Showing papers on "Health care published in 1985"

Expanding patient involvement in care. Effects on patient outcomes.

Abstract: An intervention was developed to increase patient involvement in care. Using a treatment algorithm as a guide, patients were helped to read their medical record and coached to ask questions and negotiate medical decisions with their physicians during a 20-minute session before their regularly scheduled visit. In a randomized controlled trial we compared this intervention with a standard educational session of equal length in a clinic for patients with ulcer disease. Six to eight weeks after the trial, patients in the experimental group reported fewer limitations in physical and role-related activities (p less than 0.05), preferred a more active role in medical decision-making, and were as satisfied with their care as the control group. Analysis of audiotapes of physician-patient interactions showed that patients in the experimental group were twice as effective as control patients in obtaining information from physicians (p less than 0.05). Results of the intervention included increased involvement in the interaction with the physician, fewer limitations imposed by the disease on patients' functional ability, and increased preference for active involvement in medical decision-making.

Gender and health: an update on hypotheses and evidence.

Abstract: This is a "state of the issue" paper about gender and physical health. It organizes the hypotheses proposed for male-female differences in physical health status, therapeutic health behaviors, and longevity and it summarizes empirical research, especially sociological research, on the topic over the past 10-15 years. Capsule summaries of sex differentials in health and of recent trends in health and morality are also presented for American (U.S.) men and women. The central theoretical viewpoint of this paper is that sex differences in health are principally the outcome of differential risks acquiredfrom roles, stress, life styles, and preventive health practices. Psychosocial factors-how men and women perceive and evaluate symptoms, and their readiness and ability to take therapeutic actions-are important as well, but typically secondary to acquired risks. Other factors such as prior health care, biological risks, health reporting, and caretaker effects (for example, physician sex bias) have even smaller importance. We hypothesize that the relative weight of acquired risks and psychosocialfactors varies for different types of health problems as follows: (1) Psychosocial factors have their greatest weight in responses to chronic, nonfatal, or low severity diseases and injuries and (2) gender differences are also greatest in responses to these; that is, men and women differ more in their perception, evaluation, and treatment of prolonged, mild conditions than of acute, life-threatening, or severe ones. The paper suggests some strategies for social science research on male-female health differences in the next decade or two.

Just Health Care

Abstract: How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area.

Therapist Success and Its Determinants

Abstract: • This study examined the relatively unexplored contribution of the therapist's performance in determining outcomes of treatment. Nine therapists were studied: three performed supportive-expressive psychotherapy; three, cognitive-behavioral psychotherapy; and three, drug counseling. Profound differences were discovered in the therapists' success with the patients in their case loads. Four potential determinants of these differences were explored: (1) patient factors; (2) therapist factors; (3) patient-therapist relationship factors; and (4) therapy factors. Results showed that (1) patient characteristics within each case load (after random assignments) were similar and disclosed no differences that would have explained the differences in success; (2) therapist's personal qualities were correlated with outcomes but not significantly (meanr=.32); (3) an early-in-treatment measure of the patienttherapist relationship, the Helping Alliance Questionnaire, yielded significant correlations with outcomes (meanr=.65); (4) among the therapy techniques, "purity" provided significant correlations with outcomes (meanr=.44), both across therapists and within each therapist's case load. The three therapist-related factors were moderately associated with each other.

Expanding Patient Involvement in Care

Abstract: An intervention was developed to increase patient involvement in care Using a treatment algorithm as a guide, patients were helped to read their medical record and coached to ask question

Handbook of toxic and hazardous chemicals and carcinogens

Abstract: Concise chemical, health, and safety information on some 1,300 toxic and hazardous chemicals (up from less than 800 in the second edition) for chemical manufacturers, safety equipment producers, toxicologists, industrial safety engineers, waste disposal operators, health care professionals, and othe

The economic costs of illness: a replication and update.

Abstract: The economic burden resulting from illness, disability, and premature death is of major importance in the allocation of health care resources and in the evaluation of health research and programs. This article updates the 1963 and 1972 studies of the costs of illness. In 1980, the estimated total economic costs of illness were $455 billion: $211 billion for direct costs, $68 billion for morbidity, and $176 billion for mortality. Diseases of the circulatory system and injuries and poisonings were the most costly, with variations in the diagnostic distributions among the three types of costs and by age and sex.

Physician utilization: the state of research about physicians' practice patterns.

