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PubMed1997

Contraceptive methods: potential for abuse.

Contraceptive technologies are one of the most extraordinary advances of the twentieth century, enabling women and men to prevent unwanted pregnancy. They have also been criticized for giving rise to abusive practices in the name of population control. Some people have even argued that contraceptive methods which have a potential for abuse should not be developed. We maintain that eliminating research on such methods does not address the problem of abuse. Abuse has been defined as the violation of the right to liberty and security of the person, which requires that an individual's free and informed consent be given before research is done on, or treatment is provided to, that individual. A number of international guidelines on the ethical conduct of research involving human subjects, and on the provision of medical services, emphasise the importance of informed consent as part of informed decision-making of individuals. Irrespective of the contraceptive methods already available or under development, much public education is needed to ensure that investigators, health providers, users of services and research participants fully understand what informed consent means, what it implies and how it should protect people. Non-governmental organizations and others can use the various national and international mechanisms that exist to investigate cases of alleged abuse and to bring redress in such situations. The international community has a duty to foster and strengthen ethical practices in research and service provision of contraceptive methods.

Contraception↗
PubMed2002

Discrepancies between patients and professionals in the assessment of patient needs: a quantitative study of Norwegian mental health care.

BACKGROUND: Sensitivity to and respect for the user perspective are important facets of user-centred services and empowerment in contemporary mental health care. Little is known about the extent to which new policies influence mental health work in practice. AIMS: To investigate discrepancy between patients and professionals in the assessment of patient needs. Analyses could indicate emphasis on user orientation in Norwegian mental health care. METHODS: Patients and their respective health professionals (n = 1080) completed separate questionnaires regarding patient characteristics and needs. Identifiers were removed from the data locally and then entered into a national database. Descriptive statistics and multiple regression analysis were used to explore mean levels of discrepancy and predictors of discrepancy. RESULTS: Mean discrepancy was low, as, on average, 30 of the listed 40 needs were considered absent by both the patients and their respective professional. However, the parties showed distinct disagreement as to the amount and type of needs that were present. Specifically, professionals identified more needs than patients (9.3 vs. 4.3, respectively) and this difference was characterized by a strong professional emphasis on needs regarding professional monitoring and follow-up. Results showed that symptoms of severe cognitive disability were over-represented in the group of patients with the highest level of discrepancy, however, the majority of high-discrepancy patients were not severely disabled on cognitive functions. A multiple regression analysis revealed 10 predictors of high discrepancy. DISCUSSION: A low professional emphasis on user-orientation may be indicated in some cases. Results are discussed with relation to the tension between autonomy and beneficence. Suggestions for practice and further research conclude the paper.

Adult↗
PubMed1986

Fast Inter Library Loans and Statistics, enhanced version 2.0.

F.I.L.L.S. is a library-specific software package developed by librarians for library staff with little or no computer experience. MacNeal Hospital's Health Science Resource Center designed F.I.L.L.S. to allow libraries to save 60 percent of the time devoted to the interlibrary loan function while improving service to users. As a management tool, F.I.L.L.S. creates a dozen (12) preprogrammed reports that provide invaluable information such as Number of Requests for Periodicals, including copyright information; which libraries are borrowed from frequently; and which libraries provide the fastest or slowest service in filling loan requests. The article describes F.I.L.L.S., its capabilities and its limitations in greater detail.

Computers↗
PubMed2001

Impact of a broadband interactive televisit/teleconsultation service for residential and working environments.

The availability of health care attention at the point of need is one of the key benefits of telemedicine. Home environment and working place are the two scenarios selected in this article to evaluate the impact of a televisit and teleconsultation service. 31 users from four different medical and patient groups participated in this study supported by European Commission ATTRACT project. The experiences, carried out in Madrid and Valencia Spanish sites, benefited from interactive broadband access networks to provide cost-effective telecare services. Key areas analyzed encompass systems usability, clinical outcomes, patients quality of care and infoethic issues. Services advantages were verified and compared both from patients and medical staff points of view. Main benefits pointed out refer to displacement reduction, better communication doctor/patient, provision of comfort or friendliness, more precise therapy follow-up and increases in patients sense of well being.

