Self-disclosure experience of people with HIV infection in dedicated and mainstreamed dental facilities

The article deals with a case report on the technology transfer of the Lifeline community social alarm system to Slovenia. The main reason the project was initiated is the ageing of the Slovenian population (11% of the population is 65 or over). With this system we intend to support the public's wish to allow the elderly to remain in their own homes for as long as possible instead of placing them in institutional care. Between 1992 and 1995 the following results were achieved: the acceptability of the system in the social environment was increased; a pilot control centre in Ljubljana was established and has been operational for two-and-a-half years; a national dissemination plan was prepared; the integration of the programme into other information systems has been started. One of the main conclusions is that for the successful transfer of a technology which also affects social values in society, a social innovation must support the process.     

Optimizing the consent process for organ donation

The need for home health care has been increasing in Japan and the application of various techniques such as medical informatics are desired to support home health care services. Therefore, we developed an information system for health evaluation of the elderly including patients at home by applying multifunctional telephone set and an IC memory card, by which complaints, symptoms, and conditions by them can be collected, recorded, and transmitted to medical facilities. We also conducted an experiment for trial use of the system with the cooperation of elderly female volunteers. It was recognized that the elderly volunteers could operate the system with the help of public health nurses and their health information could be collected by the system. Although the developed system has some problems, it was suggested that the system would be useful for the support of health evaluation of elderly at home.     

Care for Canada's frail elderly population: fragmentation or integration?

Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. Demonstration projects are needed to evaluate its cost-effectiveness and address issues raised by its introduction.     

In vitro metabolism of cyanohydroxybutene: formation of a glutathione-S-transferase catalyzed product

This paper examines the financing of elderly health care in Japan for medical institutions, nursing homes, and at home. The analysis demonstrates that the conventional figures for elderly health expenditures in Japan systematically underestimate the real costs by excluding the costs of uninsured services, nursing homes, and home health care. The paper estimates these costs and shows that they add about 10% to the conventional figure for elderly health care costs in Japan. This inquiry also shows how government policy for health care financing shaped distinctive Japanese patterns of elderly care provision. The financing system provided a hidden subsidy--through national health insurance coverage of long-term hospitalization--that encouraged high institutionalization rates of elderly in medical facilities. Public financing for long-term elderly hospitalization, however, has not been matched by government attention to quality of care, resulting in serious quality problems and reflecting a social trade-off between cost and quality. Also, until recently the financing system rarely reimbursed home health care, thereby creating strong disincentives to the development of formal home health care services. This analysis has important implications for reforms now being considered by the Japanese government in the financing and provision of health care for the elderly, especially the limitations of relying on reimbursement price policy. The reforms could have unintended negative consequences for equity, efficiency, and quality of care.     

Effects of styrene exposure on middle latency auditory evoked potentials and glial cells in rat

The demand for health care and social welfare services for the elderly has increased and in Japan, there is a need in the social system to improve the quality of life, especially for those who are disabled. This article directs attention to bed-ridden elderly persons from the standpoint of social problems attending economic development and population changes based on data from Japan, the United States, Sweden, and OECD countries. Compared to the United States, there are more bed-ridden elderly in Japan, and inadequate public resources for caring. Physicians, nurses, care workers, and rehabilitation specialists such as physiotherapist and occupational therapist per 1000 aged sixty-five or over are 89.5 in Japan while 237.4 in Sweden. Japan has the fewest such health and welfare personnel among developed countries. Even with increases in such personnel through the New Gold Plan, future increase in aged population would off-set the effect and the problem of providing care for the elderly remains.     

