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At least 1,621 records · Page 90Linked to original sources

PubMed2002

Reforms of health care system in Romania.

AIM: To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. METHOD: We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of the health care system. RESULTS: The reforms of the health care system in Romania have been realized in a rather difficult context of scarcity of financial and human resources. The Gross Domestic Product spent on health care in 2000 was 4% and the number of physicians in 1999 was 42,975. The main changes due to the legislative reforms have been the introduction of a new social health insurance and strengthening of the position of family physicians. Negative effects of the reforms have been the decrease in health care accessibility and growing inequity in utilization of health care services. Health care users still pay physicians under-the-table, and have more out-of-pocket health care expenses. CONCLUSION: Future reforms in Romania should encourage the positive effects of current reforms: free choice of physician, autonomy of the primary health care system, and increasing financial resources for the health care system.

Delivery of Health Care↗

PubMed1993

Is reasonable access what we want? Implications of, and challenges to, current Canadian policy on equity in health care.

Considerations of equity in the context of health care systems are often related closely to the presence or level of prices incurred by users of health care services. Some politicians and commentators have suggested that the removal of user charges under the Canadian health care system has led to equal access to care. But it is not clear that the equity principle inferred from these claims corresponds to the equity goals of current Canadian health policy. In this article the authors identify the precise equity principle that lies behind current health policy in Canada and consider the extent to which that principle is reflected in the performance of the system. They then consider other approaches to equity in health care in the context of the stated objectives of Canadian health policy and identify the implications of pursuing reasonable access in future health policy. The authors suggest that the implications of the current equity goals have not been recognized by policy makers, and if they were to be recognized it is not clear that they would be acceptable to Canadian populations and/or policy makers. Moreover, some of the implications would appear to be incompatible with other stated objectives of public policy.

Canada↗

PubMedDate not supplied

Cessation of drug use: impact of time in treatment.

Many studies have found that the longer a drug user remains in treatment, the more positive the outcome. The majority of studies on the effects of time in treatment have followed subjects from the time they enter treatment. The subjects of the present study are injection drug users and crack users who were out of treatment at the time of their recruitment to the study. Between the initial and six-month follow-up interviews, some chose to enroll in drug treatment. The more time a subject spent in treatment during the follow-up period, the more likely it was that s/he was not using heroin or cocaine at follow-up (OR=.51; 95% C.I., .39-.67; p<.001). Unlike the results of some prior studies, positive effects of time in treatment were found even when time in treatment was less than 90 days. The findings of the present study strongly suggest that treatment is beneficial even for those who remain for less than 90 days. Those who provide treatment services to drug users should attempt to maintain contact with dropouts, and support their return to treatment.

Adult↗

PubMed2006

A rapid assessment of heroin use in Mombasa, Kenya.

This article reports on a rapid assessment (RA) carried out in the city port of Mombasa, Kenya in March 2004 by the Omari Project to inform the scaling up of their services to heroin users. Heroin has been a street drug in Mombasa for over 25 years. From 1998, white crest, probably from Thailand, started to replace brown sugar, and there was a major shift from inhalation of the vapor ("chasing the dragon") to injecting. The Omari Project has been monitoring the heroin situation in Mombasa and treating heroin users from Mombasa since 1997. In the course of the RA, 496 heroin users were interviewed of whom 95% were men and 5% were women. A range of methods were used, including mapping of the Mombasa region, work with a key informant/guide who was a heroin user, administration of a brief questionnaire and informal interviews, and feedback of findings to other local agencies working with drug users. Respondents were from a wide range of cultural/ethnic groups, the two largest being Mijikenda and Swahili, who are indigenous to the Kenya coast. Overall, 15% of respondents had "ever injected" heroin, and 7% were current injectors (n = 37). These data indicate a shift away from injecting but also reflect the death of many established injectors, either through overdose or AIDS or hepatitis. The figure of 7% of the sample reporting being current injectors is likely to be an underestimate. Syringes were available from a number of pharmacies and most injectors reported using a syringe for 1-3 days. The majority reported injecting in a group of three or more and described risk behaviors for HIV transmission. The results of the assessment highlight the need for a range of services, including needle exchange, counseling, and referral to residential treatment programs. However, progress toward responding to the findings of the RA by establishing effective services are hampered because of legal impediments to operating needle exchange programs in Kenya.

