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PubMed1989

A morphologic study of Vietnam veterans.

The possibility that service in Vietnam has had an adverse effect on Vietnam veterans and is the cause of some of their current illnesses has been a controversial issue in the post-Vietnam period. Addressing this problem, a pathology study has been carried out at the Armed Forces Institute of Pathology (AFIP). Pathologic diagnoses found in Vietnam veterans have been compared with a control group of contemporary veterans without Vietnam service. This has revealed no statistically significant or unexplained differences in their demographic, anatomic, or morphologic findings. The essential similarity of their disease profiles to date fails to suggest the presence of any unique environmental factor that might have acted on the Vietnam group.

2,4,5-Trichlorophenoxyacetic Acid↗
PubMed1989

Perinatal mortality in Northern Ireland: where are we now?

Perinatal mortality in Northern Ireland has been declining over the last 30 years, but the factors which may account for this fall have not been clearly delineated. Crude perinatal mortality figures yield very little insight into the problem, and meaningful management statistics are urgently required if service performance is to be reasonably assessed. This paper sets out the case for birth-weight standardisation and explores the utility of a broad diagnostic taxonomy of causes of death.

Birth Weight↗
PubMed1993

Against medical advice: Part II, The Army experience 1971-1988.

The Army experience with discharges against medical advice (AMA) from 1971 to 1988 is analyzed. AMA discharges have declined in a statistically significant manner in both medical centers and community hospitals. Discharges have decreased among men but increased among women. AMA discharges have decreased for both blacks and whites. Among clinical services, only obstetrics and gynecology demonstrated statistically significant increases. Among patient categories, only family members showed an increase. The possible sources of these various changes are discussed.

Female↗
PubMed1996

Disability among Canada's aboriginal peoples in 1991.

In 1991, disability rates among adults were high for Aboriginal people, compared with the total Canadian population: 31% versus 13%. For all ages and levels of education, Aboriginal disability rates were much higher than those of Canadians overall. While most younger Aboriginal persons with a disability were only slightly disabled and did not need help with their daily activities, at age 55 and over, more than half of Aboriginal persons with a disability were either moderately or severely disabled and required such help. Nonetheless, most of the Aboriginal population with disabilities who needed help received it, so only a small proportion of them had unmet needs for assistance. The need for assistance, however, increased with the severity of disability. Recent improvements in survivorship mean that more Aboriginal people will live to older ages, at which disability rates are higher. This has implications for their need for health and social services, and the associated costs. Statistics Canada's 1991 Aboriginal Peoples Survey (APS) was used to examine the prevalence and severity of disability and the degree of dependence in the Aboriginal population. Where possible, these results are compared with data for the total Canadian household population from the 1991 Health and Activity Limitation Survey (HALS).

Adolescent↗
PubMedDate not supplied

Onsite clinical services in the era of managed health care.

Both the employer and employee sustain an array of costs related to illness and injury. Dr. Larkin discusses evolving U.S. health care delivery models and cost designs and presents a case study demonstrating that the provision of workplace health care services can substantially reduce these costs.

Cost-Benefit Analysis↗
PubMed1998

Maternal mortality in Kentucky.

This paper reviews maternal mortality in Kentucky over the 30 year period of 1966 through 1995. Data were reviewed from the minutes of the State Maternal Mortality Study Committee and the reports of the State Cabinet of Health Services, State Centers for Health Statistics. There has been a marked fall in the number of births during this 30 years and an even more dramatic reduction in maternal mortality. Identifiable causes for maternal death have changed over the years. Today, the three leading causes of maternal mortality in Kentucky mirror those of the nation, i.e., hemorrhage, pulmonary embolus, and toxemia.

Adolescent↗
PubMedDate not supplied

[Economic fields and accessibility to health care: study areas for occupations].

The recent mapping of France into 365 employment study areas provides a higher socio-economic coherence from the geographic point of view. When analyzing the supply of health services on the basis of these 365 areas, one can observe that the GP/population ratio is evenly high in the southern part of France. In the northern part, it is more heterogeneous. Moreover, it decreases where the proportion of manual workers increases. The medical specialists/population ratio is high in large cities, especially in those with a significant service sector. Geographic distribution of health manpower does not appear to coincide with the demand for health services.

Delivery of Health Care↗
PubMed2002

Evaluation of the national control of diarrhoeal disease programme in the Philippines, 1980-93.

