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PubMed1998

An evaluation of services for women with long-term mental health problems.

This paper presents the results of an evaluation study of services for women with long-term mental health problems. The study, which was conducted in a long-term rehabilitation and community care service, examined the adequacy, accessibility, and responsiveness of services provided for women users; explored differences between the men and women using the service and those newly admitted to it; and explored the views and experiences of service providers and the women users themselves. The results of the study confirm and extend those of previous studies and suggest a number of service recommendations. The unevenness in attention to the needs of women across services needs to be addressed. Services should be more attractive to women. Agencies and facilities for women outside mental health services should be supported to ensure that they can accommodate women with long-term mental health problems, and the women themselves need to be offered the support necessary to ensure they have access to such facilities. Finally, efforts must be made to ensure that services both recognize the losses that women with long-term mental health problems have experienced and foster their continued hopes and aspirations for the future.

Adult↗
PubMed1997

[Day care as a component of comprehensive health care structure after introduction of nursing care insurance].

Detailed time protocols based on direct observation as well as socio-demographic and morbidity-related data were collected in Day-Care-Facilities for the Aged and the Handicapped (Tagespflege), in order to gain information regarding the users and the service activities of these institutions. Women aged 80 years and over constitute the main users; they use the facilities between 8 am and 4.30 pm in most cases. The analysis of employee activities showed that roughly one quarter of the time was spent on specific services of such facilities, e.g. group activities, individual activating therapy of patients. Should Day-Care-Facilities play an (increasingly) important role in the domestic social service provision for the aged and the handicapped, the financing of their costs (on the average DM 88 per day, not counting transportation cost) must be reconsidered.

Aged↗
PubMed2005

Experiences with and perceptions of, barriers to substance abuse and HIV services among African American women who use crack cocaine.

Significant health disparities in the rates of HIV infection exist that primarily impact African American women. While research has demonstrated that HIV is preventable through changes in high-risk behaviors facilitated by substance abuse treatment, an individual must first be able to access and engage with treatment to derive any benefit from these services. While there is some research that identifies barriers to treatment access and engagement for African American women who use crack cocaine, these barriers require further examination. Current literature has focused primarily on internal motivation and treatment readiness without placing these concepts within the unique environmental context of social stressors for crack cocaine-using African American women. This study presents the results of eleven focus groups with eighty-nine African American women in which respondents document the HIV risk behaviors of crack cocaine users, present their experiences in accessing substance abuse and HIV services, and documents their perceptions of barriers and services needs. The results of this study may further develop an understanding of the means by which individual service users experience their relationships with service providers and the factors that affect these relationships in order to better target potential interventions to reduce the spread of HIV.

Adult↗
PubMed2000

The delivery of oral care services to elderly people living in a noninstitutionalized setting.

Advances in medical science are enabling people to survive more illness and disability. As people live longer, their mobility and/or ability for self-care often are reduced by physical or mental disability and other chronic diseases. It may become unreasonable or impractical for them to access mainstream dental services. Increasing numbers of dentate elderly people with expectations of oral health higher than earlier cohorts of elderly people are likely to bring increasing demands to the dental profession for their continuing care. Thus, the oral care for disabled elderly people in noninstitutionalized settings may pose a challenge. The oral care options available to this group of people include the dental surgery/operatory, a mobile dental service, home-based or domiciliary dental care, a mix-and-match combination of surgery-based and domiciliary care, and cyberspace. Noninstitutionalized, disabled elderly people may have to rely on domiciliary care services for their oral health care. This paper explores the training implications, the necessary knowledge and skills base, the benefits and limitations to both the service provider and user, the equipment available, and the cost/funding of domiciliary dentistry. Domiciliary dental care services need to be developed by improving pre- and postdoctoral training programs and by establishing realistic remuneration for dental teams providing this care so that noninstitutionalized, disabled elderly people can access oral health care.

Aged↗
PubMed2006

Dental caries risk in the U.S. Air Force.

BACKGROUND: This study describes the dental caries risk in the active duty U.S. Air Force population from October 2000 through September 2004. METHODS: The authors used data collected from two Air Force databases (personnel and dental files) by cross-referencing Social Security numbers from both databases with date. RESULTS: During the study period, the percentages of people at high and moderate risk of developing caries decreased by 31 percent and 12 percent, respectively, while the percentage of people at low risk of developing caries increased by 9 percent. Among Air Force members who were enrolled continuously during the study period, the percentages at high and moderate risk of developing caries decreased by 57 percent and 18 percent, respectively, while the percentage at low risk of developing caries increased by 14 percent. The authors observed improvement in caries risk in 83 percent and 73 percent of the people at high and moderate caries risk, respectively, for those continuously enrolled. High caries risk was related inversely to age, rank, education and years in service. Also, tobacco users had an elevated risk of developing caries. CONCLUSIONS: The Air Force Dental Service has made great strides in improving the oral health of the Air Force population. The results of this study suggest that caries risk is decreasing in the Air Force population, but oral health disparities still exist and require further evaluation. CLINICAL IMPLICATIONS: This investigation suggests that a caries risk assessment can be conducted successfully, and caries risk can be reduced by using a comprehensive population-based prevention program. This caries risk assessment also can identify factors associated with dental caries disparities in a large-scale population.

