Science.gov

Sample records for acute health crisis

  1. A randomized trial of a mental health consumer-managed alternative to civil commitment for acute psychiatric crisis.

    PubMed

    Greenfield, Thomas K; Stoneking, Beth C; Humphreys, Keith; Sundby, Evan; Bond, Jason

    2008-09-01

    This experiment compared the effectiveness of an unlocked, mental health consumer-managed, crisis residential program (CRP) to a locked, inpatient psychiatric facility (LIPF) for adults civilly committed for severe psychiatric problems. Following screening and informed consent, participants (n = 393) were randomized to the CRP or the LIPF and interviewed at baseline and at 30-day, 6-month, and 1-year post admission. Outcomes were costs, level of functioning, psychiatric symptoms, self-esteem, enrichment, and service satisfaction. Treatment outcomes were compared using hierarchical linear models. Participants in the CRP experienced significantly greater improvement on interviewer-rated and self-reported psychopathology than did participants in the LIPF condition; service satisfaction was dramatically higher in the CRP condition. CRP-style facilities are a viable alternative to psychiatric hospitalization for many individuals facing civil commitment. PMID:18626766

  2. Capitals diminished, denied, mustered and deployed. A qualitative longitudinal study of women's four year trajectories after acute health crisis, Burkina Faso

    PubMed Central

    Murray, Susan F.; Akoum, Mélanie S.; Storeng, Katerini T.

    2012-01-01

    Accumulating evidence indicates that health crises can play a key role in precipitating or exacerbating poverty. For women of reproductive age in low-income countries, the complications of pregnancy are a common cause of acute health crisis, yet investigation of longer-term dynamics set in motion by such events, and their interactions with other aspects of social life, is rare. This article presents findings from longitudinal qualitative research conducted in Burkina Faso over 2004–2010. Guided by an analytic focus on patterns of continuity and change, and drawing on recent discussions on the notion of ‘resilience’, and the concepts of ‘social capital’ and ‘bodily capital’, we explore the trajectories of 16 women in the aftermath of costly acute healthcare episodes. The synthesis of case studies shows that, in conditions of structural inequity and great insecurity, an individual's social capital ebbs and flow over time, resulting in a trajectory of multiple adaptations. Women's capacity to harness or exploit bodily capital in its various forms (beauty, youthfulness, physical strength, fertility) to some extent determines their ability to confront and overcome adversities. With this, they are able to further mobilise social capital without incurring excessive debt, or to access and accumulate significant new social capital. Temporary self-displacement, often to the parental home, is also used as a weapon of negotiation in intra-household conflict and to remind others of the value of one's productive and domestic labour. Conversely, diminished bodily capital due to the physiological impact of an obstetric event or its complications can lead to reduced opportunities, and to further disadvantage. PMID:23063215

  3. Capitals diminished, denied, mustered and deployed. A qualitative longitudinal study of women's four year trajectories after acute health crisis, Burkina Faso.

    PubMed

    Murray, Susan F; Akoum, Mélanie S; Storeng, Katerini T

    2012-12-01

    Accumulating evidence indicates that health crises can play a key role in precipitating or exacerbating poverty. For women of reproductive age in low-income countries, the complications of pregnancy are a common cause of acute health crisis, yet investigation of longer-term dynamics set in motion by such events, and their interactions with other aspects of social life, is rare. This article presents findings from longitudinal qualitative research conducted in Burkina Faso over 2004-2010. Guided by an analytic focus on patterns of continuity and change, and drawing on recent discussions on the notion of 'resilience', and the concepts of 'social capital' and 'bodily capital', we explore the trajectories of 16 women in the aftermath of costly acute healthcare episodes. The synthesis of case studies shows that, in conditions of structural inequity and great insecurity, an individual's social capital ebbs and flow over time, resulting in a trajectory of multiple adaptations. Women's capacity to harness or exploit bodily capital in its various forms (beauty, youthfulness, physical strength, fertility) to some extent determines their ability to confront and overcome adversities. With this, they are able to further mobilise social capital without incurring excessive debt, or to access and accumulate significant new social capital. Temporary self-displacement, often to the parental home, is also used as a weapon of negotiation in intra-household conflict and to remind others of the value of one's productive and domestic labour. Conversely, diminished bodily capital due to the physiological impact of an obstetric event or its complications can lead to reduced opportunities, and to further disadvantage. PMID:23063215

  4. [Financial crisis and mental health].

    PubMed

    Giotakos, O

    2010-01-01

    Most studies investigating the effects of the economic crisis on the quality of life indicate a correlation between unemployment or other economic indexes and the general levels of death rates, depression, and suicide tendencies. The most common effects of an economic crisis are unemployment, spending power cuts, general insecurity and public spending retrenchment, including health related budget cuts. Under conditions of economic crisis, the poor represent a high risk group since they are the first ones to be put at risk. At the same time, due to their pre-existing functionality reduction, individuals already experiencing psychiatric diseases also represent a high risk group, thus creating a vice circle where poverty nurtures psychiatric disorders and vice-versa. For every country in the midst of a recession, protecting high risk target groups is the first priority. In these cases, research showcases that social security networks' reinforcement represents the first strategic priority. Other factors, for instance personality features related to increased vulnerability to psychosocial threat -such as low tolerance to frustration or low self esteem- also play an important role. At the organizational level, one has to research practices and policies that employers use to respond to changing conditions. An economic recession is a chance to revamp essential services toward weaker populations that need to be protected. This translates into a buttressing of the social welfare system while promoting timely interventions. Amongst others, the registration of high risk population groups, the rehabilitation and social inclusion of unemployed individuals and individuals with psychiatric problems, the training of first responders and primary care physicians, the tracing and curing of depression and other usual disorders, as well as an improved access to the psychiatric-health provision system.

  5. Enhancing crisis leadership in public health emergencies.

    PubMed

    Deitchman, Scott

    2013-10-01

    Reviews of public health emergency responses have identified a need for crisis leadership skills in health leaders, but these skills are not routinely taught in public health curricula. To develop criteria for crisis leadership in public health, published sources were reviewed to identify attributes of successful crisis leadership in aviation, public safety, military operations, and mining. These sources were abstracted to identify crisis leadership attributes associated with those disciplines and compare those attributes with crisis leadership challenges in public health. Based on this review, the following attributes are proposed for crisis leadership in public health: competence in public health science; decisiveness with flexibility; ability to maintain situational awareness and provide situational assessment; ability to coordinate diverse participants across very different disciplines; communication skills; and the ability to inspire trust. Of these attributes, only competence in public health science is currently a goal of public health education. Strategies to teach the other proposed attributes of crisis leadership will better prepare public health leaders to meet the challenges of public health crises. PMID:24274133

  6. Enhancing crisis leadership in public health emergencies.

    PubMed

    Deitchman, Scott

    2013-10-01

    Reviews of public health emergency responses have identified a need for crisis leadership skills in health leaders, but these skills are not routinely taught in public health curricula. To develop criteria for crisis leadership in public health, published sources were reviewed to identify attributes of successful crisis leadership in aviation, public safety, military operations, and mining. These sources were abstracted to identify crisis leadership attributes associated with those disciplines and compare those attributes with crisis leadership challenges in public health. Based on this review, the following attributes are proposed for crisis leadership in public health: competence in public health science; decisiveness with flexibility; ability to maintain situational awareness and provide situational assessment; ability to coordinate diverse participants across very different disciplines; communication skills; and the ability to inspire trust. Of these attributes, only competence in public health science is currently a goal of public health education. Strategies to teach the other proposed attributes of crisis leadership will better prepare public health leaders to meet the challenges of public health crises.

