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PubMed2004

Co-payments in the Austrian social health insurance system. Analysing patient behaviour and patients' views on the effects of co-payments.

Austrian health politicians constantly claim that patients have to be the focus of interest when providing health care services. However, due to increasing demand, scarce resources and insufficient guidance for health care provision at the national level, Austrian patients have been confronted with a variety of health care reforms during recent years. These reforms include the introduction of additional, mainly lump sum co-payments and the increase of existing (lump sum) co-payments. Using a sample of 378 socially-insured patients, the aim of this study is to analyse patients' attitudes towards co-payments, their views on the effects of co-payments on health care demand and their actual behaviour in response to co-payments. The study is descriptive rather than hypothesis testing due to the limited data. The results of this survey indicate that co-payments have no major guiding effect on health care demand. This is confirmed by what the patients indicate as regards their actual behaviour.

Austria↗

PubMed1986

Human behaviour and the transmission of dracunculiasis: a case study from the Ilorin area of Nigeria.

Dracunculiasis, infection with guinea worm, Dracunculus medinensis, is a debilitating disease causing considerable human misery and having an adverse impact on food production in affected areas. It can be entirely eradicated by the provision of protected drinking water for all members of the community. There are two phases in the transmission cycle associated with human activities, swallowing the infective guinea worm larvae in infected water and, 10-12 months later, the immersion of a limb with a guinea worm lesion on it in a drinking water source. In planning control strategies it is essential to understand the patterns of behaviour associated with these two phases of transmission. These include water consumption, water use and water treatment, patterns of water collection and population mobility. The recent increase in the levels, frequency and distance involved in population circulation is associated with increased prevalence rates. This analytical framework is used in a study of disease transmission in the area within a 50 kilometer radius of Ilorin, the capital of Kwara State, Nigeria. The conclusion briefly suggests some benefits which might accrue to affected areas as the result of the consideration of behavioural factors involved in disease transmission.

Adult↗

PubMed2000

Editorial.

There has been a consensus that children "in care" show a much increased frequency of behavioural difficulties but the reasons why this should be so are much less well understood. The study by Roy et al. sheds important new light on this issue. They found that children admitted into residential group homes as babies are much more likely than children admitted into foster care at the same age to show hyperactivity and inattention. Although the study sample was small, the groups were closely comparable in coming from a very high-risk family background. The evidence from both questionnaire and observational measures was consistent in indicating that the difference in the pattern of rearing made a substantial difference to the child's behaviour. The findings are sobering in their implication that the pattern of care provided to protect children at high risk seemed to have acted in a detrimental manner. The study clearly provides food for thought in terms of the need to improve provision for this vulnerable group of children. The findings are also provocative in their implication that hyperactivity/inattention, although strongly influenced by the child's biology, can also be affected by the pattern of rearing. The message is that clinicians should not assume that the causes of this hyperactive behaviour necessarily reside entirely within the child but there is also the need to clarify whether the form of hyperactivity/inattention arising from these experiences is in someway atypical. The paper by Reynolds and colleagues is an attempt to evaluate the efficacy of emotional disclosure to offset distress in children experiencing negative life events. There is a developing literature on such interventions in adults but, as these authors suggest, little work has yet been done to test the value of such disclosure in children. Using a randomised controlled trial Reynolds et al. were unable to show a specific benefit from the opportunity provided to write about negative events. Rather, there was a general reduction in symptoms from all groups. Although the results suggest that the efficacy of writing about negative events is less marked in 8-13-year-olds than in adults, they also indicate that it is both feasible and potentially valuable to give children opportunities to engage in discussion about sources of stress and their reaction to them.

Journal Article↗

PubMed2005

The effect of performance-related pay of hospital doctors on hospital behaviour: a case study from Shandong, China.