Catchment Area, Health↗

PubMedDate not supplied

Who enrolls in a self-help cessation program for smokeless tobacco?

To further our understanding of the representativeness of the smokeless tobacco (SLT) user recruited to various treatment settings, and to suggest gaps in services available to SLT users, we first compared participants who enrolled in a self-help cessation program with two samples of nontreatment-seeking SLT users: SLT users identified through a random digit dialing (RDD) survey, and SLT users who came to 1 of 75 dental practices for a routine cleaning visit. We found that those in the self-help SLT cessation program were older, more educated, more likely to have made a serious quit attempt, and used more SLT weekly than those who did not seek treatment. Secondly, we compared SLT users seeking treatment in three different treatment settings varying in accessibility and intensity: self-help study participants, SLT users enrolled in a clinic-based study, and callers to the California Help Line for SLT cessation. Participants differed across the three studies on demographics, some measures of dependence, and history of SLT use.

Adult↗

PubMedDate not supplied

The organization and delivery of women's health care in Department of Veterans Affairs Medical Center.

Congressional eligibility reforms have profoundly changed the array of services to be made available to women veterans in Department of Veterans Affairs (VA) health care facilities. These include access not only to primary and specialty care services already afforded VA users, but also to a full spectrum of gender-specific services, including prenatal, obstetric, and infertility services never before provided in VA settings. The implications of this legislative mandate for delivering care to women veterans are poorly understood, as little or no information has been available about how care for women veterans is organized. This article reports on the first national assessment of variations in the organization of care for women veterans.

Ambulatory Care↗

PubMed2002

Health technology assessment for the NHS in England and Wales.

In healthcare decision making, there is an important functional separation between assessment and appraisal. In the U.K. National Health Service (NHS), this distinction is illustrated by the separation of roles between the Health Technology Assessment Programme and the National Institute for Clinical Excellence. However, it can be seen at every level within the healthcare system. Assessment of a technology is a scientific task that synthesizes all relevant evidence on effectiveness and cost-effectiveness; its results are therefore generalizable. Appraisal of the technology is informed by the assessment but adds context-specific judgments on the applicability of the evidence, the feasibility and impact of alternative options, relative priorities, and wider social and ethical aspects. An explicit distinction between assessment and appraisal is helpful in achieving clarity, consistency, and consensus. It also makes clear the need for a wide range of assessment reviews to support decision making by commissioners, providers, and users of health services. Increasingly, the secondary research supported by the NHS R&D Programme is being distributed electronically. It is also being used to identify areas in which further primary research should be commissioned.

Academies and Institutes↗

PubMed1996

Attitudes to drug users according to staff grade.

The attitudes of professionals working with intravenous drug users are likely to be affected by clinical grade. Perceptions of service delivery to intravenous drug users are likely to be affected by status. Senior professionals tend to be more positive in their attitudes towards intravenous drug users. Attitudes and perceptions of service delivery are very important in determining the standard of care delivery.

Adult↗

PubMed2006

Effects of health decentralization, financing and governance in Mexico.

