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Meals and snacks among elderly self-managing and disabled women.

AIM: The aim of this study was to describe the frequency and distribution of self-managing and disabled elderly women's eating events, as well as to investigate which definition/names the women had given their different eating events and to categorise these into meals and snacks. An additional aim was to study the composition of meals and snacks, and analyse the nutritional significance of these eating events in terms of energy and macronutrients. SUBJECTS: Elderly women, both self-managing (n=139) and disabled (n=63; with Parkinson's disease, rheumatoid arthritis or stroke), aged 64-88 years, and living at home participated. METHODS: A repeated 24 h recall and an estimated food diary for three consecutive days were used. RESULTS: The eating events defined by the women that were categorised as meals contributed 74% of the total daily energy intake, while snacks contributed 22-23%. The meals that the women had defined as dinner, was the most energy dense meal. The frequency of eating events not defined by the women, was 30-34%, but contributed only 3-4% of the total daily energy intake. The disabled women had a significantly lower energy content in meals and most snacks, compared to the self-managing women. CONCLUSION: The main conclusion was that elderly women still living at home had their meals distributed during the day and that these meals were characterised by individuality and flexibility.

Aged↗

Impact of a nurses strike on a medical center emergency department.

A strike of registered nurses in a large voluntary teaching hospital required changes in prehospital and emergency department delivery of services. An explanation of how the strike was handled by one emergency department is offered, as are comments on implications for emergency physicians and lessons for future strike situations.

Emergency Service, Hospital↗

Pharmaceutical reform and physician strikes in Korea: separation of drug prescribing and dispensing.

Before the recent pharmaceutical reform in Korea that mandates the separation of drug prescribing and dispensing, physicians and pharmacists both prescribed and dispensed drugs, resulting in the overuse and misuse of drugs. The pharmaceutical reform attempts to change the provider's economic incentives by eliminating the providers' profit from drugs that have been a major source of their income. It also influences the pharmaceutical industry that has thrived on offering high margins to physicians rather than on producing high-quality drugs. However, physician strikes forced the government to modify some critical elements of the reform package and to raise medical fees substantially to compensate for the income loss of physicians. Lack of a strategic plan of implementation, failure to appreciate the change in the paradigm of health policy process, and failure to convince consumers of the benefits of the reform, are the major reasons that the historic reform of the separation of drug prescribing and dispensing has resulted in greater social cost than expected.

Community Participation↗

Structure as a causal factor in nurses' strikes.

Nurses employed in Alberta's hospitals have earned a reputation of militancy as a result of four province-wide strikes in the 11-year period 1977-1988. Based on a case study of the first three strikes, the principal causes of the labour disputes are discussed: namely, union ideology, economic factors and inherent constraints in the structure of bargaining in the public sector. Interorganizational relationships of the three main players, the United Nurses of Alberta, the Alberta Hospital Association and the provincial government have been contributing factors in all three strikes. Although issues in the disputes were primarily economic, demands associated with the needs of working women, and demands that threatened the traditional prerogatives of management were at the heart of every impasse.

Alberta↗

Nurses strike in Israel.

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Attitude of Health Personnel↗

The effect of a mental hospital strike on general hospital psychiatric services.

Data collected from 6043 psychiatric in-patient records were analysed to assess the impact of a strike at a mental hospital on in-patient services in general hospital psychiatric units in St John's, Newfoundland, Canada. As a whole, during the strike general hospital units showed an increase in the number of involuntary admissions, the number of prior mental hospital admissions of patients, and indications of violent or suicidal behaviour; and a decrease in the occupational status of patients admitted and the prescription of minor tranquillizers. There was also evidence of considerable variation between general hospitals in the extent to which their admission pattern changed during the strike and the permanence of some of the strike effects. The data indicate that all patients showing violent or suicidal behaviour who would normally have been admitted to the mental hospital were treated in the general hospital units during the strike. On the other hand, a large number of patients diagnosed with schizophrenia, personality disorder or mental retardation, who normally would have been admitted to the mental hospital, apparently went without hospitalization during the strike. A substantial proportion of this latter group would usually have been admitted involuntarily.

Delivery of Health Care↗

The junior hospital doctors' pay dispute 1975-1976: an analysis of events, issues and conflicts.

In late 1975, for the first time in the history of the National Health Service, junior hospital doctors in the United Kingdom took industrial action. Their pay and working conditions were basic issues, but the dispute was complex. The first part of this article describes these complexities - the significant events, and the grievances and their resolution. In the second part the dispute is analysed in terms of its causes, effects and implications, particularly for the medical profession. The ambivalence, confusion and ignorance about the new contract and the question of breaking government pay policy, problems of representation, and conflicts of interests within the profession are highlighted. It is suggested that the significant economic gains of the junior doctors were not achieved by industrial action.

Conflict, Psychological↗