Attitude of Health Personnel↗
PubMed1998

Clinical applications of the Adelaide Activities Profile.

OBJECTIVE: The Adelaide Activities Profile (AAP) was developed from the Frenchay Activities Index, and has been shown to be a valid measure of the lifestyle activities of elderly people. The goals of the current study were to illustrate the value of applying the AAP in the clinical setting, and to demonstrate the relationship of the AAP to the use of formal services. DESIGN: Data were collected as part of the Australian Longitudinal Study of Ageing (ALSA). A community sample, stratified by age and sex, was chosen to be representative of the elderly population of Adelaide, South Australia. PARTICIPANTS: A sample of 1799 community-dwelling people aged 70 years and over. MEASURES: Lifestyle activities were assessed with the AAP, which provides measures of activity on four scales: domestic chores, household maintenance, service to others, and social activities. Participants were defined as users of formal services if they were active clients of any of the Domiciliary Care and Rehabilitation Services, Meals-on-Wheels, or the Royal District Nursing Society. RESULTS: Age and sex norms for the AAP were provided, and the clinical value of using these norms was illustrated by two contrasting case studies. Users of formal services had lower activity levels than nonusers for all AAP scales, particularly household maintenance and domestic chores. CONCLUSIONS: The AAP is a valuable addition to the standard battery of instruments used in the assessment of elderly people, and has clinical application as both a health outcome measure and an indicator of the need for intervention.

Activities of Daily Living↗
PubMed1997

The physician and the Internet.

The Internet is one of the greatest developments in informational exchange during the past century. It allows almost anyone to access information available throughout the world. Nonetheless, the Internet is often misunderstood by physicians. It can be considered a super computer network that allows users to transfer a wide variety of information at a low cost. The information can be transferred through functions such as electronic mail, file transfer protocols, the Usenet, or the most widely recognized World Wide Web. Electronic mail functions like the usual postal service but is carried through the Internet, and delivery is usually within the hour. It can serve as a method of communication between physicians and patients. File transfer protocols function as a method for transferring large amounts of information such as software through the Internet. The Usenet acts like an international bulletin board service, allowing users anywhere to post messages and to respond to messages from other users. Several patient support groups have Usenet sites for exchanging specific disease information. The World Wide Web has received the greatest attention because most of the information on the Internet is text, sound, or pictures. Numerous medical organizations have established Web sites. This article attempts to describe each of these functions and the benefits to physicians.

Computer Communication Networks↗
PubMed1987

Consumerism in health care. Prevalence and predictors.

Current efforts to contain health care costs include a variety of strategies aimed at the users of health services. These approaches attempt to encourage users to be more cost-conscious and to shop for lower-cost services and more efficient health care plans. The primary method for achieving this is by increasing the consumer's exposure to the cost of health insurance and the cost of care. The assumption is that approaches that increase cost-sensitivity will stimulate greater consumerism among the users of care. This paper presents findings from a study that investigates the extent to which members of insured populations have a consumer approach to health care, identifies factors related to consumer behaviors and attributes, and examines the degree to which consumer cost-sensitivity is associated with other consumer-oriented behaviors. The data used are derived from face-to-face interviews. Only a minority of the respondents engage in the examined consumer behaviors. Both social demographic and attitudinal factors affect the likelihood of engaging in consumer behaviors. Being cost-sensitive appears to be only a minor stimulant to other consumer attributes. Policy implications are discussed.

Adult↗
PubMed1998

Suitability of casemix classification for output funding of blood services in Victoria. Victorian Blood Users Group.