  7. The Impending Oral Health Crisis.

    PubMed

    Tegtmeier, Carl H; Miller, David J; Shub, Judith L

    2016-04-01

    Last May, the New York State Dental Association and the New York State Dental Foundation convened the first "Oral Health Stakeholders' Summit on the Future of Special Needs Dentistry, Hospital Dentistry and Dental Education." The summit was chaired by David J. Miller, then NYSDA President Elect, and Carl H. Tegtmeier, then chair of the NYSDA Council on Dental Health Planning and Hospital Dentistry. It brought together experts, called to frame the issues and provide information necessary for a reasoned response. And it sought input from attendees to develop recommendations to ensure that patients with intellectual and developmental disabilities, as well as an aging population with Alzheimer's disease and dementia, have access to appropriate oral health care in the years ahead. Over 100 participants, representing dentistry, hospital training programs, third-party payers, state government offices and related patient support associations, attended the two-day event in Albany. They focused on the impact of reductions in funding, the transition of Medicaid services into a managed care model, a loss of service providers and the need for expanded training programs. They heard from speakers epresenting a broad spectrum of those involved in he oral health care of patients with intellectual and evelopmental disabilities, the Alzheimer's Association, dental educators and researchers, hospital dentistry and the benefits industry, whose presentations focused on a looming oral health crisis threatening access to dental care for patients with disabilities. PMID:27348951

  8. Financial crisis, austerity, and health in Europe.

    PubMed

    Karanikolos, Marina; Mladovsky, Philipa; Cylus, Jonathan; Thomson, Sarah; Basu, Sanjay; Stuckler, David; Mackenbach, Johan P; McKee, Martin

    2013-04-13

    The financial crisis in Europe has posed major threats and opportunities to health. We trace the origins of the economic crisis in Europe and the responses of governments, examine the effect on health systems, and review the effects of previous economic downturns on health to predict the likely consequences for the present. We then compare our predictions with available evidence for the effects of the crisis on health. Whereas immediate rises in suicides and falls in road traffic deaths were anticipated, other consequences, such as HIV outbreaks, were not, and are better understood as products of state retrenchment. Greece, Spain, and Portugal adopted strict fiscal austerity; their economies continue to recede and strain on their health-care systems is growing. Suicides and outbreaks of infectious diseases are becoming more common in these countries, and budget cuts have restricted access to health care. By contrast, Iceland rejected austerity through a popular vote, and the financial crisis seems to have had few or no discernible effects on health. Although there are many potentially confounding differences between countries, our analysis suggests that, although recessions pose risks to health, the interaction of fiscal austerity with economic shocks and weak social protection is what ultimately seems to escalate health and social crises in Europe. Policy decisions about how to respond to economic crises have pronounced and unintended effects on public health, yet public health voices have remained largely silent during the economic crisis.

  9. Financial crisis, austerity, and health in Europe.

    PubMed

    Karanikolos, Marina; Mladovsky, Philipa; Cylus, Jonathan; Thomson, Sarah; Basu, Sanjay; Stuckler, David; Mackenbach, Johan P; McKee, Martin

    2013-04-13

    The financial crisis in Europe has posed major threats and opportunities to health. We trace the origins of the economic crisis in Europe and the responses of governments, examine the effect on health systems, and review the effects of previous economic downturns on health to predict the likely consequences for the present. We then compare our predictions with available evidence for the effects of the crisis on health. Whereas immediate rises in suicides and falls in road traffic deaths were anticipated, other consequences, such as HIV outbreaks, were not, and are better understood as products of state retrenchment. Greece, Spain, and Portugal adopted strict fiscal austerity; their economies continue to recede and strain on their health-care systems is growing. Suicides and outbreaks of infectious diseases are becoming more common in these countries, and budget cuts have restricted access to health care. By contrast, Iceland rejected austerity through a popular vote, and the financial crisis seems to have had few or no discernible effects on health. Although there are many potentially confounding differences between countries, our analysis suggests that, although recessions pose risks to health, the interaction of fiscal austerity with economic shocks and weak social protection is what ultimately seems to escalate health and social crises in Europe. Policy decisions about how to respond to economic crises have pronounced and unintended effects on public health, yet public health voices have remained largely silent during the economic crisis. PMID:23541059

  10. Neurological crisis mimicking acute pancreatitis in tyrosinemia type I.

    PubMed

    Kalkanoğlu, H S; Coşkun, T

    1999-01-01

    Hereditary tyrosinemia results from an inborn error in the final step of tyrosine metabolism. Neurological manifestations have been reported in nearly half of patients during illness to have characteristics of altered consciousness, weakness, anorexia, vomiting, and pain in the extremities and abdomen. His physical findings and laboratory results pointed out acute pancreatitis. There have been some reports of acute and chronic pancreatitis in patients with metabolic diseases; however, this is the first case with tyrosinemia type I who exhibited clinical and biochemical findings of acute pancreatitis during neurological crisis. The presented case suggests the possibility that the pancreas is affected in neurological crisis. The determination of amylase concentration both in serum and urine samples of further cases will clarity the association between pancreatitis and neurological crisis. PMID:10770119

  11. Greece's health crisis: from austerity to denialism.

    PubMed

    Kentikelenis, Alexander; Karanikolos, Marina; Reeves, Aaron; McKee, Martin; Stuckler, David

    2014-02-22

    Greece's economic crisis has deepened since it was bailed out by the international community in 2010. The country underwent the sixth consecutive year of economic contraction in 2013, with its economy shrinking by 20% between 2008 and 2012, and anaemic or no growth projected for 2014. Unemployment has more than tripled, from 7·7% in 2008 to 24·3% in 2012, and long-term unemployment reached 14·4%. We review the background to the crisis, assess how austerity measures have affected the health of the Greek population and their access to public health services, and examine the political response to the mounting evidence of a Greek public health tragedy.

  12. Mental health in the foreclosure crisis.

    PubMed

    Houle, Jason N

    2014-10-01

    Current evidence suggests that the rise in home foreclosures that began in 2007 created feelings of stress, vulnerability, and sapped communities of social and economic resources. Minority and low SES communities were more likely to be exposed to predatory lending and hold subprime mortgages, and were the hardest hit by the foreclosure crisis. Little research has examined whether and how the foreclosure crisis has undermined population mental health. I use data from 2245 counties in 50 U.S. states to examine whether living in high foreclosure areas is associated with residents' mental health and whether the foreclosure crisis has the potential to exacerbate existing disparities in mental health during the recessionary period. I use county-level data from RealtyTrac and other data sources, and individual-level data from the Behavioral Risk Factor Surveillance Survey from 2006 to 2011. I find that - net of time invariant unobserved between-county differences, national time trends, and observed confounders - a rise in a county's foreclosure rate is associated with a decline in residents' mental health. This association is especially pronounced in counties with a high concentration of low SES and minority residents, which supports the perspective that the foreclosure crisis has the potential to exacerbate existing social disparities in mental health. PMID:25084488

  13. Flint Water Crisis Taking High Toll on Health, Productivity

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_160307.html Flint Water Crisis Taking High Toll on Health, Productivity Michigan ... 2016 MONDAY, Aug. 8, 2016 (HealthDay News) -- The water crisis in Flint, Mich., has cost $395 million ...

