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PubMed2000

[Ambulatory palliative care--special qualities].

During the last phase of progressive cancer numerous problems may arise. Additionally to pain and other symptoms, psycho-social and spiritual considerations supervene. In such cases palliative medicine offers positive options. In Germany, these options have been made available mainly for in-patients (at palliative care units or hospices). But out-patient care must continue to be a priority, since most patients wish to remain at home as long as possible and die at home. There are various problems that also arise at a patient's home. As the possibilities of palliative medicine are still generally unknown in out-patient care, new structures of medical care have to be established. This is where home care services come in; staff, especially educated professionals supported by volunteers assist the patients at home, together with general practitioners and health and advice centres. The work of home care services focuses on supervising pain therapy and symptom control as well as psychosocial advice and support of patients and their families. The statistics of the home care service Bonn shows that in 1999 73 per cent of patients could be treated at home until the end of live. In 43 per cent physicians made the initial contact with this service organisation. This proves the necessity and acceptance of new structures in palliative out-patient care.

Germany↗
PubMed2006

Physicians perception of health insurance in Saudi Arabia.

OBJECTIVE: To assess physicians views on health insurance and its implication on the health care system. METHODS: We carried out a cross-sectional study in 2 major hospitals in Riyadh, Kingdom of Saudi Arabia. Data were collected from January to December 2002 through self-administered questionnaires that were distributed to a total sample of 400 physicians. The instrument consisted of 28 items that focused on assessing physicians' perception towards health insurance and its effect on health services. We performed a descriptive statistics and analysis of variance using the Statistical Package for Social Sciences. RESULTS: Overall, 151 physicians (38%) completed the survey. This study clearly shows that access to health care services is a major concern; more than 94% of the respondents agree that everyone in the Kingdom should have access to healthcare services. Respondents also agree that health insurance will improve access to healthcare services for all citizens. Physicians also believed that health insurance would lead to more regulations and utilization review of services, create more competition between healthcare providers, and create new jobs in the healthcare sector. Saudi physicians reported a higher mean score for 11 items with significant p-values as compared with non-Saudi physicians. CONCLUSION: Physicians in this survey believed that accessibility is a major policy concern, and that health insurance will have a positive effect on access to the health care system. Yet, accessibility is an illusive term with many aspects that go beyond the identification of need for health care to the actual delivery of health care services and the organizational structures to match the needs of society. Cooperation as a national health system should be built on collaborative efforts rather than market competition in itself. It has been suggested that markets are stronger in the role of delivery than in the financing of health care, that markets tend to promote more expenditure on technological innovation rather than producing the most desired set of social outcomes. Cooperative health insurance can be an answer to the current problems facing the health care system in the Kingdom of Saudi Arabia as long as it remains cooperative rather than competitive.

Attitude of Health Personnel↗
PubMedDate not supplied

1985 survey of biomedical & clinical engineering departments in U.S. hospitals.

The Journal of Clinical Engineering has conducted a broad scope survey of hospital biomedical and clinical engineering departments throughout the U.S. An earlier report provided salary and job responsibility data. This second report provides, for the first time, numerical data on the administration, facilities, budgets, department workload, personnel workload, employment benefits, quality assurance, and other professional aspects of the departments. The present report represents approximately 6% of all U.S. hospitals, 10% of all U.S. hospital beds, and over $1.1 Billion dollars worth of hospital equipment service responsibilities. Readers are cautioned not to use the statistical averages presented here as standards or guidelines because of the substantial and appropriate differences between departments. Nevertheless, the survey data provide a useful overview of the hospital-based clinical and biomedical engineering field. The survey determined that 58% of hospital biomedical activities are organized as separate departments reporting to hospital administration. From 1984 to 1985, department budgets increased by +12% overall. While all budget categories increased, wages were the greatest factor (+11%). Teaching facilities have substantially higher budgets than non-teaching. Department floor space increased +3.2% from year to year. Nationwide, an average of 226 sq. ft. is used per department staff member. Department test equipment increased by +11.4% from 1984 to 1985. During the same period, the total dollar value of equipment serviced by the departments increased by +10.5% and the number of devices serviced increased by +4.8%. Nationwide, the statistically average department serviced 2,220 devices worth $7,068,000. Department employment is growing at +10.8% per year (teaching department staffs +7.6%; non teaching +15.9%). Employment of BMETs grew by +8.6%; Clinical Engineers by +11.5%. A measure called Devices Per Person was steady at 500 devices per person from year-to-year. A second measure called Beds Per Person was, on average, 95 beds per department staff member (lower in teaching, higher in non teaching). Other averages are 136 Beds/BMET; 402 Beds/CE; and 390 Beds/Supervisor. Hospital employment benefits are detailed. Only 23% of departments are now equipped to use telecommunications. Virtually all departments have major Q.C. procedures in place.

