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PubMed2005

[Public care for breast cancer women in the state of Rio de Janeiro, Brazil].

OBJECTIVE: New policies on oncology care implemented in the Brazilian Unified Health System (SUS) in November 1999 established substantial changes to cancer treatment in affiliate units. The objective was to describe the profile of these cancer services and their users after the implementation of new policies. METHODS: A descriptive study was carried out on breast cancer care in health services covered by SUS in the state of Rio de Janeiro, from 1999 to 2002. Data was collected in the healthcare units from outpatient registries and from the patients' high-complexity cancer procedure authorizations and their medical records. A random sample of 310 medical records of breast cancer women treated in 15 cancer health units was analyzed. Data analysis was performed using the percentile distribution of data according to categories of interest and the Chi-square test to assess the association between variables. RESULTS: The study results show the predominance of breast cancer care in highly complex units (81.3%); public units (73.5%); and in the capital of the state (78.1%). There was also seen an imbalance among health units regarding patient attendance, where only one of them served 70% of women sampled. The use of interventions varied between patients with and without health insurance in lower complexity health services; non-insured patients were associated to lower use of interventions. It was also found underutilization of recommended interventions as well as utilization of contraindicated interventions. The characterization of population studied showed that 43.9% of the women were given a cancer diagnosis with no perspective of cure and 68.4% lived in cities having SUS-affiliated services. CONCLUSIONS: These results indicate relevant differences among health units and point out to the need of practical recommendations to the Brazilian national policy for cancer control.

Adolescent↗
PubMed2003

The CORAS approach for model-based risk management applied to a telemedicine service.

The CORAS risk management process is based on the Australian standard for risk management and aims at improved methodology for precise, unambiguous, and efficient risk assessment of security critical systems. CORAS addresses security critical systems in general, but places particular emphasis on IT security. For CORAS, a system is not just technology, but also the humans interacting with the technology and all relevant aspects of the surrounding organisation and society. The use of graphical models in CORAS furthers communication between the different stakeholders of a risk assessment, and makes it easier for non-technicians to take part. Telemedicine services and electronic applications used in the health sector have a high demand for security. The medical developers, providers and users of such services and systems are important contributors in the risk assessment of these services and systems. CORAS has successfully been used to involve medical professionals in the model-based risk assessment of a telemedicine system called Tele-cardiology in Crete. This paper presents the use of the CORAS framework to assess this telemedicine system giving some conclusions on the experience gained.

Computer Security↗
PubMed1990

The consequences of offering fee-based services in a medical library.

Fee-based services may influence, both subtly and dramatically, the operation of a medical library. Fears that have been raised about the consequences of fee-based services are recalled and applied to the context of medical librarianship. Specifically covered are the effects of fee-based services on service to traditional user groups, collection development, interlibrary cooperation, and management style. The discussion includes references to the program of fee-based services offered by the New York Academy of Medicine Library.

Fees and Charges↗
PubMed1995

A model for connecting doctors to university based medical resources through the Internet.

Medical Students and academics at large universities have access to rich and varied information resources. These resources tend not to be available from off campus sites. We have been running a trial to connect practicing doctors to some of the medical resources that are available within our university. We are using the Internet to facilitate this process. In doing so, a large number of non academic, but very practical problems have had to be solved. We examine in particular the roles that Internet service providers and Internet information providers play in such a project. In particular we describe the factors used in advising users on external service providers, and why we as part of a university have chosen not to fulfil the internet service provision role ourselves.

Australia↗
PubMed1999

Patients' perceptions of the Odstock Dropped Foot Stimulator (ODFS).

OBJECTIVE: To determine the perceived benefit, pattern and problems of use of the Odstock Dropped Foot Stimulator (ODFS) and the users' opinion of the service provided. DESIGN: Questionnaire sent in a single mailshot to current and past users of the ODFS. Returns were sent anonymously. SETTING: Outpatient-based clinical service. SUBJECTS: One hundred and sixty-eight current and 123 past users with diagnoses of stroke (CVA), multiple sclerosis (MS), incomplete spinal cord injury (SCI), traumatic brain injury (TBI) and cerebral palsy (CP). INTERVENTION: Functional electrical stimulation (FES) to correct dropped foot in subjects with an upper motor neuron lesion, using the ODFS. MAIN OUTCOME MEASURES: Purpose-designed questionnaire. RESULTS: Return rate 64% current users (mean duration of use 19.5 months) and 43% past users (mean duration of use 10.7 months). Principal reason cited for using equipment was a reduction in the effort of walking. Principal reasons identified for discontinuing were an improvement in mobility, electrode positioning difficulties and deteriorating mobility. There were some problems with reliability of equipment. Level of service provided was thought to be good. CONCLUSION: The ODFS was perceived by the users to be of considerable benefit. A comprehensive clinical follow-up service is essential to achieve the maximum continuing benefit from FES-based orthoses.