  14. [THE CRISIS PHENOMENA AND HEALTH].

    PubMed

    Tishuk, E A

    2015-01-01

    The analysis was carried out concerning impact of cyclicity of social economic development on population health of the Russian Federation. The conclusions are made related to necessity of determining priorities of development of national system of population health care. PMID:27116830

  15. Police and mental health clinician partnership in response to mental health crisis: A qualitative study.

    PubMed

    McKenna, Brian; Furness, Trentham; Oakes, Jane; Brown, Steve

    2015-10-01

    Police officers as first responders to acute mental health crisis in the community, commonly transport people in mental health crisis to a hospital emergency department. However, emergency departments are not the optimal environments to provide assessment and care to those experiencing mental health crises. In 2012, the Northern Police and Clinician Emergency Response (NPACER) team combining police and mental health clinicians was created to reduce behavioural escalation and provide better outcomes for people with mental health needs through diversion to appropriate mental health and community services. The aim of this study was to describe the perceptions of major stakeholders on the ability of the team to reduce behavioural escalation and improve the service utilization of people in mental health crisis. Responses of a purposive sample of 17 people (carer or consumer advisors, mental health or emergency department staff, and police or ambulance officers) who had knowledge of, or had interfaced with, the NPACER were thematically analyzed after one-to-one semistructured interviews. Themes emerged about the challenge created by a stand-alone police response, with the collaborative strengths of the NPACER (communication, information sharing, and knowledge/skill development) seen as the solution. Themes on improvements in service utilization were revealed at the point of community contact, in police stations, transition through the emergency department, and admission to acute inpatient units. The NPACER enabled emergency department diversion, direct access to inpatient mental health services, reduced police officer 'down-time', improved interagency collaboration and knowledge transfer, and improvements in service utilization and transition.

  16. The Economic Crisis and Acute Myocardial Infarction: New Evidence Using Hospital-Level Data

    PubMed Central

    Maggioni, Aldo Pietro

    2015-01-01

    Objective This research sought to assess whether and to what extent the ongoing economic crisis in Italy impacted hospitalizations, in-hospital mortality and expenditures associated with acute myocardial infarction (AMI). Methods The data were obtained from the hospital discharge database of the Italian Health Ministry and aggregated at the hospital level. Each hospital (n = 549) was observed for 4 years and was geographically located within a “Sistema Locale del Lavoro” (SLL, i.e., clusters of neighboring towns with a common economic structure). For each SLL, the intensity of the crisis was determined, defined as the 2012–2008 increase in the area-specific unemployment rate. A difference-in-differences (DiD) approach was employed to compare the increases in AMI-related outcomes across different quintiles of crisis intensity. Results Hospitals located in areas with the highest intensity of crisis (in the fifth quintile) had an increase of approximately 30 AMI cases annually (approximately 13%) compared with hospitals in area with lower crisis intensities (p<0.001). A significant increase in total hospital days was observed (13%, p<0.001) in addition to in-hospital mortality (17%, p<0.001). As a consequence, an increase of around €350.000 was incurred in annual hospital expenditures for AMI (approximately 36%, p<0.001). Conclusions More attention should be given to the increase in health needs associated with the financial crisis. Policies aimed to contrast unemployment in the community by keeping and reintegrating workers in jobs could also have positive impacts on adverse health outcomes, especially in areas of high crisis intensity. PMID:26574745

  17. Human resources for health: overcoming the crisis.

    PubMed

    Chen, Lincoln; Evans, Timothy; Anand, Sudhir; Boufford, Jo Ivey; Brown, Hilary; Chowdhury, Mushtaque; Cueto, Marcos; Dare, Lola; Dussault, Gilles; Elzinga, Gijs; Fee, Elizabeth; Habte, Demissie; Hanvoravongchai, Piya; Jacobs, Marian; Kurowski, Christoph; Michael, Sarah; Pablos-Mendez, Ariel; Sewankambo, Nelson; Solimano, Giorgio; Stilwell, Barbara; de Waal, Alex; Wibulpolprasert, Suwit

    In this analysis of the global workforce, the Joint Learning Initiative-a consortium of more than 100 health leaders-proposes that mobilisation and strengthening of human resources for health, neglected yet critical, is central to combating health crises in some of the world's poorest countries and for building sustainable health systems in all countries. Nearly all countries are challenged by worker shortage, skill mix imbalance, maldistribution, negative work environment, and weak knowledge base. Especially in the poorest countries, the workforce is under assault by HIV/AIDS, out-migration, and inadequate investment. Effective country strategies should be backed by international reinforcement. Ultimately, the crisis in human resources is a shared problem requiring shared responsibility for cooperative action. Alliances for action are recommended to strengthen the performance of all existing actors while expanding space and energy for fresh actors. PMID:15567015

  18. [Financial crisis and mental health in Greece].

    PubMed

    Giotakos, O; Karabelas, D; Kafkas, A

    2011-01-01

    Several studies indicate an association between economic crises and psychological burden. To investigate the possible impact of the current economic crisis on mental health in Greece, the association between two economic indicators (unemployment and average income) and mental health variables (psychiatric clinic admittance, visits to outpatients' departments and emergency units, suicides, homicides, mortality rates and divorces) was studied. The data were gathered by the Greek Statistical Service and some others were provided by the following hospitals: Eginition Hospital, Psychiatric Hospital of Attica, Athens General Hospital and Evaggelismos Hospital. Simple and multiple regression analyses were performed on the data. There was no significant correlation between the level of unemployment, as well as the average income, and admittance to the psychiatric clinics. A significant correlation was isolated between unemployment and visits to outpatients' department (R2 = 0.40, p = 0.001) and emergency unit (R2 = 0.49, p = 0.0002) of Eginition Hospital. The unemployment rate during the period 1981-2008 was positively associated with the number of homicides (R2 = 0.16, beta = 0.000049, p = 0.03), as well as the number of divorces (R2 = 0.20, beta = 0.005, p = 0.02) during the same period. The average income showed positive association with the visits to both outpatients' department (R2 = 0.55, p < 0.001) and emergency unit (R2 = 0,37, p = 0.004) of Eginition Hospital. However, the data from the 4 hospitals of the study revealed a negative correlation between average income and visits to outpatients' departments (R2 = 0.70, p = 0.02) and emergency units (R2 = 0.90, p < 0.001). Furthermore, a significant negative correlation between the average income and suicide rates (R2 = 0.37, p = 0.007), as well as a positive correlation between the average income and divorce rates (R2 = 0.73, p < 0.001) were found. The findings show several similarities with previous surveys in

  19. [Financial crisis and mental health in Greece].

