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PubMed1992

School nurses: constraints and opportunities for the future.

School nurses are all too often the forgotten element of the school health services, lacking in central guidance and with a great variety of duties and functions which have grown up in an ad hoc and unstructured way. At a time when many districts are reviewing their approach to these services in the light of current policy changes, it would be helpful to step back and consider the issues from a historical perspective in order to understand the great variability in the role of school nurses today. Changing management structures demand improved understanding and acceptance of review and evaluation mechanisms, but where basic information is lacking, overall considerations of need and effectiveness may be severely limited.

Forecasting↗

PubMed1978

The distributional effects of national health insurance in Quebec.

In November of 1970 a major change in public health policy occurred in Quebec: the movement from a mixed private-public system to a completely public system of financing health care (known as Medicare). This policy change had important economic effects on the distribution of income, taxation, and health care costs. This paper analyzes these economic effects by focusing on the changes in financial burden of medical care costs between 1969-70 and 1971-72 for eight income classes. The key results that emerge are: the total cost of medical care increases sharply for all of the income groups, and the burden of the cost of medical care becomes more equitable across the income groups. Based on these results, policy considerations for the present debate on national health insurance in the United States are offered.

Financing, Government↗

PubMed1976

Psychosocial factors in low-incidence genetic disease: the case of osteogenesis imperfecta.

Osteogenesis imperfecta (OI), a dominant genetic disorder, was examined in an exploratory case study of psychosocial implications. The cross-sectional survey sample consisted of 13 OI-affected adults and 21 families with an OI-affected child who were interviewed. Findings revealed numerous psychosocial concerns and problems in addition to their complex and lifelong medical problems. Specific problem areas differed according to the severity of the disease, type, and mode of genetic inheritance. The results indicate the need for local as well as national policy changes through legislation and extensions of existing services for low-incidence disease groups such as OI-affected persons. Implications for social work practice interventions call for greater involvement with genetic diseases, more aggressive approaches in case identification and service coordination, and performing longer-range monitoring functions than is usually the case.

Adult↗

PubMed1991

Advertising and alcohol sales: a legal impact study.

According to the single distribution theory increases in the availability of alcoholic beverages in the general population are associated with increases in average consumption and increases in alcohol-related damage. If it can be demonstrated that advertising contributes to availability, perhaps in the form of what has been called social or subjective availability, then advertising could be considered an appropriate target of prevention. A 58-year ban on advertising of alcoholic beverages was lifted in Saskatchewan in 1983. Data on monthly sales of beer, wine and distilled spirits were examined for the years 1981 to 1987. Box-Jenkins time series techniques were used to estimate the statistical relationship between the policy change and volume of sales of alcoholic beverages. The results revealed that sales of beer increased and sales of spirits decreased following the change in legislation that permitted alcohol advertising in Saskatchewan. The main finding is that there was no impact on wine and total alcohol sales from the introduction of alcohol advertising. Alcohol advertising may have produced a substitution effect with respect to beer and spirits, but this was not predicted. This evaluation suggests that alcohol advertising is not a contributory force that influences the overall level of alcohol consumption. The place of advertising in the single distribution theory remains not proven, and the place of advertising as an instrument of public policy with respect to the prevention of alcohol-related damage remains in question.

Advertising↗

PubMed1976

Fear of trying.

Unless the nutrition community intervenes in national and international policymaking, the world could well be headed for serious trouble with deaths from starvation on a consequential scale. There has been near-total dissociation between agricultural planning policies and food distribution and nutritional needs of populations. Unfortunately, the nutrition community is out of the mainstream of forces which affect nutritional status and which produce the macro-decisions. Why? Perhaps the professionals have too narrow a view of their role; although malnutrition is a health problem, the solution is not necessarily one of health delivery. Perhaps they don't seriously wish to be involved with policy change and the work it entails. Perhaps, by being unable to achieve consensus within their own ranks, they have generated a lack of credibility. The nutrition community needs to recognize a broader scope for nutrition and to take new approaches in advocacy directed to education policy-makers. No one else can play this role with authority.

Agriculture↗

PubMed1992

Back to direct payment: German dentists lobby to leave the national sickness fund scheme.

