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PubMed1998

Changing fruit and vegetable consumption among children: the 5-a-Day Power Plus program in St. Paul, Minnesota.

OBJECTIVES: A randomized school based trial sought to increase fruit and vegetable consumption among children using a multicomponent approach. METHODS: The intervention, conducted in 20 elementary schools in St. Paul, targeted a multiethnic group of children who were in the fourth grade in spring 1995 and the fifth grade in fall 1995. The intervention consisted of behavioral curricula in classrooms, parental involvement, school food service changes, and industry support and involvement. Lunchroom observations and 24-hour food recalls measured food consumption. Parent telephone surveys and a health behavior questionnaire measured psychosocial factors. RESULTS: The intervention increased lunchtime fruit consumption and combined fruit and vegetable consumption, lunchtime vegetable consumption among girls, and daily fruit consumption as well as the proportion of total daily calories attributable to fruits and vegetables. CONCLUSIONS: Multicomponent school-based programs can increase fruit and vegetable consumption among children. Greater involvement of parents and more attention to increasing vegetable consumption, especially among boys, remain challenges in future intervention research.

Child↗
PubMedDate not supplied

[Physiologic evaluation of health status of workers at aluminum casting robot complexes "Rostselmash"].

Physiological parameters of physical state of workers was studied. Results showed relationship between hemodynamics and psychophysiological status and length of service. Changes of physical state and physical capacity for work depend on the hemodynamics. Therefore after-working rehabilitation should include remedies for normalization of vasovegetative reactions in workers.

Adaptation, Physiological↗
PubMed1990

Early identification of hearing loss: screening and surveillance methods.

Service monitoring data on the outcomes of health visitors' screening for hearing loss at 8 months in West Berkshire indicate low sensitivity and low positive predictive value, despite efforts to improve the conduct of the screen. Nevertheless, data on a recent series of severely hearing impaired children indicate significantly earlier diagnosis than previously, due in part in the introduction of other service changes including neonatal 'at risk' screening and surveillance using parental observation. For a trial period the traditional screening method for the detection of hearing loss in babies will be discontinued and effort concentrated on these alternative procedures.

Age Factors↗
PubMed1985

Economic growth of the dental profession: comparisons with other health care sectors.

This paper describes the economic growth of the dental profession and concludes, on the basis of increases in real output in excess of the GNP, that the dental services sector of the economy is a growth industry. The analysis shows that, on a relative basis, dentistry also appears to be growing with respect to other important health service sectors, including physician services. Changes in output appear to be related to the expansion of the supply of dental workforce, the increased productivity of individual general practitioners, population growth, and the increase in the portion of the population with dental insurance.

Dental Care↗
PubMed1995

Uses and misuses of serum hCG--a clinical audit.

A 24-hour laboratory-based service was established in the City Hospital, Birmingham, England, in 1987 for semi-quantitative serum human chorionic gonadotrophin (hCG) assay and specific clinical criteria for requests were agreed. However, a 309% increase in workload between 1988 and 1992 prompted a detailed clinical audit of this service. During a representative month only 35% of 142 requests conformed to the agreed criteria. Those for routine diagnosis of pregnancy, threatened miscarriage, and 'abdominal pain screen' comprised 49% of total requests and seemed inappropriate. No pregnancy was diagnosed by 'abdominal pain screen'. Adhering to agreed clinical criteria, therefore, would not jeopardise patient care and could halve the cost of the service. As a result of this audit the established criteria for serum hCG estimation were reinforced and re-issued to all relevant clinical teams. Additionally, to improve delivery of service and reduce costs a semi-quantitative urine hCG assay was introduced in the Accident and Emergency Department for use by approved staff. Records in this department showed no increase in hCG requests during the six months after the service change, compared with those in the preceding half year. However, theoretical cost savings of 5173 pounds per annum were eroded by an estimated 10% because 208 (26%) tests were unaccounted for. The reasons for this apparent 'wastage' are unclear, and highlight the difficulty in auditing a biochemical test performed outside the laboratory.

Chorionic Gonadotropin↗
PubMed1998

Changes in the daily practice of primary care for children.