Experienced anesthetists show better reaction to central gas supply dropout--an anesthesia simulator study

The reform process underway within the Italian National Health System is aimed at making decision makers responsible for appropriate and efficient resource utilisation and at ensuring quality of care, eliminating conflict between fairness, quality and cost control. The risk for the quality of the services provided entailed by resource rationalisation is avoidable and controllable. This article explains how the Italian NHS has managed the reform process assuring quality improvement, and describes the policy and the tools adopted. As well as involving all players and the system as a whole in constant improvement, the Italian NHS's policy in pursuing quality of care is based on the adoption of a wide range of measures: measurement of health care and of clinical outcomes, systematic data collection, team work and protocols. The tools adopted, currently under implementation, to support quality control are: an integrated system of indicators for measuring efficiency and quality of NHS structures (demand and accessibility indicators, resource related indicators, activity indicators and result indicators); compulsory accreditation as a prerequisite for health care providers; a system to monitor and control the effects of the new prospective payment system; clinical guidelines (each related to a specific clinical problem); a menu of services (Carta dei Servizi) released by all NHS accredited service providers with full information and warranties regarding the services provided and their quality.     

Mental health and aging: The need for an expanded federal response.

Discusses the mental health problems that may occur as elderly people must face adjustments because of bereavement, poor physical health, the demands of caring for an ill spouse, drug/alcohol abuse, dementia and cognitive impairments, and multiple health problems. Negative social stereotypes associated with both elderly patients and mental health care, limited access to and a lack of trained professionals in the area of geriatric mental health care, lack of outreach, inadequate benefits under prepaid health plans, Medicare and Medicaid, and special problems of ethnic minority and rural elderly people all contribute to an inadequate mental health care system. The author, a US representative, suggests a redesigning of the system and outlines an initiative that addresses the development of an effective mental health care system for the elderly, modification of Medicare and Medicaid, and improvements in quality assurance and access protection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient-oriented quality assurance. Information and cooperation of the health services as a condition for integrated care

The increasing care needs of the elderly and chronically ill have a growing impact on health care services. With complex needs to meet, the patient's quality of life depends on multiple factors, of which the continuity of care plays an important role. Information on the past and present health state and on self care resources are prerequisites for adequate rehabilitation efforts that are patient-oriented and of high quality. Institutionally induced "cascade episodes of incompetence" (Ulmer & Saller, 1994) have to be avoided. To make sure that interventions promote or stabilize the quality of life, the participation of the client is crucial in all stages of the process of care planning and coordination. Integrated care requires the exchange of information and close coordination on the concept of care between all participants in the care process. Yet, collaborative care is often seriously jeopardized by lack of knowledge about the concepts, scope of action and requests of the involved health professionals and services. At the Agnes Karll Institute of Nursing Research an action research project aiming at cooperative quality assurance was carried out. It became obvious that there is a large amount of intersectoral knowledge necessarily needed by all professionals and services to ensure seamless professional care. But often they have no access to the information needed. Therefore a client's accompanying booklet was developed to pass on basic information. It is kept by the client and shall be used and filled out by them, their relatives and the different health professionals and health care services involved.     

The health and welfare system for elderly in France

Dichotomy is the main characteristic of the Health and Welfare system in France. This system lies on two distinct fields, the medical field which is managed by the National Government, and the social field managed by the Local Government. The French home care policy for the elderly has developed a large number of services to assist in activities of daily living, to provide nursing and medical care at home, to improve living conditions, to maintain social relationships, and to postpone institutionalization and hospitalization, respectively. The main home care service is represented by "home helpers" who provide maid Notiniralics services. The second widely used service is the "home care service" performed by a team of nurses, assistant-nurses, psychologists, physiotherapists. This team provides nursing care and assistance in activities of daily living. As for institutions for the elderly, they are divided into welfare and medical institutions. The welfare institutions include social establishments like shelter homes and nursing homes. The medical institutions are mostly represented by long-term care hospitals. One of the main goals of the aging policy is to create medical wards in welfare institutions in response to the increased dependency of the institutionalized elderly. Recent experimental and innovative concepts have been established, such as "shelter homes for dependent elderly" for physically or cognitively impaired elderly.     

Painless dentistry. Fact or fiction?

