PUBLIC ADMINISTRATION, Issue 2 2008
STEPHEN PECKHAM
Decentralization is a central plank of current government health policy. However, it is possible to discern both centralist and decentralist movements in the UK. This paper examines existing frameworks of decentralization in relation to identifying whether policy is decentralist or not and identifies a number of problems that limit their value. Key problems relate to the way decentralization is conceptualized and defined. Existing frameworks are also highly contextualized and are therefore of limited value when applied in different contexts. The paper then presents a new framework which, it is argued, provides a more useful way of examining centralization and decentralization by providing a way of categorizing policies and actions and avoids the problems of being contextually constrained. The paper ends with a discussion of how the framework can be applied in a health context and shows how this framework helps avoid the problems found in previous discussions of decentralization. [source]

REVIEW OF THE EXTENT TO WHICH ORCHIDOPEXY IS PERFORMED AT THE OPTIMAL AGE: IMPLICATIONS FOR HEALTH SERVICES

ANZ JOURNAL OF SURGERY, Issue 11 2008
Christine J. P. Bruijnen
Background: In recent decades, the recommended age for orchidopexy for primary undescended testes has decreased, in the expectation that this might improve subsequent fertility. The aim of this study was to investigate whether this is reflected in a reduction in the age at which orchidopexies are carried out, and the implications for child health services. Methods: All boys who underwent an orchidopexy for an undescended testis carried out by the Christchurch-based paediatric surgical service between January 1997 and December 2007 were identified through a prospectively collected database. They were analysed according to the age at time of operation and year of surgery to determine whether there was any trend over time. The proportions of children younger than 2 years and between 2 and 5 years of age were calculated for each year. Results: In total, 788 boys underwent orchidopexies for primary undescended testes, with 335 (42.5%) boys having surgery before the age of 2 (mean age 54.3 months, median 31.1 months). During the whole 11-year period, there was no significant change in age at orchidopexy, whereas from 2003, a significant trend towards lower age at operation (Spearman's rank ,0.1112, P = 0.0071) and a significant increase in the proportion of boys having surgery before the age of 2 (Spearman's rank 0.9000, P = 0.0374) were seen. Conclusions: Although there has been a modest reduction in the mean age of orchidopexy since 2003, overall, the mean age at orchidopexy remains well above the recommended optimal age, implying that more attention should be paid towards earlier diagnosis and referral for primary undescended testes. [source]

A HISTORICAL PERSPECTIVE ON MENTAL HEALTH SERVICES IN AUSTRALIA: 1883,84 TO 2003,04

AUSTRALIAN ECONOMIC HISTORY REVIEW, Issue 2 2009
Article first published online: 22 JUN 200, Darrel Phillip Doessel
Australia; deinstitutionalisation; mental health expenditure; mental health policy; public psychiatric hospitals This paper describes changes in the number of residents and admissions to public psychiatric hospitals in Australia, and in the state of Queensland in particular, from 1883 to 2003. It identifies when the deinstitutionalisation of dedicated psychiatric institutions began in Queensland and finds that the policy described as ,opening the back door' (discharging residents) began around 1952,53, while the policy of ,closing the front door' (reducing admissions) began in 1962,63. Deinstitutionalisation in Queensland thus began earlier than most contemporary writers suggest. [source]

GOAL ATTAINMENT SCALING: AN EFFECTIVE OUTCOME MEASURE FOR RURAL AND REMOTE HEALTH SERVICES

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2002
Ruth Cox
ABSTRACT: The aim of this paper is to demonstrate the utility of Goal Attainment Scaling (GAS) as an effective, multidisciplinary measure of client outcomes for rural and remote health services. Goal Attainment Scaling was adopted by the Spinal Outreach Team (SPOT) as a client-focussed evaluation tool, as it is sensitive to the individual nature of clients' presenting issues and the multidisciplinary focus of the team. It enables individualised goals to be set on a five-point scale. Goal Attainment Scaling was introduced to the SPOT service after a pilot trial established guidelines for its effective implementation. An ongoing review process ensures that goal scaling remains realistic and relevant. Service outcomes can be effectively summarised using a frequency distribution of GAS scores. One of the important benefits of GAS is its facilitation of collaborative goal setting between clinician and client. Goal Attainment Scaling is recommended to rural and remote multidisciplinary health services because of its ability to summarise outcomes from heterogeneous service activities. [source]