BACKGROUND: The environment in which medicine is practiced has changed in the past 2 decades, but little information has been available on how the day-to-day practice of primary care for children has changed during this period. OBJECTIVE: To identify aspects of primary care practices for children that are undergoing substantial changes. DESIGN: Analysis of National Ambulatory Medical Care Surveys from 1979 to 1981, 1985, and 1989 to 1994. PARTICIPANTS: Primary care practitioners recorded data on 58,488 child visits. MAIN OUT COME MEASURES: Characteristics and insurance status of children, physician activities during visits, and disposition after visit. RESULTS: Child visits to primary care physicians increased by 22% between 1979 and 1994. The mean age of children visiting primary care physicians decreased from 6.7 years in 1979 to 5.7 years in 1994 (P for trend, < .001). The ethnic diversity of child visits increased primarily as a result of an increasing proportion of visits by Hispanic (6.0% in 1979 to 12.6% in 1994, P for trend, < .001) and Asian patients (1.6% in 1979 to 4.1% in 1994, P for trend, < .001). Medicaid and managed care increased dramatically as sources of payment. Changes in physician activities included an increase in some preventive services, changes in the most commonly encountered medications, and an increased mean duration of patient visits (11.8 minutes in 1979 to 14.2 minutes in 1994, P for trend, < .001). CONCLUSIONS: These data may assist in the development of educational and research initiatives for physicians caring for children. The declining proportion of adolescent visits may present physicians with challenges in the care of adolescents. Physician prescribing practices showed changes without evidence of a benefit to child health. The increased ethnic diversity and provision of preventive services were associated with an increased mean duration of primary care visits. The increased duration of child visits may conflict with the managed care emphasis on physician productivity.

Asian↗
PubMed1998

The role of the old age psychiatry consultation liaison nurse.

OBJECTIVE: To assess and describe service changes when a psychiatric consultation liaison nursing service is introduced. DESIGN: Prospective collection of basic service data before and after implementation of the service change. SETTING: A newly established comprehensive old age psychiatry service. PATIENTS: People on medical and surgical wards aged over 65 years referred for psychiatric assessment. OUTCOME MEASURES: Numbers of referrals made and patients seen, details of psychiatric diagnoses made and follow-up offered before and after the change in the service. RESULTS: Within 6 months there was an increase in liaison referrals to the service. The proportion of people offered follow-up showed little change and delay before assessment decreased substantially with the PCLN service. CONCLUSIONS: A psychiatric consultation liaison nursing (PCLN) service was successfully initiated. Numerous difficulties were encountered but this is a useful model for old age psychiatry services to consider researching and developing further.

Aged↗
PubMed1987

Community mental health services in transition.

Major policy and funding shifts over the last several years have stimulated a series of changes in local mental health agencies. Services offered CMHCs became less comprehensive and more oriented toward chronic and severely ill patients. Decreases occurred in other services, primarily indirect services. Changes in services and in clients served caused reconfiguration in staffing patterns, and also affected the types of activities some staff perform. The implications of these service and staffing changes for local mental health agencies are discussed.

Community Mental Health Centers↗
PubMed1995

Usefulness of a non-experimental study design in the evaluation of service developments for infant feeding in a general hospital.

There are likely to be many situations in which it is not possible to use a randomized controlled trial (RCT) for the evaluation of local service developments, and the usefulness of non-experimental study designs need to be assessed. This is examined with reference to a study carried out to evaluate the appointment of a baby feeding adviser (BFA) and other policy changes for infant feeding at a district general hospital (DGH). Surveys of Maternity Unit staff attitudes and practices, and of mothers' experiences were carried out in 1988 (prior to the changes) and afterwards in 1990. Service changes were; appointment of a BFA, removal from the postnatal wards of dextrose, seminars on baby feeding for midwifery staff, and a reduction of night-only shifts. There was no change in the initial breast feeding rate of about 80%, but there was an increase in breast feeding at 6 weeks postnatally from 57% (95% CI; 51-64) to 64% (95% CI; 59-69); P = 0.15. The percentage of women who stopped breast feeding by 6 weeks fell from 30% in 1988 to 22% in 1990; P = 0.11. Mothers who did not see the BFA (1990 only) were significantly less likely to begin breast feeding (P = 0.03), independent of social class and age, but a similar association was not seen at 6 weeks. There were significant reductions in the percentage of midwifery staff viewing feeding policy as unimportant (P = 0.02), and in the use of supplements for breast-fed babies (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

AIDS and injecting drug use in the United Kingdom, 1987-1993: the policy response and the prevention of the epidemic.

