health problems and health research; we review recent conceptual models for the analysis of the determinants of child survival; and we outline a framework, focusing on modifiable determinants of health and life-cycle health effects, which is used in subsequent sections. In Section 2, relationships between national and societal level determinants and health are reviewed and then set aside. In Section 3, we review available data on world patterns and trends of morbidity and mortality, highlighting the data deficiencies and lacunae. In Section 4, we follow the life of a woman in a developing country and examine the health problems, and their determinants, which she and her children face. In Section 5, we draw these strands together and, having reviewed current approaches to prioritizing health problems and suggested some ways in which they could be improved, in Section 6 identify several research priorities, emphasizing the need for methodological research. This paper was commissioned in March 1987; prepared in draft and presented to a meeting at Chateau de Bossey, Geneva, Switzerland during 15-17 July; and revised and completed in September 1987. It is in no sense definitive or final.(ABSTRACT TRUNCATED AT 400 WORDS)

Developing Countries↗
PubMed1989

Teenage pregnancy: a theoretical analysis of a social problem.

This paper begins by contrasting the two basic ways of defining a social problem (i.e., as a "problem" in society or of society). The implications of these two definitions are discussed within the context of the various approaches which have emerged from each. A typology is then developed which allows these divergent approaches to be synthesized into three broad categories (Social Disorganizational, Social Definitional, and Social Organizational). This typology helps to further clarify the implications of isolating certain noxious conditions (whether personal or social) and conceptualizing them as social problems. These implications for the emergence, scope, and possible solution to the problem of teenage pregnancy are discussed. The paper concludes with a theoretical critique that leaves little room for optimism about the piecemeal solutions to teenage pregnancy offered by either the social disorganizational or the social definitional approaches, yet it recognizes the unlikely prospects that the holistic solution is likely to be adopted soon. The paper thus concludes that this problem is likely to be with us for some time to come, and the best that we can hope to do is to treat the symptoms.

Adolescent↗
PubMed1988

Postmolar contraception.

Recent studies on the etiology and the cytogenetics of trophoblastic tumors suggest that hydatidiform mole and choriocarcinoma may be conditions with no causal relationship. With the advent of newer diagnostic methods which aid in the early diagnosis of pregnancy and help to differentiate it from abnormal pregnancy together with the increasing concern over the safety of use of the contraceptive measures following a hydatidiform mole, it is suggested that a period of postmolar contraception may no longer be necessary. The follow-up of these patients should include serial sonography in association with other currently available methods. Pregnancy should also be allowed to occur naturally if the patient so desires.

Contraception↗