The complex chronic health problems and functional limitations common in the elderly population place them at risk for complicated hospitalizations and discharge planning. The purpose of this study was to investigate the effectiveness of a discharge planning protocol in identifying elderly patients' home care needs. The sample in this quasiexperimental study consisted of 507 hospitalized patients age 65 years or older. The control group received the usual hospital discharge planning protocol. In the experimental group, nurse/social worker teams coordinated the discharge planning process, using an adapted form of the Discharge Planning Questionnaire (DPQ) to identify the home care needs of elderly patients. Thirty days after hospital discharge, both patient groups participated in a telephone survey to obtain information about health care problems they experienced during home recovery and their use of health care resources. The findings indicated that the majority of the elderly patients had functional dependencies, which required the help of another person to carry out daily household duties and provide assistance with basic needs, especially ambulation. These functionally dependent patients only received home care referrals about 50% of the time. These findings raise questions about current reimbursable services. Logistic regression analysis indicated that patients with increased functional dependency and patient problems during home recovery had a greater likelihood of rehospitalization and emergency department usage. This information about the home care of elderly patients after hospitalization supports the need for comprehensive functional assessment as part of discharge planning. This study also suggests that the nurse/social worker team can provide effective screening and discharge planning coordination of home care. Physician involvement and effective communication networks must be in place.     

How can usability measurement affect the re-engineering process of clinical software procedures?

As a consequence of the dramatic improvements achieved in information technology standards in terms of single hardware and software components, efforts in the evaluation processes have been focused on the assessment of critical human factors, such as work-flow organisation, man-machine interaction and, in general, quality of use, or usability. This trend is particularly valid when applied to medical informatics, since the human component is the basis of the information processing system in health care context. With the aim to establish an action-research project on the evaluation and assessment of clinical software procedures which constitute an integrated hospital information system, the authors adopted this strategy and considered the measurement of perceived usability as one of the main goals of the project itself: the paper reports the results of this experience.     

Internet information sources for the identification of emerging health technologies. A starting point

The basis of an early warning system for new and emerging health technologies is information, and in particular, information that has been selectively extracted from the huge quantity of data in the fields of medicine, science, and biobusiness. The information will be useful only if presented in a format suitable to the needs of health care decision makers and produced at the time most likely to influence the introduction or diffusion of new technologies. In 1997 the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) began a one-year pilot project to identify and provide information on developments in medical technologies that may have a significant impact on health care in Canada. We began by examining the information available to us through the Internet, based on the assumption that electronic sources can offer more timely access to a greater range of information, often with little or no cost involved. It was important to identify the sites that offered the most relevant information in the least amount of time.     

Serological responses in Lyme disease: the influence of sex, age, and environment

Social workers in a rehabilitation hospital established an outreach service through which volunteers with previous amputations visited patients with recent amputations, acting as role models and offering emotional support and information. Volunteers received in-depth training and continued with their own system of support. Patients who were visited had strong positive responses to the program. Critical components of the program were developing a collaborative partnership between volunteers and social workers; demonstrating credibility to health care professionals; linking emotional support, information, and affirmation; providing benefits to both patient and volunteer; and strengthening linkages among patient, community, and institution.     

Hypochondriasis in the elderly: a reaction to social stress

Hypochondriasis in the elderly is often a preventable or reversible syndrome. It can become chronic if the patient finds no relief from social stress or becomes dependent upon medical services as a source of support. When this is recognized, psychotherapeutic intervention is necessary. Although no socioeconomic group is exempt, hypochondriasis in the elderly occurs more often among the lower social classes. Its higher prevalence in this group is attributable to the frequency and severity of social stress and the loss of alternative social opportunities. If psychotherapeutic intervention is necessary, the elderly hypochondriac patient should be helped to recognize social stress as a major source of the problem and to develop a realistic method of coping with it. Apparently the precipitating factors are often in the socioeconomic sphere; hence, social planners should be aware of this fact if the demands on the health care system are to be reduced.     