This paper assesses policy development, service changes and trends in HIV infection and risk behavior among injecting drug users (IDUs) in the United Kingdom. In 1986, the U.K. was faced with the possible rapid spread of HIV infection among IDUs. The combination of an outbreak of HIV infection with prevalence levels of 50% or more in Edinburgh, the recent diffusion of drug injecting, and high levels of syringe-sharing risk behaviour, suggested that HIV infection might spread rapidly through IDU populations. HIV prevention activities commenced in 1986 and developed in 1987. The first report on AIDS and Drugs Misuse by the Advisory Council on the Misuse of Drugs in 1988 was a major catalyst for change. It supported and legitimized emergent views on new ways of working with drug users. Between 1988 and 1993 innovative public health projects increased the ability to target vulnerable populations through syringe distribution, expansion of methadone treatment and outreach to hard-to-reach populations. There were major changes in service philosophy and practices, as ideas of harm minimization, accessibility, flexibility and multiple and intermediate goals were developed. There is evidence that these public health projects encouraged extensive changes in the health behaviour of IDUs. There have been major reductions in syringe-sharing risk behaviour and sharing syringes is no longer the norm. Evaluation of specific interventions (e.g. syringe-exchange) shows their importance in encouraging reductions in risk behaviour. Levels of HIV infection in IDUs remain low by international standards. Outside of London rates of about 1% have been reported; London has a low and declining prevalence of infection to around 7% in 1993; previous high levels in Edinburgh (55%) have since declined to 20%. Britain has to date avoided the rapid increase in HIV infection among injectors that has occurred in many parts of the world. The same period saw the continuation of high prevalence levels in New York and many European cities, and the explosive spread of HIV in many countries in south-east Asia. This paper acknowledges the difficulties is proving links between social interventions and epidemic prevention. It argues that there is prima facie evidence for the success of public health prevention, that the collection of intervention approaches in the U.K. had a significant impact on IDUs behaviour, and that this has helped prevent an epidemic of HIV infection among IDUs. The U.K. experience adds to the growing evidence of the significance of early interventions in encouraging behaviour change and in limiting the spread of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The behavior of Italian family physicians regarding the health problems of women and, in particular, family planning (both contraception and NFP).

The hospital-centered trend that has dominated medical culture and the management of health care during this entire century has, in the last few years, undergone a reversal in Italy. Conditions in other countries suggest that similar changes have or will become increasingly common. The family physician today manages many of the functions previously handled by hospitals and specialists. In the field of reproductive health, family physicians are responsible not only for diagnosis and treatment, but also for prevention and education. The present study considers this new context with the objective of investigating the knowledge and behavior of Italian family physicians in the field of women's health, with particular regard to family planning (including natural family planning), through (1) a qualitative study (focus groups) of a small group of family physicians and (2) a questionnaire sent to 500 family physicians throughout Italy. The results of the focus group are summarized in the form of obstacles that the family physician finds in providing family planning services and proposals for change. The results indicate that because of their holistic approach, the family physician is an appropriate provider of family planning services although continued use of specialists' services, changes in logistics of the family physicians' practice, increased gender sensitivity, and additional training and information are necessary. The results of the questionnaire (121 responses, 24.2%) indicate that the Italian family physician currently lacks certain important information about family planning and would require logistical support to provide these services but is interested in acquiring information and is an appropriate family planning provider. An additional challenge for encouraging family practitioners to provide natural methods is that they favor a "medical" approach rather than a "behavioral" one in their treatment preferences for several other conditions.

Contraception↗
PubMed1998

All change: cancer services in transition.

The policy and health service background to this discussion are the radical changes in cancer services currently underway in the wake of the Calman-Hine Report and the wider changes ushered in by the NHS and Community Care Act 1990 (UK). Using the changing face of hospice care as the focus, the authors explore some of the potential issues and dilemmas involved in providing supportive care for cancer patients and their families. Three 'themes', or areas of concern, are highlighted: links between services, changing organizational factors, and increasing 'medical imperialism'. Potential benefits and drawbacks of the changing ethos and organizational structures are discussed. Interview data are used as 'triggers' for the presentation of the authors' own reflections on developments in the hospice and cancer services' arenas. The paper draws on interview data collected in the pilot phase of a 3-year study on the psycho-social needs of cancer patients and their informal carers in north-west England. Twenty-nine interviews were conducted with a range of professionals involved in the provision of cancer services in Lancaster and Kendal. In the spirit of 'gathering thoughts' and facilitating debate, a commentary on developments in the hospice sector is offered rather than any firm conclusion.

Health Care Reform↗
PubMed1992

Managing service change in post HIV drugs services--a case study from Inner London.