Biomedical Engineering↗
PubMed1993

Use of infertility services in the United States.

OBJECTIVE: To examine the characteristics of women in the 1988 National Survey of Family Growth who reported having obtained medical services for impaired fecundity. METHODS: From a national sample of 8450 women between the ages of 15-44, drawn from the civilian, noninstitutionalized population of the entire United States in 1988, we estimated the use of infertility services in the United States. Multivariate statistical modeling was used to identify the characteristics associated with use of infertility services among the 770 women who reported impaired fecundity in this survey. RESULTS: Of all women with impaired fecundity, 43% had obtained some form of infertility service and 24% had obtained specialized infertility treatment--ovulation drugs, treatment of fallopian tubes, artificial insemination, or in vitro fertilization. Older, white, married women of higher socioeconomic status were most likely to have obtained specialized services, and a history of endometriosis was also strongly associated with having received such services. CONCLUSION: Most women with impaired fecundity had not obtained infertility services. Use of specialized services was strongly associated with certain sociodemographic variables or a history of endometriosis.

Adolescent↗
PubMedDate not supplied

Utilization of medical services by Veterans Health Study (VHS) respondents.

The first objective of this study was to profile Veterans Health Study (VHS) respondents' use of medical services-the types of services used, use of a regular source of care, and the propensity to use services for selected symptoms. We focused on differential use of VA and non-VA services and highlighted differences in use by age group. The second objective was to use multivariate analysis to identify factors associated with respondents' use of any medical services and with VA services specifically. We incorporated 2 self-reported variables not used in previous studies of VA utilization-health status and disease burden. Patients receiving ambulatory care services in 4 VA ambulatory outpatient clinics in the greater Boston area were eligible for inclusion in the VHS. A sample of 2425 community-dwelling male veterans was randomly selected from among veterans receiving ambulatory services at Boston-area VA facilities. This analysis focuses on 1909 respondents for whom we had complete data. Interviews and questionnaires were used to collect cross-sectional, observational data on sociodemographic, economic, and clinical characteristics; health status; disease burden; and service-connected disability (SCD) rating. To measure health status, we used 2 summary measures, the Physical Component Summary (PCS) and the Mental Component Summary (MCS), derived from the 8 scales of the Medical Outcomes Study Short Form 36-item Health Survey (MOS SF-36). To measure disease burden, we used the Physical Comorbidity Index (PHYCI) and Mental Comorbidity Index (MENCI), composed of 30 physical and 6 mental health conditions and symptoms, respectively. Information on the availability of non-VA insurance was obtained from administrative VA files. Information on utilization prior to the interview was self-reported. Recall periods of 3 and 12 months were used for ambulatory and inpatient services, respectively. We used descriptive statistics to profile respondents and their utilization patterns. We used multivariate probit models to identify respondent characteristics associated with use of any medical services, medical visits, mental health visits, and hospital stays. Independent variables used in the models were socioeconomic and demographic characteristics, and measures of disease burden, health status, and VA eligibility. The respondents relied heavily on the VA for medical care: 74% of the respondents said the VA was their regular source of care; 72% of all the respondents and 87% of those who had used any medical service in the recall period had used a VA service; 68% of those who were hospitalized used a VA hospital; and 76% of the medical care the respondents received and 60% of their hospital stays were in VA facilities. Younger veterans (aged 22-44) used substantially more mental health services than older respondents, but they were less likely than older veterans to have seen a doctor recently for most of the medical symptoms studied. PHYCI and PCS were significantly related to use of any medical services and to use of inpatient services; MENCI and MCS were significantly related to use of mental health services (P<.05 for each, respectively). Lower income and lack of alternatives to VA care were directly related to use of any VA services and VA inpatient services. Information on the reasons for differential use of VA and non-VA services can be useful to the VA as it serves an aging veteran population, seeks to provide comprehensive care to a wider spectrum of veterans, and moves into a more competitive healthcare marketplace.