Survey of the pre-school child health surveillance programme in Sweden

ACTA PAEDIATRICA, Issue 2000
R Kornfält
A survey of the programme for developmental surveillance in the Child Health Centres (CHCs) in Sweden was performed using a questionnaire administered to the Chief Medical Officers (CMO) of the Child Health Services. The questionnaire asked about methods used for auditory examination, developmental surveillance and identification of disturbances in mother-child interaction. Activities for health promotion concerning breastfeeding, non-smoking and allergy prevention were also queried. Thirty-four CMOs representing 1731 CHCs and 645000 children answered the questionnaire. The reply rate was 81%. Various methods of auditory examination are offered all infants and children in Sweden. The national guidelines for health supervision are followed fairly closely by all. Screening for disturbances in attention, motor development and perception (DAMP) is performed by all but four districts, with various methods, resources and degrees of co-operation with school health services. Support in mother-child interaction is considered very important and new methods to identify and treat disturbances are gradually introduced. Breastfeeding is encouraged; breast milk is the main source of food for 67% of babies at 4 mo of age. Activities to stop or diminish use of tobacco are ongoing everywhere, as are programmes to identify children at risk of developing allergies and for allergy prevention. Thus, the Child Health Services maintain a high standard and are ambitious about introducing new methods and ideas. [source]

Avulsion of primary teeth and sequelae on the permanent successors

DENTAL TRAUMATOLOGY, Issue 6 2005
Pia Christophersen
Abstract,,, The purpose of the present study was to determine the frequency of avulsion of primary teeth and the location of the avulsed tooth in a representative population of Danish children. Also, the frequency and the type of developmental disturbances in the permanent successors were assessed and related to age at the time of injury. The material included dental records of 4238 children from three clinics in Municipal Dental Health Services near Copenhagen, Denmark. The children were born between 1 January 1983 and 31 December 2000. Thirty-five children (0.8%) were identified as having avulsed in all 44 primary teeth most frequently the maxillary incisors (89%). Thirty-three fully erupted permanent successors were included in the study, the prevalence of developmental disturbances was 30% (10 teeth). The results showed the risk of developmental disturbances in the permanent successors to be more frequent the younger the age at the time of injury (P = 0.04). Discolouration affected all 10 permanent teeth, but also hypoplasia and horizontal enamel hypoplasia were found. [source]

Violence among schizophrenia out-patients compliant with medication: prevalence and associated factors

ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2009
J. Bobes
Objective:, Aggressive behaviour has been related to schizophrenia both in in-patient and out-patient samples. In this study, we aimed to assess the prevalence and factors associated with aggressive behaviour in out-patient compliant with their prescribed medication. Method:, Eight hundred and ninety-five patients were interviewed at Community-Based Mental Health Services about aggressive,violent behaviour within the week prior to the study visit. Adult patients diagnosed with schizophrenia and receiving stable pharmacological treatment were enrolled. Presence of aggressive episodes, including type of aggression, severity and frequency, was assessed with the Modified Overt Aggression Scale (MOAS). Violence was defined as a score of 3 or more in any of the MOAS subscores. Results:, Prevalence of recent aggressive behaviour was 5.07%, (95% CI 5.04,5.10), where 47% (43 behaviours 91) reached the violent threshold. Among the 91 violent episodes rated, most episodes were verbal (44%), followed by physical violence towards objects (29%), violence towards others (19%) and self-directed violence (8%). Recent episodes of any severity were more likely among patients with a history of violence and also with relapses within the previous year and with low treatment satisfaction. Conclusion:, Five per cent of the studied cases showed aggressive behaviour in the week prior to assessment, despite having been compliant with their medication. Most aggressive behaviour was verbal rather than physical. [source]

A pilot examination of social context and everyday physical activity among adults receiving Community Mental Health Services

ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2009
B. P. McCormick
Objective:, Community mental health center (CMHC) clients include a variety of people with moderate to severe mental illnesses who also report a number of physical health problems. Physical activity (PA) has been identified as one intervention to improve health among this population; however, little is known about the role of social context in PA. The purpose of this study was to examine the role of social context in everyday PA among CMHC clients. Method:, Data were collected from CMHC clients in two cultures using accelerometery and experience sampling methods. Data were analyzed using hierarchical linear modeling. Results:, Independence in housing nor culture was significantly associated with levels of PA. Being alone was significantly negatively related to PA level. Conclusion:, Social isolation appears to be negatively related to PA at the level of everyday life. Physical activity interventions with this population should consider including social components as a part of PA. [source]

The Australian experience of deinstitutionalization: interaction of Australian culture with the development and reform of its mental health services

ACTA PSYCHIATRICA SCANDINAVICA, Issue 2006
A. Rosen
Objective:, To describe the Australian experience of deinstitutionalization of the Australian National Mental Health Strategy in the context of the history of mental health services in Australia, and of Australian culture. Method:, The development of Australian Mental Health Services is described with reference to developments in both psychiatric intervention research and Australian culture. The effects and achievements of national mental health reforms are described and critically examined. Results:, The relationship in Australia between the development of mental health services and the development of Australian society includes the stories of colonization, gold rushes, suppression of indigenous peoples' rights, incarceration of mentally ill people, and incompatible state service systems. Mental health services required reform to provide consistent services and support for full citizenship and rights for such individuals who are still on the margins of society. Recent national developments in service models and service system research have been driven by the Australian National Mental Health Strategy. The translation of national policy into state/territory mental health service systems has led to a ,natural' experiment between states. Differing funding and implementation strategies between states have developed services with particular strengths and limitations. Conclusion:, The effects of competition for limited resources between core mental health service delivery and the shift to a population-based public health approach (to prevention of mental illness and promotion of mental health), leaves our services vulnerable to doing neither particularly well. The recent loss of momentum of these reforms, due to failure of governments to continue to drive and fund them adequately, is causing the erosion of their considerable achievements. [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]

Childhood negative experiences and subclinical psychosis in adolescence: a longitudinal general population study

EARLY INTERVENTION IN PSYCHIATRY, Issue 2 2007
Ellen De Loore
Abstract Background:, Accumulating evidence suggests that experiences of trauma and victimization during childhood are associated with an increased risk to develop clinical and subclinical psychosis in adulthood. A recent cross-sectional study showed a significant association between trauma and psychotic experiences in adolescents. The current study aimed to extend these findings by investigating the longitudinal effects of negative life experiences on the risk for subclinical psychotic symptoms 2 years later in an adolescent general community sample. Methods:, Data were derived from the standard health screenings of the Youth Health Care Divisions of the Public Health Services, in the South of the Netherlands. A total of 1129 adolescents filled out a self-report questionnaire at age 13/14 years and 2 years later (15/16 years), assessing psychotic experiences, as well as experiences of being bullied, sexual trauma, and negative life events. Results:, Logistic regression analyses revealed that sexual trauma increased the risk for psychotic symptoms 2 years later. Life events contributed to the risk for psychosis over time and psychosis in turn gave rise to new life events. No significant association with bullying was found after controlling for confounders. Conclusion:, The results provide further evidence for an association between childhood environment and psychosis in the crucial developmental period of early adolescence. Early and later psychological stress, if severe, may impact on the risk for psychosis in adolescence through mechanisms of person,environment interaction and correlation. [source]

Improving transfer of mental health care for rural and remote consumers in South Australia