Oral health care in Germany is delivered by private dentists working predominantly in solo practice. Services are financed indirectly by sickness funds for 89 percent of the population. With caries rates declining, dentists' numbers increasing, and federal policies changing the remuneration regulations to enhance preventive behavior in consumers, dentists are concerned about their shrinking incomes. In an attempt to secure their professional interests, a faction among dentists advocates to return to direct payment and to opt out of the sick fund scheme. Their strategy and professional goals are described and the chances of succeeding discussed.

Dentists↗

PubMedDate not supplied

Attitudes of program directors toward women in pediatric dentistry training programs.

The number of women entering pediatric dentistry graduate programs is increasing. A formal survey was conducted in the fall of 1990 to determine what impact, if any, this increase is having on the programs. The survey sample consisted of the 57 pediatric dentistry graduate program directors from the United States and Canada. The survey form included program data about gender distribution in the current and previous classes, and female faculty distribution within the programs. The survey requested information about the attitudes of various groups of individuals who interacted with the residents relative to the gender of the resident and again, relative to whether the resident was pregnant. Inquiry was made concerning maternity leave policies and selected treatment scenarios involving pregnant residents. Finally, questions were asked about motivational factors, personal priorities, and policy change for female vs. male residents. Fifty forms were returned for a return rate of 88%. The 48 forms analyzed revealed that 52% of current classes are female and 51% of applicants for 1991 were female. Women comprise 23% of full-time and 26% of part-time faculty. There was no single issue perceived by program directors as a group to be a significant concern or problem relating to gender. Program directors would consider removing pregnant females from contact with combative patients (83%) and environmental hazards (85%), but fewer would consider removing them from contact with for HIV+ or Hb+ patients.

Administrative Personnel↗

PubMed1992

Assessing the impact of patient care policies using simulation analysis.

Simulation models are ideal for assessing the performance of strategic, tactical, and operational policies for hospitals. Simulation can validate a proposed policy, uncover fallacies of a proposal, or determine the sensitivity of the response to a policy change. A simulation model was developed to analyze the complex interactions comprising patient placement processes, beginning with patient arrivals and continuing through discharge. The model reflects current and potential patient assignment policies at a major southeastern general hospital. The system developed was utilized to assess proposed policies for the hospital. The simulated results of the hospital policy proposals, as well as other proposals, demonstrate the usefulness of simulation analysis in hospital policy decision-making.

Bed Occupancy↗

PubMed1992

A national survey of the home visiting practice and attitudes of family physicians and internists.

BACKGROUND: Over the past decade, while physician home visiting has continued to decline, the home care industry has been experiencing dramatic growth. In response, several major physician organizations have been encouraging increased physician education and involvement in home care and urging related health policy changes. This study provides the first in-depth, nationally representative descriptive data on the current home visiting practice and related attitudes of physicians. METHODS: Data were gathered through a structured 15-minute telephone survey, consisting of 141 items covering physician's general practice, personal home visiting practice, interaction with other home care providers, and attitudes regarding home care issues. Subjects were a nationally representative, randomly selected sample of 2200 family practice physicians (FPs) and internal medicine physicians (IMs) currently in active practice with at least 10 hours per week of professional time spent in ambulatory care. RESULTS: Sixty-five percent of eligible participants completed the survey. Of all physicians surveyed, 65% of FPs and 44% of IMs reported that they may make house calls (P less than .001). Mean number of visits per year was 21.2 (median, 10) for FPs, and it was 15.7 (median, 6) for IMs. Physicians in rural practice were more likely to make home visits (P less than .001). Physician attitudes related to home care reflect a strong dissatisfaction with reimbursement, but positive opinions about the use of other home care professionals and the importance of home visits for selected patients. Logistic regression analysis comparing home-visiting physicians with non-visiting physicians allowed for prediction of the correct classification 73% of the time, and it revealed six variables that were significant predictors of home visiting. The strongest of these predictors were the physician's positive attitude regarding the importance of home visits for selected patients and his or her perception of having time available for home visits. Other significant variables predictive of home visiting were family practice specialty, rural location of practice, greater numbers of referrals to home care agencies, and, interestingly, dissatisfaction with reimbursement. CONCLUSIONS: Although the great majority (over 75%) of FPs and IMs still regard the physician home visit as important for the care of selected patients, only about half report making one or more home visits within a 12-month period. Family physicians generally report a greater involvement in home care than do IMs. Physician reimbursement for home visits is perceived to be inadequate, and almost half (45%) indicate that they would do more home visits if reimbursement were increased. Most physicians (over 80%) have the opinion that home care agencies should be used more.

