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At least 19 recordsLinked to original sources
PubMed1990

The development of national medical care programs in the United Kingdom and Canada: applicability to current conditions in the United States.

After a hiatus in the early to mid-1980s, a growing number of policy leaders, policy organizations, and citizen groups are advocating programs that ensure basic medical care for all. Although a large literature examines the applicability to the U.S. of national medical care programs that have been established in other countries from the perspective of operations and effectiveness, little attention has been given to the applicability of the experience of other nations in securing these programs. This paper examines the development of national programs in the U.K. and Canada and addresses two questions. First, what factors were critical to the establishment of the British National Health Service and the Canadian hospital and physician insurance programs? Second, how applicable are those factors to current conditions in the U.S.? The paper reviews the roles played by dislocations in society, by established models of state-sponsored medical care programs, by political institutions and leaders, and by the major medical sectors. It shows that the U.S., while differing in many particulars, presents several parallels to the U.K. and Canada. The paper argues that the current environment in the U.S. offers the nation the opportunity to develop at state or local levels government-sponsored programs that guarantee basic medical benefits to all. A new and powerful coalition, moreover, may in the coming years advance the cause of broader, more substantive change at the national level.

Canada↗
PubMed1994

Surveillance for stroke in Canada.

The goal of surveillance is to identify patterns of disease occurrence, detect disease outbreaks, develop clues about possible risk factors, find persons that need further investigation, and anticipate health service needs. Two sources of data are available for the purposes of surveillance: primary data, such as those arising from health surveys or local population-based registries; and secondary data, arising from large administrative databases. The effectiveness of any program to monitor the health of a community can be judged by the application of three "r's": right (accuracy), reasonable (cost) and rapid (speed). Programs using primary sources of data satisfy only one of the three "r's," that of accuracy. Programs using secondary sources sacrifice accuracy for speed and cost. The challenge for Canada in setting up surveillance for stroke is that there is a relatively small population unevenly distributed over a very large geographical area. To date, surveillance in Canada has consisted of a combination of individually initiated research projects and government sponsored programs. The main focus has been to tackle the issue of the accuracy of the large databases by validating the discharge codes listed in the provincial hospital discharge databases. Three provinces have carried out independent validation studies yielding remarkably similar results, and this lends confidence that hospital discharge databases will provide a means of carrying out surveillance for at least this one aspect of stroke. It is likely that any program for stroke surveillance in Canada will be multifaceted, involving the use of large computerized databases supplemented by hospital-based registries set up in a few highly motivated local centres. Stroke surveillance will best be accomplished by a joint effort between government and researchers to ensure that the end product is of high quality and will meet the needs of improving the health of Canadians.

Aged↗
PubMed1994

Parasite-associated morbidity: liver fluke infection and bile duct cancer in northeast Thailand.

Infection with the liver fluke, Opisthorchis viverrini, remains a major public health problem in Northeast Thailand, where approximately one-third of the population is infected. The northeast region is largely populated by Laos-descendent Thais who enjoy eating raw fish, which harbour the infective stage of the fluke. The parasite has maintained its presence in the population despite the widespread use of praziquantel and dissemination of health education material throughout the region by vigorous government-sponsored programs in recent years. The most severe consequence of liver fluke infection is cholangiocarcinoma, i.e. cancer of the bile duct epithelium. Although mortality due to the parasites alone appears to be uncommon, cholangiocarcinoma arising as a result of infection is one of the leading causes of death in the region. This paper reviews the pathogenesis of infection and the geographic, hospital-based and community studies which demonstrate the close relationship between infection and cancer. In addition, data from the Cancer Registry of Khon Kaen, Northeast Thailand and population-based studies using ultrasonography to visualize early tumours which illuminate the very high frequency of the cancer among heavily infected individuals and communities are discussed. Finally, the paper will close with a brief commentary on the prospects for control of the parasite and its likely impact on the frequency of cancer given the current epidemiological situation of liver fluke infection.

Animals↗
PubMed1989

Characteristics of males at a public health department contraceptive service.

To effectively confront teenage pregnancy, the characteristics, attitudes, and behaviors of males, along with females, need to be better understood. This pilot study examined young males who visited the family planning clinic of a public health department to obtain free condoms. Questionnaires were distributed over a 4-week period. Nearly 30% of males reported having sex 11+ times a month. However, an equal proportion reported having sex three or fewer times in the same interval. Most males reported using condoms during sex, although one quarter reported use as "seldom." The health department was a major source of condoms and was positively evaluated because condoms were free and there were "no questions asked." Only one third of the males reported using another method of contraception. Results suggest a major role of the health department in condom availability and the potential need for contraceptive services for males.

Contraceptive Devices, Male↗