    PubMed

    Giotakos, O; Karabelas, D; Kafkas, A

    2011-01-01

    Several studies indicate an association between economic crises and psychological burden. To investigate the possible impact of the current economic crisis on mental health in Greece, the association between two economic indicators (unemployment and average income) and mental health variables (psychiatric clinic admittance, visits to outpatients' departments and emergency units, suicides, homicides, mortality rates and divorces) was studied. The data were gathered by the Greek Statistical Service and some others were provided by the following hospitals: Eginition Hospital, Psychiatric Hospital of Attica, Athens General Hospital and Evaggelismos Hospital. Simple and multiple regression analyses were performed on the data. There was no significant correlation between the level of unemployment, as well as the average income, and admittance to the psychiatric clinics. A significant correlation was isolated between unemployment and visits to outpatients' department (R2 = 0.40, p = 0.001) and emergency unit (R2 = 0.49, p = 0.0002) of Eginition Hospital. The unemployment rate during the period 1981-2008 was positively associated with the number of homicides (R2 = 0.16, beta = 0.000049, p = 0.03), as well as the number of divorces (R2 = 0.20, beta = 0.005, p = 0.02) during the same period. The average income showed positive association with the visits to both outpatients' department (R2 = 0.55, p < 0.001) and emergency unit (R2 = 0,37, p = 0.004) of Eginition Hospital. However, the data from the 4 hospitals of the study revealed a negative correlation between average income and visits to outpatients' departments (R2 = 0.70, p = 0.02) and emergency units (R2 = 0.90, p < 0.001). Furthermore, a significant negative correlation between the average income and suicide rates (R2 = 0.37, p = 0.007), as well as a positive correlation between the average income and divorce rates (R2 = 0.73, p < 0.001) were found. The findings show several similarities with previous surveys in

  20. Police and mental health clinician partnership in response to mental health crisis: A qualitative study.

    PubMed

    McKenna, Brian; Furness, Trentham; Oakes, Jane; Brown, Steve

    2015-10-01

    Police officers as first responders to acute mental health crisis in the community, commonly transport people in mental health crisis to a hospital emergency department. However, emergency departments are not the optimal environments to provide assessment and care to those experiencing mental health crises. In 2012, the Northern Police and Clinician Emergency Response (NPACER) team combining police and mental health clinicians was created to reduce behavioural escalation and provide better outcomes for people with mental health needs through diversion to appropriate mental health and community services. The aim of this study was to describe the perceptions of major stakeholders on the ability of the team to reduce behavioural escalation and improve the service utilization of people in mental health crisis. Responses of a purposive sample of 17 people (carer or consumer advisors, mental health or emergency department staff, and police or ambulance officers) who had knowledge of, or had interfaced with, the NPACER were thematically analyzed after one-to-one semistructured interviews. Themes emerged about the challenge created by a stand-alone police response, with the collaborative strengths of the NPACER (communication, information sharing, and knowledge/skill development) seen as the solution. Themes on improvements in service utilization were revealed at the point of community contact, in police stations, transition through the emergency department, and admission to acute inpatient units. The NPACER enabled emergency department diversion, direct access to inpatient mental health services, reduced police officer 'down-time', improved interagency collaboration and knowledge transfer, and improvements in service utilization and transition. PMID:26040444

  1. The Health Care Crisis in America. Public Talk Series.

    ERIC Educational Resources Information Center

    Niedergang, Mark

    This guide provides a framework for study circles to use in discussing the health care crisis in the United States. The guide begins with a background section that gives an overview of the health care crisis; then it presents a two-part framework for discussion. Part 1 focuses on the ethical issues that underlie any policy decisions. It points out…

  2. Drug shortages: a complex health care crisis.

    PubMed

    Fox, Erin R; Sweet, Burgunda V; Jensen, Valerie

    2014-03-01

    National tracking of drug shortages began in 2001. However, a significant increase in the number of shortages began in late 2009, with numbers reaching what many have termed crisis level. The typical drug in short supply is a generic product administered by injection. Common classes of drugs affected by shortages include anesthesia medications, antibiotics, pain medications, nutrition and electrolyte products, and chemotherapy agents. The economic and clinical effects of drug shortages are significant. The financial effect of drug shortages is estimated to be hundreds of millions of dollars annually for health systems across the United States. Clinically, patients have been harmed by the lack of drugs or inferior alternatives, resulting in more than 15 documented deaths. Drug shortages occur for a variety of reasons. Generic injectable drugs are particularly susceptible to drug shortages because there are few manufacturers of these products and all manufacturers are running at full capacity. In addition, some manufacturers have had production problems, resulting in poor quality product. Although many suppliers are working to upgrade facilities and add additional manufacturing lines, these activities take time. A number of stakeholder organizations have been involved in meetings to further determine the causes and effects of drug shortages. A new law was enacted in July 2012 that granted the Food and Drug Administration additional tools to address the drug shortage crisis. The future of drug shortages is unknown, but there are hopeful indications that quality improvements and additional capacity may decrease the number of drug shortages in the years to come.

  3. Evaluating multidisciplinary health care teams: taking the crisis out of CRM.

    PubMed

    Sutton, Gigi

    2009-08-01

    High-reliability organisations are those, such as within the aviation industry, which operate in complex, hazardous environments and yet despite this are able to balance safety and effectiveness. Crew resource management (CRM) training is used to improve the non-technical skills of aviation crews and other high-reliability teams. To date, CRM within the health sector has been restricted to use with "crisis teams" and "crisis events". The purpose of this discussion paper is to examine the application of CRM to acute, ward-based multidisciplinary health care teams and more broadly to argue for the repositioning of health-based CRM to address effective everyday function, of which "crisis events" form just one part. It is argued that CRM methodology could be applied to evaluate ward-based health care teams and design non-technical skills training to increase their efficacy, promote better patient outcomes, and facilitate a range of positive personal and organisational level outcomes.

  4. A Self-Insured Health Program: From Crisis to Opportunity

    ERIC Educational Resources Information Center

    Steffes, Gary D.

    2008-01-01

    Moberly Area Community College faced a crisis in healthcare coverage that eventually lead to enhanced benefits, greater control, plan stability, and increased flexibility through a self-insured program. Presented here is how Moberly Area Community College overcame the health care coverage crisis and how other institutions can benefit from the…

  5. Help, care and support during a mental health crisis.

    PubMed

    Glasper, Alan

    Emeritus professor Alan Glasper, from the University of Southampton, discusses the recently published Care Quality Commission (CQC) report Right here, right now, which documents people's experiences of help, care and support during a mental health crisis. PMID:26450676

  6. Improving maternal, newborn and women's reproductive health in crisis settings

    PubMed Central

    Chi, Primus Che; Urdal, Henrik; Umeora, Odidika Uj; Sundby, Johanne; Spiegel, Paul; Devane, Declan

    2015-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To identify, synthesise and evaluate the effects of health system and other interventions aimed at improving maternal, newborn and women's reproductive health in crisis settings.