OBJECTIVE: To evaluate the impact of the National Control of Diarrhoeal Disease Programme (NCDDP) in the Philippines over the period 1980-93, describing levels and trends in programme activities, and relating them to severe diarrhoea morbidity and mortality among under-5-year-olds. METHODS: Routinely collected data on morbidity and mortality trends were obtained from health statistics reports of the Health Intelligence Service and the NCDDP. Socioeconomic indicators, including annual average family income and expenditures, gross national product, and unemployment rates, were derived from the Philippine population census data collected by the National Statistics Office. FINDINGS: In relation to baseline levels, diarrhoea mortality among infants and young children fell by about 5% annually over the 18-year period under review. The decline was faster than those related to acute respiratory infections (ARIs) among children of similar age and to perinatal causes. Diarrhoea hospital admission rates registered an annual decline of 2.4% relative to the baseline level. CONCLUSION: These findings suggest that the programme had a substantial impact; the period under review also witnessed some degree of improvement in other factors with positive influences on health, such as exclusive breastfeeding, nutrition and environmental sanitation. The quality, particularly completeness and reliability, of the existing data did not allow further analysis, thus, making it difficult to conclude beyond doubt that the observed trends indicate that they were solely due to NCDDP.

Breast Feeding↗
PubMed1991

Board certification and practice style: an analysis of office-based care.

BACKGROUND: The relationship between family practice certification and practice style has important health policy implications. We used data from the RAND Health Insurance Experiment to study the relationship between family practice certification and (1) patient characteristics including age and sex of patients, and (2) facets of practice style including probability of hospital admission, number of visits in an episode of care, number of physicians seen per episode, total charges per episode, charges per service category, and inputs per service category. METHODS: Data on health care service utilization by a sample of 5554 nonelderly individuals over a 1-year period were used to define episodes of care. Multivariate regression techniques were used to measure the association between family practice certification and patient characteristics and between family practice certification and practice style, controlling for the effects of patients characteristics. RESULTS: Patients of certified family physicians were an average of 3 years younger than patients of noncertified family physicians, but other demographic characteristics were similar. Certified family physicians had higher pathology services charges and inputs, but no statistically significant differences in other measures of charges and inputs. CONCLUSIONS: Certified and noncertified family physicians treat similar patients. Certification in family practice is not associated with major differences in total service charges, but is associated with differences in the use of laboratory diagnostic services.

Adolescent↗
PubMed1993

Effect of full-time, specialized physician supervision on the success of a large, urban emergency medical services system.

OBJECTIVES: Despite the universal proliferation of emergency medical services programs throughout the United States since 1970, only a few have ever documented a valid lifesaving effect, particularly in large, urban centers. The purpose of this study was to demonstrate the effect of specialized physician supervision on the effectiveness of an emergency medical services system. DESIGN: Prospective, cohort study. SETTING: Large, urban municipality (population 2 million). PATIENTS: Evaluation of victims of out-of-hospital sudden cardiac death cases, before (n = 152) and after (n = 200) the introduction of specialized physician supervision for the emergency medical services system. INTERVENTIONS: The hiring of a full-time, salaried emergency medical services system physician whose principal duties would be to provide intensive individualized training, direct operational supervision, and continuous system monitoring, including frequent on-scene oversight of emergency medical services personnel. MEASUREMENTS AND MAIN RESULTS: Comparison of existing hospital discharge rates for out-of-hospital sudden cardiac death cases to those rates achieved 5 yrs after recruitment of the specialized emergency medical services system physician. A dramatic increase in hospital discharge rates was demonstrated for sudden death patients presenting with ventricular fibrillation, from zero at year 0 (0 of 152 patients survived), to 21% (42 of 200 patients) by year 5 (p < .001). This result was achieved despite the fact that all other related factors (budget, paramedic numbers, response times) significantly worsened during the comparison periods. CONCLUSIONS: The introduction of the new factor into the emergency medical services system (specialized physician supervision) was associated with significantly improved patient outcome. In view of current suboptimal outcome statistics found in most municipal emergency medical services programs across the United States, future goals of medical community leaders should be directed at efforts to properly train, certify, and establish appropriate positions for physicians who specialize in emergency medical services system supervision.

Allied Health Personnel↗
PubMed2003

Predicting length of service provision in school-based occupational therapy.