OBJECTIVE: To study the suitability of diagnosis-related groups (DRGs) to quantify blood use in order to fund hospitals directly for fresh blood components. DESIGN: (i) Retrospective empirical analysis of hospital inpatient separation data, matching DRG classification with blood usage. (ii) Prediction of blood usage based on actual DRGs and comparison with actual blood products issued from the blood service. SETTING: Eight large public hospitals, April 1994-March 1995, the Department of Human Services and the Australian Red Cross Blood Service in Victoria, 1994-1997. MAIN OUTCOME MEASURES: Requirement for transfusion according to DRG; quantity of blood or blood products transfused; and statistical reliability of measuring blood component usage by DRG. RESULTS: A match between patient records and transfusion records for 287,117 patient separations showed that the patients had received 51,115 units of red cells, 30,451 units of platelet concentrates, 9043 units of fresh frozen plasma and 1273 units of cryoprecipitate. Ten per cent of DRGs (527) accounted for over 70% of blood product usage. The numbers of DRGs in which blood products were used for at least 30 separations (with a relative SEM [for units of blood used per separations using blood] of up to 20% at a 95% confidence level) were 56 for red cells, 8 for platelets and 4 for fresh frozen plasma. Estimates of red cell usage calculated from actual DRGs for three consecutive years (1994-1997) showed that DRGs predicted aggregate issues of red cells by the Red Cross Blood Service (ratio of actual red cells issued to red cell usage estimates were 1.036 for 1994-95, 0.994 for 1995-96, and 1.021 for 1996-97, respectively). CONCLUSION: DRGs are moderately good predictors of blood product usage, and could be used to allocate funds for blood products to hospitals instead of to the blood service. However, DRG data are not designed to manage blood issue policies, because DRGs do not represent single diagnoses or procedures and some are surrogate descriptions of procedures.

Australia↗
PubMed1992

Utilization in Alberta's universal dental plan for the elderly, 1974-91.

Since 1973 the government of Alberta, a Canadian province of 2.4 million people, has funded a dental care plan for all residents over 64 years old and their dependents. It is the only dental plan in North America that covers all seniors and their dependents residing in a state or province. Under this plan, just over 270,000 persons (in 1990-91) are eligible for comprehensive, premium-free dental services provided by dentists and denturists in private practice on a fee-for-service basis. The plan's design, administration, utilization, and costs are reviewed. Utilization increased from 27 percent of eligibles using the plan in 1974-75 to 44 percent in 1990-91, and the mean number of services per user rose from 4.9 to 6.9 during the same time period. Although the cost per eligible person has increased about 200 percent, from Canadian (C) $42 to C $131, these costs only began to exceed the rate of inflation in 1986-87. Even though just 12 percent of the two main providers participating in the plan are denturists, nearly 22 percent of plan patients attended denturists rather than dentists for their complete dentures. Fees paid to dentists by the plan have decreased over time relative to the standard fees for the various services listed annually in the Alberta Dental Association fee guide. The apparent growth of direct additional billing by dentists of plan users to recover the difference between their usual fees and those paid by the plan and the effects of greater plan utilization are discussed, as are future potential difficulties in the plan's administration.

Aged↗
PubMed2000

Women-specific alcohol use(r) intervention programs: a preliminary dimension analysis based on specialized services in Western New York State.

Women-specific models have been proposed as a means for achieving the best service user-treatment match for women who experience alcohol use related problems. To better understand how theoretical and empirical knowledge are being applied in real world programs, interviews were conducted at seven programs in Western New York State where specialized women's alcohol use(r) services have been developed. A preliminary analytical model of women's services is proposed, consisting of the following three dimensions: 1) level of orthodoxy, 2) population specificity, and 3) change target.

Alcoholism↗
PubMed2001

Ecstasy pill testing: harm minimization gone too far?

