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PubMedDate not supplied

[9 reflexions on health and medical education in Mexico].

In Mexico's case, the fields of healthcare and medical education are closely vinculated. On the other hand, contemporary society lives in a deep transformation process. In the present article, some paradoxes and contrasts in relation to health and medical education characterize the reality in Mexico. Particular emphasis is made on the analysis of the profound differences which exist between the two federative entities which present the extreme figures on life expectancy at birth. The thesis which supports the document, recognizes the need for integral analysis of the organizational and administrative processes of healthcare and medical education in Mexico.

Cause of Death↗

PubMed1982

Identifying school children with behavior disorders.

Behavioral screening criteria were developed through the collaborative efforts of multidisciplinary professionals to enable teachers to identify school children with behavior disorders within the school setting. The criteria which were developed provide a step towards a practical means of implementing the legislative mandate of PL 94-142 in a medically and psychologically sound manner. An analysis of the criteria presented in the federal guidelines and working criteria proposed by experts in the field is presented. Increased liaison between professionals of all involved disciplines is encouraged for the identification, evaluation, treatment and placement of behavior disorder children. The background and process of developing the criteria is described.

Affective Symptoms↗

PubMed1976

Change in the mental health field?

An analysis of the current roles of the federally funded community mental health center and the public mental hospital suggests that despite the rhetoric about a community mental health revolution, the mental field has yet to undergo significant change. Ideological, political, economic, and structural barriers-characteristics of the field itself-impede such change outside, inside, and across the centers and hospitals. Recent court decisions on patients' rights, however, have the potential for moving the field into a period where "bold new action" actually can occur.

Attitude of Health Personnel↗

PubMed1993

[Mortality of foreign and indigenous population in the German Federal Republic].

Comparative mortality studies with respect to nationality have not yet been published in a comprehensive way for the Federal Republic of Germany. A recent special analysis of causes of death for German mortality statistics of the year 1986 indicates a lower mortality risk among the migrant compared to the indigenous population. Apart from potential biases, such as underreporting of nationality of death cases or overestimation of the size of the non-indigenous population in Germany, from the perspective of socio-epidemiology the possibility arises that selection processes lastingly affect the mortality risk of migrants. The dependence of the length of stay from the quality of the state of health or rather a plausible increased likelihood of remigration in case of chronic disease may constitute important influences, which could explain the differences in mortality between indigenous and migrant population.

Adult↗

PubMed2003

[Individual needs and allocation of home-based community psychiatric services. Analysis of an example for ambulatory care living].

In the Federal Republic of Germany, rebuilding the structures of complementary care in the newly formed eastern states created the opportunity to provide at-home care in the community as a low-threshold flanking measure for chronically mentally ill individuals generally capable of living independently. For a group of patients with chronic schizophrenic disorders (ICD-10: F20) living on their own in the community with at-home mental health care ( n=83), a study of data focusing on psychopathology, social disability, need for psychiatric care, and (subjective) quality of life demonstrates that the principle of need-oriented care has not yet been realized consistently. This applies especially to the provision of community services of varying treatment intensity based on the differing severities of psychopathological symptoms and social disabilities of individual clients. Furthermore, the results of the study show that the severity of psychosocial impairments is associated with a rather negative assessment of the subjective quality of life, whereas the living arrangement has no influence on satisfaction with life. The conclusion for organizing community mental health care is to establish flexible provision of services oriented to standardized individual analyses of needs for care.

Community Mental Health Services↗

PubMed2002

Predictors of Canadian legislators' support for tobacco control policies.

