Medical Care (medical + care)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Medical Care

  • emergency medical care
  • usual medical care

  • Terms modified by Medical Care

  • medical care cost
  • medical care program
  • medical care setting
  • medical care survey
  • medical care system
  • medical care utilization

  • Selected Abstracts


    MEDICAL CARE AND TECHNOLOGY

    JOURNAL OF CLINICAL HYPERTENSION, Issue 10 2005
    Paul A. Macri MD
    No abstract is available for this article. [source]


    Information Technology and Emergency Medical Care during Disasters

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2004
    Theodore C. Chan MD
    Abstract Disaster response to mass-casualty incidents represents one of the greatest challenges to a community's emergency response system. Rescuers, field medical personnel, and regional emergency departments and hospitals must often provide care to large numbers of casualties in a setting of limited resources, inadequate communication, misinformation, damaged infrastructure, and great personal risk. Emergency care providers and incident managers attempt to procure and coordinate resources and personnel, often with inaccurate data regarding the true nature of the incident, needs, and ongoing response. In this chaotic environment, new technologies in communications, the Internet, computer miniaturization, and advanced "smart devices" have the potential to vastly improve the emergency medical response to such mass-casualty incident disasters. In particular, next-generation wireless Internet and geopositioning technologies may have the greatest impact on improving communications, information management, and overall disaster response and emergency medical care. These technologies have applications in terms of enhancing mass-casualty field care, provider safety, field incident command, resource management, informatics support, and regional emergency department and hospital care of disaster victims. [source]


    The Within-Year Concentration of Medical Care: Implications for Family Out-of-Pocket Expenditure Burdens

    HEALTH SERVICES RESEARCH, Issue 3 2009
    Thomas M. Selden
    Objective. To examine the within-year concentration of family health care and the resulting exposure of families to short periods of high expenditure burdens. Data Source. Household data from the pooled 2003 and 2004 Medical Expenditure Panel Survey (MEPS) yielding nationally representative estimates for the nonelderly civilian noninstitutionalized population. Study Design. The paper examines the within-year concentration of family medical care use and the frequency with which family out-of-pocket expenditures exceeded 20 percent of family income, computed at the annual, quarterly, and monthly levels. Principal Findings. On average among families with medical care, 49 percent of all (charge-weighted) care occurred in a single month, and 63 percent occurred in a single quarter). Nationally, 27 percent of the study population experienced at least 1 month in which out-of-pocket expenditures exceeded 20 percent of income. Monthly 20 percent burden rates were highest among the poor, at 43 percent, and were close to or above 30 percent for all but the highest income group (families above four times the federal poverty line). Conclusions. Within-year spikes in health care utilization can create financial pressures missed by conventional annual burden analyses. Within-year health-related financial pressures may be especially acute among lower-income families due to low asset holdings. [source]


    Multidimensional Attitudes of Medical Residents and Geriatrics Fellows Toward Older People

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2005
    Ming Lee PhD
    Objectives: To examine dimensions of a validated instrument measuring geriatric attitudes of primary care residents and performances on these dimensions between residents and fellows. Design: Cross-sectional and longitudinal studies. Setting: An academic medical center. Participants: Two hundred thirty-eight primary care residents (n=177) and geriatrics fellows (n=61) participated in the study from 1995 to 2000. Measurements: A 14-item, 5-point Likert scale previously validated for measuring primary care residents' attitudes toward older people and geriatric patient care was used. Results: Factor analysis showed four dimensions of the scale, labeled Social Value, Medical Care (MC), Compassion (CP), and Resource Distribution, which demonstrated acceptable reliability. Both groups of subjects showed significantly (P<.001) positive (mean>3) attitudes across the dimensions and times, except for residents, who had near-neutral (mean=3) attitudes on MC. Residents' mean attitude scores on the overall scale and the MC and CP subscales were significantly (P<.001) lower than those of fellows over time. Residents and fellows showed different change patterns in attitudes over time. Residents' attitudes generally improved during the first 2 years of training, whereas fellows' attitudes declined slightly. Personal experience was a strong predictor of residents' attitudes toward older patients. Ethnicity, academic specialty, professional experience, and career interest in geriatrics were also associated with residents' attitude scores. Conclusion: The multidimensional analysis of the scale contributes to better understanding of medical trainees' attitudes and sheds light on educational interventions. [source]