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2009
Judy Taylor BA Dip Soc Wk MSW PhD
Abstract In Australia, it is commonplace for tertiary mental health care to be provided in large regional centres or metropolitan cities. Rural and remote consumers must be transferred long distances, and this inevitably results in difficulties with the integration of their care between primary and tertiary settings. Because of the need to address these issues, and improve the transfer process, a research project was commissioned by a national government department to be conducted in South Australia. The aim of the project was to document the experiences of mental health consumers travelling from the country to the city for acute care and to make policy recommendations to improve transitions of care. Six purposively sampled case studies were conducted collecting data through semistructured interviews with consumers, country professional and occupational groups and tertiary providers. Data were analysed to produce themes for consumers, and country and tertiary mental healthcare providers. The study found that consumers saw transfer to the city for mental health care as beneficial in spite of the challenges of being transferred over long distances, while being very unwell, and of being separated from family and friends. Country care providers noted that the disjointed nature of the mental health system caused problems with key aspects of transfer of care including transport and information flow, and achieving integration between the primary and tertiary settings. Improving transfer of care involves overcoming the systemic barriers to integration and moving to a primary care-led model of care. The distance consultation and liaison model provided by the Rural and Remote Mental Health Services, the major tertiary provider of services for country consumers, uses a primary care-led approach and was highly regarded by research participants. Extending the use of this model to other primary mental healthcare providers and tertiary facilities will improve transfer of care. [source]

Studying the Organisation and Delivery of Health Services: Research Methods

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2002
Nick Goodwin Ba (Hons) PhD
No abstract is available for this article. [source]

User Fees for Health Services: Guidelines for Protecting the Poor, by William Newbrander, David Collins and Lucy Gilson.

HEALTH ECONOMICS, Issue 2 2002
2001., Boston, Management Sciences for Health
No abstract is available for this article. [source]

Quantifying Components of Drug Expenditure Inflation: The British Columbia Seniors' Drug Benefit Plan

HEALTH SERVICES RESEARCH, Issue 5 2002
Steven G Morgan
Objective. To quantify the relative and absolute importance of different factors contributing to increases in per capita prescription drug costs for a population of Canadian seniors. Data Sources/Study Setting. Data consist of every prescription claim from 1985 to 1999 for the British Columbia Pharmacare Plan A, a tax-financed public drug plan covering all community-dwelling British Columbians aged 65 and older. Study Design. Changes in per capita prescription drug expenditures are attributed to changes to four components of expenditure inflation: (1) the pattern of exposure to drugs across therapeutic categories; (2) the mix of drugs used within therapeutic categories; (3) the rate of generic drug product selection; and (4) the prices of unchanged products. Data Collection/Extraction Methods. Data were extracted from administrative claims files housed at the UBC Centre for Health Services and Policy Research. Principal Findings. Changes in drug prices, the pattern of exposure to drugs across therapeutic categories, and the mix of drugs used within therapeutic categories all caused spending per capita to increase. Incentives for generic substitution and therapeutic reference pricing policies temporarily slowed the cost-increasing influence of changes in product selection by encouraging the use of generic drug products and/or cost-effective brand-name products within therapeutic categories. Conclusions. The results suggest that drug plans (and patients) would benefit from more concerted efforts to evaluate the relative cost-effectiveness of competing products within therapeutic categories of drugs. [source]

Costs of community-based public mental health services for older adults: variations related to age and diagnosis

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2006
Todd Gilmer
Abstract Background Several studies have examined service use among older adults although, to our knowledge, none has examined costs from a systems perspective. This study examined use and costs of mental health services among older adults in San Diego County in order to determine how expenditures and modes of service varied by age cohort and psychiatric diagnosis. Methods Utilization data from San Diego County Adult and Older Adult Mental Health Services (AOAMHS) were used to identify older adults (age,,,60) receiving services in the community during fiscal year 2003,2004. Cost data were derived from detailed examination of cost reports, and Medicaid fee schedules. Trends in demographic and clinical characteristics by six age cohorts were described. Multivariate models were used to estimate the relationships between costs, age, and clinical diagnosis while controlling for other demographic and clinical characteristics. Components of costs were also examined. Results Total expenditures declined from age cohorts 60,64 through ages 85 and over. Expenditures were similar, and greatest, for clients with schizophrenia and bipolar disorder, while outlays were lower for those with major depression, other psychotic disorder, other depression, anxiety, substance use disorder, and cognitive disorders. Clients diagnosed with cognitive disorder had high use of emergency services and little connection to outpatient services. Conclusions Expenditures were related to age and clinical diagnosis. Future efforts should investigate older adults' pathways to care, and should determine whether older adults presenting in emergency services would benefit from a specialized case management program providing linkages to community based resources. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Evaluating the context within which continence care is provided in rehabilitation units for older people

INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2007
Jayne Wright
Aim., This paper presents the first phase of an all Ireland 2-year study between the University of Ulster and University College Cork, to determine the contextual indicators that enable or hinder person centred continence care and management in rehabilitation settings for older people. The primary outcome of the study was the development of a tool to enable practitioners to assess the practice context within which continence care is provided. The main focus of this paper is the value of understanding practice ,context' (culture, leadership and evaluation) and its impact to the provision of person centred continence care. Background., The literature highlights the effect of continence problems on the quality of life of older people. Incontinence is often seen by health care professionals and older people as an inevitable consequence of ageing and difficult to treat. Furthermore, health care professionals do not always have the necessary skills and knowledge of best practice in continence care and treatments. The Promoting Action on Research Implementation in Health Services (PARIHS) framework utilized in the study proposes that successful implementation of evidence in practice is dependent on the inter-relationship of three key elements; the nature of the evidence, the quality of the context and expert facilitation. Kitson et al. propose that for successful implementation, evidence needs to be robust, the context receptive to change and appropriate facilitation is needed. Consequently understanding practice ,context' and its impact on the provision of person centred continence care is of value. Methods., Case study methodology with several data collection methods was utilized to measure all aspects of ,context' as identified by the PARIHS framework. Methods include: Royal College of Physicians Audit Scheme, Staff Knowledge questionnaire, semi-structured observation of practice and multidisciplinary focus groups. Findings., The data were analysed in two stages. Stage 1 using both qualitative and quantitative (SPSS 12) methods. Stage 2 analysed all the data utilizing the characteristics of context from the PARIHS framework in order to identify the strong and weak characteristics of the context within which continence care was provided. Continence care and management in this study was found to be focused on continence containment rather than proactive management. The evidence suggests that the context (leadership, culture and evaluation) was weak and not conducive to person centred continence care and management. Conclusion., An analysis of the data using the context framework provided a picture of the context within the units and the identification of the specific contextual issues hindering and enabling the delivery of person centred continence care. This process has thus, added to our understanding of the importance of context to the provision of person-centred care. [source]

Oral health status in relation to ethnicity of children in the Municipality of Copenhagen, Denmark

INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2003
A. Sundby
Summary. Approximately 25% of children under the age of 18 in the Municipality of Copenhagen have a non-Danish ethnic background, and it is suspected that there may be major inequalities in oral health as a result. Objectives. The objectives of this study were to describe the occurrence of dental caries in different ethnic minorities, and to analyse whether the dental caries experience of the children may be affected by cultural and behavioural differences. Materials and methods. The study was conducted in Copenhagen as a cross-sectional investigation of 794 children, aged 3 and 5 years old (preschool), 7 years old (Grade 1) and 15 years old (Grade 9). Children of Danish, Turkish, Pakistani, Albanian, Somali and Arabian backgrounds were selected by convenience sampling. Epidemiological data were retrieved from the Danish Recording System for the Public Dental Health Services (SCOR) and sociological data were collected by postal questionnaires. Results. Marked differences in dental caries prevalence were observed when different ethnic minorities were compared to Danish children. These were most prominent for the primary dentition. At age 7, 53% of the Danish and 84% of the Albanian children were affected by dental caries, the mean caries experience was 3·5 dmfs (decayed, missed and filled surfaces) and 13·8 dmfs, respectively. Caries in incisors and/or smooth surfaces was observed in 10% of the Danish children and 48% of the Albanian children. There were cultural differences in dental attendance and self-care practices of children and parents. These socio-behavioural factors may help to explain the differences in dental caries prevalence and severity. Conclusions. Development of appropriate oral health promotion strategies is urgently needed to improve oral health behaviour and attitudes of parents and children of ethnic minorities. Preventive programs should be organized at local community level in close collaboration with key persons of ethnic minority societies. [source]

Scientific Basis of Health Care, 1st edition edited by O. Westwood, Harcourt Health Services, London, 1999, 595 pages, £19·95, ISBN: 0 723 42440 3.