  7. [Public health in major socio-economic crisis].

    PubMed

    Cosmacini, G

    2014-01-01

    The term "crisis" in different cultures (such as ancient Greece or China) can have a positive meaning, since it indicates a time of growth, change and opportunity. Over the centuries there have been times of severe economic and social crisis that led to the implementation of major reforms and improved population health. Nowadays, despite the new economic crisis which has also affected health care for its rising costs, health economics does not hesitate to affirm the importance of key objectives such as prevention and medical assistance. Prevention is not prediction. Prevention means "going upstream" and fixing a problem at the source; the goal is to reduce diseases' effects, causes and risk factors, thereby reducing the prevalence of costly medical conditions.

  8. [Economic crisis and mental health. SESPAS report 2014].

    PubMed

    Gili, Margalida; García Campayo, Javier; Roca, Miquel

    2014-06-01

    Studies published before the financial crisis of 2008 suggest that economic difficulties contribute to poorer mental health. The IMPACT study conducted in primary health care centers in Spain found a significant increase in common mental disorders. Between 2006 and 2010, mood disorders increased by 19%, anxiety disorders by 8% and alcohol abuse disorders by 5%. There were also gender differences, with increased alcohol dependence in women during the crisis period. The most important risk factor for this increase was unemployment. In parallel, antidepressant consumption has increased in recent years, although there has not been a significant inrease in the number of suicides. Finally, the study offers some proposals to reduce the impact of the crisis on mental health: increased community services, employment activation measures, and active policies to reduce alcohol consumption and prevent suicidal behavior, particularly among young people.

  9. [Economic crisis and mental health. SESPAS report 2014].

    PubMed

    Gili, Margalida; García Campayo, Javier; Roca, Miquel

    2014-06-01

    Studies published before the financial crisis of 2008 suggest that economic difficulties contribute to poorer mental health. The IMPACT study conducted in primary health care centers in Spain found a significant increase in common mental disorders. Between 2006 and 2010, mood disorders increased by 19%, anxiety disorders by 8% and alcohol abuse disorders by 5%. There were also gender differences, with increased alcohol dependence in women during the crisis period. The most important risk factor for this increase was unemployment. In parallel, antidepressant consumption has increased in recent years, although there has not been a significant inrease in the number of suicides. Finally, the study offers some proposals to reduce the impact of the crisis on mental health: increased community services, employment activation measures, and active policies to reduce alcohol consumption and prevent suicidal behavior, particularly among young people. PMID:24661346

  10. [Treatment of acute crisis in child and adolescent psychiatry].

    PubMed

    Walter, Joachim; Hoffmann, Sascha; Romer, Georg

    2005-01-01

    Crises from the child and adolescent psychiatric point of view must be considered as unique or repeated moments of basic questioning of self-focused and relational perception. Hospitalisation if necessary depends on a well prepared social, legal, physical and cooperative framework. Patients, their family or social environment are in need of clarity, structure, and a professional counterpart willing to engage responsibly within an inpatient or--mostly--outpatient framework. He must adapt his diagnostic or therapeutic action to the patient's experience of fear, loss of orientation and insecurity. Then a crisis may be experienced like a bonding experience. Concerning the capacity of action confronted to psychiatric crisis the authors stress the importance of the scenic understanding, expressed symptoms and the acted-out crisis dynamics more than diagnostic classification. The diagnostic and decisive process of atunement to the patient in crisis is being described. A model for psychodynamic understanding of perception of and action towards crisis is proposed, which allows describing the interference between relational dynamics and intra-psychic conflicts leading to crisis. This can then be used as therapeutical focus for the crisis intervention or a consecutive psychotherapeutic treatment.

  11. [Development of a Crisis Management Manual for Occupational Health Experts].

    PubMed

    Matsuoka, Juri; Tateishi, Seiichiro; Igarashi, Yu; Ide, Hiroshi; Miyamoto, Toshiaki; Hara, Tatsuhiko; Kobashi, Masaki; Inoue, Megumi; Kawashima, Megumi; Okada, Takeo; Mori, Koji

    2015-12-01

    When crises such as natural disasters or industrial accidents occur in workplaces, not only the workers who are injured, but also those who engage in emergency or recovery work may be exposed to various health hazards. We developed a manual to enable occupational health (OH) experts to prevent health hazards. The manual includes detailed explanations of the characteristics and necessary actions for each need in the list of "OH Needs During Crisis Management" developed after an analysis of eight cases in our previous research. We changed the endings of explanatory sentences so that users could learn how often each need occurred in these eight cases. We evaluated the validity of the manual using two processes: 1) Providing the manual to OH physicians during an industrial accident; 2) Asking crisis management experts to review the manual. We made improvements based on their feedback and completed the manual. The manual includes explanations about 99 OH needs, and users can learn how and what to do for each need during various crisis cases. Because additional OH needs may occur in other crises, it is necessary to collect information about new cases and to improve the comprehensiveness of the manual continuously. It is critical that this crisis management manual be available when a crisis occurs. We need to inform potential users of the manual through various media, as well as by posting it on our website.

  12. [Development of a Crisis Management Manual for Occupational Health Experts].

    PubMed

    Matsuoka, Juri; Tateishi, Seiichiro; Igarashi, Yu; Ide, Hiroshi; Miyamoto, Toshiaki; Hara, Tatsuhiko; Kobashi, Masaki; Inoue, Megumi; Kawashima, Megumi; Okada, Takeo; Mori, Koji

    2015-12-01

    When crises such as natural disasters or industrial accidents occur in workplaces, not only the workers who are injured, but also those who engage in emergency or recovery work may be exposed to various health hazards. We developed a manual to enable occupational health (OH) experts to prevent health hazards. The manual includes detailed explanations of the characteristics and necessary actions for each need in the list of "OH Needs During Crisis Management" developed after an analysis of eight cases in our previous research. We changed the endings of explanatory sentences so that users could learn how often each need occurred in these eight cases. We evaluated the validity of the manual using two processes: 1) Providing the manual to OH physicians during an industrial accident; 2) Asking crisis management experts to review the manual. We made improvements based on their feedback and completed the manual. The manual includes explanations about 99 OH needs, and users can learn how and what to do for each need during various crisis cases. Because additional OH needs may occur in other crises, it is necessary to collect information about new cases and to improve the comprehensiveness of the manual continuously. It is critical that this crisis management manual be available when a crisis occurs. We need to inform potential users of the manual through various media, as well as by posting it on our website. PMID:26667194

  13. The Asian currency crisis and the Australian health industry.

    PubMed

    Barraclough, S

    1998-01-01

    This article identifies linkages between the Australian health industry and the global economy. It discusses some of the consequences of the Asian currency crisis of 1997-98 for the Australian economy and health industry, with special emphasis upon exports. Devaluation of the Australian dollar will increase the cost of most pharmaceutical and medical imports, but may offer competitive advantages to some Australian exporters. The nascent engagement with Asia of many health industry enterprises is likely to be stifled. It is therefore important for Australian governments, as well as the Australian health industry, to provide intelligence and encouragement to those enterprises that wish to continue their engagement with Asia or resume it when economic equilibrium returns. Markets throughout the world must also be further developed. The crisis may therefore provide the stimulus for re-thinking and re-stating Australian health export policy.