It is clear that regulatory strategies can be effective in reducing tobacco use. Because legislators ultimately determine whether many of these policies are enacted, they are a key focus for tobacco policy research. This study identifies political and personal predictors of Canadian legislators' support for tobacco control policies. Data are from a 1996-97 survey of federal, provincial and territorial legislators. Multivariate regression analysis was used to assess relationships between five groups of variables (political factors including political ideology, personal characteristics, tobacco experiences, tobacco knowledge, interest group saliency) and support for tobacco control based on an 11-item scale. Support for tobacco control varied by political party. Support was higher among legislators who thought government had a duty to promote healthy lifestyles, knew second-hand smoke could cause lung cancer, knew tobacco caused more deaths than alcohol, and said they wanted more contact with medical associations about tobacco issues. Support was lower among current smokers and those with tobacco industry jobs in their ridings. The findings indicate that political party membership cannot be ignored in enlisting legislator support for tobacco control. It also appears that legislators who oppose tobacco control measures may not be opposed to tobacco control per se, but are more generally opposed to a government role in health promotion. Thus, public health professionals and tobacco control advocates need to be more attentive to the way tobacco control issues are framed for particular legislators. Further, meetings with health groups about tobacco issues would be welcomed by many legislators; non-governmental organizations and other health advocates could work to increase tobacco knowledge among legislators.

Attitude to Health↗

PubMed2003

Search for linkage between hand osteoarthritis and 11q 12-13 chromosomal segment.

OBJECTIVE: The aims of the present study were: (1) to evaluate the extent and mode of inheritance of hand osteoarthritis by using a large sample of ethnically homogeneous pedigrees of Caucasian origin; (2) to examine whether the synthetic measure of osteoarthritis according to Kellgren and Lawrence (K-L) and the more specific measure, namely, the extent of osteophytes development, have a similar putative genetic determination and pattern of biological inheritance and (3) to test the hypothesis that hand osteoarthritis dependent phenotypes are linked to the 11q 12-13 chromosomal region. METHODS: The population of the present study comprised 1190 Chuvashians (Russian Federation) belonging to 295 nuclear families. Segregation analysis was carried out on a total sample. Sub-sample of 571 individuals was used to conduct Transmission/disequilibrium test (TDT) and model-based linkage analysis. RESULTS: Adjusted for age, sex and other covariates, both OA phenotypes showed significant familial aggregation. The model fitting analysis strongly supported the hypothesis of a major gene effect on study traits. The inferred major gene explained about 52% of the osteophyte score (OPS) and 49% of the K-L score variation adjusted for confounding variables. The series of model-based linkage analyses and TDTs provided inconclusive evidence on possible linkage of both phenotypes to the 11q 12-13 chromosomal region. CONCLUSIONS: We support the hypothesis of a major gene effect in heritability of hand osteoarthritis in both phenotypes. Despite the fact that some DNA markers showed statistically significant association to studied primary phenotypes, we find only weak evidence of linkage disequilibrium between hand osteoarthritis and the proximal part of the 11q 12-13 chromosomal segment (D11S1983 for K-L score and D11S1313 for OPS). The subject, however, a merit requires further investigation.

Adolescent↗

PubMed2005

[Quality measurement between illusion and reality--is the quality of medical care measurable?].

The current implementation of external quality assurance focuses on identical, albeit simple univariate procedures. This approach proves to be inefficient, exhibiting low specificity. Definitions of performance indicators were classified by the local steering committee and applied to Bavarian obstetric data augmented with multivariate and confidence interval analyses as well as statistical simulations. A highly selected group of units with multivariate extreme values was audited. Blind application of federal regimes without further in-depth analysis of concomitant data is inefficient and may lead to wrong conclusions. Exclusive univariate analyses of performance indicators are not enough. Multivariate analyses have a higher specificity. Classification reveals an imbalance in the indicator set with respect to varying degrees of coverage as well as a bias towards outcome. Deficiencies in the organisational processes crucial for quality of care are often only revealed by dedicated cause and effect analyses within the hospital, thus constituting an essential prerequisite for desired changes in health care policies. It is unlikely that mere publication of performance indicators in the impending quality report will generate lucidity in spite of abundant structure. The installation of standardised programmes with identical computation rules may appear convincing as long as no doubt is cast upon the efficacy of the performance indicators in respect to their intended usage as well as upon the expected feedback effects. The experience so far however teaches us that these elements may be essential yet although not sufficient.

Benchmarking↗

PubMed1987

[Diphtheria, an imported disease].