JOURNAL OF ADVANCED NURSING, Issue 2 2001
Dinah Gould
No abstract is available for this article. [source]

Managing Mental Health Services

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 2 2000
Amanda Reynolds & Graham Thornicroft
No abstract is available for this article. [source]

Retention of Pregnancy-Related Weight in the Early Postpartum Period: Implications for Women's Health Services

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2005
Lorraine O. Walker
Objective: To examine the proportion of women who reached their prepregnant weight at 6 weeks postpartum and the average amount of weight retained or lost by this time; to determine predictors of early (6 week) postpartum weight retention; and to propose related implications for women's health care and services. Data Sources: The literature review was based on a search of Medline for the years 1986 to 2004 using the keywords postpartum weight with inclusion of additional articles known to the authors that did not appear in the electronic search. Study Selection: The resulting 83 articles were scrutinized to identify those that reported data on weight retention at 6 weeks postpartum (range, delivery to 3 months) and associated anthropometric, social, obstetric, or behavioral predictors. A total of 12 articles met inclusion criteria for the review. Data Extraction: Data were extracted related to the proportion of women achieving their postpartum weight at 6 weeks postpartum, the amount of weight retained or lost up to 6 weeks postpartum, and predictors of amount of weight retained or lost. Data Synthesis: On average, at 6 weeks postpartum, women retain 3 to 7 kg of the weight gained during pregnancy, with at least two thirds exceeding their prepregnant weights. Gestational weight gain is the most significant predictor of weight retention. Conclusions: Women vulnerable to obesity and weight gain need weight-related health care and improved access to such care to promote weight loss after 6 weeks postpartum. [source]

Aggression and violence in mental health services: categorizing the experiences of Irish nurses

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2007
J. MAGUIRE msc ba(hons) ffnrcsi rpn rgn dip
There is growing evidence that nurses in mental health services are likely to be victims of violence or aggression. One of the key difficulties in comparing international findings, however, has been that there has been an inadequate categorization of the types of incident to which staff are exposed. The current study aimed to identify the types of violent or aggressive incidents that staff in Irish Mental Health Services were exposed to within a 1-month long period. A cross-sectional study was undertaken with all nurses working in one of the Mental Health Services in Ireland, serving both an urban and rural population. Data were collected through a questionnaire (Scale of Aggressive and Violent Experiences) adapted from the Perceptions of Prevalence of Aggression Scale. The questionnaire was designed to collect data relating to both personal and professional demographics of the sample as well as experiences of aggressive or violent incidents respondents may have encountered in their work situation. There was a response rate of 31%. Data were analysed utilizing SPSS-11. Both descriptive and inferential analyses were undertaken. The relevant data were subjected to a series of one-way anovas and chi-squared analysis. The findings suggest that nursing staff in this Mental Health Service experienced high levels of verbal aggression, with distinctions obvious between threatening and non-threatening aggression, suggesting discernment in terms of intentionality. Additionally, respondents encountered greater levels of covert or indirect violence or aggression than forms that were overtly directed towards staff. The implications are discussed in relation to both policy and practice. [source]

Improving Dental Public Health Services through Advancement of a Workforce Agenda

JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 1 2006
Robert J. Weyant DMD
No abstract is available for this article. [source]

Changing Dentate Status of Adults, Use of Dental Health Services, and Achievement of National Dental Health Goals in Denmark by the Year 2000

JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2004
DrOdontSci, MSc (Sociology);, Poul Erik Petersen DDS
ABSTRACT Objectives: This study analyzes the current profile of dentate status and use of dental health services among adults in Denmark at the turn of the millennium, assesses the impact on dentate status of sociodemographic factors and use of dental health services in adulthood and in childhood, and highlights the changes over time in dental health conditions among adults. Finally, the intention of the study was to evaluate the Danish dental health care system's level of achievement of the official goals for the year 2000 as formulated by the World Health Organization and the National Board of Health. The subjects of this study included a national representative sample of 16,690 Danish citizens aged 16 years and older (response rate=74.2%). A subsample (n=3,818) took part in a survey of dental care habits in childhood and prevalence of removable dentures; 66 percent of persons selected responded. Methods: Personal interviews were used to collect information on dentate status, use of dental health services and living conditions; data on dental care habits in childhood and prevalence of removable dentures were collected by self-administered questionnaires. Results: In all, 8 percent of interviewed persons were edentulous, while 80 percent had 20 or more natural teeth. At age 65,74 years, 27 percent were edentulous and 40 percent had 20 teeth or more; 58 percent wore removable dentures. Dentate status and prevalence of dentures were highly related to educational background and income, particularly for older age groups. Among persons interviewed, 80 percent paid regular dental visits and visits were most frequent among persons of high education and income. At age 35,44 years 95 percent had participated in regular dental care in childhood compared to 49 percent of 65,74-year-olds. Multivariate analyses revealed that sociobehavioral factors had significant effects on dentate status. Conclusions: Compared to similar studies carried out in 1987 and 1994, the present survey indicates a positive trend of improved dentate status in adult Danes in general and regular use of dental health services increased considerably over time. The WHO goals for better dental health by the year 2000 were achieved for 35,44-year-olds, whereas the goal of more people with functional dentitions at age 65 years or older was not achieved. It remains a challenge to the Danish dental health system to help even out the social inequalities in dental health. [source]

Strategies for Implementing School-Located Influenza Vaccination of Children: A Systematic Literature Review

JOURNAL OF SCHOOL HEALTH, Issue 4 2010
John Cawley PhD
BACKGROUND: The Advisory Committee on Immunization Practices (ACIP) recommends influenza vaccinations for all children 6 months to 18 years of age, which includes school-aged children. Influenza immunization programs may benefit schools by reducing absenteeism. METHODS: A systematic literature review of PubMed, PsychLit, and Dissertation Abstracts available as of January 7, 2008, was conducted for school-located vaccinations, using search words "School Health Services" and "Immunization Programs"; limited to "Child" (6-12 years) and "Adolescent" (13-18 years) for PubMed and "mass or universal" and (immuniz* or immunis* or vaccin*) and (school or Child or Adolescen*) for PsychLit and Dissertation Abstracts. Fifty-nine studies met the criteria for review. RESULTS: Strategies such as incentives, education, the design of the consent form, and follow-up can increase parental consent and number of returned forms. Minimizing out-of-pocket cost, offering both the intramuscular (shot) and intranasal (nasal spray) vaccination, and using reminders can increase vaccination coverage among those whose parents consented. Finally, organization, communication, and planning can minimize the logistical challenges. CONCLUSIONS: Schools-based vaccination programs are a promising option for achieving the expanded ACIP recommendation; school-located vaccination programs are feasible and effective. Adhering to lessons from the peer-reviewed scientific literature may help public health officials and schools implement the expanded recommendation to provide the greatest benefit for the lowest cost. Given the potential benefits of the expanded recommendation, both directly to the vaccinated children and indirectly to the community, prospective, well-controlled trials to establish the cost-effectiveness of specific vaccination strategies should be high priorities for future research. [source]

Implementation of a Coordinated School Health Program in a Rural, Low-Income Community

JOURNAL OF SCHOOL HEALTH, Issue 9 2007
BSHRM, Lisa Cornwell RN
ABSTRACT Background:, Coordinated school health programs (CSHPs) bring together educational and community resources in the school environment. This method is particularly important in rural areas like Kansas, where resources and trained health professionals are in short supply. Rural Stafford County, Kansas, struggles with health professional shortages and a low-income, high-need population. Methods:, In 2001, Stafford County's Unified School District 349 began a multiyear CSHP development process, which required adaptations for implementation in a rural area. First, a CSHP team was formed of community and administrative stakeholders as well as school system representatives. Next, the CSHP team assessed school district demographics so the program framework could be targeted to health needs. During a yearlong planning phase, the CSHP team determined 4 priority areas for program development, as limited staff and funds precluded developing programs in all 8 traditional CSHP areas. Program activities were tailored to the population demographics and available resources. Results:, Program outcomes were supported by School Health Index (SHI) data. Of the 8 CSHP focus areas, the SHI found high scores in 3 of the Stafford CSHP's priority areas: Health Services; Psychological, Counseling, and Social Services; and Physical Education. The fourth Stafford CSHP priority area, Nutrition Services, scored similarly to the less prioritized areas. Conclusions:, The process by which the Stafford school district modified and implemented CSHP methods can serve as a model for CSHPs in other rural, high-need areas. [source]