Adult↗
PubMed2000

Resource distribution in mental health services: changes in geographic location and use of personnel in Norwegian mental health services 1979-1994.

BACKGROUND: During the last decades, a central aim of Norwegian health policy has been to achieve a more equal geographical distribution of services. Of special interest is the 1980 financial reform. Central government reimbursements for the treatment of in-patients were replaced by a block grant to each county, based on indicators of relative "need". AIMS OF THE STUDY: The aim of this paper is to assess whether the distribution of specialized mental health services did take the course suggested by the proponents of the reform (i.e. a more equal distribution), or the opposite (i.e. a more unequal distribution) as claimed by the opponents. METHODS: Man year per capita ratios were used as indicators for the distribution of mental health services by county. Ratios were estimated for "all personnel", and for MDs and psychologists separately. Man years were assigned to counties by location of services (i.e. in which county the services were produced), and by residence of users (i.e. in which county the services were consumed). Indicators of geographic variation were estimated using the standard deviation (STD) as a measure of absolute variation, and the coefficient of variation (CV) and the Gini index as indicators of relative variation. Indicators were estimated for 1979, 1984, 1989 and 1994, based on data for all specialized adult mental health services in the country. Changes in distributions over the period were tested, using Levene's test of homogeneity. RESULTS: Relative variations in the distribution of personnel by location of services were substantially reduced over the period, the CV being reduced by more than 50% for all groups. Variations in the personnel ratios by residence of users were smaller at the start of the period, and the reductions were also smaller. Still, relative variations were reduced by 20-35, 40 and 60% approximately for "all personnel", MDs and psychologists respectively. In spite of a major increase in the supply of MDs and psychologists, absolute variations in the personnel ratios were in all cases either reduced, or fairly stable. These results give little support to the views expressed by the opponents of the 1980 reform, although the main result seems to have been relocations in the production of services, more than re-distributions in the consumption of services. DISCUSSION: These results can be seen as a result of three aspects of the reform: 1 Distributing government grants to counties in their capacity as users of services rather than producers of services. This shift has primarily facilitated relocations in the production of services. 2 Relocation of services was also expected to produce a more equal distribution in the use of services, since reduced distances would increase accessibility. This, however, was counteracted by increased county control with use of services in other counties. 3 Distribution of grants based on "needs" rather than services produced was expected to produce a more equal distribution in the use of services. This effect seems to have been less than expected, probably because counties with high reimbursements under the old system also provided services to people from other counties. Other policy reforms have, however, contributed to the results. These reforms include increased supply of personnel, de-institutionalization of services, regionalization/sectorization of services, and the establishment of smaller psychiatric units in general hospitals. POLICY IMPLICATIONS: In recent years the 1980 reform has been under attack; partly due to alleged inequalities created by the system. As a result of the critique, government reimbursements for in-patient treatment have been reintroduced for general hospital services. In mental health services, more resources are distributed to specific projects. According to this study, this shift in policy is based on faulty premises and might lead to greater inequalities in the future.

Journal Article↗
PubMed2006

Internet-based self-assessment of drinking--3-month follow-up data.

This study aims to make an initial evaluation of an Internet-based self-assessment tool for Finnish drinkers () and its effects on their use of alcohol. The subjects (n=343) were recruited from among the 1598 anonymous respondents to the survey on this self-assessment service. The subjects' baseline data were first compared to those of a random sample of the users of this Internet service during the same period. Their responses to the survey were then analyzed. Finally, their drinking and drinking-related problems at the baseline and 3 months later were compared. The study participants were heavier drinkers than the average users of this Internet service. More than nine out of ten were satisfied with the service. The response rate to the follow-up was 78%. There were highly significant reductions (p=.000) in all the outcome measures. The service appealed more to women than men, but there were no sex differences in drinking-related outcomes. The results supported the further development of this model to a randomized controlled trial.

Adult↗
PubMed2002

Joint commissioning. Going halves.

Joint commissioning and provision of mental health services in Somerset failed to produce significant benefits to users over its first two years. Users considered access to services deteriorated and concerns remain that there is no alternative to hospital admission in crises. Users and carers were included as non-voting members of the commissioning board, but users felt less involved in care planning than previously. The combined health and social care trust does not seem to have delivered anything which has not been achieved elsewhere without the transfer of social care staff to a new employer.

Continuity of Patient Care↗
PubMed2006

Sterile syringe access and disposal among injection drug users newly enrolled in methadone maintenance treatment: a cross-sectional survey.