  14. The Asian currency crisis and the Australian health industry.

    PubMed

    Barraclough, S

    1998-01-01

    This article identifies linkages between the Australian health industry and the global economy. It discusses some of the consequences of the Asian currency crisis of 1997-98 for the Australian economy and health industry, with special emphasis upon exports. Devaluation of the Australian dollar will increase the cost of most pharmaceutical and medical imports, but may offer competitive advantages to some Australian exporters. The nascent engagement with Asia of many health industry enterprises is likely to be stifled. It is therefore important for Australian governments, as well as the Australian health industry, to provide intelligence and encouragement to those enterprises that wish to continue their engagement with Asia or resume it when economic equilibrium returns. Markets throughout the world must also be further developed. The crisis may therefore provide the stimulus for re-thinking and re-stating Australian health export policy. PMID:10537568

  15. Global health disparities: crisis in the diaspora.

    PubMed Central

    Cox, Raymond L.

    2004-01-01

    The United States spends more than the rest of the world on healthcare. In 2000, the U.S. health bill was 1.3 trillion dollars, 14.5% of its gross domestic product. Yet, according to the WHO World Health Report 2000, the United States ranked 37th of 191 member nations in overall health system performance. Racial/ethnic disparities in health outcomes are the most obvious examples of an unbalanced healthcare system. This presentation will examine health disparities in the United States and reveal how health disparities among and within countries affect the health and well-being of the African Diaspora. PMID:15101675

  16. 5 CFR 550.409 - Evacuation payments during a pandemic health crisis.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... health crisis. 550.409 Section 550.409 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... during a pandemic health crisis. (a) An agency may order one or more employees to evacuate from their... the employee) during a pandemic health crisis without regard to whether the agency and the...

  17. 5 CFR 550.409 - Evacuation payments during a pandemic health crisis.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... health crisis. 550.409 Section 550.409 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... during a pandemic health crisis. (a) An agency may order one or more employees to evacuate from their... the employee) during a pandemic health crisis without regard to whether the agency and the...

  18. 5 CFR 550.409 - Evacuation payments during a pandemic health crisis.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... health crisis. 550.409 Section 550.409 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... during a pandemic health crisis. (a) An agency may order one or more employees to evacuate from their... the employee) during a pandemic health crisis without regard to whether the agency and the...

  19. The health sector gap in the southern Africa crisis in 2002/2003.

    PubMed

    Griekspoor, Andre; Spiegel, Paul; Aldis, William; Harvey, Paul

    2004-12-01

    The southern Africa crisis represents the first widespread emergency in a region with a mature HIV/AIDS epidemic. It provides a steep learning curve for the international humanitarian system in understanding and responding to the complex interactions between the epidemic and the causes and the effects of this crisis. It also provoked much debate about the severity and causes of this emergency, and the appropriateness of the response by the humanitarian community. The authors argue that the over-emphasis on food aid delivery occurred at the expense of other public health interventions, particularly preventative and curative health services. Health service needs were not sufficiently addressed despite the early recognition that ill-health related to HIV/AIDS was a major vulnerability factor. This neglect occurred because analytical frameworks were too narrowly focused on food security, and large-scale support to health service delivery was seen as a long-term developmental issue that could not easily be dealt with by short-term humanitarian action. Furthermore, there were insufficient countrywide data on acute malnutrition, mortality rates and performance of the public health system to make better-balanced evidence-based decisions. In this crisis, humanitarian organisations providing health services could not assume their traditional roles of short-term assistance in a limited geographical area until the governing authorities resume their responsibilities. However, relegating health service delivery as a long-term developmental issue is not acceptable. Improved multisectoral analytical frameworks that include a multidisciplinary team are needed to ensure all aspects of public health are dealt with in similar future emergencies. Humanitarian organisations must advocate for improved delivery and access to health services in this region. They can target limited geographical areas with high mortality and acute malnutrition rates to deliver their services. Finally, to

  20. Protecting Pakistan's health during the global economic crisis.

    PubMed

    Jooma, R; Khan, A; Khan, A A

    2012-03-01

    The world is facing an unprecedented global economic crisis, with many countries needing to reconsider their level of health care spending. This paper explores the many consequences of the global economic turndown on Pakistan's health, including reduced government and donor spending and increased poverty with the consequent diversion of funds away from health. Nevertheless, these challenges may provide opportunities not only to mitigate the adverse effects of the economic crisis but also to institute some much-needed reforms that may not receive political support during more affluent times. Our suggestions focus on setting priorities based on the national disease burden, prioritizing prevention interventions, demanding results, curbing corruption, experimenting with innovative funding mechanisms, advocating for increased funding by presenting health spending as an investment rather than an expense and by selected recourse to civil society interventions and philanthropy to bridge the gap between available and needed resources. PMID:22574485

  1. Protecting Pakistan's health during the global economic crisis.

    PubMed

    Jooma, R; Khan, A; Khan, A A

    2012-03-01

    The world is facing an unprecedented global economic crisis, with many countries needing to reconsider their level of health care spending. This paper explores the many consequences of the global economic turndown on Pakistan's health, including reduced government and donor spending and increased poverty with the consequent diversion of funds away from health. Nevertheless, these challenges may provide opportunities not only to mitigate the adverse effects of the economic crisis but also to institute some much-needed reforms that may not receive political support during more affluent times. Our suggestions focus on setting priorities based on the national disease burden, prioritizing prevention interventions, demanding results, curbing corruption, experimenting with innovative funding mechanisms, advocating for increased funding by presenting health spending as an investment rather than an expense and by selected recourse to civil society interventions and philanthropy to bridge the gap between available and needed resources.

  2. Collaboration in crisis: Carer perspectives on police and mental health professional's responses to mental health crises.

    PubMed

    Brennan, Alice; Warren, Narelle; Peterson, Violeta; Hollander, Yitzchak; Boscarato, Kara; Lee, Stuart

    2016-10-01

    For many situations involving a mental health crisis, carers (e.g. family or friends) are present and either attempt to help the person overcome the crisis or request assistance from professional services (e.g. mental health or police). Comparatively, little research has explored how carers experience the crisis, the professional response and how the nature of the response, in turn, impacts carers. The current study was conducted to explore these issues during individual interviews with nine carers who had previous contact with police and mental health services during a crisis response. Collected data described the definition and perceived impact of a mental health crisis for carers, how carers had experienced a crisis response from police and mental health services, and how the professional response had impacted on carers. Of importance was the finding that carers were often themselves traumatized by witnessing or being involved in the crisis, however, were rarely offered direct education or support to help them cope or prevent future crises. A number of carers described a reluctance to request assistance from professional services due to previous poor experiences. This highlighted the importance of implementing strategies to deliver more timely, respectful, specialist and collaborative crisis responses to improve carer and consumer outcomes.

  3. Collaboration in crisis: Carer perspectives on police and mental health professional's responses to mental health crises.