BACKGROUND: With the recognition that public hospitals are often productively inefficient, reforms have taken place worldwide to increase their administrative autonomy and financial responsibility. Reforms in China have been some of the most radical: the government budget for public hospitals was fixed, and hospitals had to rely on charges to fill their financing gap. Accompanying these changes was the widespread introduction of performance-related pay for hospital doctors--termed the "bonus" system. While the policy objective was to improve productivity and cost recovery, it is likely that the incentive to increase the quantity of care provided would operate regardless of whether the care was medically necessary. METHODS: The primary concerns of this study were to assess the effects of the bonus system on hospital revenue, cost recovery and productivity, and to explore whether various forms of bonus pay were associated with the provision of unnecessary care. The study drew on longitudinal data on revenue and productivity from six panel hospitals, and a detailed record review of 2303 tracer disease patients (1161 appendicitis patients and 1142 pneumonia patients) was used to identify unnecessary care. RESULTS: The study found that bonus system change over time contributed significantly to the increase in hospital service revenue and hospital cost recovery. There was an increase in unnecessary care and in the probability of admission when the bonus system switched from one with a weaker incentive to increase services to one with a stronger incentive, suggesting that improvement in the financial health of public hospitals was achieved at least in part through the provision of more unnecessary care and drugs and through admitting more patients. CONCLUSION: There was little evidence that the performance-related pay system as designed by the sample of Chinese public hospitals was socially desirable. Hospitals should be monitored more closely by the government, and regulations applied to limit opportunistic behaviour. Otherwise, the containment of government financing for public facilities may result in an increase in the provision of unnecessary care, an increase in health costs to society, and a waste in social resources.

Journal Article↗

PubMedDate not supplied

Factors affecting the implementation of health legislation and its impact on the rural poor in China: a case study of implementation of the maternal and infant health care law in two poor counties.

This paper presents and discusses a case study of health legislation in China. In the transition to a market economy, legislation has been developed to offset the weakening in the central planning mechanism and political control that have historically influenced the behaviour of institutions and individuals in the Ministry of Health. There has been relatively little empirical examination of the implementation and impact of legislation as a tool for influencing health service provision in low-income countries. The study aimed to contribute towards filling this gap by exploring the factors affecting the implementation and impact of the Maternal and Infant Health Care Law, through a case study of two poor, rural counties in Chongqing municipality, China. The study found that key local actors perceive health legislation to be an important tool for safeguarding access to essential health care. However, the implementation of health legislation is inevitably a political process. The study illustrates the difficulties involved in efforts to influence provider behaviour through a national level legislative framework in a situation of decentralization of control over those providers, due to extreme regional variation in economic situations and limited resource inputs from the centre. Lessons are drawn for Chinese and international policy makers.

Child Health Services↗

PubMedDate not supplied

Prevalence of tobacco use among school and college going adolescents of Haryana.

The prevalence of tobacco use among the school and college going adolescents of Haryana, a state in northern India was studied. 1130 male and 256 female students were given a self administered questionnaire regarding tobacco use. 160 (14.2%) male and 6 (2.3%) female students reported to have smoked at any time in the past. The prevalence of current smoking (defined as smoked in last one week) was only 7.1%. Of the 166 ever smokers, 44% had started this habit between 10 to 15 years of age. There was no rural-urban difference. Univariate analysis showed, male sex, age > 15 years, smoking by father, mother, sister, and friends to be significantly associated with smoking by the adolescent children. By logistic regression, only smoking by friend (O.R. 6.14), brother (O.R. 1.74) and male sex (O.R. 4.67) were found to be significantly associated with smoking by adolescent children. About 8% of the smokers were spending more than Rs. 10 per week on this habit. Both the smokers and non smokers were well aware of the adverse health effects of smoking indicating that mere provision of information on hazards of smoking may not be enough to reduce the prevalence of smoking. A more concerted effort for inducing behavioural change including legislation, communication is called for the fight against smoking.

Adolescent↗

PubMed2004

Critical appraisal skills training for health care professionals: a randomized controlled trial [ISRCTN46272378].

INTRODUCTION: Critical appraisal skills are believed to play a central role in an evidence-based approach to health practice. The aim of this study was to evaluate the effectiveness and costs of a critical appraisal skills educational intervention aimed at health care professionals. METHODS: This prospective controlled trial randomized 145 self-selected general practitioners, hospital physicians, professions allied to medicine, and healthcare managers/administrators from the South West of England to a half-day critical appraisal skills training workshop (based on the model of problem-based small group learning) or waiting list control. The following outcomes were assessed at 6-months follow up: knowledge of the principles necessary for appraising evidence; attitudes towards the use of evidence about healthcare; evidence seeking behaviour; perceived confidence in appraising evidence; and ability to critically appraise a systematic review article. RESULTS: At follow up overall knowledge score [mean difference: 2.6 (95% CI: 0.6 to 4.6)] and ability to appraise the results of a systematic review [mean difference: 1.2 (95% CI: 0.01 to 2.4)] were higher in the critical skills training group compared to control. No statistical significant differences in overall attitude towards evidence, evidence seeking behaviour, perceived confidence, and other areas of critical appraisal skills ability (methodology or generalizability) were observed between groups. Taking into account the workshop provision costs and costs of participants time and expenses of participants, the average cost of providing the critical appraisal workshops was approximately pound 250 per person. CONCLUSIONS: The findings of this study challenge the policy of funding 'one-off' educational interventions aimed at enhancing the evidence-based practice of health care professionals. Future evaluations of evidence-based practice interventions need to take in account this trial's negative findings and methodological difficulties.