Adult↗

PubMed1992

Health Care Linkage Project: improving access to care.

The primary objective of the Health Care Linkage Project, funded by a grant from the Chicago Community Trust, is to develop, implement, and evaluate a primary health care linkage network within the city of Chicago that creates formalized linkages between community health centers, the Chicago Department of Health clinics, and hospitals. Six linkage networks are currently operational, with an additional two sites phased in during 1991. The success of the pilot project has been demonstrated by hundreds of patients receiving primary care and ancillary services on a more timely basis, by greater coordination between the public and private sector, by cost-savings to both patients and providers through reducing inappropriate use of services, and by a variety of spin-off projects which have improved the quality and accessibility of services. A second important objective is the development of a Health Care Linkage Manual that describes the practical experience and lessons gained from the linkages, the status of comparable arrangements in other U.S. cities, replicability of the linkage models, and recommendations for policy changes which will make linkages more effective.

Chicago↗

PubMed1992

Controlling a syphilis epidemic.

In 1986 the rate of infectious syphilis (primary and secondary) in Los Angeles County began to rise from previously stable levels of about 23.5 per 100,000 to peak at 55.6 per 100,000 in 1987. The incidence of congenital syphilis increased from 205 cases in 1987 to 575 cases in 1989. The county's Sexually Transmitted Disease Program instituted a disease-specific plan to address the epidemic. Factors considered in designing the program included the high morbidity and mortality associated with congenital infection, the existence of latent infection, self-limiting symptoms, and the availability of an inexpensive screening test and curative treatment. Policy changes implemented comprised expanded screening, expanded surveillance, increased contact tracing, and the initiation of condom promotion programs. To evaluate the relative effectiveness of Los Angeles County's syphilis control efforts, the epidemic curve for infectious syphilis was compared with trends in other urban areas. Although the rate of infectious syphilis climbed a year earlier in Los Angeles than in other cities, it returned to baseline levels when other cities' rates remained at epidemic levels.

Health Education↗

PubMed1992

Income allowance policies of state Medicaid agencies as work incentives or disincentives for ICF/MR residents.

Results of a survey of six Midwestern states demonstrated that although some state Medicaid agencies have had work incentive policies for ICF/MR residents for some time, others continue to utilize policies that are a disincentive to work. Policy changes toward employment incentives in state Medicaid agencies should improve work opportunities for workers with mental retardation at little expense to the government.

Adult↗

PubMed1992

Volume responses to exogenous changes in Medicare's payment policies.

The purpose of this study is to obtain estimates of the "volume offset," which is the slippage in the costs or the savings that would, in the absence of behavioral responses, result from exogenous changes in Medicare's payment policies. An estimate of this offset is essential to accurate cost estimation for fee proposals under Medicare. Estimates are obtained using Medicare claims data from Colorado for 1976 and 1978, before and after implementation of an abrupt and substantial change in the way Medicare's fees were determined. Reliable estimates could be obtained only for two specialty groups-general practitioners and internists. For these physicians, the results indicate that about half of an initial drop in their Medicare receipts caused by a change in payment policy would be offset by an increase in their volume of services. For physicians whose receipts would increase because of the policy change, the best estimates indicate that about a third of their initial gain would be offset by a fall in the volume of services they provide. The difference in response between gaining and losing practices is not a statistically significant one, however. One could conclude from this study that--for both gaining and losing practices--changes in volume would offset about half of any initial change in receipts caused by a payment change.

Colorado↗

PubMed1992

The prevalence and aeromedical certification considerations of contact lens use by civilian pilots.