Adult↗
PubMed2005

Prevalence of visual impairment in adults with intellectual disabilities in the Netherlands: cross-sectional study.

PURPOSE: To obtain the first representative and valid population-based prevalence figures on visual impairment and blindness in adults with intellectual disabilities (ID) and to identify risk groups. METHODS STUDY DESIGN: Cross-sectional survey. An age-Down's syndrome-stratified random sample of 1,598 persons from a base population of 9,012 adult users of ID services with mild to profound intellectual disabilities was screened. Participants underwent protocollised on-site screening of visual functions. Results were related to degree of ID, occurrence of Down's syndrome (DS) and age. MAIN OUTCOME MEASURE: Prevalences of visual impairment and blindness in the study population and in subgroups and weighted prevalences in the total Dutch population using ID services. RESULTS: Prevalences of visual impairment ranged from 2.2% (95% confidence interval (CI), 0.5-6.4) in young adults with mild ID and no Down's syndrome to 66.7% (95% CI, 41.0-86.7) in older adults with profound ID and Down's syndrome; prevalences of blindness ranged from 0.7% (95% CI, 0.1-4.1) to 38.9% (95% CI, 28.1-50.3). Weighted prevalences of visual impairment and blindness in the total Dutch population of adult users of intellectual disability services are 13.8% (95% CI, 9.3-18.4) and 5.0% (95% CI, 3.8-6.2), respectively. Prior to this study, visual impairment or blindness had remained undiagnosed in 106/261 (40.6%) persons. CONCLUSIONS: As compared to published figures for the general Dutch population aged 55 years and over (visual impairment 1.4%, blindness 0.5%), prevalences of visual impairment and blindness are higher in all subgroups with intellectual disabilities, including the young and mildly handicapped group. The diagnosis is too often missed. All persons with severe or profound intellectual disabilities, and all older adults with Down's syndrome, should be considered visually impaired until proved otherwise.

Adult↗
PubMed1995

Core and comprehensive health care services: 3. Ethical issues.

The CMA's Working Group on Core and Comprehensive Health Care Services recognizes ethics to be one of the three key factors in determining which services should be publicly funded. The role of ethics is to identify and make explicit the principles and values, at individual and societal levels, that lie behind judgements and positions. Two types of ethical issues are addressed: one deals with the criteria for these services and the other with the process to be followed. The five ethical criteria discussed are fairness, age, lifestyle, the identifiable versus the statistical patient, and futility. An ethical process incorporates appropriate roles for the public physicians and payers (government) and accountability of all participants. A provided checklist for determining a fair process asks such questions as Do potential users of a service, its providers and the public have an adequate say in the decision about whether the service should be publicly funded? Are the reasons for the decision communicated to those affected by it? and is the service being denied to potential users on the basis of unfair discrimination or lifestyle?

Age Factors↗
PubMed2002

[Serving the public].

What is meant by Public Service? Does it mean serving the public or, since the service is for everyone, must the public leave it up to the discretion of the administration, in the hopes of obtaining what it is entitled to? The question is important at a time when the public is no longer satisfied with a simple service, but demands acknowledgement, quality and performance from the general Administrations and in particular hospital institutions. With an aim for global efficiency, the annual report of the General Authority of Social Affairs "Les Institutions socials face aux usagers", has courageously tackled the eternal items: information for the public, administration of the users, quality of service rendered. This recent report offers the opportunity to review, from the users' point of view, the quality of public services and, with the malaise in this sector today, this represents a major social stake in the short-term.

Delivery of Health Care↗
PubMed1995

Physicians' utilization of health care.

OBJECTIVE: To describe how physicians attend to their own health care needs. SETTING: Rhode Island. PARTICIPANTS: A random sample of Blue Cross/Blue Shield providers. The 306 respondents (67% of 458) primarily (92%) had MD or DO degrees. The nonphysician providers were chiropractors, dentists, optometrists, and podiatrists. DESIGN: A mailed survey provided data describing the respondents' medical conditions and utilization of formal and informal care during a three-year period. Questions asked about provider visits, physical examinations, preventive and diagnostic tests, and medication use. The respondents indicated whether services had been initiated by themselves or by another physician. MAIN RESULTS: The physicians' overall use of formal health services was low; their number of office visits was a fourth of the national average. Two-thirds of the respondents reported having a primary care physician, and one-third had sought informal care. The respondents' use of preventive services was high. During the three-year period, 82% of the women physicians had received a Pap test, and 81% of the women physicians over the age of 40 years had received mammography. Cholesterol levels were checked for more than two-thirds of all the respondents. Medical examinations and laboratory tests tended to be ordered by another physician, although self-prescribing was not uncommon. Furthermore, 61% of the respondents had self-prescribed at least one medication. CONCLUSIONS: Physicians' care-seeking behavior covers a broad spectrum, ranging from self-care, to informal consultation, to formal treatment by another physician. Physicians appear to be low users of formal services overall, but high users of preventive care.

