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PubMed2005

Using pooled budgets to integrate health and welfare services: a comparison of experiments in England and Sweden.

The lack of collaboration between health, social and other welfare services is believed to impair efficiency and reduce effectiveness in addressing the complex problems of patients. Differences in funding streams, political accountabilities, organisational structures and professional cultures are all alleged to contribute to barriers between services. Drawing on their respective evaluations, this paper describes experiments in England and Sweden that use pooled budgets between services to improve interagency and interprofessional collaboration and presents evidence on their impact. Despite differences in the funding and organisation of health and welfare services in each country, some similar conclusions are reached. Among senior managers and politicians, budget pooling broadened their awareness of interdependencies with other agencies and professionals in promoting patients' welfare. However, these broadened perspectives were not immediately shared by professionals working at the front line, with whom patients had immediate contact. Moreover, neither experiment yielded unequivocal evidence of improved cost-effectiveness or of the benefits of budget pooling on the outcomes for service users. These experiments also raise questions about the equity and accountability of welfare services because in both countries only a limited range of services has been integrated under the umbrella of the pooled budgets.

Budgets↗
PubMed1992

Epidemiological research on cocaine use in the USA.

In the study of cocaine, epidemiology offers a way to reckon the experience of human populations, from time to time, from region to region, from community to community, and from group to group. Continuing surveillance of cocaine experiences in diverse segments of the United States population has allowed us to plot the course of our most recent cocaine epidemic in more detail than in the past. Still, much remains to be learned about the dynamics of the cocaine epidemic before public health agencies or anyone else should ride to glory on the descending limb of this epidemic curve. Beyond basic surveillance, epidemiology has the capacity to teach us about the conditions under which human cocaine use starts, is maintained, and stops, including the array of perceived and actual consequences of cocaine use that may determine specific patterns of use. In this respect, there is some value in making a chronicle of cocaine users' life experiences, with a comparison to the life experiences of others. However, the perceptions of cocaine users do not always map onto observations made under controlled conditions of laboratory research. Finally, it is not essential for epidemiology to rely solely upon what individuals perceive and report as causal linkages between cocaine use and their other life experiences. One effective alternative is to use the epidemiological case-control method and related strategies to probe suspected causal linkages involving cocaine. As demonstrated in recent research, these strategies have a resolving power that goes beyond that of standard epidemiological survey reports. Of course, the resulting epidemiological evidence does not stand alone. Rather, it complements laboratory and clinical research, giving a more complete view of cocaine's impact on human health.

Cocaine↗
PubMed1982

Patterns of contraceptive use among female adolescents: method consistency in a clinic setting.

Major changes in contraceptive use among adolescents in the United States have been documented through surveys and analysis of family planning program service statistics. While we know of the changes in the adolescent population as a whole and those served by organized family planning programs, little is known about the patterns of contraceptive use by individuals. This study examines patterns of contraceptive use among 547 clients of a new contraceptive and counseling service for adolescents in New York City. The principal concern is consistency of contraceptive method use as determined from clinic statistics. Findings show generally high degrees of method consistency, with new and current users displaying more consistency than prior users. Among clients who switch methods, two major patterns emerged: switching among the more effective methods and from less effective to more effective methods. Younger new users were the most consistent subgroup suggesting that a service designed for adolescents may have a positive influence on teenagers without prior contraceptive experience. Prior users were the least consistent subgroup suggesting that programs incorporate screening procedures to identify prior users and to develop new approaches to understanding their past contraceptive use patterns to improve their future use.

Adolescent↗
PubMedDate not supplied

Factors associated with use of the female condom.

Black, Hispanic and white women recruited for an HIV prevention intervention were instructed in the use of the female condom and encouraged to try the device. Of the 231 women who completed the intervention, 29% tried the condom over the course of a month; 30% of those who tried it used it during at least half of their sexual encounters. Both ethnicity and age were associated with trying the device: Nearly 40% of black women and 30% of Hispanic women did so, compared with 18% of white women; 37% of those aged 25-34 tried the female condom, compared with 22% of women younger than 25. Trying the device was more likely among women living with a partner, those with a history of sexually transmitted disease infection, women who had had an HIV test, those who did not believe that the method afforded them a greater degree of overall control than did the male condom and those who had no prior knowledge of the device. Among women who used the device during at least half of their sexual encounters, 27% were black and 44% were Hispanic: 38% were younger than 25, and 43% were single. More regular users were about half as likely as less regular users to experience difficulty with insertion and one-eighth as likely to report the device slipping during use; they were more likely than less regular users to report that sex was more pleasurable with the female condom than with the male condom.