A comparative analysis of 4256 persons living in the Federal Republic of Germany and 4751 applicants for asylum in the FRG allows the conclusion that in the FRG diphtheria is caused by imported toxinogenic strains, originating mostly from developing countries. Since 1975 a total of 109 cases have been observed, 22 ending in death. Such severe cases can be avoided by systematic revaccination even of adults.

Adolescent↗

PubMed1995

Data sources for aging research on racial and ethnic groups.

This article reports the results of a survey of recent and ongoing aging-related data sources supported by U.S. federal agencies. The survey sought to obtain data on the sample sizes and topics covered within the data sets maintained and frequently used by the various federal agencies engaged in data collection and/or analysis. The objective of the study was to determine the suitability of these data sets to conduct research on minority elders. Formal tests of the adequacy of data set sample sizes to support analysis on various minority groups were performed. Each data set was found to be large enough to conduct research on white elders, and a majority of the data sets were large enough for research on African American elders. However, Hispanics, American Indians, Alaska Natives, Asian Americans, and Pacific Islanders were rarely included in sufficient numbers.

Aged↗

PubMed1989

Suicide and mental illness in the elderly.

This report deals with the relation of suicide to mental illness in the elderly. Our investigation of this relation proceeds from the following two points of view: First, we asked whether the fact that the elderly are most at risk of committing suicide is confounded with their increased psychiatric morbidity. Second, we asked to what extent suicides of older mentally ill persons are definitely created by their mental illness. The sample includes 310 suicides of psychiatric in-patients. There were explored in the course of a multicentre study of 6 psychiatric state hospitals in the south of the Federal Republic of Germany. The method of analysis involved the motives of the suicidal acts. Results demonstrate that the age is an autonomous risk factor and not to be confounded with the psychiatric morbidity. Psychiatric morbidity of older suicides is not sufficient to explain the suicidal act. Moreover, we found that if mental illness played a part, motives reflecting aspects of chronicity predominated motives reflecting psychopathology (i.e. feeling of being persecuted, loosing mind) of the suicidal patients. Results are discussed with special reference to preventing and managing suicides in the elderly.

Aged↗

PubMed2006

Elevated serum triglycerides is the strongest single indicator for the presence of metabolic syndrome in patients with type 2 diabetes.

BACKGROUND: Patients with diabetes already fulfill one diagnostic criterion for MS according to the existing classifications. Our aim was to identify one single clinical parameter, which could effectively predict the presence of MS in patients with type 2 diabetes. METHODS: We studied all patients with type 2 diabetes who attended our Diabetes Outpatient Clinic during a three-month period. Waist circumference, blood pressure and serum lipids were measured. Establishment of MS diagnosis was based a) on National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria and b) on International Diabetes Federation (IDF) criteria. Receiver operating characteristic (ROC) analysis was applied in order to identify the clinical parameter with the highest predictive capability for MS. Among the 500 participating patients (231 males, 269 females), MS was diagnosed in 364 patients (72.8%) according to the NCEP ATP III criteria and in 408 patients (81.6%) according to the IDF criteria. RESULTS: For the NCEP ATP III classification, serum triglycerides (in the overall population), waist and HDL (in female population) demonstrated the highest predictive capability for MS (AUCs:0.786, 0.805 and 0.801, respectively). For the IDF classification, no single parameter reached an AUC > 0.800 in the overall population. In females, HDL displayed a satisfactory predictive capability for MS with an AUC which was significantly higher than the one in males (0.785 vs. 0.676, respectively, p < 0.05). CONCLUSION: Elevated serum triglycerides strongly indicate the presence of MS in patients with type 2 diabetes. In female patients with type 2 diabetes, central obesity was the second stronger predictor of MS besides hypertriglyceridemia.

Aged↗

PubMed1983

Legal issues raised by private review activities of medical peer-review organizations.