Abstract: Reprinted with permission from Medical Care 1985;23:461-483 Copyright ? 1985 by JB Lippincott Company A group of Americans who represent less than one half of 1% of the population determine how nearly 10% of the nation's gross national product will be spent, Although physicians' professional fees represent only one fifth of health care expenditures, they are responsible far decisions that govem the way that as much as 90% of each health care dollar is used Despite the economic importance of physicians' decisions, only recently have investigators begun to explore the factors that govem medical decision making Even more recently have health services researchers begun to evaluate ways of motivating doctors to provide more costeffective medical care

The Stanford Five-City Project: design and methods.

Abstract: The Stanford Five-City Project is a large experimental field study of community health education for the prevention of cardiovascular disease. It will provide data on fundamental questions in cardiovascular disease epidemiology, communication, health education, behavior change, and community organization, and will also test the ability of a potentially cost-effective program to prevent cardiovascular disease at the community level. This paper describes the purposes, hypotheses, design, and methods of the Five-City Project as a reference for future papers describing results. It is hypothesized that a 20% decrease in cardiovascular disease risk will lead to a significant decline in cardiovascular disease event rates in two treatment communities compared with three reference communities as a result of a six-year intervention program of community-wide health education and organization. Risk factor change will be assessed through four surveys of independent samples and in a repeatedly surveyed cohort. Cardiovascular disease event rates will be assessed through continuous community surveillance of fatal and nonfatal myocardial infarction and stroke.

Medicine in China : a history of ideas

Abstract: In the first comprehensive and analytical study of therapeutic concepts and practices in China, Paul Unschuld traces the history of documented health care from its earliest extant records to present developments.

Measurement of health status.

Abstract: According to a now classic article by Moriyama,1 until the early 1960s, death rates provided the only relevant and sensitive measure of the health of populations. But by the mid 1960s, death rates, whether population-specific or general, no longer seemed sensitive to the changes that were taking place in health and health care in the United States. Further, Moriyama argued that death rates were unlikely to change materially except if major medical breakthroughs to increase life expectancy occurred. At about the same time, more reliance was being placed on measures of morbidity-which had been refined by the early 1960s-to assess health status. The National

A study of occupational exposure to antineoplastic drugs and fetal loss in nurses.

Abstract: In a case--control study, we examined the relation between fetal loss and occupational exposure to antineoplastic drugs in nurses in 17 Finnish hospitals. The pregnancies studied occurred in 1973 through 1980 and were identified using three national sources: the Central Register of Health Care Personnel, the Hospital Discharge Registry, and policlinic data. Each nurse with fetal loss was matched with three nurses who gave birth. Data on health and exposure were obtained by self-administered, mailed questionnaires; a response rate of 87 per cent was achieved after three mailings. A statistically significant association was observed between fetal loss and occupational exposure to antineoplastic drugs during the first trimester of pregnancy: odds ratio = 2.30 (95 per cent confidence interval, 1.20 to 4.39). Analyses suggested associations between fetal loss and cyclophosphamide, doxorubicin, and vincristine, although the independent effect of each individual drug could not be specifically identified, since many nurses reported handling more than one of these agents. The results of this study, combined with existing data on animals and human beings, suggest that caution be exercised in the handling of these valuable drugs.

Contact with health professionals for the treatment of psychiatric and emotional problems.

Abstract: This study focuses on predisposing, enabling, and need factors affecting contact with health professionals for the treatment of psychiatric and emotional problems during a 6-month period. Data are from the first wave of the Yale Epidemiologic Catchment Area (ECA) Project. The study confirms the important relationship of psychopathology to both the likelihood of using mental health related services and the quantity of service contacts. Sex, age, race, education, marital status, usual source of medical care, and attitudes toward mental health services were found to exert independent effects on the likelihood of contact with a health professional after controlling for clinical status. Factors affecting the quality of service contacts among utilizers were psychiatric status, usual source of care, and attitudes.

A simple language-based acculturation scale for Mexican Americans: validation and application to health care research.

Abstract: A simple scale for quantifying English use among Mexican Americans was constructed from four brief questions which proved to have excellent scaling characteristics by Guttman Scalogram Analysis in two independent data sets. Construct validity was established by significant associations of the scale with ethnicity, place of birth, generation within the United States, and type of neighborhood. Highly significant associations were found between scale scores and use of oral contraceptives, parity, "fatalism" regarding health, and attitudes toward folk healers. These associations remained significant (though weak) after controlling for education and family income. The language scale thus appears to be reliable and valid, to be capable of distinguishing meaningful subsets among the Mexican American population, and to be applicable to health care investigation.