The advent of HIV/AIDS has presented a major ideological challenge to established drug treatment agencies, where the incorporation of HIV-prevention strategies has proved problematic. This case study analyses the response to the HIV/AIDS epidemic by the drug misuse services of one Inner London district health authority (Bloomsbury) during the period 1985-89. While innovation and enthusiasm were much in evidence, a number of special problems prevented an effective and coherent strategic response. Key factors in the management of change in drugs/HIV services are identified which may be of special importance to clinicians, managers and funders and a number of key organizational and managerial competencies are suggested.

HIV Infections↗
PubMed1996

Validity and reliability of the Parent Satisfaction Questionnaire.

The development of a postal consumer satisfaction questionnaire for a child and adolescent psychology service is reported. A preliminary analysis of content, construct and concurrent validity suggests that the questionnaire has an acceptable degree of validity. Factor analysis identified five factors with three being identifiable as relating to the outcome of contact, appointments and the timing of contact. The remaining two factors were minor dyads which were difficult to interpret. The reliability and utility of the questionnaire is good, proving a useful way of identifying service shortfalls and directing service change. The need to methodologically evaluate consumer satisfaction questionnaires is stressed and their routine use in monitoring and assuring service quality highlighted.

Adolescent↗
PubMed1996

Changes in utilization and cost sharing within the Danish National Health Insurance dental program, 1975-90.

The aims of the analysis were 1) to examine the development in utilization of dental care provided for adults in Denmark under the National Health Insurance during the period 1975-90; 2) to assess the appropriateness of available dental care statistics for studies of oral health trends; and 3) to analyze the price development of dental services during 1975-90 and its impact on patient and Insurance expenses, respectively. Utilization and economic data were retrieved from available registers and analyzed. Three trends were found. First, the utilization has increased more than what could be explained by the population increase; secondly, the panorama of dental services changed from predominantly restorative/extraction services to predominantly diagnostic/preventive services. Thirdly, the price paid by Danish adults for dental care increased disproportionately to other price developments in society. On the basis of traditional health economic theory this development could be expected to affect demand for dental services negatively.

Adult↗
PubMed1997

Health service reform: the perceptions of medical specialists in Australia (New South Wales), the United Kingdom and New Zealand.

OBJECTIVE: To examine the effect of recent healthcare service changes (including significant resource constraint and a greater role for the non-medical manager) in the United Kingdom, Australia and New Zealand on medical specialists' perceptions of their healthcare organisation goals and service delivery, and their enthusiasm for their work. DESIGN: Postal questionnaire survey, answered anonymously. PARTICIPANTS AND SETTING: Medical specialists employed either part- or full-time in two United Kingdom National Health Service Trusts (one acute, one mental health/community service), an Australian Area Health Service and a New Zealand Crown Health Enterprise in 1995. MAIN OUTCOME MEASURES: Participants' rating of their knowledge of employers' organisational goals, ability to influence management, perceptions of changes in resources and service availability since 1990 and changes in enthusiasm for their work over the past four years. RESULTS: 369 of 521 eligible specialists responded (71%); by country-United Kingdom, 123/186 (66%); New Zealand, 123/160 (77%); Australia, 123/175 (70%). New Zealand specialists were less aware of their employers' organisational goals and had less congruence between these and their own personal goals than United Kingdom or Australian specialists (P < 0.05). Interest in influencing central management was similar in the three countries, but Australian specialists felt management was less likely to follow their advice compared with United Kingdom specialists (P < 0.05). New Zealand specialists perceived that waiting times for non-urgent patients were currently longer than in 1990 compared to United Kingdom specialists (P = 0.02). In all three countries, inpatient beds were perceived to be less available than in 1990, but less so in New Zealand. The ease of replacing equipment was better in New Zealand than in Australia and the United Kingdom (P = 0.00001). More than 50% of participants in all three countries (183/361; 50.7%) reported that their enthusiasm for their work had decreased in the past four years. CONCLUSION: The effects of health service reforms seem to have reduced enthusiasm for work among medical specialists in Australia, the United Kingdom and New Zealand.

Attitude of Health Personnel↗
PubMed1991

Evaluation of family support services: changes in availability and accessibility.

Changes in availability and accessibility of family support services were studied by surveying county mental health authorities in Michigan before and after the implementation of new policy on and funding for such programs. An overall increase in the availability of family support services was found. Access to services as measured by length of time families waited for services remained unchanged following the increase in funds. Policy and funding implications of the study were discussed.

Adaptation, Psychological↗