OBJECTIVE: To identify the effects of decentralization on health financing and governance policies in Mexico from the perspective of users and providers. METHODS: A cross-sectional study was carried out in four states that were selected according to geopolitical and administrative criteria. Four indicators were assessed: changes and effects on governance, financing sources and funds, the final destination of resources, and fund allocation mechanisms. Data collection was performed using in-depth interviews with health system key personnel and community leaders, consensus techniques and document analyses. The interviews were transcribed and analyzed by thematic segmentation. RESULTS: The results show different effectiveness levels for the four states regarding changes in financing policies and community participation. Effects on health financing after decentralization were identified in each state, including: greater participation of municipal and state governments in health expenditure, increased financial participation of households, greater community participation in low-income states, duality and confusion in the new mechanisms for coordination among the three government levels, absence of an accountability system, lack of human resources and technical skills to implement, monitor and evaluate changes in financing. CONCLUSIONS: In general, positive and negative effects of decentralization on health financing and governance were identified. The effects mentioned by health service providers and users were related to a diversification of financing sources, a greater margin for decisions around the use and final destination of financial resources and normative development for the use of resources. At the community level, direct financial contributions were mentioned, as well as in-kind contributions, particularly in the form of community work.

Community Participation↗

PubMed2005

The impact of severe mental illness, co-morbid personality disorders and demographic factors on psychiatric bed use.

BACKGROUND: The use of inpatient psychiatric services has been correlated with certain demographic and clinical variables. However, there is limited information about the impact of personality disorder. AIMS: To describe the impact of severe mental illness, personality disorders and demographic variables on psychiatric bed use amongst people in contact with a Community Mental Health Team (CMHT). METHOD: Two-year retrospective and 2-year prospective bed use by the caseload of one Community Mental Health Team. RESULTS: Psychotic disorders (odds ratio 2.7), personality disorders (OR 2.2), marital status (OR 2.1) and unemployment (OR 1.9) were significantly related to psychiatric admissions from community care. Gender, accommodation, drug and alcohol problems, and ethnicity were not. CONCLUSIONS: Psychosis, personality disorder and unemployment appear to have independent effects on psychiatric bed use. Patients with a combination of psychotic disorders and diffuse personality disorders were very high users of inpatient services. This suggests that this group have particular needs that community mental health teams find difficult to manage.

Adolescent↗

PubMed2004

Evaluation of an accident and emergency teleconsultation service for north-east Scotland.

We evaluated an accident and emergency teleconsultation service provided to 14 community hospitals in north-east Scotland. Each community hospital was equipped with a videoconferencing system and a document camera to allow transmission of radiographs. The network used 384 kbit/s ISDN connections. A total of 1392 teleconsultations were recorded during a 12-month study period. Seventy-seven per cent of patients (n = 1072) were managed locally and 23% (n = 320) were transferred to Aberdeen. The majority (95%) of teleconsultations were conducted on weekdays, and 90% of these occurred between the hours of 09:00 and 16:00. The mean delay in contacting a doctor was 9 min and the mean consultation time was 10 min. The majority of patients were suffering from fractures or suspected fractures of the limbs. Radiograph transmission was used in 75% of all teleconsultations. A high degree of satisfaction was recorded by all users of the service.

Adult↗

PubMed2006

Illicit tranquilliser use and dependence among female opiate users.

This study determined the predictors of 12-month dependence on illicit tranquillisers among female opiate users attending three services in Glasgow, Scotland, UK. Twelve-month drug dependence was measured using the Diagnostic Interview Schedule. The Revised Clinical Interview Schedule (CIS-R) measured current neurotic symptoms. 60% (159/266) had used illicit tranquillisers in the past 30 days, and 50% (132/266) met criteria for 12-month dependence on illicit tranquillisers. Polydrug use, injecting drug use, childhood and adulthood abuse, adverse life experiences and current and previous mental health problems were associated with 12-month dependence on illicit tranquillisers. Using multiple logistic regression, polydrug use in last 30 days (OR 3.2, 95% CI 1.5 - 7.0), history of deliberate self-harm (OR 2.5, 95% CI 1.4 - 4.4), history of injecting drug use (OR 2.5, 1.2 - 5.2) and likely to need treatment for current neurotic symptoms (CIS-R > or = 18) (OR 2.4, 95% CI 1.3 - 4.4) predicted 12-month dependence on illicit tranquillisers. Drug users in general and female drug users in particular who are using illicit tranquillisers are also particularly likely to have psychiatric symptoms requiring treatment. Mental health problems should be assessed and monitored among this client group and counselling and psychosocial support should be provided when indicated.