Struggles for control: the social roots of health and healing in modern Africa.

Abstract: This paper is a general interpretation of the social determinants of health and health care in Africa over the past century. The evolution of health cannot be separated from the broader story of social change. The political and economic forces which shaped the continent's history also established the framework within which patterns of diagnosis and treatment, health and disease, emerged. The implication of this is that healers of all kinds—whether doctors or “traditional healers”—have been less influential than we commonly think in shaping states of health or in healing the sick. This position opens up a range of difficult problems which are addressed in the following pages. What is the exact nature of the link between the broad political-economic forces and the distribution of health or disease? Which of these forces have driven therapeutics along its historical path, and by what means? What role do healers actually play? The body of the paper is divided into three main sections. The first explores the micro-sociology of changing treatment of illness. In most African communities several kinds of healers work side by side: physicians or medical assistants, specialists in sorcery or spirit possession, Christian or Muslim religious healers, and others. Multiple authorities co-exist, and therefore no one healer decides the cause or cure of illnesses in a way which others accept as beyond challenge. But treatment cannot exist without coordination. Someone must decide on a course of action when lives are threatened.

Professional satisfaction and client outcomes. a comparative organizational analysis

Abstract: In studies of the effectiveness of health care organizations, the job satisfaction level of professional staff is often viewed as an "outcome," since providing a climate that satisfies participants' needs is one aspect of organizational effectiveness. Staff satisfaction, however, has not been linked with outcomes associated with clients. In this article, the authors examine the relationship between the aggregate job satisfaction level of nursing staff in 77 family planning clinics and two client outcomes: the aggregate satisfaction level of teenage clients with contraceptive services obtained in the clinic, and the subsequent rate of client compliance with contraceptive prescriptions. Among the variables studied in testing an organizational-level model, it is found that the job satisfaction level of nursing staff is the strongest determinant of the aggregate satisfaction level of clients; client satisfaction level, in turn, predicts the rate of clients' subsequent contraceptive compliance. Staff satisfaction has a noteworthy indirect effect on compliance through client satisfaction. Compliance, however, appears to be more susceptible to variations in clinic structure than to variations in staff satisfaction levels. Implications of these findings for studies of effectiveness of health services and for management of health care organizations are discussed.

A randomized controlled study of a home health care team.

Abstract: This report describes the findings of a randomized study of a new team approach to home care for homebound chronically or terminally ill elderly. The team includes a physician, nurse practitioner, and social worker delivering primary health care in the patient's home, including physician house calls. Weekly team conferences assure coordination of patient care. The team is available for emergency consultation through a 24-hour telephone service. The team physician attends to the patient during necessary hospitalizations. This approach was evaluated in a randomized experimental design study measuring its impact on health care utilization, functional changes in patients, and patient and caretaker satisfaction. The team patients had fewer hospitalizations, nursing home admissions, and outpatient visits than the controls. They were more often able to die at home, if this was their wish. As expected, they used more in-home services, measured in weighted cost figures; their overall cost was lower than their controls, but the difference was not statistically significant. Their functional abilities did not change differently from the controls, but they, and especially their informal caretakers in the home, expressed significantly higher satisfaction with the care received.

Health Care of the Elderly

Abstract: OVER the next several decades the practice of medicine in the United States will be increasingly influenced by the health care needs of our rapidly enlarging elderly population. Just as children are not merely young versions of adults, the elderly are not simply old adults. They require special approaches and an understanding of the physiologic, psychosociological, and pathologic impacts of aging. This paper discusses the special considerations important to the proper evaluation of elderly patients, highlights some current controversies in the field, and reviews recent progress in the management of several common clinical problems in the elderly. Coupling Longevity with . . .

Using importance-performance analysis to develop health care marketing strategies.

Abstract: Importance-performance analysis is a useful marketing research technique that can be easily and effectively applied in the health care sector to suggest successful marketing strategies. This article describes how this procedure was used to develop marketing strategies for hospital obstetric services in a southwestern community.

Good health at low cost.