Increasingly, medical peer-review organizations are entering into contracts with insurance companies and self-insured employers to conduct utilization reviews and quality-of-care assessments. Such private review activities raise new legal issues, requiring analysis of state law as well as federal law. This paper analyzes several of the most important of these legal issues, and suggests some directions for peer-review organizations to take in order to avoid unnecessary legal problems.

Confidentiality↗

PubMed2006

Stakeholder analysis of Florida farmworker housing.

Farmworkers, farmworker advocates, state and federal policy-makers, and researchers all consider adequate housing as central to successful migration, community building, and quality of life, including good health, among farmworkers. This study analyzes results from interviews and focus groups with stakeholders involved in Florida farmworker housing conducted with the goal of providing recommendations for future farmworker housing policy. These recommendations include considering housing needs within a life continuum and understanding how wages and housing are interconnected. The concurring perspectives of stakeholders can be considered as building blocks in developing more effective state and local housing policy.

Adult↗

PubMed2004

Poverty and macroeconomic performance across space, race, and family structure.

We examined the effects of macroeconomic performance and social policy on the extent and depth of poverty in America using state-level panel data from the 1981-2000 waves of the Current Population Survey. We found that a strong macroeconomy at both the state and national levels reduced both the number of families who were living in poverty and the severity of poverty. The magnitude and source of these antipoverty effects, however, were not uniform across family structures and racial groups or necessarily over time. While gains in the eradication of poverty, in general, were tempered by rising wage inequality, simulations indicated that female-headed families and families that were headed by black persons experienced substantial reductions in poverty in the 1990s largely because of the growth in median wages. An auxiliary time-series analysis suggests that the expansions in the federal Earned Income Tax Credit of the 1990s accounted for upward of 50% of the reduction in after-tax income deprivation.

Black or African American↗

PubMed2004

Can Community Health Center funding enhance health services for Native American tribes and organizations?

This paper reports on the applicability of the Public Health Service Act (42 USC, 254b) Section 330 Community Health Center program to Arizona Native American tribes and organizations. Data review and analysis consisted of a review of two federal government documents concerning the funding of Community Health Center applications and a review of questionnaire responses received from the Arizona Native American health care community. Findings indicate a general lack of knowledge among the Arizona Native American health care community about the program as well as a need for capacity building among Arizona Native American tribes and organizations. As currently designed, the program has built-in barriers that prevent Native American tribes and organizations from applying for funding. Changes must be made to the existing program and local-level seminars must be offered to make this program and funding more readily available to Arizona Native American tribes and organizations.

Administrative Personnel↗

PubMedDate not supplied

[Haydée Guanais Dourado: charisma and personality to the service of an ideal].

This is a descriptive-social study which looks at the performance of Haydée Guanais Dourado (HGD) in the Brazilian nursing scene, in the mid-20's. The objectives are to describe her personal and professional profile; analyze her participation in ABEn (Brazilian Association of Nursing) and discuss the relationship between her attributes and her contribution to the development of nursing in Brazil. The sources used consisted of Revista Brasileira de Enfermagem-REBEn (Brazilian Journal of Nursing), written documents and oral reports obtained from the Documentation Center of Anna Nery Nursing School in the Federal University of Rio de Janeiro. The analysis and the interpretation of the data were made by means of the triangulation of the primary and secondary sources, and the historical contextualization. The study evidenced the singularity of HGD and the importance of her contribution to the institutionalization of the nursing profession in the Brazilian society.

Brazil↗

PubMed1995

Causes of Medicaid expenditure growth.

Expenditures for the Medicaid program grew at the alarming and unexpected average annual rate of nearly 20 percent from 1989 ($58 billion) to 1992 ($113 billion). These statistics raise a critical question: What caused spending to grow so dramatically? Using State-level data from 1984-92, this analysis examines the determinants of Medicaid expenditure growth. The results indicate that Medicaid enrollment, Federal Medicaid policy, and State policy are significantly related to Medicaid expenditure growth. The analysis also finds the prevalence of acquired immunodeficiency syndrome (AIDS) to be significantly related to Medicaid expenditures.

Acquired Immunodeficiency Syndrome↗