Showing papers on "Health care published in 1980"

Patients and healers in the context of culture : an exploration of the borderland between anthropology, medicine, and psychiatry

Abstract: List of Figures Preface 1. Orientations 1: The Problem, the Setting, and the Approach 2. Orientations 2: Culture, Health Care Systems, and Clinical Reality 3. Orientations 3: Core Clinical Functions and Explanatory Models 4. The Cultural Construction of Illness Experience and Behavior, 1: Affects and Symptoms in Chinese Culture 5. The Cultural Construction of Illness Experience and Behavior, 2: A Model of Somatization of Dysphoric Affects and Affective Disorders 6. Family-Based Popular Health Care 7. Patients and Healers: Transactions Between Explanatory Models and Clinical Realities. Part 1. Sacred Folk Healer-Client Relationships 8. Patients and Healers: Transactions Between Explanatory Models and Clinical Realities. Part 2: Professional Practitioner-Patient and Family-Patient Relationships 9. The Healing Process 10. Epilogue: Implications Glossary Bibliography Index

Alternative to Mental Hospital Treatment: I. Conceptual Model, Treatment Program, and Clinical Evaluation

Abstract: • A conceptual model for the development of communitybased treatment programs for the chronically disabled psychiatric patient was developed, and the results of a controlled study and follow-up are reported A community-treatment program that was based on the conceptual model was compared with conventional treatment (ie, progressive short-term hospitalization plus aftercare) The results have shown that use of the community program for 14 months greatly reduced the need to hospitalize patients and enhanced the community tenure and adjustment of the experimental patients When the special programming was discontinued, many of the gains that were attained deteriorated, and use of the hospital rose sharply The results suggest that community programming should be comprehensive and ongoing

Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries

Abstract: 1624 patients who were attending primary health facilities in 4 developing countries were examined to determine how many were suffering from mental disorder. Using stringent criteria to establish the presence of psychiatric morbidity, 225 cases were found, indicating an overall frequency of 13.9%. The great majority of cases were suffering from neurotic illnesses and for most the presenting complaint was of a physical symptom, such as headache, abdominal pain, cough or weakness. The health workers following their normal procedure correctly detected one third of the psychiatric cases.

Technology in mental health care delivery systems

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Treatment of Out-of-Hospital Cardiac Arrests with Rapid Defibrillation by Emergency Medical Technicians

Abstract: The survival rate for patients with out-of-hospital cardiac arrest is low in communities where emergency service is provided solely by emergency medical technicians. We trained such technicians in a suburban community of 79,000 to recognize and treat out-of-hospital ventricular fibrillation with up to three defibrillatory shocks without the use of medications or special airway protection. Outcomes from cardiac arrest due to underlying heart disease were determined during two periods: two years with standard care by emergency medical technicians and one year with defibrillator-trained technicians. During the period with standard care, four of 100 patients with cardiac arrest were resuscitated and discharged alive from the hospital, as compared with 10 of 54 patients during the period with defibrillator-trained technicians (P less than 0.01). In 12 of 38 patients with ventricular fibrillation, a stable perfusing cardiac rhythm followed defibrillatory shocks given by defibrillator technicians. The enhanced survival after cardiac arrest is encouraging, and further trials of defibrillation by emergency medical technicians are warranted.

The development of a subjective health indicator

Abstract: Changing patterns of concern in medicine and health care have interacted with philosophic trends in social sciences and politics to create demands for new directions in the measurement of health. Traditional indicators such as morbidity and mortality are seen to require supplementation by more subjective assessments of need. The addition of subjective data, collected in a standardized way could enable those concerned to delineate more closely the needs and problems of the community. The practical development of a subjective health indicator is described. The ultimate objective is to produce an instrument which can be used as a population survey tool, where the information obtained could add a new dimension to traditional indices of health. Studies carried out over the past four years have led to the construction of an indicator in the form of a profile which has been shown to provide valid measures of perceived health status and to be acceptable to respondents.