    PubMed

    Brennan, Alice; Warren, Narelle; Peterson, Violeta; Hollander, Yitzchak; Boscarato, Kara; Lee, Stuart

    2016-10-01

    For many situations involving a mental health crisis, carers (e.g. family or friends) are present and either attempt to help the person overcome the crisis or request assistance from professional services (e.g. mental health or police). Comparatively, little research has explored how carers experience the crisis, the professional response and how the nature of the response, in turn, impacts carers. The current study was conducted to explore these issues during individual interviews with nine carers who had previous contact with police and mental health services during a crisis response. Collected data described the definition and perceived impact of a mental health crisis for carers, how carers had experienced a crisis response from police and mental health services, and how the professional response had impacted on carers. Of importance was the finding that carers were often themselves traumatized by witnessing or being involved in the crisis, however, were rarely offered direct education or support to help them cope or prevent future crises. A number of carers described a reluctance to request assistance from professional services due to previous poor experiences. This highlighted the importance of implementing strategies to deliver more timely, respectful, specialist and collaborative crisis responses to improve carer and consumer outcomes. PMID:27339118

  4. Global Health and the Global Economic Crisis

    PubMed Central

    Gill, Stephen; Bakker, Isabella

    2011-01-01

    Although the resources and knowledge for achieving improved global health exist, a new, critical paradigm on health as an aspect of human development, human security, and human rights is needed. Such a shift is required to sufficiently modify and credibly reduce the present dominance of perverse market forces on global health. New scientific discoveries can make wide-ranging contributions to improved health; however, improved global health depends on achieving greater social justice, economic redistribution, and enhanced democratization of production, caring social institutions for essential health care, education, and other public goods. As with the quest for an HIV vaccine, the challenge of improved global health requires an ambitious multidisciplinary research program. PMID:21330597

  5. Acute Splenic Sequestration Crisis in a 70-Year-Old Patient With Hemoglobin SC Disease

    PubMed Central

    Squiers, John J.; Edwards, Anthony G.; Parra, Alberto; Hofmann, Sandra L.

    2016-01-01

    A 70-year-old African American female with a past medical history significant for chronic bilateral shoulder pain and reported sickle cell trait presented with acute-onset bilateral thoracolumbar pain radiating to her left arm. Two days after admission, Hematology was consulted for severely worsening microcytic anemia and thrombocytopenia. Examination of the patient’s peripheral blood smear from admission revealed no cell sickling, spherocytes, or schistocytes. Some targeting was noted. A Coombs test was negative. The patient was eventually transferred to the medical intensive care unit in respiratory distress. Hemoglobin electrophoresis confirmed a diagnosis of hemoglobin SC disease. A diagnosis of acute splenic sequestration crisis complicated by acute chest syndrome was crystallized, and red blood cell exchange transfusion was performed. Further research is necessary to fully elucidate the pathophysiology behind acute splenic sequestration crisis, and the role of splenectomy to treat hemoglobin SC disease patients should be better defined. PMID:27047980

  6. [The economic crisis and its effects on health].

    PubMed

    Mena Castro, E

    1991-01-01

    In recent years, health indicators in developing countries including most of Latin America have deteriorated as a consequence of low economic growth rates, inflation, and reduced spending on health, education, and social assistance for the absolutely impoverished. It will be difficult to determine the extent to which the long crisis has hampered achievement of reduced infant and child mortality rates and low weight births, or of increased primary school attendance and per capita calorie consumption. The difficulty of analysis stems from the inadequacy of most national statistical series, which are susceptible to bias. Available information suggests that the crisis has been disastrous for the most vulnerable sectors. The level of absolute poverty has increased to 50% of the population, which in itself demonstrates the limitations that will be faced by programs to improve health indicators.

  7. The Crisis in Mental Health Research.

    ERIC Educational Resources Information Center

    Brown, Bertram S.

    Presented is a speech by Bertram Brown, director of the National Institute of Mental Health, on the effects of decreased federal funding of mental health research. Brown notes that there has been a 56% slash in the purchasing power of the research grant program when inflation is accounted for. It is suggested that causes of the dwindling support…

  8. Public Health Intelligence: Learning From the Ebola Crisis.

    PubMed

    Carney, Timothy Jay; Weber, David Jay

    2015-09-01

    Today's public health crises, as exemplified by the Ebola outbreak, lead to dramatic calls to action that typically include improved electronic monitoring systems to better prepare for, and respond to, similar occurrences in the future. Even a preliminary public health informatics evaluation of the current Ebola crisis exposes the need for enhanced coordination and sharing of trustworthy public health intelligence. We call for a consumer-centric model of public health intelligence and the formation of a national center to guide public health intelligence gathering and synthesis. Sharing accurate and actionable information with government agencies, health care practitioners, policymakers, and, critically, the general public, will mark a shift from doing public health surveillance on people to doing public health surveillance for people. PMID:26180978

  9. Public Health Intelligence: Learning From the Ebola Crisis

    PubMed Central

    Weber, David Jay

    2015-01-01

    Today’s public health crises, as exemplified by the Ebola outbreak, lead to dramatic calls to action that typically include improved electronic monitoring systems to better prepare for, and respond to, similar occurrences in the future. Even a preliminary public health informatics evaluation of the current Ebola crisis exposes the need for enhanced coordination and sharing of trustworthy public health intelligence. We call for a consumer-centric model of public health intelligence and the formation of a national center to guide public health intelligence gathering and synthesis. Sharing accurate and actionable information with government agencies, health care practitioners, policymakers, and, critically, the general public, will mark a shift from doing public health surveillance on people to doing public health surveillance for people. PMID:26180978

  10. Public Health Intelligence: Learning From the Ebola Crisis.

    PubMed

    Carney, Timothy Jay; Weber, David Jay

    2015-09-01

    Today's public health crises, as exemplified by the Ebola outbreak, lead to dramatic calls to action that typically include improved electronic monitoring systems to better prepare for, and respond to, similar occurrences in the future. Even a preliminary public health informatics evaluation of the current Ebola crisis exposes the need for enhanced coordination and sharing of trustworthy public health intelligence. We call for a consumer-centric model of public health intelligence and the formation of a national center to guide public health intelligence gathering and synthesis. Sharing accurate and actionable information with government agencies, health care practitioners, policymakers, and, critically, the general public, will mark a shift from doing public health surveillance on people to doing public health surveillance for people.

  11. Burma: a country's health in crisis.

    PubMed

    Chelala, C

    1998-08-15

    Economic deterioration and a decade of military rule have had a disastrous impact on the health of women and children in Burma. In 1996, Burma's infant mortality rate was 105/1000 live births. The major causes of child mortality and morbidity are intestinal and respiratory infections, malaria, malnutrition, and vaccine-preventable diseases. Low birth weight, iodine and vitamin A deficiency diseases, and iron-deficiency anemia are widespread. Cholera outbreaks occur each year. The Universal Child Immunization Program, supported by UNICEF, reaches less than 60% of eligible children. The maternal mortality rate is 580/100,000 live births; most are related to unsafe abortion. Basic reproductive health care is available only in select areas of the country. 17-22% of women use modern contraception. UNAIDS has estimated that 440,000 Burmese are HIV-infected and there are 14,000 AIDS orphans. HIV prevalence is 26.5% in urban prostitutes, 91% among injecting drug users near the Chinese border, and 10.6% among pregnant women in one border town. Any improvement in the health status of the population requires a shift in priority on the part of the military government from weapons build-up to health promotion and protection.