Parents and school administrators commonly ask how long a child is likely to need school-based occupational therapy services. In an effort to provide a statistically supported answer, a record review of 464 cases of students discharged from school-based occupational therapy services in the past 7 years was performed. This review demonstrated that some general statements about service patterns could be determined for this particular caseload. Of note was the significant variability in length of services for students with multiple disabilities as compared to the more discrete length of service provision for students with speech impairments, learning disabilities and those students without a specific classification. The applicability to other practice settings is limited, but this study serves as a beginning point for discussion on the topic.

Adolescent↗
PubMed2005

Introducing and evaluating parent-child interaction therapy in a system of care.

A growing body of knowledge exists about what works for children with mental health needs. There is a paucity of literature to describe the experiences of service providers or service-providing agencies as they work toward implementing evidence-based practices or provide an understanding of their effectiveness in "real-world" settings. No research exists that examines the effectiveness of specific treatment modalities with children with severe emotional disturbance who participate in comprehensive mental health service systems (systems of care). This article describes the experiences that a community mental health agency and an evaluation team had when implementing parent-child interaction therapy, an evidence-based practice, in a system of care.

Adolescent↗
PubMed1998

Assessing physician/patient relationships in the presence of HIV/AIDS: an exploratory study.

The following study investigates the nature of the relationship between physicians and HIV/AIDS patients within the context of the rapidly evolving services/relationship marketing literatures. The emerging evidence suggests that service providers generally play a critical role in the development of positive consumer attitudes and behaviors, and that relationship marketing practices can contribute to the delivery of health services. However, to date, there appears little evidence supporting the efficacy of employing relationship marketing practices in relation to a target market of HIV/AIDS patients. This exploratory study contributes to the body of knowledge by more closely investigating the nature of the patient-physician relationship relative to HIV/AIDS patients' attitudes, marketing-related behaviors, and overall quality-of-life/life satisfaction judgments. The results of this study first suggest that HIV/AIDS patients use the expectancy disconfirmation model when evaluating the performance of their physician. A reliance on expectancy disconfirmation suggests the likely prevalent role of service quality perceptions and satisfaction judgments in evaluating their relationship with their physician. Second, the results appear to support the conclusion that the patient's evaluation of their physician relationship and subsequent behaviors (e.g., word-of-mouth) are directly related to the patient's general perception of received health services. Thus, the patient/physician relationship may play a particularly powerful role in determining patient (marketing related) outcomes relative to other health service settings. Third, a direct influence is supported between negative affective reactions by patients and subsequent outcome behaviors. This finding lends support for the potential efficacy of service recovery efforts when rendering treatment to HIV/AIDS patients. Finally, evidence is presented demonstrating the effect of positive perceptions of the patient/provider relationship on these patients' overall evaluation of their quality-of-life/life satisfaction. The managerial and research implications of this study are presented and discussed.

Attitude to Health↗
PubMed1995

[Analysis of factors associated with medical expenditure for the elderly in Fukuoka].

Based on "the Report of National Health Insurance Plan in Fukuoka", "the Report of Health Services for the Elderly in Fukuoka", and "the Health Statistics of Fukuoka" of 1987 and 1991, factors associated with medical expenditures for the elderly were examined. According to the result of correlation analyses, the general medical examination participation rate under the Health Service Law for the Elderly showed a statistically significant negative correlation with the in-patient medical expenditures as well as the out-patient medical expenditures for the elderly. The analysis concerning the three components of medical expenditure has clarified that this negative correlation is mainly explained by the low utilization of medical services among communities with a high general medical examination participation rate under the Law. This fact suggests that the general medical examination service might have a complementary effect against receiving care in medical facilities. However, there exists a possibility that the negative correlation observed in this study might be explained by the existence of "the third factor" intervening the pathway. In order to clarify the mechanism of relation observed, a micro-level analysis should be required.

Aged↗
PubMed2000

The veil of experience: do consumers prefer what they know best?

There is growing interest from health policy makers in eliciting consumer preferences for health care services. This is particularly the case when assessing the likely impact of innovations. Some people may be wary of innovations because they prefer the service they have previously experienced. Consumer preferences for an existing and a hypothetical new bowel cancer testing programme were measured using a discrete choice experiment questionnaire. The results showed that consumers had a statistically significant preference for the existing service (status quo) when all other factors remained constant. It suggested that consumers make decisions under a 'veil of experience'. Possible explanations for this result include the endowment effect, status quo bias and loss aversion. Future evaluations of health service innovation should be aware of this tendency to favour the status quo.

Attitude to Health↗