Strategies for enhancing patient compliance

Abstract: Patient noncompliance is a substantial obstacle to the achievement of therapeutic goals. This paper reviews a number of practical interventions with demonstrated efficacy in enhancing patient adherence, including (1) improving patients' levels of information concerning the specifics of their regimens, reinforcing essential points with review, discussion, and written instruction, and emphasizing the importance of the therapeutic plan, (2) taking clinically appropriate steps to reduce the cost, complexity, duration, and amount of behavioral change required by the regimen and increasing the regimen's convenience through “tailoring” and other approaches, (3) obtaining a compliance-oriented history of the patient's prior experiences and present health beliefs and, where necessary, employing strategies to modify those perceptions likely to inhibit compliance, (4) improving levels of patient satisfaction, particularly with the provider-patient relationship, (5) arranging for the continued monitoring of the patient's subsequent compliance to treatment, (6) increasing staff awareness of the magnitude and determinants of the noncompliance phenomenon and attempting to develop an “active influence orientation” in each member of the health care team, (7) using such techniques as patient-provider contracts to involve the patient in therapeutic decisions and in the setting of treatment objectives and creating incentives (through rewards and reinforcements) for achieving these objectives, (8) arranging for as much continuity of provider (and other staff) as possible, (9) establishing methods of supervising the patient, including involvement of the patient's social support network, and (10) involving fully the assistance of all available health care providers, assigning specific roles and responsibilities for activities directed at improving adherence to treatment.

Assessment of preferences for self-treatment and information in health care.

Abstract: It has been assumed that it is beneficial for patients to become active and informed participants in health care. Previous research, however, suggests that individuals differ in their receptiveness to information and self-care in treatment stiuations. This article reports the development and validation of the Krantz Health Opinion Survey, a measure of preferences for different treatment approaches. This measure yields a total score and two relatively independent subscales that measure, respectively, preferences for information and for behavioral involvement (i.e., self-care and active participation) in medical care. Three related studies demonstrated the ability of the subscales or total score to predict with some specificity (a) criterion group membership (clinic users and enrollees in a self-care course), (b) reported use of clinic facilities, and (c) overt behavior (e.g., inquisitiveness, self-diagnosis) in a medical setting. Discriminant validity of the instrument is also established. Theoretical implications of the preference constructs are described in terms of the concept of personal control, and practical implications of the measure are presented.

Bringing the models together: An empirical approach to combining variables used to explain health actions

Abstract: Considerable confusion has existed among researchers with regard to the selection of a particular model of health behavior for study, and many investigators have long felt that the actual number of truly distinct concepts relevant to explaining health-related actions is considerably lower than the large number of variables currently employed. This paper explores selected approaches and models which have been advanced to explain health actions, in terms of structural similarities and differences identified by a panel of judges who are the relevant experts in this field. Judges were asked to partition a set of 109 variables, representing 14 different models, into 12-14 groups on the basis of similarity. The structural similarities among the variable groups were evaluated using Smallest Space Analysis. Six interpretable factors emerged from the analyses: (1) accessibility to health care, (2) evaluation of health care, (3) perception of symptoms and threat of disease, (4) social network characteristics, (5) knowledge about disease, and (6) demographic characteristics. The results of the study provide a first step in developing a unified framework for explaining health actions.

Principles of economic appraisal in health care

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Health Care in the U.S.: Equitable for Whom?

Abstract: This is an important study of health care in America, which was conducted by the Center for Health Administration Studies, University of Chicago. Who, it asks, has access to health care and at what price? A large sample of people from various groups, including those with low incomes, and ethnic and rural groups, answered questions on such topics as the availability of doctor appointments and emergency care, waiting time in doctors' offices, and confidence in the doctor's ability. One of the study's most innovative features is its development of ways to measure health care needs. '...this book makes an important contribution to the fields of medical sociology and health services research.' -- American Journal of Sociology

Predicting the outcome of psychotherapy: Findings of the Penn Psychotherapy Project.