Follow-Up Comparisons of Intervention and Comparison Schools in a State Tobacco Prevention and Control Initiative

JOURNAL OF SCHOOL HEALTH, Issue 3 2006
Phyllis Gingiss
The intervention, which was funded through the Texas Department of State Health Services, consisted of guidance, training, technical assistance, and reimbursement of approximately $2000 per year for program expenses. Self-administered written surveys for Principals and Health Coordinators, based on the School Health Education Profile Tobacco Module, were designed for periodic assessment of the status of school programs. Surveys were sent in 2002 to intervention (n = 74) and comparison (n = 60) schools. Response to the Principal Survey was received from 109 (81%) schools, and response to the Health Coordinator Survey was received from 84 (63%) schools. Survey analysis showed that intervention schools more frequently (p , .05) reported: (1) being extremely or moderately active in student cessation support, teacher training, policy development, family involvement, and assessment of the prevention program; (2) using recommended curricula, offering more tobacco-related lessons, involving more teachers, and using more recommended teaching methods such as role-playing, simulations or practice, and peer educators; and (3) having more interest in staff development and more funding to purchase release time. Similarities across schools are provided, as well as recommendations for future planning. (J Sch Health. 2006;76(3):98-103) [source]

Building a Partnership to Evaluate School-Linked Health Services: The Cincinnati School Health Demonstration Project

JOURNAL OF SCHOOL HEALTH, Issue 10 2005
Barbara L. Rose
Partners from the Cincinnati Health Department, Cincinnati Public Schools, Cincinnati Children's Hospital Medical Center, and The Health Foundation of Greater Cincinnati wanted to determine if levels of school-linked care made a difference in student quality of life, school connectedness, attendance, emergency department use, and volume of referrals to health care specialists. School nurses, principals and school staff, parents and students, upper-level managers, and health service researchers worked together over a 2.5-year period to learn about and use new technology to collect information on student health, well-being, and outcome measures. Varying levels of school health care intervention models were instituted and evaluated. A standard model of care was compared with 2 models of enhanced care and service. The information collected from students, parents, nurses, and the school system provided a rich database on the health of urban children. School facilities, staffing, and computer technology, relationship building among stakeholders, extensive communication, and high student mobility were factors that influenced success and findings of the project. Funding for district-wide computerization and addition of school health staff was not secured by the end of the demonstration project; however, relationships among the partners endured and paved the way for future collaborations designed to better serve urban school children in Cincinnati. (J Sch Health. 2005;75(10):363-369) [source]

School Mental Health Services for Homeless Children

JOURNAL OF SCHOOL HEALTH, Issue 7 2002
Laura A. Nabors PhD
No abstract is available for this article. [source]

The Israeli Model for Managing The National List of Health Services in an Era of Limited Resources

LAW & POLICY, Issue 2 2002
Segev Shani
In order to attain financial stability, equality, and quality of care, Israel placed its basic health insurance system under strict government regulation in the National Health Insurance Act (NHIA) of 1994. The act creates the National List of Health Services (NLHS), which outlines the minimal health services (including drugs and medical devices) that the four pre,exiting Sick Funds must supply to their members free of charge or for a relatively small defined co,payment This article analyzes the mechanisms that update the NLHS to ensure the quality of health services provided to all citizens with respect to the constant developments in health technologies both for medical procedures and diagnosis, and for drugs. The article's main conclusion is that Israel offers a unique model for explicit rationing. The process of updating the list of services leads to clear decision making at a national level, one which offers new technologies to all citizens by public funding each year within the limits of an allocated and defined budget. However, the Israeli model is far from perfect, especially as the act does not establish a defined mechanism for allocating an annual budget for updating the list. Therefore, the act cannot assure a health care system with the stability and certainty it requires. [source]