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At least 397 records · Page 22Linked to original sources
PubMed2005

Reflections on expert consensus: a case study of the social trends contributing to obesity.

BACKGROUND: In Australia, as elsewhere in the developed world, researchers and policy makers have expressed concern about rising rates of obesity. Explanations for the increasing weight of the Australian population have focused on both declining levels of physical activity and changes in food consumption patterns. METHODS: The primary aim of our study was to determine the views of obesity, dietary and physical activity experts, about the most important social trends that have contributed to Australia's obesogenic environment over the last 50 years. We used a modified Delphi technique to successfully contact 50 such experts to obtain their views on this topic. The process involved a semi-structured interview with each expert to identify the trends and then a round of ranking of the trends by these experts. A second aim was to comment on the utility of expert opinion in public policy. RESULTS: The experts identified the most important social trends as 'escalating car reliance', 'increasing "busy-ness" and lack of time' and 'rising use of convenience and pre-prepared food'. Because we asked experts to explain their responses, a diversity of opinion emerged on both the aetiology of these trends and how the environment is embodied to produce rising levels of obesity. CONCLUSION: We reflect on the implications of this dissensus for the utility of expert opinion in public policy and argue that one way through the smorgasboard of competing expert explanations for health differentials, including obesity levels, is practice-based evidence gathered through community level action research.

Australia↗
PubMed2005

Lack of compliance by UK andrology laboratories with World Health Organization recommendations for sperm morphology assessment.

BACKGROUND: Sperm morphology is known to correlate with the probability of conception both in vitro and in vivo, but the assessment of sperm morphology in the laboratory remains problematic. The 4th edition (1999) of the World Health Organization (WHO) Laboratory Manual has attempted to improve matters by giving rigorous recommendations regarding sperm morphology assessment. However, it is unknown how well these recommendations have been implemented in practice. METHODS: A survey of the methods used to undertake the assessment of sperm morphology during semen analysis was undertaken in 37 laboratories in the UK. RESULTS: In total, only two laboratories (5%) were compliant with all current WHO guidelines regarding morphology assessment, including methods of staining and observation, classifying and sampling methods, and the participation in internal and external quality control programmes. CONCLUSION: These results illustrate an urgent need for education and training initiatives to encourage laboratories to become compliant with current WHO guidelines for sperm morphology assessment.

Andrology↗
PubMed1995

We all need a good wife to support us.

A survey of 890 appointment committee members undertaken in South Thames (West) Regional Health Authority showed that women doctors are less likely to apply for posts in hospital medicine, although if they do apply they stand a better chance of getting appointed. Male respondents perceived role conflict in combining professional and family demands, child-care arrangements and career breaks to be the main barriers facing female hospital doctors. In contrast female doctors considered organizational culture, career structure and working practices to be the main barriers. Candidates, particularly female candidates, are still being asked questions about their plans to have a family and ability to combine family and professional demands. There is a need to ensure the culture, attitudes and organizational practices within the medical profession are changed if there is to be equity of opportunity and effective use of resources in the future.

Career Mobility↗
PubMed2003

Information giving in clinical trials: the views of medical researchers.

It is both an ethical and legal requirement that patients who participate in clinical trials must generally give their consent. As part of this process, patients must be provided with adequate information to enable them to decide whether or not to take part. In the UK, the pharmaceutical companies that sponsor such research, as well as Local Research Ethics Committees, specify in detail the information that must be given to trial participants. The researchers who conduct clinical trials inevitably form views on the amount of information they are required to provide, and about patients' comprehension of that information. The literature in this area suggests that some medical researchers may be unhappy with the amount of information that they must give patient participants. There have been, however, few systematic attempts to determine their views. This paper reports a study that explored researchers' views as to (i) the amount of information provided to trial participants, and (ii) participants' understanding of that information. Researchers generally felt that they were required to give trial participants an appropriate amount of information, and that most patients had at least a reasonable understanding of key aspects of the clinical trials' process. However, there were differing views as to the level of information that they felt patients themselves wanted. The researchers did not generally feel that the patients' inability to comprehend information rendered the process of obtaining 'informed consent' a waste of time. However, some did believe that they were required to burden patients with excessive information.

Attitude of Health Personnel↗
PubMed1991

Medicaid's effect on the elderly: how reimbursement policy affects priorities in the nursing home.

This article examines the social impact of Medicaid policy on the elderly in long-term care and identifies a previously unrecognized problem produced by Medicaid in New York State. Recent fieldwork in proprietary nursing homes in New York City shows that this state's Medicaid system results in a selection hierarchy on admissions and within nursing homes not only in terms of sponsor of payment but also in value, based on residents' functional level. Specifically, New York State Medicaid's Resource Utilization Groups (RUGs II) system is responsible for a new and startling phenomenon in long-term health care of the elderly: the creation of "minihospitals" in lieu of traditional skilled nursing facilities. This problem indicates the complex ways in which reimbursement policy drives priorities in nursing homes and creates unintended negative outcomes. In light of this consideration, various policy alternatives to Medicaid that would improve the plight of the elderly in long-term care are suggested and evaluated.

Activities of Daily Living↗
PubMed1990

Achieving competitive advantage through strategic human resource management.