Abstract: • Our study of predictability of outcomes of psychotherapy used predictions of two kinds: (1) direct predictions by patients, therapists, and clinical observers; and (2) predictive measures derived from the same sources. Seventy-three nonpsychotic patients were treated in psychoanalytically oriented psychotherapy (mean, 44 sessions). Two thirds of the therapists were residents in psychiatry; one third were more experienced. The two main composite outcome measures, measured at termination, were Raw Gain (residualized) and Rated Benefits, which intercorrelated at .76. Most patients improved and showed a considerable range of benefits. The clinical observers' direct predictions of Rated Benefits were highest (.27, P 39 ( P

Success and failure in time-limited psychotherapy. A systematic comparison of two cases: comparison 1

Abstract: • Why do some patients succeed in psychotherapy whereas others fail? Moreover, what can be learned from a comparison of two comparable patients treated by the same therapist under very similar conditions? Two cases drawn from the Vanderbilt Psychotherapy Project, a controlled study of process and outcome, were studied with a view toward deepening scientific and clinical understanding of time-limited psychoanalytic psychotherapy. Analyses of this kind are also important because the typical psychotherapy outcome study largely ignores individual cases entering into data of "average improvement." Based on systematic outcome and process measures, combined with a detailed study of complete process recordings, the case histories presented herein were those of two young men suffering from anxiety, depression, and social withdrawal who were treated by the same psychotherapist. The results of this analysis, the first of a series, suggest that therapy outcomes are importantly determined by the patient's ability to take advantage of the particular relationship the therapist has to offer; conversely, therapy fails if there is a poor match on these dimensions. Pertinent variables are further specified.

Methodological issues in health care surveys of the Spanish heritage population.

Abstract: This paper examines national survey data on access to medical care to explore methodological issues associated with conducting health care surveys of Spanish-heritage persons. These include problems of identifying and sampling such groups, achieving respondent cooperation, designing valid interview protocols, and controlling biases that may result from the cultural specificity of the concepts being studied. The findings suggest that more attention should be given to the following in designing health care surveys of Spanish-heritage individuals: cultural and economic heterogeneity of "Spanish-heritage" grouping, validity studies of health care utilization, and yea-saying tendencies related to health care attitude items. Given that there is a paucity of information available on methodological problems associated with health care surveys of Spanish-heritage persons, these analyses should serve to inform researchers of issues to be taken into account in designing such studies and to suggest useful hypotheses ...

Hospital and home support during infancy: impact on maternal attachment, child abuse and neglect, and health care utilization.

Abstract: Effects of early and extended postpartum contact and paraprofessional home visits on maternal attachment, reports of child abuse and neglect, and health care utilization were determined by random assignment of 321 low-income women to intervention or control groups immediately after delivery. Observations of maternal attachment were made at four months and 12 months. Hospital, health and welfare agency records, and interviews were used to determine reports of child abuse and neglect and health care utilization. After establishing a control for maternal background variables, early and extended contact explained statistically significant but small amounts of variance in several of the attachment measures. There were no statistically significant effects of the home visit interventions on maternal attachment, and neither intervention was related to reports of child abuse and neglect and health care utilization. Although the study supported earlier findings that early and extended contact has a significant effect, additional interventions are needed to support mother-infant attachment.

Creating critical consciousness in health: applications of Freire's philosophy and methods to the health care setting.

Abstract: Paulo Freire's philosophy of “education for critical consciousness” takes on special relevance within the context of the health care system. This dialogical approach to change, stressing action based on critical reflection by the people, is seen here as importantly supplementing current efforts to deal with the “health care crisis” in the United States and many developing countries.Applications of the Freire approach in a health context of necessity involve the perception of health and medical care within the total oppressive structure of society. Viewed thusly, health “reform” cannot justifiably be envisioned except within the context of broader structural transformations. Two case studies are presented to illustrate the application of the Freire approach within a health context. Successful utilization of the methodology among peasants in rural Honduras and a relatively unsuccessful application among impoverished elderly residents of an urban United States ghetto are described and analyzed.Modifications ...

Improvements in burn care, 1965 to 1979.