Adolescent↗
PubMedDate not supplied

Postural instability induced by virtual reality exposure: development of a certification protocol.

Exposure to virtual environments often causes users to experience symptoms of motion sickness. An accessory manifestation of motion sickness symptoms is postural disequilibrium. If the postural disequilibrium that occurs persists beyond the time an individual is within the confines of the laboratory or system site, user safety could be compromised and products liability issues could be forthcoming. In this study, a portable, automated postural assessment system is developed that can be employed before and after exposure to a virtual reality (VR) system in order to certify that a user's balance on exiting the system is at least demonstrably as good as it was on entering. It is argued that if the "coming out" balance performance is sufficiently poorer than the "going in" balance, then the user should be retained until the pretest balance performance is regained. The results from a set of normative and validation experiments on postural equilibrium identified several reliable measures of stance that could serve as a basis for certification. Furthermore, a new automated video-based measure using only head movement showed that performance over sessions is stable and reliable. The head movement changes that occur with stimuli, such as alcohol and simulator exposure, are well behaved, predictable, and significant even with small samples. The implication is that the proposed objective measure of postural stability, in conjunction with procedures for obtaining self-reports of symptoms, can afford some measure of certification that exposure to a given VR system is without harm.

Accident Prevention↗
PubMed2003

PsyScript: a Macintosh application for scripting experiments.

PsyScript is a scriptable application allowing users to describe experiments in Apple's compiled high-level object-oriented AppleScript language, while still supporting millisecond or better within-trial event timing (delays can be in milliseconds or refresh-based, and PsyScript can wait on external I/O, such as eye movement fixations). Because AppleScript is object oriented and system-wide, PsyScript experiments support complex branching, code reuse, and integration with other applications. Included AppleScript-based libraries support file handling and stimulus randomization and sampling, as well as more specialized tasks, such as adaptive testing. Advanced features include support for the BBox serial port button box, as well as a low-cost USB-based digital I/O card for millisecond timing, recording of any number and types of responses within a trial, novel responses, such as graphics tablet drawing, and use of the Macintosh sound facilities to provide an accurate voice key, saving voice responses to disk, scriptable image creation, support for flicker-free animation, and gaze-dependent masking. The application is open source, allowing researchers to enhance the feature set and verify internal functions. Both the application and the source are available for free download at www.maccs.mq.edu.au/-tim/psyscript/.

Computer Graphics↗
PubMed1986

Licensing criteria for nuclear medicine.

The use of radioactive materials in medicine is one of the most highly regulated areas the physician has to deal with. There are three basic types of licenses for use of radioactive material defined in the Code of Federal Regulations (CFR), chapter 10, part 35. These are the general license, which is mainly applicable to small volume in vitro work; the specific license, which is used in most medical facilities; and the broad license, which is suited for larger research-oriented practices. Licensing requires proof of competence of the user and of adequate provision for protection of public health. Materials used in medicine are grouped for convenience into three diagnostic categories and two therapeutic categories. A sixth group, for sealed implants, is not generally applicable in nuclear medicine. Training and experience of users may be documented in a number of ways, including board certification in nuclear medicine. Therapeutic applications require additional proof of direct personal experience. The radiation safety officer is a pivotal individual in the licensing procedure, being directly responsible for carrying out the highly detailed requirements for protection of personnel and patients. A radiation safety program based on the "as low as reasonably achievable" (ALARA) concept requires personal monitoring, inventory control, detection and control of contamination, and strict adherence to licensing rules. Training of personnel and proper maintenance of equipment and facilities are also vital parts of the licensing process. The requirements of licensing and for renewal are clearly spelled out by the various regulatory agencies and require meticulous record keeping with documentation that all prescribed procedures have been followed and duly recorded.

Facility Regulation and Control↗
PubMed1996

User involvement in the nursing curriculum: seeking users' views.

This qualitative study considers the views of users of mental health services on a pre-registration nursing curriculum. Semistructured group interviews were used to gain the (illustrative) views of twenty members of two user groups on nursing knowledge, skills and qualities. Interest in users' views has generally been belated or reluctant. In more recent literature, statements emerge about the need to develop a climate of respect, acceptance and sensitivity. While nurses have a central role in mental health care, a detailed examination from the user's perspective has been lacking. Despite the rhetoric of involvement, commentaries on nursing practice suggest little has changed. Findings suggest an eclectic knowledge base that respects individual differences and the user's experience, knowledge of local communities, and better recognition of physical illness is required. 'Knowledge of life' is seen as important. An emphasis on interpersonal skills is suggested, including flexible responses, information-giving, and sensitive handling of tense situations. This should be balanced against 'practical' nursing. Traditional teaching in relation to 'psychotic' experiences is challenged. It is suggested that caring should be emphasized as much as 'rational knowledge'. Developing responsive qualities that minimize 'distancing' may demand a reevaluation of boundaries between user and professional.