Adult↗
PubMed1985

[Epidemiologic analysis of a contingent of patients with psychoses who applied for emergency psychiatric services in Ethiopia].

A clinico-statistical analysis covers 825 psychotic patients who applied to the Amanuel mental hospital in Addis-Abeba over the first 3 months of 1983. The population of patients had the following characteristics associated with cultural factors: a considerable predominance of males, a dramatic reduction in the number of both male and female patients with an increasing distance between their place of residence and the hospital, a large percentage of non-working individuals, single men and divorced women. Among the entire number of mental patients primary patients constituted 67.1%; 42.9% of all patients were hospitalized. A total of 6.7% of patients could not be hospitalized because of overcrowding in the hospital. As regards diagnoses, the patients were distributed in the following way: schizophrenia 46.1%, reactive psychoses 19%, intoxicational 15.6%, organic 3.9%, involutional 2.8%, senile 2.5%, epileptic 2.3%, manic-depressive 2.1%, unspecified psychoses 4.8%. The identified characteristics of the local psychopathology in Ethiopia are discussed.

Adolescent↗
PubMed1996

What can child homicide rates tell us about the effectiveness of child welfare services?

This paper examines the methodological problems involved in using child homicide rates as measures of the success or failure of child protection efforts. A comprehensive review of child homicide research identifies three major methodological issues: (1) The classification of child deaths as homicides is unreliable; (2) child homicides may not generally represent the endpoint of a continuum of violence ranging from inadequate parenting to maltreatment to death; and (3) child homicides are not frequent enough occurrences to effectively measure the impact of child welfare services and policies. We conclude that while improved reporting and classification procedures may lead to some useful avenues for research, relying on child homicide statistics to evaluate child welfare services may contribute to further narrowing the scope of child welfare by stressing procedures geared primarily to preventing child homicides. Child welfare services need to develop outcome measures that tap the broader mandate of improving the circumstances and well-being of children.

Adolescent↗
PubMed2003

A survey of refugee health assessments in the United States.

We conducted a survey among nine geographically dispersed, large metropolitan refugee health programs to estimate the number of U.S. refugee arrivals during 1997 and 1998, the number receiving health assessments, and the percentage of sites offering health services. The nine sites received an estimated 40% of all U.S. refugee arrivals during the study period. Of these refugees, 76% received a health assessment. The completeness of health assessments, including services offered, varied by site; some services were provided by the private sector. Most sites offered services for infectious diseases and vaccinations. While 78% of the sites offered mental health care, but only 33% actually performed mental status examinations. These statistics show that such health services need to be provided on a broader basis and possibly reflect a need to address cultural and language barriers that might be preventing their delivery to this diverse population.

Centers for Disease Control and Prevention, U.S.↗
PubMed2003

A randomised controlled trial of breast cancer genetics services in South East Scotland: psychological impact.

This study compared the psychological impact of two models of breast cancer genetics services in South East Scotland. One hundred and seventy general practices were randomised to refer patients to the existing standard regional service or the novel community-based service. Participants completed postal questionnaires at baseline (n=373), 4 weeks (n=276) and 6 months (n=263) to assess perceived risk of breast cancer, subjective and objective understanding of genetics and screening issues, general psychological distress, cancer worry and health behaviours. For participants in both arms of the trial, there were improvements in subjective and objective understanding up to 4 weeks which were generally sustained up to 6 months. However, improvements in subjective understanding for the women at low risk of breast cancer (i.e. not at significantly increased risk) in the standard service arm did not reach statistical significance. Cancer worry was significantly reduced at 6 months for participants in both arms of the trial. The two models of cancer genetics services tested were generally comparable in terms of the participants' psychological outcomes. Therefore, decisions regarding the implementation of the novel community-based service should be based on the resources required and client satisfaction with the service.