Adult↗
PubMed1992

Dental visit satisfaction in a group of adults aged 50 years and over.

Studies have found that utilization of dental services is generally less common than utilization of medical services, particularly by older persons. Because satisfied dental patients were found to be greater users of the service than nonsatisfied patients, it was decided to investigate the correlates of dental visit satisfaction in older subjects. Predictions that satisfaction would be positively related to regular use of dental services and negatively related to dental anxiety were confirmed. The results also suggested that older dental patients have different expectations of their dentists than younger ones.

Age Factors↗
PubMed2004

A combined fuzzy-neural network model for non-linear prediction of 3-D rendering workload in grid computing.

Implementation of a commercial application to a grid infrastructure introduces new challenges in managing the quality-of-service (QoS) requirements, most stem from the fact that negotiation on QoS between the user and the service provider should strictly be satisfied. An interesting commercial application with a wide impact on a variety of fields, which can benefit from the computational grid technologies, is three-dimensional (3-D) rendering. In order to implement, however, 3-D rendering to a grid infrastructure, we should develop appropriate scheduling and resource allocation mechanisms so that the negotiated (QoS) requirements are met. Efficient scheduling schemes require modeling and prediction of rendering workload. In this paper workload prediction is addressed based on a combined fuzzy classification and neural network model. Initially, appropriate descriptors are extracted to represent the synthetic world. The descriptors are obtained by parsing RIB formatted files, which provides a general structure for describing computer-generated images. Fuzzy classification is used for organizing rendering descriptor so that a reliable representation is accomplished which increases the prediction accuracy. Neural network performs workload prediction by modeling the nonlinear input-output relationship between rendering descriptors and the respective computational complexity. To increase prediction accuracy, a constructive algorithm is adopted in this paper to train the neural network so that network weights and size are simultaneously estimated. Then, a grid scheduler scheme is proposed to estimate the queuing order that the tasks should be executed and the most appopriate processor assignment so that the demanded QoS are satisfied as much as possible. A fair scheduling policy is considered as the most appropriate. Experimental results on a real grid infrastructure are presented to illustrate the efficiency of the proposed workload prediction--scheduling algorithm compared to other approaches presented in the literature.

Journal Article↗
PubMed1979

Sex differences in the utilization of health services for psychiatric problems in Saskatchewan.

Comprehensive data on all pscyhiatric patients in Saskatchewan show that women are substantially higher users of health services for psychiatric problems than are men. Women: 1) use up to twice as many services as men in the private sector, but use almost the same number of public sector services; 2) tend to be treated for psychosomatic and neurotic disorders on an outpatient basis; 3) have only a slightly greater chance than men of being hospitalized; and 4) are less likely than men to have organic or addictive diagnoses. These differentials in utilization cannot be explained by age, diagnoses and/or marital status. Sex is the best predictor of utilization. These results are largely consistent with utilization and epidemiological literature. It seems more likely that these sex differences in utilization result from the interaction of biology, sex roles, and the functioning and labelling processes of the health system rather than from any single factor. Combining Andersen's components of health behaviour with Freidson's lay-professional construction of illness continuum yields a possible framework for understanding sex differences in the utilization of psychiatric health services.

Adult↗
PubMed1997

[The disinfection of nebulizers in a basic health unit in Ribeirão Preto].

Considering the widely divergent views of the nursing staff with respect to nebulizer disinfection in Basic Health Units (BHU) and to the lack of standardization of the use of chemical products and of the disinfection process as a whole, the author undertook an investigation with the following objectives: to observe systematically the routine procedure of nebulizer disinfection in the aerosol room of a BHU, and to detect, point out and warn about possible faults in the disinfection process. The disinfection process was observed directly and systematically and a questionnaire with open questions was applied to the nurse responsible for the service. The results showed that the process of disinfection performed is not consistent with recommendations by the Health Department and/or State Health Secretariat, and that the personnel involved in this activity has incomplete knowledge of the standardization of the use of the chemical products utilized and of the conditions that interfere with their action during the disinfection process. The results obtained indicate the need for a standardization of the disinfection process as whole, according to current sanitary norms and for continual in-service education in order to improve the quality of nursing care provided to the users of health services.

Brazil↗
PubMed2004

[Factors promoting follow-up services after medical examinations by municipal governments].