    Comments on Progress, Medical Care, and the Overuse of Technology

    JOURNAL OF CLINICAL HYPERTENSION, Issue 8 2005
    Marvin Moser MD Editor in Chief
    No abstract is available for this article. [source]


    Delivery of Medical Care for Migrants in Germany: Delay of Diagnosis and Treatment

    JOURNAL OF TRAVEL MEDICINE, Issue 3 2006
    Katja Lenz MD
    Background Migrants form 9% of Germany's population and 13% of its capital Berlin. Only limited data are available regarding general health status and prevalence of tropical diseases among migrants in Germany. This study was conducted to investigate the spectrum and frequency of tropical diseases among migrants in Berlin and to evaluate the quality of the medical care provided. The necessity of a routine screening for tropical diseases among migrants was assessed. Methods Anonymized data of migrants presenting to the Berlin Institute of Tropical Medicine between 1999 and 2004 with a stay in Germany below 1 year (n= 153) were analyzed. Results Of all examined migrants, 48% needed immediate medical treatment and 38% carried an infectious disease, mainly nematodes and intestinal protozoa. 19% suffered from a noninfectious disease, mainly anemia, and 12% were transferred to other specialists for further investigation. These figures were similar among asymptomatic and symptomatic patients. The median duration of stay in Germany until presentation was 42 days. While 40% of the migrants were examined within the first 4 weeks of their stay, 20% had not received a medical examination after 6 months. Of this population, 50% required treatment upon presentation. Conclusions The high proportion of delayed diagnosis and treatment indicates a lack of medical service for migrants. While this clearly translates into increased health risks for the individual patient, it also indicates a potential risk for transmission of communicable diseases in the community. The lack of a correlation between symptoms and detected infectious disease indicates the need for a standardized routine screening examination in all migrants. [source]


    Rationing Medical Care on the Basis of Age: The Moral Dimensions

    NURSING PHILOSOPHY, Issue 2 2007
    Steven Edwards
    [source]


    Medical Care at the End of Life.

    THE HEYTHROP JOURNAL, Issue 1 2008
    A Catholic Perspective.
    First page of article [source]


    A Normative Justification for Distinguishing the Ethics of Clinical Research from the Ethics of Medical Care

    THE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 3 2005
    Paul Litton
    First page of article [source]


    Markets and Medical Care: The United States, 1993,2005

    THE MILBANK QUARTERLY, Issue 3 2007
    JOSEPH WHITE
    Many studies arguing for or against markets to finance medical care investigate "market-oriented" measures such as cost sharing. This article looks at the experience in the American medical marketplace over more than a decade, showing how markets function as institutions in which participants who are self-seeking, but not perfectly rational, exercise power over other participants in the market. Cost experience here was driven more by market power over prices than by management of utilization. Instead of following any logic of efficiency or equity, system transformations were driven by beliefs about investment strategies. At least in the United States' labor and capital markets, competition has shown little ability to rationalize health care systems because its goals do not resemble those of the health care system most people want. [source]


    The Economics of Public Health and Medical Care

    THE MILBANK QUARTERLY, Issue 4 2005
    RAY LYMAN WILBUR MD
    First page of article [source]


    Knowledge Translation in International Emergency Medical Care

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
    L. Kristian Arnold MD
    More than 90% of the world population receives emergency medical care from different types of practitioners with little or no specific training in the field and with variable guidance and oversight. Emergency medical care is being recognized by actively practicing physicians around the world as an increasingly important domain in the overall health services package for a community. The know-do gap is well recognized as a major impediment to high-quality health care in much of the world. Knowledge translation principles for application in this highly varied young domain will require investigation of numerous aspects of the knowledge synthesis, exchange, and application domains in order to bring the greatest benefit of both explicit and tacit knowledge to increasing numbers of the world's population. This article reviews some of the issues particular to knowledge development and transfer in the international domain. The authors present a set of research proposals developed from a several-month online discussion among practitioners and teachers of emergency medical care in 16 countries from around the globe and from all economic strata, aimed at improving the flow of knowledge from developers and repositories of knowledge to the front lines of clinical care. [source]


    Commentary: The Muslim Ethical Tradition and Emergent Medical Care: An Uneasy Fit