Harm reduction has become the focus of public health initiatives and therapeutic intervention in the management of dependent drug use over the last 20 years. The last decade has seen such approaches being extended to recreational drug use. Most harm reduction initiatives have aimed to inform users about risks and ways of minimizing risk. The concept of providing illicit drug users with quality assessment of their chosen drug is one possible harm reduction intervention that until recently has received little attention. In response to well-publicized 'ecstasy'-related deaths organizations in some European countries and the United States have chosen to provide a 'pill testing service' for users. There are two broad categories of pill testing offered. Simple colour reagent test kits (Marquis Reagent and colour charts) form the most widely used on-site pill testing method. Less frequently, but more accurately, laboratory personnel with access to sophisticated chromatographic equipment (high performance liquid chromatography (HPLC) or gas chromatography-mass spectrometry (GC-MS)) may provide analysis of a pill. Pill testing kits have been advocated as a 'tool to protect yourself against the polluted XTC market'. We refute this line of reasoning. Of the different tests only techniques such as GC-MS can identify satisfactorily the psychoactive constituents present in ecstasy pills. Colour tests based on an interpretation of a colour response in the presence of a drug are, at best, subjective. Pill testing of any description does not guarantee safety, or protect the consumer against individual responses to pills. At best it gives an artificial 'shine of safety' to a group of diverse drugs that remain both illicit and potentially harmful. Other simpler harm reduction mechanisms are likely to be more effective.

Chromatography, Gas↗
PubMed2005

Kinefold web server for RNA/DNA folding path and structure prediction including pseudoknots and knots.

The Kinefold web server provides a web interface for stochastic folding simulations of nucleic acids on second to minute molecular time scales. Renaturation or co-transcriptional folding paths are simulated at the level of helix formation and dissociation in agreement with the seminal experimental results. Pseudoknots and topologically 'entangled' helices (i.e. knots) are efficiently predicted taking into account simple geometrical and topological constraints. To encourage interactivity, simulations launched as immediate jobs are automatically stopped after a few seconds and return adapted recommendations. Users can then choose to continue incomplete simulations using the batch queuing system or go back and modify suggested options in their initial query. Detailed output provide (i) a series of low free energy structures, (ii) an online animated folding path and (iii) a programmable trajectory plot focusing on a few helices of interest to each user. The service can be accessed at http://kinefold.curie.fr/.

Algorithms↗
PubMed1993

Public Mental Health Services to Asian American Ethnic Groups in Two California Counties.

PURPOSE OF THE STUDY: The purpose of this article is to examine the use of public mental health services among Chinese, Filipino, Southeast Asians, Japanese, and other Asian Americans. SEARCH METHODS USED: This article used two data sources from San Francisco City and County and Santa Clara County. By combining data from these two counties, the study had access to information on 3,095 adult Asian users of services. SUMMARY OF IMPORTANT FINDINGS: The study found differences among various Asian ethnic groups in their likelihood of using individual service modalities, but fewer statistically significant differences in the amount of use once services started. MAJOR CONCLUSIONS: Differences in the use of public mental health services were related to differences in the two counties' implementing services. KEY WORDS: Asian Americans, Public Mental Health Services, Utilization, Ethnic Differences

Journal Article↗
PubMed2004

Socioeconomic marginality and health services utilization among Central Harlem substance users.

The article examines whether decrements in socioeconomic measures in a poor, substance using population predict changes in health services utilization. The sample consisted of 658 "hard drug" (crack, powder cocaine, and heroin) users drawn from Central Harlem in New York City during 1998 and 1999. Chain referral and social networking were used in order to gain access to hidden users. The sample was stratified according to operational measures indicating socioeconomic marginality, one calculated using indices of income, education, and employment and another designed to measure lived homelessness. Rates of self-reported utilization of 10 health services were compared across strata. In this sample socioeconomic marginality reflected by low levels of income, education, and employment sometimes predicts greater rates of health services utilization and, in other cases, it predicts lower rates. When the sample is stratified according to an operational measure of homelessness, the gradient of greater utilization and self-reported morbidity for the homeless is more marked and consistent. Results are supportive of a public health model of drug user treatment that recommends that it occur as part of an integrated strategy addressing poverty, homelessness, violence, and related social problems.