OBJECTIVE: All Japanese municipal governments have a responsibility to conduct a medical examination for their residents aged 40 or more under the Health Services for the Elderly Act since 1984. According to the results of the medical examination, municipal governments should give appropriate follow up services to all users. The objective of this study was to find the factors promoting follow up services after medical examinations conducted by municipal governments. SUBJECTS AND METHODS: Mailed questionnaire surveys on follow up services after medical examination were sent out to all 3,255 municipal governments in Japan. The 2,447 municipal governments that answered all items on the questionnaire were enrolled in this study. Follow-up services by municipal government for persons with abnormal findings at medical examinations included "Suggestion to have a more detailed examination", "Confirmation of having had a detailed examination", "Individual health consultation", and "Home visit for medical guidance". These follow-up services were analysed in terms of the number of public health nurses per population and whether a continuous data set was maintained for medical examinations. RESULTS: Follow-up services were conducted more frequently in municipalities that maintained continuous data sets of medical examination than those that did not. They were also carried out more frequently in municipalities with higher numbers of health visitors per population than in those with lower numbers. The percentage of municipal governments that maintained continuous data of medical examinations was higher among those that conducted group medical examinations than those that conducted individual medical examinations at local medical facilities. CONCLUSION: Follow-up services after medical examinations by municipal governments showed a significant relationship with maintenance of a continuous data set of medical examinations and the number of public health nurses.

Aged↗
PubMed1995

[The user perspective studied by users of psychiatric institutions].

The perspective of users of psychiatric services has mostly been studied by professional researchers. In this study a group of users investigated subjective quality of life, assessment of psychiatric treatment and needs of other users. A special questionnaire was constructed and used. Psychiatric institutions were assessed as being on average good to satisfactory; satisfaction with different life domains was fairly good; needs for support varied very much.

Adult↗
PubMed2002

Standards for comprehensive sexual health services for young people under 25 years.

This document is a first response to the need to develop sexual health services for young people on a single site whilst awaiting research from pilot studies of 'one stop shops' suggested in the Sexual Health and HIV strategy. It is a document which is intended to be a tool to use for those wishing to set up a service providing testing for sexually transmitted infections and provision of contraceptive services for those under 25 years. It is not intended that such a service would replace existing specialist or general practice care but complement it, allowing clients to choose the service most appropriate and acceptable to them, with close links and clear pathways of care for referral between services. This paper should be used as a template when initiating and monitoring a clinic but some of the standards may not be achievable without significant financial input. However, economic limitations should not detract from striving to achieve the best possible care for those most at risk from sexually transmitted infections and unwanted pregnancies. For example, not all clinics will be able to provide the recommended tests for the diagnosis for gonorrhoea and chlamydia immediately, but should work towards achieving them. Although the upper age limit in this document is defined as 25 years, some providers may wish to limit clinics to those under 20 depending on local needs. Detailed information on specific issues such as consent and confidentiality, provision of contraception, investigation of non-sexually transmitted vaginal infections and sexually transmitted infection management and diagnosis are referenced and we recommend these are accessed by the users of this document. Many of the references themselves are live documents available on the worldwide web, and are constantly updated. The Sexual Health and HIV Strategy has now been published and these standards are aimed at those who wish to provide a level 2 sexual health service for young people wherever the setting e.g. genitourinary outreach clinic, contraceptive services, general practice. This document is a starting point to be reviewed and updated as new research becomes available, as the Sexual Health Strategy is implemented and with further input from providers of care (family planning, general practice, genitourinary medicine, gynaecology and paediatrics) and service users. All service providers must maintain a high quality of care and have networks both with those who provide more specialized services (Level 3) and Level 1 services. This document is an initial attempt to ensure that there is equity of clinical provision wherever a Level 2 sexual health service is provided and should be a useful tool for those setting up or monitoring services.

Adolescent↗
PubMed2003

Effective electron-density map improvement and structure validation on a Linux multi-CPU web cluster: The TB Structural Genomics Consortium Bias Removal Web Service.

Anticipating a continuing increase in the number of structures solved by molecular replacement in high-throughput crystallography and drug-discovery programs, a user-friendly web service for automated molecular replacement, map improvement, bias removal and real-space correlation structure validation has been implemented. The service is based on an efficient bias-removal protocol, Shake&wARP, and implemented using EPMR and the CCP4 suite of programs, combined with various shell scripts and Fortran90 routines. The service returns improved maps, converted data files and real-space correlation and B-factor plots. User data are uploaded through a web interface and the CPU-intensive iteration cycles are executed on a low-cost Linux multi-CPU cluster using the Condor job-queuing package. Examples of map improvement at various resolutions are provided and include model completion and reconstruction of absent parts, sequence correction, and ligand validation in drug-target structures.

Apolipoproteins E↗