    ACADEMIC EMERGENCY MEDICINE, Issue 3 2007
    Amer Z. Aldeen MD
    No abstract is available for this article. [source]


    Avoidable mortality trends in Aboriginal and non-Aboriginal populations in the Northern Territory, 1985-2004

    AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2009
    Shu Qin Li
    Abstract Objectives: To analyse rates of avoidable mortality in Aboriginal and non-Aboriginal residents of the Northern Territory (NT) from 1985 to 2004, in order to assess the contribution of health care to life expectancy improvements. Methods: Australian Bureau of Statistics (ABS) death registration data for NT residents were used to identify ,avoidable' deaths, with further separation into three categories of conditions amenable to either medical care or health policy, and a category for ischaemic heart disease (IHD). A Poisson regression model was used to calculate the average annual change in avoidable mortality by sex and Aboriginality in the NT compared with Australia as a whole. Results: In the 20 years between 1985 and 2004, avoidable mortality rates fell 18.9% in NT Aboriginal people, 61.1% in NT non-Aboriginal people and 59.5% in Australians overall. NT Aboriginal people continued to experience higher avoidable mortality than other Australians and the disparity increased over time. Most of the decline in avoidable mortality for Aboriginal Territorians occurred for conditions amenable to medical care. Conclusion: Medical care has made a significant contribution to improvements in Aboriginal life expectancy in the NT, however, reductions in avoidable mortality from IHD and conditions amenable to health policy have been variable. Implications: The results highlight the need for ongoing investment in comprehensive programs incorporating appropriate health policy interventions and management of chronic diseases. [source]


    Is Consent "Informed" When Patients Receive Care from Medical Trainees?

    ACADEMIC EMERGENCY MEDICINE, Issue 12 2008
    Daniel J. Pallin MD
    Abstract Objectives:, Medical care requires consent and consent requires information. Prior studies have shown that patients are poorly informed about the medical training hierarchy. The authors assessed the impact of "informed" on "consent," by assessing willingness to be seen by trainees before and after information about trainee's credentials. Methods:, A convenience sample of patients in an urban emergency department (ED) waiting room was surveyed, ascertaining willingness to be seen before and after information about trainees credentials, using Likert scales. McNemar's test, linear regression, and mixed models were used to assess statistical significance of information in changing preferences and patient characteristics predicting knowledge, willingness, and change in willingness to be seen with more information. Results:, The authors approached 397 patients, and 199 (50%) English speakers participated. Initially, 45% of subjects knew the meaning of "medical student," and 35%"intern" and "resident." In a controlled multivariate linear regression, educational attainment (p < 0.0001) predicted more knowledge, Hispanic ethnicity predicted less (p = 0.03). Subjects were less willing to be seen by lower-ranking trainees (p < 0.001). Information about trainees caused a significant increase in unwillingness to be seen by medical students (17% to 28%, p = 0.004) and interns (8% to 13%, p = 0.029). Conclusions:, Substantial numbers of ED patients would prefer not to be seen by trainees. When patients are informed about trainees' credentials, they become less willing to be seen by more junior trainees. Further research should clarify informed consent for care among non,English speakers and should address these issues in other medical settings. [source]


    Evaluating the accuracy of Malformations Surveillance Program in detecting virilization due to congenital adrenal hyperplasia

    CONGENITAL ANOMALIES, Issue 1 2005
    Julie Travitz
    ABSTRACT Malformations surveillance programs of newborn infants have been developed as a method for identifying serious and relatively common birth defects. The virilization of newborn infants with the classic 21-hydroxylase form of congenital adrenal hyperplasia must be identified early if the associated metabolic crisis in the perinatal period is to be prevented. We compared the detection of virilization associated with 21-hydroxylase congenital adrenal hyperplasia in infants by three methods: an ,active' malformations surveillance of medical records at a large urban hospital; routine medical care by examining physicians; and newborn biochemical screening of blood samples. The experience at a large maternity center in Boston, since 1972, showed that pediatricians often recognized affected females (6/6), but not males (0/2); the state newborn screening program, begun in 1990, identified correctly all affected males and females. The Active Malformations Surveillance Program was the least effective screening method, identifying four of six affected females and neither of the affected males. The low rate of detecting affected females by the Surveillance Program was attributed to a failure to sensitize the research assistants to the importance of physicians' notations regarding the signs and symptoms of virilization. The failure of examining physicians, and thereby, the malformations surveillance program, to detect virilized newborn males was due to the lack of consistent associated physical features. These comparisons between these three methods of detection can be used to design and improve malformations surveillance programs. [source]