Attitude of Health Personnel↗

PubMedDate not supplied

Developing adolescent services in general practice.

BACKGROUND: Adolescence is recognised as a time of risk-taking behaviour, yet it is also a crucial time for laying down the foundations for future health. This literature review examines current adolescent healthcare provision in the community, particularly general practice. The role of the practice nurse in meeting adolescents' healthcare needs is also explored. CONCLUSION: Although health professionals and teenagers see general practice as an appropriate location for health promotion activity, generally it is not the first choice for health information for young people. There is no consensus on effective interventions in teenage health care, as different methods work in different areas. The stigma of adolescent healthcare provision, where young people are seen as a difficult group that requires specialist provision, should be removed. However, there should be specific healthcare provision for this age group.

Adolescent↗

PubMedDate not supplied

An introduction to providing cognitive behavioural therapy.

This article outlines the theory underpinning the practice of cognitive behavioural therapy (CBT) and some of the intervention techniques commonly used by CBT psychotherapists. It also looks at government publications relating to the provision of psychotherapies in the NHS and training requirements for different levels of CBT psychotherapy and practice.

Cognition↗

PubMed1990

A study of police referrals to Woodbridge Hospital.

This is a retrospective study of 127 cases brought by the police under Section 32 of the Mental Health Act (1973). The aims of the study were to collect epidemiological data and to review the mental health provisions. Majority of the patients were Chinese, male, 20-39 age-group, single, unemployed, schizophrenic with previous admissions to Woodbridge Hospital. Aggressive behaviour and public nuisance were the commonest reasons for police interventions. Ninety percent of the patients required admissions to hospital. There was no apparent misuse of the Mental Health Act.

Adult↗

PubMed1985

[Research on the aged within the framework of social geography].

Until now social gerontological research in the Netherlands has primarily been done by psychologists and sociologists. Geographic contributions are subordinate. Nevertheless there are innumerable geographical aspects which influence ageing and human behaviour of the elderly. Several studies on ageing have already been made, considering geographical topics as distribution, migration, housing, mobility and accessibility of provisions. The geographer can supply enhanced contributions in the future.

Aged↗

PubMed2006

Reproductive health problems and help seeking behavior among adolescents in urban India.

OBJECTIVE: To assess their reproductive health problems and help seeking behaviour among urban school going adolescents. METHOD: A sample of 300 urban school going adolescents between 11-14 years were chosen at random and assessed using four tools namely, self administered questionnaire : provision of adolescent friendly services; medical screening and focus group discussions. RESULTS: Seventy two percent girls and 56% boys reported health problems during survey with an average of 1.93 complaints per girl and 0.5 complaints per boy. However, only 43% girls and 35% boys reported to the clinic voluntarily to seek help and only one fifth the amount of problems were reported at the clinic in comparison to the quantum of problems reported in survey, which probably reflects a poor health seeking behaviour. A medical checkup with emphasis on assessment of reproductive health and nutritional status helped in detecting almost the same number of reproductive health problems as reported by them in survey. This intervention helped to increase the client attendance in subsequent period of next one year from 43% to 60% among girls and from 35% to 42% among boys. CONCLUSION: Our study shows that to increase help seeking behaviour of adolescents, apart from health and life skill education, their medical screening with a focus on reproductive health by trained physicians, parental involvement, supported by adolescent friendly centers (AFC) for counseling, referral and follow up are essential.

Adolescent↗

PubMed2000

Training strategies to maintain immunocompetence in athletes.