BACKGROUND: We sought to assess injection practices, means of acquiring and disposing of syringes, and utilization and knowledge of harm reduction resources among injection drug users (IDUs) entering methadone maintenance treatment (MMT). METHODS: Interviews with 100 consecutive patients, including 35 IDUs, entering a MMT program in the Bronx, NY. RESULTS: Utilization of unsafe syringe sources was reported by 69% of IDUs in our sample. Most (80%) IDUs reused syringes, and syringe sharing was also common. Fewer than half knew that non-prescription pharmacy purchase of syringes was possible. The most common means of disposing of injecting equipment were the trash (63%) and syringe exchange programs (49%). CONCLUSIONS: These findings indicate that drug users entering treatment under-utilize sanctioned venues to obtain sterile syringes or safely dispose of used injection equipment. Programs providing services to drug users should adopt a proactive stance to address the safety and health issues faced by injectors.

Journal Article↗
PubMed1989

Clinical biochemistry in Singapore.

During the period from 1982 to mid-1989, there has been very significant changes and improvement in the practice and application of clinical biochemistry in Singapore. This paper highlights recent developments in the repertoire of biochemical analyses, utilisation of laboratory tests, biochemical screening in preventive health care, handling and delivery of patient specimens, advances in analytical techniques, automation, computerisation, quality assurance, training of laboratory personnel, and professional activities. It also draws attention to the restructuring of the Singapore General Hospital and the government Department of Pathology which frees these government institutions from the constraints of the civil service so that they would be sufficiently flexible to respond readily to the changing needs and expectations of the patients and users of laboratory services. This is the most prominent event and policy change in the history of health care services in Singapore that is expected to result in more cost-effective utilisation of resources and greater improvement in the quality of health care.

Automation↗
PubMed2005

The performance of health workers in Ethiopia: results from qualitative research.

Insufficient attention has been paid to understanding what determines the performance of health workers. This paper reports on findings from focus group discussions with both health workers and users of health services in Ethiopia, a country with some of the poorest health outcomes in the world. We describe performance problems identified by both health users and health workers participating in the focus group discussions, including absenteeism and shirking, pilfering drugs and materials, informal health care provision and illicit charging, and corruption. In the second part of the paper we present four structural reasons why these problems arise: (i) the ongoing transition from health sector dominated by the public sector, towards a more mixed model; (ii) the failure of government policies to keep pace with the transition towards a mixed model of service delivery; (iii) weak accountability mechanisms and the erosion of professional norms in the health sector; and (iv) the impact of HIV/AIDS. The discussions underline the need to base policies on a micro-analysis of how health workers make constrained choices, both in their career and in their day to day professional activities.

Ethiopia↗
PubMed2006

[The experience of family carers of older people in the use of support services in Europe: selected findings from the EUROFAMCARE project].

This article presents selected findings of the EUROFAMCARE research project, reporting up-to-date information on the use and accessibility of support services for family carers of older people in six European countries representing different typologies of welfare systems (Germany, Greece, Italy, Poland, Sweden and the UK). Data were collected by means of face-to-face interviews to national samples of about 1000 family carers per country (i.e. 6000 in total), based on a common recruitment and data collection protocol. The reported findings reveal the crossnational usage of different support services - subdivided for comparative reasons in the categories of socio-emotional support, information, respite care, training and assessment services - as well as of available care allowances. The analysis includes the perceived experience of carers in using them, in terms of costs sustained, factors affecting service accessibility - i.e. main obstacles and greatest helps in accessing them - as well as reasons for not using (needed) services or for stopping using (still needed) services. Cross-national differences are relevant, showing a greater availability in Northern European countries, where however higher refusal rates by potential users of available services are recorded, possibly in connection to their lack of flexibility and low customization.

Aged↗
PubMed2002

Treatment inside the drug treatment court: the who, what, where, and how of treatment services.

Drug treatment courts provide a new strategy for providing treatment services to offenders within the criminal justice system. With over 400 drug treatment courts in the United States, the courts have evolved to provide treatment services under different models. This article will review the different typologies for delivery of treatment services to drug user offenders in the drug treatment court setting, and it will raise questions about some of the difficult issues underscoring an integrated service delivery model. The paper then identifies some research questions for the future.

Case Management↗
PubMed1999

Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV infection among drug users attending an STD/HIV prevention and needle-exchange program in Quebec City, Canada.

OBJECTIVES: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and human immunodeficiency virus (HIV) infection among injection and noninjection drug users in Quebec City and to identify associated risk factors. STUDY DESIGN: Cross-sectional study of 738 drug users attending a sexually transmitted disease/HIV prevention and needle-exchange program in Quebec City, Canada. RESULTS: The prevalences of N. gonorrhoeae and C. trachomatis were, respectively, 0.4% (95% CI: 0.08%-1.2%) and 3.4% (95% Cl: 2.2%-5.0%). Through multivariate analysis, risk factors associated with sexually transmitted diseases were: among women, being aged between 20 and 24 years and having unprotected sex with commercial partners; in noninjection drug users; cocaine use and first intercourse before 13 years of age; in male noninjection drug users, having regular sexual partners in the previous 6 months. No case of HIV was found in participants who have never injected drugs, but the prevalence was 5.5% (6/110) among the exinjectors and 10.1% (35/347) in current injectors. CONCLUSION: Moderate sexually transmitted disease and HIV prevalences were found, although a high proportion of drug users reported risky behaviors. Needle-exchange program sites may offer a good opportunity to provide sexually transmitted disease/HIV prevention and medical services to drug users.