Abstract: Data from the National Burn Information Exchange indicate that the quality of burn care in the United States is improving in the participating health care facilities. Case reports of 37,442 patients collected between 1965 and 1979 from 120 burn care facilities have been examined. These data show that overall survival rates are increasing and hospitalization times are decreasing at all levels of burn severity. The changes are associated with a trend toward more timely wound closure for full-thickness burns and are evident in the majority of hospitals studied. Tables of current survival rates and hospitalization times, by patient age and size of burn, are presented. ( JAMA 244:2074-2078, 1980)

Utilization of Health and Mental Health Services in a Large Insured Population

Abstract: The authors analyzed 1975 data on the use of health and mental health services by the 2.3 million people covered by Michigan Blue Cross and Blue Shield. Only 4.6% of the covered population submitted hospital or physician claims for mental disorder; these people accounted for 7.3% of total hospital and physician charges for all health services in the covered population. According to the claims submitted, nonpsychiatric physicians saw almost half of all patients who were given a diagnosis of mental disorder, but psychiatrists accounted for the great bulk of mental health services and charges to these patients. High utilizers comprise a small proportion of all patients but account for a high proportion of charges for mental disorders and for all diagnoses.

Sex differences in complaints and diagnoses.

Abstract: This paper examines male-female differences in complaints and diagnoses for ambulatory care visits. Data are from the 1975 National Ambulatory Medical Care Survey, a national probability survey of visits to office-based physicians. The results suggest that: (1) Men are often unaware of serious health problems, they delay seeking diagnosis and care for symptoms, and they hesitate to admit symptoms and known health problems when they do visit a physician. (2) Women appear to have a more diffuse view of illness. They often report both mental and physical symptoms, and their physical symptoms “radiate” throughout the body rather than remain localized. (3) Both sexes confuse reproductive, digestive, and urinary symptoms because the body systems overlap. (4) Some sex differences in diagnoses for a particular symptom reflect real morbidity differences. (5) There is little evidence that women and men differ in their perception, interpretation, and description of physical symptoms. (6) The evidence for sex bias in physicians' diagnoses is scant.

Vulnerable Children: Parents' Perspectives and the Use of Medical Care

Abstract: In a study of use of five general pediatric services, 750 parents were interviewed on site about their decisions on how and when to seek medical care for their children. Parents' fears that a particular child was "vulnerable"--ie, uniquely threatened by an episode of illness--was a recurrent concern (reported by 27%), explaining many of their medical visits. Medical record review indicated that in 40%, there was no clinical basis for these parent concerns. One important source of these unwarranted concerns was fear of recurrence of an earlier medical problem, long since resolved. In some families, the role of social and environmental issues in generating a high level of concern was evident. Vulnerable children made more visits per year and made many more of their visits to the emergency room, and their parents more often expressed dissatisfaction with care received. Recognition of reasons underlying parents' sense of the child's special status may do much to allay unnecessary fears and promote more appropriate use of health care facilities.

Doctors and Their Workshops

Abstract: Doctors are obviously influential in determining the costs of their services. But even more important, many believe, is the influence physicians have over the use and cost of nonphysician health-care resources and services. Doctors and Their Workshops is the first comprehensive attempt to use economic analysis to understand some of the physician effects on nonphysician aspects of health care.

Equity and the NHS: self-reported morbidity, access, and primary care.

Abstract: The patterns of access to primary health care for 27 154 people were examined, using the raw data of the 1974 General Household Survey about self-reported morbidity and use of services. Access rates were calculated for four categories of health: the not ill, the acutely sick, the chronically sick without restricted activity, and the chronically sick with restricted activity. Contrary to the conclusions of existing publications, the analysis shows that the NHS has achieved equity in terms of access to primary health care: there is no consistent bias against the lower socioeconomic groups and, in the case of some health care categories, these have proportionately higher rates of access than their rates of self-reported morbidity would indicate. The findings also show large variations in patterns of access both between and within these categories of health.

HMO enrollment: who joins what and why: a review of the literature.

Abstract: Enrollment in an HMO involves a simultaneous choice of insurance benefits and a provider system. Review of an extensive series of studies shows that breadth of coverage, lower cost, and assured access to benefits are key elements anticipated in the choice. But so too are the perceived limitations inherent in selection of a physician within a close-panel plan, and the inconvenience of centralized sites. For the design and evaluation of future policy, current knowledge based on past enrollment behavior offers only tentative suggestions.