Abstract: This conference report focuses on health related issues in 4 case study areas: Sri lanka India China and Costa Rica. Part 1 of the report is composed of the 4 country reports. The papers discuss the countries health statistics its health care system conductive factors of the health care system the impact of social and economic development and the health care system on infant mortality and the health changes and improvements. Part 2 is composed of 8 papers on health interventions. The presentations address 1) the economic factors that influence the quality of health within the 4 case study areas; 2) key socio-cultural factors influencing infant mortality; 3) social and political factors which contribute to improve health status; 4) education and literacy factors and their relation to health; 5) the role of water supply and sanitation in reducing mortality rates; 6) trends in nutrition food supply and infant mortality rates; 7) vertical programs specific to public health measurements; and 8) an analysis of clinical services in affecting mortality rates. Part 3 includes short remarks on the conference given by the editors of this report. Though their comments varied slightly it was unanimously agreed that high infant mortality rates can be lowered in the developing countries primarily through sustained political commitment to universal health and well being as has been illustrated by the case studies. Other significant contributors include equitable access to primary health care a uniformly accessible education system and assurance of adequate nutrition at all levels of society.

Health care episodes: definition, measurement and use.

Abstract: *Senior Investigator, Kaiser Permanente Center for Health Research, Portland, Ore.; Associate Professor, Department of Community Health Care Systems, School of Nursing, The Oregon Health Sciences University, Portland. †Internist, Northwest Permanente, P.C., Physicians and Surgeons, Portland, Ore.; Adjunct Senior Investigator, Kaiser Permanente Center for Health Research, Portland; Clinical Associate Professor of Medicine, School of Medicine, The Oregon Health Sciences University, Portland. ‡Senior Investigator, Kaiser Permanente Center for Health Research, Portland, Ore. Health care differs from other commodities because it is

Measuring need for mental health services in a general population.

Abstract: This article presents measures of need for mental health services estimated from the 1981 Eastern Baltimore Mental Health Survey, one of five sites participating in the NIMH Epidemiologic Catchment Area Program. Data were collected on the prevalence of specific psychiatric disorders, as determined b

HTLV-III infection among health care workers. Association with needle-stick injuries.

Abstract: Health care workers are caring for an increasing number of persons infected with human T-cell lymphotropic virus type III (HTLV-III), the primary etiologic agent of the acquired immunodeficiency syndrome (AIDS). We studied 361 health care and clinical laboratory personnel from institutions in several metropolitan areas with both high and moderate levels of HTLV-III infection among high-risk group members to evaluate routes of exposure to and seropositivity for HTLV-III. Protection of the privacy of subjects and prospective determination of risk factors were integral components of the study design. Six (26%) of 23 health care workers with recognized risk factors for AIDS had HTLV-III antibodies. Thirty-nine (14%) of 278 workers at one institution as well as a total of five workers from other institutions reported possible percutaneous exposure to HTLV-III, usually injuries with needles that had been used on AIDS patients. There were three HTLV-III seropositive subjects who reported possible parenteral exposure to HTLV-III but no recognized AIDS risk factors. One was a symptomatic female, subject A, and her apparent sources of HTLV-III exposure were two puncture wounds, without injection of blood, made with needles used on AIDS patients. Human T-cell lymphotropic virus type III was cultured from her asymptomatic, seronegative long-term sexual partner, apparently representing female-to-male transmission. For the two other seropositive workers (subjects B and C) with nosocomial parenteral exposure, we could not rule out heterosexual transmission as a possible source of HTLV-III exposure. These latter two cases as well as the identification of seropositive health care providers from known risk groups point to the need for thorough case investigation to identify routes of exposure in health care workers. The risk of nosocomial HTLV-III transmission appears to be low and related to percutaneous exposure. Medical personnel should be trained systematically in the proper techniques and handling of instruments for phlebotomy and similar procedures to decrease occupational exposure to HTLV-III. ( JAMA 1985;254:2089-2093)

Measurement strategies in health psychology

Abstract: Partial table of contents: INTRODUCTION The Logic and Character of Assessment in Health Psychology: Perspectives and Possibilities (P. Karoly) MOLAR APPROACHES TO ASSESSMENT Techniques of Psychosocial Epidemiology (L. Palinkas) Quality of Life Measurement (R. Kaplan) Ecobehavioral Assessment in Health Lifestyles: Concepts and Methods (R. Winett) SPECIALIZED ASSESSMENT METHODS Physical Social, and Inferential Elements of Psychophysiological Measurement (J. Cacioppo and et al.) The Use of Psychodiagnostic Questionnaires in Predicting Risk Factors and Health Outcomes (C. Green) SPECIAL TARGETS OF ASSESSMENT The Measurement of Medical Compliance in the Treatment of Disease (P. Cluss and L. Epstein) Evaluating Social Resources in Community and Health Care Contexts (R. Moos) The Assessment of Pain: Concepts and Procedures (P. Karoly) Index.