Clinical experience and empirical evidence have led to the modeling of exercise and training as a form of stress on the immune system. Coaches, athletes, and medical personnel are seeking guidelines on ways to reduce the risk of illness that compromises training or competitive performance. The immune system is influenced by a wide range of physical, environmental, psychological, and behavioural factors which, combined with clinical assessment, collectively form the basis of the following intervention strategies: 1) training: careful management of training volume and intensity, variety to overcome training monotony and strain, a periodised approach to increasing loads, and provision of adequate rest and recovery periods; 2) environmental: limiting initial exposure when training or competing in adverse environmental conditions (heat, humidity, altitude, air pollution) and acclimatising where appropriate; 3) psychological: teaching athletes self-management and coping skills and monitoring of athletes' responses to the psychological and psychosocial stresses of high-level training and competition; 4) behavioural: adopting a well-balanced diet with adequate intake of macro- and micro-nutrients, limiting transmission of contagious illnesses by reducing exposure to common infections, airborne pathogens, and physical contact with infected individuals; and 5) clinical considerations: medical screening, pathology testing, immunization and prophylaxis, and routine management of illness-prone athletes. Future experimental studies are required to develop and enhance the effectiveness of these strategies in reducing illness in athletes.

Australia↗

PubMed1998

Family history of breast cancer: what do women understand and recall about their genetic risk?

The current study has two aims: (1) to look at people's recall of risk information after genetic counselling and (2) to determine the impact of receiving an audiotape of the genetic consultation on level of recall, cancer related worry, and women's uptake of risk management methods. Using a prospective randomised controlled design, subjects receiving an audiotape were compared with a standard consultation group. Participants were drawn from attenders at the genetic clinics of two London hospitals and included 115 women with a family history of breast cancer. Assessment of perceived genetic risk, mental health, cancer worry, and health behaviour was made before counselling at the clinic (baseline) and by postal follow up. Usefulness of audiotapes and satisfaction with the clinical service was assessed by study specific measures. The data indicate that cancer worry is reduced by provision of an audiotape of the genetic consultation. Recall of the genetic risk figure, however, is not affected by provision of an audiotape and neither is it related to women's overall perception of being more or less at risk of breast cancer than the average woman. Forty-one percent of women accurately recalled their personal risk of breast cancer at one month follow up; however, 25% overestimated, 11% underestimated, and 23% could not remember or did not know their breast cancer risk. Recall of the risk figure is more accurate when the clinical geneticist has given this to the woman as an odds ratio rather than in other formats. Subsequent health behaviour is unaffected by whether women have an audiotape record of their genetic consultation. Results suggest that having a precise risk figure may be less important than women taking away from the consultation an impression that something can be offered to help them manage that risk. Provision of an audiotape of the consultation is of limited usefulness. The need for psychological care to be better integrated into genetic counselling at cancer family clinics was highlighted by the study. The results are discussed in terms of future service development.

Breast Neoplasms↗

PubMed2004

"New Choices" for women with addictions: perceptions of program participants.

BACKGROUND: Substance use in pregnancy is a major public health problem. It can have profound effects on pregnancy outcomes, and childhood health and development. Additionally, women who use substances have their own health-related issues. Although intervention is important, these women often have difficulty using traditional systems of care. The New Choices program is a centralized, multi-sector approach to service delivery that has attempted to overcome barriers to care by offering one-stop shopping in a supportive environment. As part of an evaluation of this program designed for women who are pregnant and/or parenting young children, interviews were conducted with participants to gain insight into their experiences in New Choices and perceptions of any changes attributed to program involvement. METHODS: A qualitative, exploratory design was used to guide data collection and analysis. Four women participated in a focus group interview and seven women agreed to individual interviews over the course of the program evaluation (N = 11). A semi-structured interview guide was used to explore women's experiences in New Choices and their perceptions of the program and its impact. The interview data were analyzed using NVivo software and an inductive approach to data analysis. RESULTS: The emergent themes captured women's motivations for attending New Choices, benefits of participation, and overall quality of the program. Children were the primary motivating factor for program enrollment. Perceived benefits included decreased substance use, improved maternal health, enhanced opportunity for employment, increased access to other resources, enhanced parenting skills, and improved child behaviour and development. Women highly valued the comprehensive and centralized approach to service delivery that provided a range of informal and formal supports. CONCLUSIONS: Interview findings endorse the appropriateness and potential efficacy of a collaborative, centralized approach to service provision for women with substance use issues. Although the findings provide insight into an alternative model of service delivery for women with addictions, future research is needed to evaluate the effectiveness of the intervention. Research also is needed to determine which program components or constellation of components contribute to desired outcomes, and to learn more about processes that underlie changes in behaviour.