    The Role of Clinical and Process Quality in Achieving Patient Satisfaction in Hospitals

    DECISION SCIENCES, Issue 3 2004
    Kathryn A. Marley
    ABSTRACT Managers constantly struggle with where to allocate their resources and efforts in managing the complex service delivery system called a hospital. In the broadest sense, their decisions and actions focus on two important aspects of health care,clinical or technical medical care that emphasizes "what" the patient receives and process performance that emphasizes "how" health care services are delivered to patients. Here, we investigate the role of leadership, clinical quality, and process quality on patient satisfaction. A causal model is hypothesized and evaluated using structural equation modeling for a sample of 202 U.S. hospitals. Statistical results support the idea that leadership is a good exogenous construct and that clinical and process quality are good intermediate outcomes in determining patient satisfaction. Statistical results also suggest that hospital leadership has more influence on process quality than on clinical quality, which is predominantly the doctors' domain. Other results are discussed, such as that hospital managers must be mindful of the fact that process quality is at least as important as clinical quality in predicting patient satisfaction. The article concludes by proposing areas for future research. [source]


    Dental trauma in children presenting for treatment at the Department of Dentistry for Children and Orthodontics, Budapest, 1985,1999

    DENTAL TRAUMATOLOGY, Issue 3 2001
    Katalin Gábris
    Abstract , Data on children with dental trauma who presented for treatment at the Department of Dentistry for Children and Orthodontics in Budapest over a period of 15 years were analysed. The WHO guidelines were used to classify the traumatic injuries. A total of 590 children were involved, 810 teeth being affected. Children aged 7,14 years made up 88% of the cohort. The male:female ratio was 58:42. The permanent:primary ratio for the affected teeth was 90:10. The teeth most commonly affected were the maxillary central incisors. In 70% of the cases, only one tooth was traumatised. The incidence of dental trauma peaked at 10 years of age. The most common injury type observed was enamel-dentin crown fracture. The decreasing sequence of frequency of etiological factors was playing, sports, falls, cycling, road accidents and fighting. Of the accidents, 65% occurred at school or at home. Seventy seven per cent of the patients presented for medical care in the first 3 days after the accident. [source]


    Characteristics of Medical Surge Capacity Demand for Sudden-impact Disasters

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2006
    Samuel J. Stratton MD
    Objectives To describe the characteristics of the demand for medical care during sudden-impact disasters, focusing on local U.S. communities and the initial phases of sudden-impact disasters. Methods Established databases and published reports were used as data sources. Data were obtained to describe the baseline capacity of the U.S. medical system. Information for the initial phases of a sudden-impact disaster was sought to allow for characterization of the length of time before a U.S. community can expect arrival of outside assistance, the expected types of medical surge demands, the expected time for the peak in medical-care demand, and the expected health system access points. Results The earliest that outside assistance arrived for a community subject to a sudden-impact disaster was 24 hours, with a range from 24 to 96 hours. After sudden-impact disasters, 84% to 90% of health care demand was for conditions that were managed on an ambulatory basis. Emergency departments (EDs) were the access point for care, with peak demand time occurring within 24 hours. The U.S. emergency care system was functioning at relatively full capacity on the basis of data collected for the study that showed that annually, 90% of EDs were boarding admitted inpatients, and 75% were diverting ambulances. Conclusions As part of planning for sudden-impact disasters, communities should be expected to sustain medical services for 24 hours, and up to 96, before arrival of external resources. For effective medical surge-capacity response during sudden-impact disasters, there should be a priority for emergency medical care with a focus on ambulatory injuries and illnesses. [source]


    Equipment, Supplies, and Pharmaceuticals: How Much Might It Cost to Achieve Basic Surge Capacity?