Adult↗

PubMed2006

Barriers to accessing drug treatment in Russia: a qualitative study among injecting drug users in two cities.

OBJECTIVES: To assess factors influencing access to drug treatment among injecting drug users (IDUs) in two Russian cities. METHODS: Eighty-six qualitative interviews were conducted with IDUs in Volgograd and Barnaul in 2003. IDUs were recruited through local drug treatment services, needle exchanges, and drug user networks. RESULTS: Three main barriers to treatment assess were identified: financial constraints, fear to registration as a drug user, and perceived low efficacy of available treatment services. Registration of drug users was associated with loss of employment, breaches in confidentiality. and stigma. Some participants did not think that drug treatment services could respond appropriately and effectively to their treatment needs. CONCLUSIONS: These findings highlight the importance of environmental factors in mediating IDUs access to drug treatment, which might suggest the need for social and structural interventions. Access to drug treatment services should be enhanced by reducing the financial burdens of drug treatment and minimizing the stigma associated with drug user registration. Russia should shift from a highly medicalised model of treatment toward a more holistic approach that recognises the diversity of treatment needs among IDUs. These priorities are especially timely given the urgent need to integrate drug treatment as part of wider HIV prevention responses in Russia.

Adolescent↗

PubMed2003

Who uses welfare benefits advice services in primary care?

There is considerable interest among organisations such as primary care trusts and health action zones in commissioning welfare benefits advice services in primary healthcare settings as part of local strategies to reduce health inequalities. However, very little is known about the contribution to health of such services or about the health status of those who use them. The present study reports on a longitudinal study of the contribution to individual health of welfare benefits advice in primary care that has gathered baseline demographic and health data on 345 research subjects. The average age of the subjects was 54 years, and they were likely to be unemployed or retired. Over 85% were advised to apply for welfare benefits or to appeal against the loss of a benefit, the most common benefit being Disability Living Allowance (over 50% of all subjects). Three-quarters reported a physical disability or long-term illness that limited their daily activity, and over half reported arthritis or rheumatism. Scores on the short form 36 (SF-36) which quantify self-reported physical and psychosocial aspects of health, were much lower than population norms, indicating poorer health. The burden of illness borne by users of these services is not surprising. However, reliable data has not previously been available. It appears that primary care provides good access to advice services for people in middle and old age, but not to other groups (e.g. families with young children, substance misusers or those with mental health problems). Better data collection by advice services, wherever located, would strengthen their understanding of the needs of those whom they serve, and help them to identify under-served groups. These data could be used to support requests for continued or extended funding.

Adolescent↗

PubMed2006

Perceptions of lesbian, gay and bisexual people of primary healthcare services.

AIM: This paper reports a study exploring people's perceptions of disclosure about lesbian, gay and bisexual identity to their primary healthcare providers. BACKGROUND: Disclosure of sexual identity to healthcare professionals is integral to attending to the health needs of lesbian, gay and bisexual populations, as non-disclosure has been shown to have a negative impact on the health of these people. For example, an increased incidence of suicide, depression and other mental health problems have been reported. METHOD: From April to July 2004, a national survey of lesbian, gay and bisexual persons was carried out in New Zealand. Participants were recruited through mainstream and lesbian, gay and bisexual media and venues, and 2,269 people completed the questionnaire, either electronically or via hard copy. The 133-item instrument included a range of closed-response questions in a variety of domains of interest. RESULTS: In this paper, we report results from the health and well-being domain. More women than men identified that the practitioner's attitude toward their non-heterosexual identity was important when choosing a primary healthcare provider. Statistically significantly more women than men reported that their healthcare provider usually or always presumed that they were heterosexual and in addition more women had disclosed their sexual identity to their healthcare provider. CONCLUSION: Nurses need to reconsider their approach to all users of healthcare services by not assuming everyone is heterosexual, integrating questions about sexual identity into health interviews and ensuring that all other aspects of the assessment process are appropriate and safe for lesbian, gay and bisexual people.