Federal Aviation Regulations permit the routine use of contact lenses by civilian pilots to satisfy the distant visual acuity requirements for obtaining medical certificates. Specific information identifying the prevalence of contact lenses in the civil airman population is required to guide future medical certification decisions, policy changes, and education safety programs to aviation personnel. A descriptive, retrospective epidemiologic study was performed of active airmen by 5-year intervals for a 20-year period (1967-1987) using FAA data-bases and publications. The percentage of airmen who use contact lenses quadrupled during the study period. When stratified by class of medical certificate and age, the prevalence rates for airmen with first-class medical certificates and older airmen showed the largest increases. A summary is provided of aeromedical certification factors that an optometrist and/or ophthalmologist should consider while fitting an airman with contact lenses. The increasing use of contact lenses indicates a need for ongoing review of adverse changes and safety consequences for pilots. Key words: vision; contact lens; epidemiology; medical certification.

Adult↗

PubMed1992

Long-term effect of a protocol for the diagnosis and treatment of urinary tract infection. Working Group for Urinary Tract Infection in Children of the Friuli Venezia Giulia Region (Italy).

We evaluated the policy changes of 10 pediatric departments in the Friuli Venezia Giulia region following the implementation of a new protocol for the diagnosis and treatment of urinary tract infection. Clinical data concerning 1,059 infants and children with a first episode of urinary tract infection were recorded in three periods, before (A), during (B), and after (C) implementation of the protocol application. We observed a significant increase in the total number of urinary tract infections (288 in period A, 464 in C) from period A to C, with particular regard to pyelonephritis (36.8% in period A, 64.3% in C). As radiological investigations were carried out more frequently, there was a significant increase in the number of cases of vesicoureteral reflux recorded (from 23 in period A to 76 in period C). Finally, a better therapeutic approach was progressively achieved: errors in the choice of antibiotics and the duration of treatment have been almost completely avoided in period C. In our opinion, these results demonstrate a long-term improvement of pediatricians' awareness of this frequent pediatric pathology and their policies to control it.

Child↗

PubMed1991

Pharmacology of the drugs of abuse and the development of public policy.

It is fascinating that the morality, ethics, and effectiveness of current drug prohibition policies are being criticized in an era when drug use is declining in most segments of society. The current era is also marked by increasingly restrictive policies against drug use and users, including much enhanced interdiction efforts, calls for tougher penalties and more jails, and extensive drug screening programs at the work site. Summary dismissal of workers or students who use drugs is increasingly advocated. Two distinct and opposing currents advocating policy change have emerged, one for legalization, the other for greater restriction. The current inner-city rise in drug use, particularly of cocaine and "crack," and the remarkable increase in drug-related crime is probably providing the impetus for both lines of thinking. Yet both views appear extreme and neither seems to offer a promising social policy. It is critical that we continue to attempt to develop effective strategies for reducing the impact of drug taking on the individual and society. Whereas I am sensitive to the ethical and legal perspectives of the proponents of legalization, pharmacologic and social issues persuade me that legalization of heroin and cocaine would lead to a marked increase in drug dependence and an increase in drug-related disability and crime. In response to the idea that the legalization and taxation of drug use would provide resources for more effective research, prevention, and treatment, my sense is that we should not wait for legalization but should embark on that long and expensive course immediately.(ABSTRACT TRUNCATED AT 250 WORDS)

Arousal↗

PubMed1978

Health care in early infancy.

The pattern of illness and of health care during the first 16 weeks of life in a cohort of 1210 infants was examined. Children from families in the lower social strata had a significantly increased risk of respiratory illness and gastrointestinal disturbance and received less routine well baby care than children from more socially advantaged backgrounds. A number of policy changes which might improve the distribution of health care resources are examined.

Child Health Services↗

PubMed1978

External examinations for internal evaluation: the National Board Part I Test as a case.

The appropriateness of the Part I examination of the National Board of Medical Examiners to evaluate second-year curricular performance of students at Case Western Reserve School of Medicine was examined. Review of the June 1974 examination by 37 faculty members revealed that 85% of the items reflected the content of the second-year curriculum and that 60% could be answered from information provided in the second-year teaching. Two-thirds of the items were related to the content of the first-year curriculum, and half could be answered on the basis of first-year material. The school's faculty used the study data in making policy-changing decisions.

Curriculum↗