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2006
    Dan Hanfling MD
    The ability to deliver optimal medical care in the setting of a disaster event, regardless of its cause, will in large part be contingent on an immediately available supply of key medical equipment, supplies, and pharmaceuticals. Although the Department of Health and Human Services Strategic National Stockpile program makes these available through its 12-hour "push packs" and vendor-managed inventory, every local community should be funded to create a local cache for these items. This report explores the funding requirements for this suggested approach. Furthermore, the response to a surge in demand for care will be contingent on keeping available staff close to the hospitals for a sustained period. A proposal for accomplishing this, with associated costs, is discussed as well. [source]


    DEFINING STANDARD OF CARE IN THE DEVELOPING WORLD: THE INTERSECTION OF INTERNATIONAL RESEARCH ETHICS AND HEALTH SYSTEMS ANALYSIS

    DEVELOPING WORLD BIOETHICS, Issue 2 2005
    ADNAN A. HYDER
    ABSTRACT In recent years there has been intense debate regarding the level of medical care provided to ,standard care' control groups in clinical trials in developing countries, particularly when the research sponsors come from wealthier countries. The debate revolves around the issue of how to define a standard of medical care in a country in which many people are not receiving the best methods of medical care available in other settings. In this paper, we argue that additional dimensions of the standard of care have been hitherto neglected, namely, the structure and efficiency of the national health system. The health system affects locally available medical care in two important ways: first, the system may be structured to provide different levels of care at different sites with referral mechanisms to direct patients to the appropriate level of care. Second, inefficiencies in this system may influence what care is available in a particular locale. As a result of these two factors locally available care cannot be equated with a national ,standard'. A reasonable approach is to define the national standard of care as the level of care that ought to be delivered under conditions of appropriate and efficient referral in a national system. This standard is the minimum level of care that ought to be provided to a control group. There may be additional moral arguments for higher levels of care in some circumstances. This health system analysis may be helpful to researchers and ethics committees in designing and reviewing research involving standard care control groups in developing country research. [source]


    Rethinking Medical Ethics: A View From Below

    DEVELOPING WORLD BIOETHICS, Issue 1 2004
    Paul Farmer
    ABSTRACT In this paper, we argue that lack of access to the fruits of modern medicine and the science that informs it is an important and neglected topic within bioethics and medical ethics. This is especially clear to those working in what are now termed ,resource-poor settings', to those working, in plain language, among populations living in dire poverty. We draw on our experience with infectious diseases in some of the poorest communities in the world to interrogate the central imperatives of bioethics and medical ethics. AIDS, tuberculosis, and malaria are the three leading infectious killers of adults in the world today. Because each disease is treatable with already available therapies, the lack of access to medical care is widely perceived in heavily disease-burdened areas as constituting an ethical and moral dilemma. In settings in which research on these diseases are conducted but there is little in the way of therapy, there is much talk of first world diagnostics and third world therapeutics. Here we call for the ,resocialising' of ethics. To resocialise medical ethics will involve using the socialising disciplines to contextualise fully ethical dilemmas in settings of poverty and, a related gambit, the systematic participation of the destitute sick. Clinical research across steep gradients also needs to be linked with the interventions that are demanded by the poor and otherwise marginalised. We conclude that medical ethics must grapple more persistently with the growing problem posed by the yawning ,outcome gap' between rich and poor. [source]


    Neuropsychiatric movement disorders following streptococcal infection

    DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2005
    K G Walker MB BS
    The aim of this study was to describe post-streptococcal movement disorders that form part of the acute rheumatic fever complex. The clinical records of patients diagnosed with Sydenham's chorea were analyzed retrospectively to investigate epidemiology, the significance of socioeconomic deprivation, clinical manifestations, treatments, outcomes, long-term morbidity, and disease evolution. Forty-two patients (21 males, 21 females) were diagnosed with Sydenham's chorea. The median presentation age was 9 years 8 months (range 3y 5mo to 13y 2mo). Nineteen patients were of indigenous African ancestry; 23 were of mixed ancestry. All patients lived in poverty and had poor access to medical care. Twelve of the total group had disabling symptoms for longer than 2 years; six of these patients developed paediatric autoimmune neuropsychiatric disorder associated with Streptococcus (Paediatric autoimmune neuropsychiatric disorder associated with Streptococcus [PANDAS]), five Tourette syndrome (TS), and one learning difficulties. Poor outcome was significantly more prevalent in patients of mixed ancestry, in those with a positive family history, previous behavioural problems, or a failure to complete 10 days of penicillin and ,bed-rest'/hospitalization. Sydenham's chorea is one manifestation of post-streptococcal neuropsychiatric movement disorders. This study demonstrates that patients can present with one diagnosis and evolve other neuropsychiatric conditions such as TS and PANDAS. In the South African context, it is important to delineate neuropsychiatric movement disorders associated with streptococcal infections. The potential genetic susceptibility should be explored. [source]