Adolescent↗
PubMed1997

[Characteristics of private health care services in Salvador, Bahia, Brazil]

To study the organization of private health services in the city of Salvador, Bahia, Brazil, a survey was carried out in 1994 involving 174 facilities registered at the Brazilian Institute of Statistics and Geography - IBGE. Health services characteristics studied were the following: number of physicians, hospital beds, production and cost of outpatient services, and legislative aspects. Health services were classified according to the amount of resources each type of granting agency contributed to support outpatient care. We found that the majority (51.1%) of private health care services in Salvador do not depend on public funds. The main sources of revenue for health services are private health insurance (41.9%) and other kinds of private health plans (54%). These changes in the organization of health services challenge health planners to review strategies for municipalization of health care and the relations between public and private health services in Brazil.

Journal Article↗
PubMed2004

Statistical distributions describing microbial quality of surfaces and foods in food service operations.

Data on the microbial quality of food service kitchen surfaces and ready-to-eat foods were collected over a period of 10 years in Rutgers University dining halls. Surface bacterial counts, total aerobic plate counts, and total and fecal coliform counts were determined using standard methods. Analysis was performed on foods tested more than 50 times (primarily lunch meats and deli salads) and on surfaces tested more than 500 times (36 different surfaces types, including pastry brushes, cutting boards, and countertops). Histograms and statistical distributions were determined using Microsoft Excel and Palisades Bestfit, respectively. All data could be described by lognormal distributions, once data above and below the lower and upper limits of detection were considered separately. Histograms for surfaces counts contained one peak near 1 CFU/4 cm2. Surfaces with higher levels of contamination tended to be nonmetal, with the exception of buffalo chopper bowls, which commonly had high counts. Mean counts for foods ranged from 2 to 4 log CFU/g, with shrimp salad, roast beef, and bologna having higher means. Coleslaw, macaroni salad, and potato salad (all commercially processed products, not prepared in the dining halls) had lowest overall means. Coliforms were most commonly found in sealeg salad (present in 61% of samples) and least commonly found in coleslaw (present in only 7% of samples). Coliform counts (when present) were highest on average in shrimp salad and lowest in coleslaw. Average coliform counts for most products were typically between 1 and 2 log most probable number per gram. Fecal coliforms were not typically found in any deli salads or lunch meats.

Bacteria↗
PubMedDate not supplied

Maintaining the cold chain for vaccines.

Cold chain for vaccines a is a system for storing and transporting vaccines at very low temperatures to maintain their effectiveness before use. Because vaccines are sensitive biological substances, their exposition to high temperatures directly affects the quality of vaccines and safety of immunization. The goal of this study was to assess the safety of cold chain for vaccines within the cold chain system in two services of Health Center Novi Sad. Cold Chain Monitors (CCM) and Freeze Watch (FW) indicators were used. A total of 155 (94.5%) Cold Chain Monitors (CCM) and 100 (95.2%) Freeze Watch (FW) indicators were analyzed. Only one CCM showed a breack in cold chain. A total of 3 CCMs indicated risk of vaccine wastage. A total of 9 CCMs were colorized without risk of vaccine wastage. FWs were positive in a high percentage in both services of Health Center Novi Sad. FWs were exposed to low temperatures during transport. Statistically significant differencies in the number of exposed CCMs to high temperatures and the number of exposed FWs to low temperatures were observed in these two services. A statistically significant difference in number of FWs exposed to low temperatures was observed in regard to the period of transport and the period of storage at the vaccination stations. The study shows high level of safety of the cold chain in two services of Health Center Novi Sad Cold Chain Monitor is a reliable indicator of the quality of cold chain for vaccines. Freeze Watch is a reliable indicator of the quality of cold chain during storage of vaccines, but not during their transport.

Drug Storage↗