Chemical synthesis of 15 beta-hydroxytestosterone and its derivatives using a (4-methoxyphenyl)methyl protecting group

This article describes the Community Nursing Organization, a federal health care model designed to provide specific ambulatory and outpatient services to medicare beneficiaries via a nurse managed delivery system under capitated financing. A primary nurse provider, working with the elderly client, family, physician, health care service providers, and community organizations, assesses the need for care and arranges for appropriate services. This nurse must also authorize payment of those services covered by the Community Nursing Organization (CNO). A 3-year demonstration project is currently under way. Findings at 1 year indicate that the system may have a positive effect on client health status.     

Italian ideals

Many reports have been published in the UK about the reform movement in the Italian mental health system, but there has been a relative dearth of information on the practice of psychiatric nursing. Here the author reflects on differences and similarities with Italian colleagues and calls for greater dialogue between psychiatric nurses in the two countries.     

Managing smarter: a decision support system for mental health providers

Financing of mental health care has changed radically, especially with managed care. Shrinking revenues have forced providers to look for creative ways in which to provide quality services at less expense. Delivery of quality services depends largely on the productive use of the provider's prime resource--the clinicians. Productivity was the focus of the PC-based decision support system developed for mental health providers in New York State. It enables administrators to track key indicators of productivity such as face-to-face time and non-face-to-face time against goals. Unmet goals can be pinpointed quickly, and clinicians' caseloads can be reviewed to determine the underlying causes. A key feature of the system is the conversion of raw data into actionable information to help in problem finding and problem solving. The system has been implemented in Ulster County, the pilot site for the project. The software can be customized easily to suit the data of other providers.     

Behavioral medicine, clinical health psychology, and cost offset.

The use of medical services is a function of several interacting psychological and social variables as well as a function of physical malfunction. The clinical significance of addressing patients' psychosocial issues has only occasionally been considered. However, the shift in health care economics toward health care maintenance is responsible for the increased interest in interventions in the domain of behavioral medicine and health psychology. Evidence is reviewed for 6 mechanistic pathways by which behavioral interventions can maximize clinical care and result in significant economic benefits. The rationale for further integration of behavioral and biomedicine interventions is also reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Construction and its characteristic on the concept of a 'health culture'

Toward the 21st century, subjects and methods of hygiene and public health will be specialized and subdivided. However, practical approaches to human health need an integrated method focusing to a structure of human life. Under these circumstances, the concept of 'health culture' becomes prevalent. The role of hygiene related to the improvement of life style, the development of re-cycle system, and fulfillment of a barrier-free system focussed on the handicapped and the elderly have become increasingly important. Therefore, an increase in the recognition to the concept of 'health culture' is essential to the research of hygiene. The purpose of this paper is to make a historical and theoretical analysis of health culture', in order to promote it as the leading concept of all activities concerned with health in the 21st century. The methods of this paper are mainly historical and theoretical review. 'Health culture' was introduced in American and European societies a hundred years ago. Health culture in the USA involves knowledge and skills applied to actual daily life, refrecting pragmatism as the ideal feature of American society. In Germany, the concept of 'Hygienishe Kultur' was established at the field of social hygiene by Grotjahn and by Fischer in the early 20th century. This concept recognized the importance of the development of culture and independence of life in labour based on the evolution of the concept of 'Hygienishe Kultur'. In Japan, under the influence of German social hygiene, the social hygienic theory flourished. A social hygienist, Tetsuo Hoshino used the term 'hygienic culture' in the context of life creation toward a healthy life. Health culture is the total system concerning knowledge, experience, skill, and norms related to health, which has developed with the development of society. It has fundamental function promotes the creation of culture and self-cultivation of living man, whereas, it contributes to the realization of health based on individuality, in conjunction with the co-operation of medical and health sciences. The contemporary representation of health culture includes new health care activities such as self-care, a self-help movement, and health volunteer activities. It means the basic shift of the function of health culture is from that of life style to life movement. Nowadays, the role of hygiene in the total health care system is seriously considered. The goal, objects, and methods of hygiene should be re-evaluated under the concept of 'health culture', in order to re-define hygiene as the science for people living in a society.