    International scope of medical care

    DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2002
    Jack Banta
    No abstract is available for this article. [source]


    Life expectancy among people with cerebral palsy in Western Australia

    DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2001
    E Blair PhD
    This report describes trends, predictors, and causes of mortality in persons with cerebral palsy (CP)using individuals identified by the Western Australian Cerebral Palsy Register and born between 1958 and 1994. Two thousand and fourteen people were identified (1154 males, 860 females), of whom 225 had died by 1 June 1997. Using date-of-death data, crude and standardized mortality rates were estimated and predictors of mortality sought using survival analysis stratified by decade of birth, description of impairments, and demographic and perinatal variables. For those born after 1967, the cause of death profile was examined over time. Mortality exceeded 1% per annum in the first 5 years and declined to age 15 years after which it remained steady at about 0.35% for the next 20 years. The strongest single predictor was intellectual disability, but all forms of disability contributed to decreased life expectancy. Half of those with IQ/DQ score <20 survived to adulthood, increasing to 76% with IQ/DQ score 20,34, and exceeding 92% for higher scores. Severe motor impairment primarily increased the risk of early mortality. Despite there being 72 persons aged from 25 to 41 years with severe motor impairment in our data set, none had died after the age of 25 years. Infants born after more than 32 weeks'gestation were at significantly higher risk of mortality than very preterm infants, accounted for by their higher rates of intellectual disability. No improvements in survival of persons with CP were seen over the study period despite advances in medical care, improved community awareness, and the increasing proportion of very preterm births among people with CP. This may be the result of improved neonatal care enabling the survival of infants with increasingly severe disabilities. [source]


    The Use of Cluster Sampling to Determine Aid Needs in Grozny, Chechnya in 1995

    DISASTERS, Issue 3 2000
    Sean Drysdale
    War broke out in Chechnya in November 1994 following a three-year economic blockade. It caused widespread destruction in the capital Grozny. In April 1995 Medical Relief International - or Merlin, a British medical non-governmental organisation (NGO) - began a programme to provide medical supplies, support health centres, control communicable disease and promote preventive health-care in Grozny. In July 1995 the agency undertook a city-wide needs assessment using a modification of the cluster sampling technique developed by the Expanded Programme on Immunisation. This showed that most people had enough drinking-water, food and fuel but that provision of medical care was inadequate. The survey allowed Merlin to redirect resources earmarked for a clean water programme towards health education and improving primary health-care services. It also showed that rapid assessment by a statistically satisfactory method is both possible and useful in such a situation. [source]


    Process evaluation of an out-patient detoxification service

    DRUG AND ALCOHOL REVIEW, Issue 6 2005
    Dr CLAUDIA SANNIBALE
    Abstract This paper describes the process evaluation of an out-patient detoxification service (ODS) established by Drug Health Services (DHS) to increase the supervised withdrawal options for substance users in a Sydney metropolitan Area Health Service. The ODS aimed to provide a safe and effective supervised withdrawal to substance users who were at low risk of severe withdrawal, engage those with severe dependence in further treatment and increase the involvement of general practitioners (GPs) in the medical care of ODS clients. During its first 10 months of operation, the ODS received 199 inquiries, assessed 82 individuals and admitted 76 clients for detoxification. Withdrawal treatment proceeded without complications and within the expected time frames. Fifty-four clients completed withdrawal, 10 ceased treatment, 10 remained in treatment without completing withdrawal and two were transferred elsewhere. Clients who injected substances (mainly heroin) daily at admission, compared to others, were less likely to complete withdrawal and more likely to use a range of non-prescribed substances during withdrawal. One-fifth of clients went on to further treatment with DHS, attending at least once. Overall, the ODS met its goals, providing a safe and effective supervised withdrawal to local residents, especially women, young people and those withdrawing from benzodiazepines who had significant substance dependence, impairment and previous alcohol and other drug (AOD) treatment. Non-injecting substance users benefited most from the ODS in terms of withdrawal completion and ongoing treatment. The level of GP involvement in the conjoint care of ODS clients remained constant over time. The development and expansion of the ODS are discussed. [source]