The framework presented here challenges health care executives to manage human resources strategically as an integral part of the strategic planning process. Health care executives should consciously formulate human resource strategies and practices that are linked to and reinforce the broader strategic posture of the organization. This article provides a framework for (1) determining and focusing on desired strategic outcomes, (2) identifying and implementing essential human resource management actions, and (3) maintaining or enhancing competitive advantage. The strategic approach to human resource management includes assessing the organization's environment and mission; formulating the organization's business strategy; assessing the human resources requirements based on the intended strategy; comparing the current inventory of human resources in terms of numbers, characteristics, and human resource management practices with respect to the strategic requirements of the organization and its services or product lines; formulating the human resource strategy based on the differences between the assessed requirements and the current inventory; and implementing the appropriate human resource practices to reinforce the strategy and attain competitive advantage.

Economic Competition↗
PubMed1991

Isomorphism and external support in conflicting institutional environments: a study of drug abuse treatment units.

Using institutional theory, we developed predictions about organizational units that moved from an environment making consistent demands to one making conflicting demands. Many community mental health centers have diversified into drug abuse treatment. The units providing those services face conflicting demands from the traditional mental health sector and the new drug abuse treatment sector about which clients to serve, how to assess their problems, and who should provide treatment. We propose that in response to such demands these units will adopt apparently conflicting practices. Also, isomorphism with the traditional sector will be positively associated with external support from parent mental health centers and other actors in the mental health sector. Results generally support those predictions.

Community Mental Health Centers↗
PubMed1989

Listening to the consumer: implications of a statewide study of North Carolinians.

To be successful in an increasingly competitive health care marketplace, physicians and other providers must understand the motives, needs, and preferences of patients and potential patients. The author reports findings from a statewide study of North Carolina consumers that provide insight into consumer awareness and utilization of various physician specialists, desirable physician practice attributes, and other regnant consumer preferences and perceptions.

Community Participation↗
PubMed2000

Application of simple lipid treatment goals in patients with atherosclerotic disease.

BACKGROUND AND AIM: In this multicentre observational study the "5-4-3-2-1" guideline (total cholesterol < 5.0 mmol/L, the ratio of total to high-density lipoprotein cholesterol < 4, low-density lipoprotein cholesterol < 3.0 mmol/L, triglycerides < 2.0 mmol/L and high-density lipoprotein cholesterol > 1.0 mmol/L) was compared with the new European recommendations (total cholesterol < 5.0 mmol/L and low-density lipoprotein cholesterol < 3.0 mmol/L) ("5-3") and a treatment criterion of low-density lipoprotein cholesterol < 3.0 mmol/L and triglycerides < 1.5 mmol/L ("3-1.5"), as patients with triglycerides > 1.5 mmol/L may have an increased risk of premature cardiovascular disease. METHODS AND RESULTS: In 1997/98, 2134 patients in general practice with established atherosclerotic disease on a lipid-lowering therapy were monitored. The "5-4-3-2-1" guideline was met in 19.2% and the "5-3" guideline in 36.2% and 22.5% fulfilled the "3-1.5" criterion. Our data showed a good conformity between the "5-4-3-2-1" guideline and the "3-1.5" criterion. Of the patients who achieved the "5-3" guideline approximately 50% still had unfavourable values of HDL-cholesterol and TG, while only 15% of those who fulfilled the "3-1.5" criterion had HDL-cholesterol < or = 1.0 mmol/L. CONCLUSIONS: A treatment goal of LDL-cholesterol < 3.0 mmol/L and fasting TG < 1.5 mmol/L markedly raised the proportion of patients with desirable levels of HDL-cholesterol and the ratio of total cholesterol to HDL-cholesterol and should be recommended in secondary prevention, especially in diabetic patients.

Adult↗
PubMed2001

Malaria control in Bungoma District, Kenya: a survey of home treatment of children with fever, bednet use and attendance at antenatal clinics.

OBJECTIVE: To lay the basis for planning an improved malaria control programme in Bungoma District, Kenya. METHODS: By means of a cluster sample household survey an investigation was conducted into the home management of febrile children, the use of bednets, and attendance at antenatal clinics. FINDINGS: Female carers provided information on 314 recently febrile children under 5 years of age, of whom 43% received care at a health facility, 47% received an antimalarial drug at home, and 25% received neither. Of the antimalarial treatments given at home, 91% were started by the second day of fever and 92% were with chloroquine, the nationally recommended antimalarial at the time. The recommended dosage of chloroquine to be administered over three days was 25 mg/kg but the median chloroquine tablet or syrup dosage given over the first three days of treatment was 15 mg/kg. The total dosages ranged from 2.5 mg/kg to 82 mg/kg, administered over one to five days. The dosages were lower when syrup was administered than when tablets were used. Only 5% of children under 5 years of age slept under a bednet. No bednets had been treated with insecticide since purchase. At least two antenatal visits were made by 91% of pregnant women. CONCLUSIONS: Carers are major and prompt providers of antimalarial treatment. Home treatment practices should be strengthened and endorsed when prompt treatment at a health facility is impossible. The administration of incorrect dosages, which proved common with chloroquine, may occur less frequently with sulfadoxine-pyrimethamine, as its dosage regimen is simpler. High levels of utilization of antenatal clinics afford the opportunity to achieve good coverage with presumptive intermittent malaria treatments during pregnancy, and to reach the goal of widespread bednet use by pregnant women and children by distributing nets during antenatal clinic visits.

Antimalarials↗