Attitude to Health↗
PubMed2005

Circumstances surrounding the first injection experience and their association with future syringe sharing behaviors in young urban injection drug users.

Young injection drug users are at heightened risk for acquisition of blood-borne infections because of their high rates of unsafe injection behaviors, yet there has been little research examining the circumstances surrounding injection drug users' first injection experience ('hit'). We examined the relationship between factors associated with young drug users' first hit and their future syringe sharing behaviors among 420 new initiates to injection drug use (less than 5 years), aged 15-30 years old in urban Baltimore, Maryland. Contingency table analysis and logistic regression were used to determine the association between circumstances surrounding the first hit and recent receptive syringe sharing. Participants were primarily male (58.8%), White (71.2%), and were a median age of 24 years (interquartile range [IQR]: 21-27 years). Adjusting for race, gender, and homelessness, the following variables were independently associated with recent receptive syringe sharing: age at first hit (adjusted odds ratio [AOR] = 0.92 per year increase; 95% confidence interval [CI]: 0.87-0.98), self-injection at initiation (AOR = 0.55; 95% CI: 0.32-0.97) and using a syringe that had previously been used by someone else at first hit (AOR = 2.81; 95% CI: 1.70-4.64). These data suggest that injection-related risk behaviors may be established as early as the onset of injection initiation, supporting the need to educate non-injectors of the harms associated with unsafe injection practices.

Adolescent↗
PubMed1991

User charges for health care: a review of recent experience.

This paper reviews recent experiences with increases in user charges and their effect on the utilization of health care. Evidence from several countries of differences in utilization between rich and poor is presented, and recent accounts of sharp, and often sustained, drops in utilization following fee increases, are presented and discussed. Fee income, appropriately used, represents a small but significant additional resource for health care. Recent national experiences appear to have concentrated on achieving cost recovery objectives, rather than on improving service quality and health outcomes. Appraisal of financing changes must be linked to probable health outcomes. Successful large-scale experience in linking these two is in short supply.

Developing Countries↗
PubMed1975

Lockheed experience in processing large data bases for its commercial information retrieval service.

The last few years have seen the emergence of the information retrieval services industry. This industry consists of three tiers: data base producers, retrieval service vendors, and information centers who service the end user. The experience of Lockheed Information Systems as a retrieval service vendor is recounted as it pertains to its system and to its relationship with the data base suppliers. Government competition is seen as a potential threat to the industry.

Computers↗
PubMed1988

Is there an optimal bibliographic software product for end users?

Personal bibliographic database software is one of many products being marketed to researchers. A review of the literature reflects a growing interest in using this software in office settings. Five bibliographic database software products are compared and eight important attributes are identified. We report experience in user training and in providing support by offering discounts on software sold through the library to patrons.

Information Systems↗
PubMedDate not supplied

Sex differences in marijuana use in the United States.

Marijuana and other cannabis preparations are the most widely used illicit drugs in the United States. A review of the literature reveals a number of sex differences in the epidemiology and adverse medical consequences of marijuana use. In 1995, 6.5% of females and 10.5% of males aged 12 and older reported marijuana use in the previous year. Although 4% more males than females used marijuana, the percentage of males using marijuana between 1994 and 1995 had decreased, whereas the percentage of females using marijuana during that same period had increased. Among females, the age of initiation of use is declining and the prevalence of problems with marijuana is on the rise. Both male and female marijuana users may experience adverse effects of cognitive dysfunction and airway inflammation. However, clinicians should be aware of sex-specific effects of marijuana use, including a possible increased risk of prostate cancer for male users and possible adverse effects on reproductive hormones in female users. Review of the available information on this topic indicates that we have much more to learn about the similarities and differences between males and females with respect to patterns of use, adverse consequences, and vulnerabilities to marijuana.

Cannabis↗
PubMedDate not supplied

Inequity in the Bamako Initiative programme--implications for the treatment of malaria in south-east Nigeria.