Adult↗
PubMed1997

Transeuropean network for the provision of added-VAlue Services in Telemedicine--(VAST-Net).

Populations most likely to use telemedicine are usually located far away from ISDN networks in contrast to providers of telemedical services who normally dwell in urban centers. VAST-Net is a consortium that aspires to reach such populations by introducing added-value ISDN-based telemedical services across Europe, through networking a small number of selected, strategically distributed, points-of-care and by focusing on a series of well defined health care provision scenaria. This will be achieved by relying on: (1) the Euro-ISDN infrastructure, (2) satellite based ISDN medical networks (e.g. the INMARSAT/VSAT based MERMAID network), (3) private ISDN networks. The VAST-Net telemedical network will be initially operated on a small but transnational scale in order to assess: (1) the acceptance of telemedical services by end users, (2) the economic viability of the telemedical sector, especially in an international context (3) the legal implications of telemedical practice (4) the regulatory framework within which telemedicine will be developed in the E.U. Based on this assessment the VAST-Net Consortium will proceed to develop appropriate business plans that will allow PTTs and other Telecom operators, medical groups, insurance companies and public health authorities to offer transnationally ISDN-based telemedical services. Potential forms of cooperation may include: (1) "Framework agreements" between PTTs, telemedical service providers (e.g. doctors, hospitals etc.) and "bulk users" (insurance companies, public health authorities), (2) PTT provision of "telecommunications backbones" over which competing telemedical networks can be organised, (3) organisation of a European Economic Interest Group (EEIG), modeled upon international companies such as INMARSAT, that will undertake the operation of VAST-Net.

Computer Communication Networks↗
PubMed1995

Expanding the frame of health services research in the drug abuse field.

OBJECTIVE: This article examines the distribution of heavy drug users across health and social service agencies in a community, and ways in which organizational and social policy factors influence pathways to services. DATA SOURCES/STUDY SETTING: Data are from the Community Epidemiology Laboratory, a project that includes comparable surveys of a wide variety of client, service provider, and general population groups in a single northern California county. STUDY DESIGN: The design is a cross-sectional analysis of patterns of service use and referral by heavy drug users distributed across a variety of service settings and in the general population. DATA COLLECTION: In-person, structured interviews by trained interviewers were conducted using comparable instruments, measures, sampling strategies, and fieldwork procedures. PRINCIPAL FINDINGS: The specialty drug treatment system serves only a small proportion of heavy drug users in the community. Large proportions of drug users are found in criminal justice, primary health, and welfare agencies. Patterns of service encounter and referral suggest that drug treatment clients typically have been in jail or on welfare prior to attending treatment, and are far less likely to have been referred to or from treatment by health providers. CONCLUSIONS: Health services research on drug abuse should expand its frame of reference to include services outside the specialty treatment sector. Drug treatment facilities are somewhat remote from other agencies in community service networks and are organizationally dependent on criminal justice and welfare systems. Further research should investigate both the costs and benefits of screening and providing services at earlier points of institutional involvement with drug abusers and the implications of interorganizational dependencies among criminal justice, welfare, and drug agencies for providers and clients.

Ambulatory Care↗
PubMed2001

Optimisation and evaluation of an asynchronous transfer mode teleradiology co-operative system: the experience of the EMERALD and the BONAPARTE projects.

This paper describes the work carried out to optimise and evaluate in clinical routine a multimedia telemedicine application for co-operative imaging diagnosis. This research has been attained within the framework of two European research projects, namely the EMERALD [1] and the BONAPARTE [2]. A user-centred telemedicine application was developed on an existing advanced broadband multimedia teleradiology platform to exploit the possibilities offered by Asynchronous Transfer Mode (ATM) technology to support real-time teleconsultation services for medical imaging. The evaluation of this telemedicine system in both projects has been performed with the aim of (1) characterising and optimising the ATM teleradiology platform, minimising the bandwidth requirements without degrading the quality of service offered to users and (2) evaluating the telemedicine system usability to improve the fulfillment of user's needs. The assessment outcomes have provided insights into technical limitations of broadband multimedia technologies for an optimum usage of a teleradiology co-operative diagnosis systems and the organisational difficulties and limitations involved in setting-up these new advanced telemedicine services to achieve the expected clinical benefits.

Computer Graphics↗