Adult↗

PubMed2000

Helper contributions in the cooperatively breeding laughing kookaburra: feeding young is no laughing matter.

I studied the contributions of individuals to incubation and nestling feeding in a population of cooperatively breeding laughing kookaburras, Dacelo novaeguineae. In most cooperatively breeding birds where nest success is limited by nestling starvation, related helpers increase the overall level of provisioning to the nest, thus boosting the production of nondescendent kin. However, although partial brood loss is the largest cause of lost productivity in kookaburra nests, additional helpers failed to increase overall provisioning. Instead, all group members, but especially helpers, reduced their feeding contributions as group size increased. Breeders and helpers reduced the size of prey delivered, and helpers also reduced the number of feeding visits. An important benefit of helping in kookaburras may be to allow all group members to reduce their effort. Within groups, contributions to care depended on status, sex, group size and the brood size. Breeding males delivered the most food. Breeding females provisioned less than their partner, but their effort was comparable to that of male helpers. Female helpers contributed the least food. Incubation effort followed similar patterns. The relatedness of helpers to the brood had no impact on their provisioning. Across all group sizes, helpers generally brought larger items to the nest than breeders. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed1996

Preventing childhood unintentional injuries--what works? A literature review.

AIM: The aim of this paper is to report on a systematic review of the world literature to provide information about the most effective forms of health promotion interventions to reduce childhood (0-14 years) unintentional injuries. The findings are of relevance to policy makers at a local or national level, to practitioners and researchers. METHODS: The relevant literature has been identified through the use of electronic databases, hand searching of journals, scanning reference lists, and consultation with key informants. RESULTS: Examples of interventions that have been effective in reducing injury include: bicycle helmet legislation, area wide traffic calming measures, child safety restraint legislation, child resistant containers to prevent poisoning, and window bars to prevent falls. Interventions effective in changing behaviour include bicycle helmet education and legislation, child restraint legislation, child restraint loan schemes, child restraint educational campaigns, pedestrian education aimed at the child/parent, provision of smoke detectors, and parent education on home hazard reduction. For the community based campaigns, the key to success has been the sustained use of surveillance systems, the commitment of interagency cooperation and the time needed to develop networks and implement a range of interventions. Education, environmental modification and legislation all have a part to play and their effect in combination is important. CONCLUSION: The design of evaluations in injury prevention needs to be improved so that more reliable evidence can be obtained. Better information is needed on process, so that successful strategies can be replicated elsewhere. There is also a need for literature reviews on effectiveness to be updated regularly and for their findings to be widely disseminated to policy makers, researchers, and practitioners.

Accident Prevention↗

PubMed2003

A randomised trial of an Internet weight control resource: the UK Weight Control Trial [ISRCTN58621669].

BACKGROUND: Obesity treatment is notoriously unsuccessful and one of the barriers to successful weight loss reported by patients is a lack of social support. The Internet offers a novel and fast approach to the delivery of health information, enabling 24-hour access to help and advice. However, much of the health information available on the Internet is unregulated or not written by qualified health professionals to provide unbiased information. The proposed study aims to compare a web-based weight loss package with traditional dietary treatment of obesity in participants. The project aims to deliver high quality information to the patient and to evaluate the effectiveness of this information, both in terms of weight loss outcomes and cost-effectiveness. METHODS: This study is a randomised controlled trial of a weight loss package against usual care provided within General Practice (GP) surgeries in Leeds, UK. Participants will be recruited via posters placed in participating practices. A target recruitment figure of 220 will enable 180 people to be recruited (allowing for 22% dropout). Participants agreeing to take part in the study will be randomly allocated using minimisation to either the intervention group, receiving access to the Internet site, or the usual care group. The primary outcome of the study will be the ability of the package to promote change in BMI over 6 and 12 months compared with traditional treatment. Secondary outcomes will be the ability of the Internet package to promote change in reported lifestyle behaviours. Data will be collected on participant preferences, adherence to treatment, health care use and time off work. Difference in cost between groups in provision of the intervention and the cost of the primary outcome will also be estimated. CONCLUSION: A positive result from this study would enhance the repertoire of treatment approaches available for the management of obesity. A negative result would be used to inform the research agenda and contribute to redefining future strategies for tackling obesity.

Adolescent↗