    Risk perception and smoking behavior in medically ill smokers: a prospective study

    ADDICTION, Issue 6 2010
    Belinda Borrelli
    ABSTRACT Aims To examine the influence of risk perception on intentions to quit smoking and post-treatment abstinence. Design Prospective and longitudinal. Setting United States. Participants A total of 237 adult smokers (mean age 56 years) receiving medical care from home health-care nurses. Participants did not have to want to quit smoking to participate, but received cessation counseling within the context of their medical care. Measurements Three measures of risk perception were given pre- and post-treatment: perceived vulnerability, optimistic bias and precaution effectiveness. Smoking status was verified biochemically at end of treatment and at 2, 6 and 12 months later. Findings Principal components analysis supported the theoretical discriminability of the risk perception measures, and intercorrelations provided evidence for concurrent and predictive validity. Elevated risk perception was associated with a variety of socio-demographic and psychosocial characteristics. Optimistic bias was associated significantly with older age and ethnic minority status. Smokers in pre-contemplation had lower perceived vulnerability and precaution effectiveness and greater optimistic bias than those in contemplation and preparation. Smokers in preparation had higher perceived vulnerability and lower optimistic bias than those in earlier stages. Change in perceived vulnerability predicted smoking cessation at follow-up. Optimistic bias predicted a lower likelihood of cessation and precaution effectiveness predicted a greater likelihood of smoking cessation, but only among those with a smoking-related illness. Conclusions In patients receiving medical care from home health-care nurses, change in perceived vulnerability to smoking-related disease is predictive of smoking cessation. In those with smoking-related illnesses, optimistic bias predicts continued smoking while precaution effectiveness predicts cessation. [source]


    Three-year mortality and predictors after release: a longitudinal study of the first-time drug offenders in Taiwan

    ADDICTION, Issue 5 2010
    Chuan-Yu Chen
    ABSTRACT Aims To assess the possible increase in mortality rate and associated socio-demographic and judiciary determinants among first-time drug offenders during the first 3 years after release from correctional facilities. Setting and participants A total of 22 224 male and 4444 female adults who had served a sentence of at least 1 day in correctional facilities for illegal drug-related offences were identified from the judiciary records of the Ministry of Justice, Taiwan. Design and measurements The underlying causes of death were defined by the International Classification of Diseases, ninth revision. Findings All-cause standardized mortality ratios (SMR) were 7 for schedule I (e.g. heroin) and 3 for schedule II (e.g. methamphetamine) drug offenders, respectively; accidents, suicide and circulatory diseases were three leading causes of death. After release, the risk of death among those drug offenders without subsequent incarceration increased gradually until the 9th month. Those who were aged 30 years or older, had an engagement with a higher-ranked schedule substance or who received severe sentences were two to three times more likely to die. Substantial reduction in the risk of death was linked with re-imprisonment. Conclusions The SMR estimates for external causes were greater than those for disease-related causes in drug offenders, and schedule I drugs-related mortality rate was twice as high as that with schedule II drugs. In transitioning from the correctional setting to the community, the health needs of drug offenders should be addressed by the provision of continuous, adequate medical care tailored to individual background, medical history and drug experience. [source]


    REALITIES OF HEALTH POLICY IN NORTH AMERICA: GOVERNMENT IS THE PROBLEM, NOT THE SOLUTION

    ECONOMIC AFFAIRS, Issue 4 2008
    Brett J. Skinner
    Healthcare systems in North America are sometimes criticised as being expensive or socially irresponsible relative to comparable systems in OECD (Organisation for Economic Co-operation and Development) countries or regions. These perceived health system failures are often mistakenly attributed to greater private sector involvement in the delivery of medical care or the provision of medical insurance in Canada and the USA. However, the exact nature and scope of state involvement in the healthcare sector in Canada and the USA is also often misunderstood and underestimated. This paper presents a fact-based context for evaluating health policy in North America. [source]