An exploratory study was carried out to examine the utilization of malaria treatment services in the Bamako Initiative (BI), the exemption practices and the cost recovery of user-fees for treatment of malaria in south-east Nigeria. Structured questionnaires were used from 1594 households to collect socio-economic and demographic information, the utilization of health care services and experience with user fee exemption. Historical data on malaria utilization rates from 1991 to 2000 were obtained from health centres. In addition, financial information was collected on the annual BI revenue. Health centres for malaria experienced a drop in outpatient attendance when the programme started which later rose again. The more affluent population, as assessed by household belongings and education, used the health centres more often than the poorer population, were more aware of exemptions and benefited from exemptions more than the poorer and lesser educated populations. The sale of anti-malaria drugs was a large proportion of the costs recovered. BI appears to have increased malaria care utilization but has also raised some equity issues. It seems that richer households benefited more than poorer households.

Adolescent↗
PubMedDate not supplied

Measuring contraceptive use patterns among teenage and adult women.

CONTEXT: Measures of contraceptive use at one point in time do not account for its changing nature. A measure that addresses the pattern of method use over time may better predict the cumulative risk of unintended pregnancy. METHODS: Women at risk of unintended pregnancy were selected from the 1995 National Survey of Family Growth, and their contraceptive use patterns were compared across age-groups. Survival analysis was used to validate women's long-term use pattern as an indicator of pregnancy risk, and multivariate regression analyses were used to explore potential covariates of current patterns of contraceptive use. RESULTS: More than two-thirds of women aged 15-19 report long-term uninterrupted contraceptive use, but they are more likely to report sporadic use and less likely to report uninterrupted use of a very effective method than are women aged 25-34. Compared with women aged 25-34, women aged 20-24 have higher rates of sporadic use and lower rates of effective uninterrupted use. Among teenagers, nonusers are 12 times as likely as uninterrupted effective users to experience an unintended pregnancy within 12 months at risk. Women in less stable relationships, those having more infrequent intercourse and women who have recently experienced nonvoluntary intercourse for the first time are more likely than others to have a high-risk contraceptive pattern. Women aged 17 and younger whose current partner is more than three years older are significantly less likely to practice contraception than are their peers whose partner is closer in age. CONCLUSIONS: Long-term contraceptive use pattern is a valid predictor of unintended pregnancy risk. Policies aimed at reducing unintended pregnancies should target women who do not practice contraception and those who are sporadic users. Women in unstable relationships, those having infrequent sex and women who experience sexual coercion need access to methods, such as emergency contraception, that can be used sporadically or after unprotected intercourse.

Adolescent↗
PubMed2004

[Is there a link between continuous quality improvement programs and health service users' satisfaction with prenatal care? An experience in Peruvian hospitals].

OBJECTIVES: 1. To compare the level of health service user satisfaction (US) with antenatal care in hospitals where a program of continuous quality improvement (CQI) was implemented, in comparison to a reference group of patients seen at hospitals that did not participate in the program. 2. To compare the reasons for dissatisfaction in both groups of users. 3. To identify the factors associated with US. METHODS: A quasi-experimental study of a representative sample of pregnant women attending prenatal care services. The women in the intervention group (n = 191) and the reference group (n = 185) were interviewed on leaving the prenatal care clinic. The dependent variable was satisfaction with prenatal care, and the independent variables were satisfaction of expectations, amiability, level of health information, perception of the equipment, waiting time, cleanliness and comfort. Descriptive and multivariate statistics were calculated. RESULTS: The intervention group showed higher rates of US (67.5% versus 55.1% in the reference group, P = 0.014). The main reasons for dissatisfaction were long waiting times and discourteous treatment, which were more frequent in the reference group. The multivariate analysis identified cordiality of the health professionals, information provided during the visit, satisfaction of expectations and implementation of the CQI program as the factors that were significantly associated with US. CONCLUSIONS: Our findings show that the CQI program in maternal and perinatal health services was positively associated with US. These results reinforce the need for cordiality during prenatal care contacts with providers, and the need to provide appropriate information to the user, in order to help increase acceptability of and adhesion to health care recommendations among pregnant women.

Adult↗
PubMed1995

User charges in government health facilities in Kenya: effect on attendance and revenue.

In this paper we study demand effects of user charges in a district health care system using cross-sectional data from household and facility surveys. The effects are examined in public as well as in private health facilities. We also look briefly at the impact of fees on revenue and service quality in government facilities. During the period of cost-sharing in public clinics, attendance dropped by about 50%. This drop prompted the government to suspend the fees for approximately 20 months. Over the 7 months after suspension of fees, attendance at government health centres increased by 41%. The suspension further caused a notable movement of patients from the private sector to government health facilities. The revenue generated by user fees covered 2.4% of the recurrent health budget. Some 40% of the facilities did not spend the fee revenue they collected, mainly due to cumbersome procedures of expenditure approvals. The paper concludes with lessons from Kenya's experience with user charges.

Community Health Centers↗