Adult↗

PubMed2004

The incidence of cancer in people with intellectual disabilities.

OBJECTIVE: During the last 50 years there have been significant improvements in life expectancy among people with intellectual disability (ID), and so their incidence of age-associated diseases, such as cancer, is rising. The aim of this study was to compare the rate of cancer in people with ID with that found in the general population. METHODS: Information on 9409 individuals registered with the Disability Services Commission of Western Australia was linked to the State Cancer Registry, with 200 cases of cancer detected over 156,729 person-years. Standardised incidence ratios (SIRs) and 95% confidence intervals were calculated for both sexes separately by 5-year age groups for the period 1982-2001. The same procedures were adopted in the estimation of SIRs for specific types of cancers. RESULTS: The age-standardised incidence of all cancers in people with ID was not significantly different from the general population. However, males with ID were observed to have a significantly increased risk of leukaemia, brain and stomach cancers, and a reduced risk of prostate cancer, while leukaemia, corpus uteri and colorectal cancers were significantly higher in females. CONCLUSIONS: Health practitioners need to be aware that with improvements in life expectancy the incidence of cancer in people with ID is likely to rise. More proactive health promotion campaigns may be needed for people with ID, who are likely to be poor users of screening services and whose symptoms may not be reported until they are in more advanced, less treatable stages of disease.

Adolescent↗

PubMed2003

Factors influencing hepatitis B vaccine uptake in injecting drug users.

BACKGROUND: Hepatitis B infection in injecting drug users is an important public health problem. Active immunization against hepatitis B is immunogenic and safe, but uptake rates in targeted vaccination programmes are low. This study was undertaken to identify factors associated with the uptake of hepatitis B vaccination in injecting drug users attending a needle exchange service. METHODS: A retrospective cross-sectional survey of case-note data of injecting drug users who had no markers of hepatitis B infection or immunity was undertaken within a drop-in needle exchange service for injecting drug users in a large urban area in England. A qualitative study using semi-structured interviews with needle exchange staff was also conducted. RESULTS: Of 207 injecting drug users, 180 (87 per cent) had been offered vaccine, 123 (59 per cent) accepted at least one dose and 55 (27 per cent) received three or more doses. Vaccine was less likely to be offered to those sharing injecting equipment or known to have hepatitis C. Needle sharing was also associated with failure to accept vaccine, as was increasing age and the length of contact with the service. CONCLUSIONS: Those who are most at risk are least likely to be offered vaccine and accept it. This calls into doubt the effectiveness of hepatitis B vaccination strategies targeted at high-risk groups and adds weight to arguments for universal vaccination.

Adolescent↗

PubMed2005

Knowledge of sexually transmitted infections and sources of information amongst men.

The objective of this study was to investigate men's awareness of sexually transmitted infections (STIs) and sexual health services, together with the best ways of providing information about them. Information was collated via a self-administered questionnaire, which was answered by 429 men, giving a response rate of 31%. Men aged 16+ living in two primary care trusts (PCTs) in the north-west of England were accessed through a range of different sources, including social, educational, health, work and religious facilities. Despite the high rates of STIs in the north-west, approximately one in five men had not heard of herpes, syphilis or chlamydia. One in ten had not heard of gonorrhoea. The majority of men were unaware that many STIs could be asymptomatic. Only 13% knew where their local genitourinary medicine (GUM) clinic was. The main deterrents to accessing the clinic were embarrassment and not knowing where it was. Men's knowledge of STIs is limited, particularly in relation to the symptoms. The best way of providing information, according to the respondents, was through their general practitioner (GP). However, in practice this might be difficult, as men are reluctant users of GP services in general. Knowledge of the whereabouts of the local GUM clinics is also limited. Although most men thought that they would visit their GP if they thought they might have an STI, this may result from them not knowing the alternatives, rather than having a real choice. More information, targeted wisely, is thus necessary in order to educate men about STIs and service provision.

Adolescent↗