Adult↗
PubMedDate not supplied

Users of reproductive health clinic services in a school pregnancy prevention program.

Although the potential of school-based programs in the prevention of adolescent pregnancy is well recognized, few have been evaluated. This paper describes the use of a reproductive health care clinic associated with a school pregnancy prevention program which had demonstrated success. The program operated in one junior and one senior high school in a large city during the 3 school years from 1981 to 1984. Three facets of the 818 users of the program clinic are explored: who enrolled in the clinic, why they enrolled and what contraceptive methods they received, and their continuation with the clinic. Chi-square analysis and Student's t-tests were used to test for significant differences between the two school and sex groups. Life table and regression techniques were employed to examine clinic continuation. The main findings are teens of both sexes used the clinic, and junior high males used it in surprisingly large numbers; there were no major school or sex differences in the characteristics of those who enrolled; most students enrolled to obtain a contraceptive method; although many females served by the clinic had previously used another family planning clinic, the majority of them had unmet needs; the rate of clinic continuation was high; and certain factors contributed to clinic continuation. These findings suggest that a clinic in a school-linked setting can successfully attract students to use its services and it may offer certain advantages for reaching sexually active teens in search of contraceptive protection.

Adolescent↗
PubMedDate not supplied

[Various aspects of a care system tuned to the requirements of those needing assistance].

The risk of becoming a nursing case dependent on care is one not covered by social insurance in the Federal Republic of Germany. The costs involved have to be borne by the individual needing care, his family or the respective public aid institution. The currently existing facilities for care, especially the nursing homes, are generally not considered acceptable and satisfactory by potential users. Social service provisions outside nursing homes are more widely appreciated, specially on account of the usual desire to retain a more independent and autonomous life style. Most inmates of nursing homes are dependent on public aid, considering the costs of these institutions. Fiscal burdens on public households in connection with providing public aid to persons in nursing homes have increased more than proportionately. Moreover the number of the very old aged who will be nursing cases with a very high probability is increasing. Taking into consideration the interest of the potential users as well as the economic restrictions, the use of existing in-patient nursing facilities in accordance with actual need, as well as the increase of out-patient service stations, seems to make an increase in the in-patient nursing facilities unnecessary. As prerequisite for this, however, in-patient care has to be restricted to those cases really requiring such care, and out-patient services must not altogether neglect criteria of efficiency.

Aged↗
PubMed2001

Across the health-social care divide: elderly people as active users of health care and social care.

Several ways in which elderly people may assume an active role when using welfare services are discussed here. Selected findings are presented from a study that explored the experience and behaviour of elderly people on discharge from inpatient care with regard to criteria indicating user influence or control (namely participation, representation, access, choice, information and redress). Data were collected via semistructured interviews with service users (n = 30) soon after their return home from hospital. A number of differences were revealed between health care and social care in relation to users being provided with opportunities to assume an active role and in being willing and able to assume an active role. These differences were manifest in elderly service users accessing services, seeking information, exercising choice and acting independently of service providers. It appeared paradoxical that contact points were more easily defined with regard to health care yet users were more likely to exercise choice and act independently in securing social care. It is suggested that social care needs and appropriate service delivery are more easily recognised than making the link between perceived health care needs and appropriate services. In addition, it appeared that informal and private providers are more widely available and accessible for social care. If comprehensive continuing care is to be provided, incorporating both health and social care elements, greater uniformity appears to be required across the welfare sector. Lessons for social care provision from the delivery of health care suggest the clear definition of contact points to facilitate service use. Making health care more accessible, however, does not appear to be easily attainable due to the monopoly provision of health care and the lack of direct purchasing power by potential users.

Aged↗