  12. Rely and Toxic Shock Syndrome: A Technological Health Crisis

    PubMed Central

    Vostral, Sharra L.

    2011-01-01

    This essay examines factors leading to the identification of Toxic Shock Syndrome with the bacteria Staphylococcus aureus in 1978 and the specific role of Rely tampons in generating a technologically rooted health crisis. The concept biologically incompatible technology is offered to explain the relationship between constituent bacteria, women’s menstrual cycles, and a reactive technology that converged to create the ideal environment for the S. aureus bacteria to live and flourish in some women. The complicated and reactive relationship of the Rely tampon to emergent disease, corporate interests, public health, and injury law reveals the dangers of naturalizing technologies. PMID:22180682

  13. Rely and Toxic Shock Syndrome: a technological health crisis.

    PubMed

    Vostral, Sharra L

    2011-12-01

    This essay examines factors leading to the identification of Toxic Shock Syndrome with the bacteria Staphylococcus aureus in 1978 and the specific role of Rely tampons in generating a technologically rooted health crisis. The concept biologically incompatible technology is offered to explain the relationship between constituent bacteria, women's menstrual cycles, and a reactive technology that converged to create the ideal environment for the S. aureus bacteria to live and flourish in some women. The complicated and reactive relationship of the Rely tampon to emergent disease, corporate interests, public health, and injury law reveals the dangers of naturalizing technologies.

  14. [Acute painful crisis in a female Nigerian patient with sickle cell disease].

    PubMed

    Nin, Sayaka; Seki, Masanori; Maie, Koichiro; Kuroda, Akihiro; Miyamoto, Kana; Ogawa, Shinichi; Ito, Yufu; Kurita, Naoki; Yokoyama, Yasuhisa; Sakata Yanagimoto, Mamiko; Obara, Naoshi; Hasegawa, Yuichi; Ogino, Yasuko; Ito, Takayoshi; Chiba, Shigeru

    2015-01-01

    We report a 38-year-old Nigerian woman with sickle cell disease. Sickle cell disease had been diagnosed when she experienced her first sickle cell crisis episode at age 8 years. Thereafter, she had infrequent minor episodes. She visited a hospital presenting with fever, anemia, jaundice, and systemic pain, and was then transferred to our hospital. Together with rehydration and red blood cell transfusion, analgesics and antibiotics were prescribed, and produced gradual improvement of all symptoms and signs. The patient was discharged on day 9 of hospitalization. Sickle cell crisis is an acute painful episode caused by occlusion of arterioles. The degree of pain and accompanying symptoms, as well as the frequencies of crises, are variable. Moreover, one third of individuals with sickle cell disease never experience a crisis. As our society becomes increasingly globalized, the probabilities of encountering sickle cell disease patients will be higher. PMID:25745965

  15. Psychoanalytic perspectives on the treatment of an acute suicidal crisis.

    PubMed

    Maltsberger, John T; Weinberg, Igor

    2006-02-01

    The psychoanalytic understanding of suicide has greatly expanded in the past 30 years, and the older therapeutic approach has been modified. Although the turning of murder on the self inferred by Freud 90 years ago remains a cornerstone, current practice concentrates on the identification of a precipitating event, the escalation of intolerable painful affect that the patient cannot moderate, the self-perception of helplessness, the evolution of hopelessness as a secondary affect, increasing fantasies of suicide as a means of escape, and ego regression (self-deconstruction), leading progressively to suicide. Recent clinical research, advances in the study of cognition, and neurobiological studies have contributed to the reorientation and enrichment of the psychoanalytic perspective on suicide. The treatment of a university student who had fallen into a suicide crisis is discussed from the psychoanalytic point of view, and evidence for the efficacy of this treatment is reviewed. PMID:16342290

  16. Public health services, an essential determinant of health during crisis. Lessons from Cuba, 1989-2000.

    PubMed

    De Vos, Pol; García-Fariñas, Anaí; Álvarez-Pérez, Adolfo; Rodríguez-Salvá, Armando; Bonet-Gorbea, Mariano; Van der Stuyft, Patrick

    2012-04-01

    During the 1990s, Cuba was able to overcome a severe crisis, almost without negative health impacts. This national retrospective study covering the years 1989-2000 analyses the country's strategy through essential social, demographic, health process and health outcome indicators. Gross domestic product (GDP) diminished by 34.76% between 1989 and 1993. In 1994 slow recuperation started. During the crisis, public health expenses increased. The number of family doctors rose from 9.22 to 27.03 per 104 inhabitants between 1989 and 2000. Infant mortality rate and life expectancy exemplify a series of health indicators that continued to improve during the crisis years, whereas low birth weight and tuberculosis incidence are among the few indicators that suffered deterioration. GDP is inversely related to tuberculosis incidence, whereas the average salary is inversely related to low birth weight. Infant mortality rate has a strong negative correlation with the health expenses per inhabitant, the number of maternal homes, the number of family doctors and the proportion of pregnant women receiving care in maternal homes. Life expectancy has a strong positive correlation with health expenses, the number of nursing personnel and the number of medical contacts per inhabitant. The Cuban strategy effectively resolved health risks during the crisis. In times of serious socio-economic constraints, a well conceptualized public health policy can play an important role in maintaining the overall well-being of a population.

  17. [THE GLOBAL AND ECONOMIC CRISIS. AND HEALTH MANAGEMENT].

    PubMed

    del Rey Calero, Juan

    2014-01-01

    The Global and economic crisis and Health Management The Health care process discussed are 4 steps: assessment, planing, intervention and evaluation. The identify association between social factors linked to social vulnerability (socio economic status, unemployed, poverty) and objective health relate quality of life. The poverty rate is 24.2%, unemployed 26.26%, youth unemployed 56.13%.ratio worker/retired 2.29. Debts 100% GDP The health inequality influence on health related quality of life. The Health System efficiency index. according Bloomber rate (2,013) Spain is 5 degrees in the world, points 68.3 on 100, for the life expectancy 82.3 years, the personal cost of health care 2,271€. Health care 10% GDP (public 7%,private 3%), SS protected population 92.4%, retired person cost 9.2% GDP, p. capita GDP 23,737€. Cost of Care: Hospital/specialist 54%, P. Care 15%, Pharmaceutical 19.8%, P. Health 3.1%. PMID:27386674

  18. Health care's human crisis - RX for an evolving profession.

    PubMed

    Kimball, Bobbie

    2004-05-31

    In 2001, the Robert Wood Johnson Foundation commissioned a study on the nursing shortage in the United States to gain a better understanding of the drivers and inform the Foundation's response. This article discusses the impetus for, and a brief summary of, the resulting report, "Health Care's Human Crisis: The American Nursing Shortage," published by the Foundation in 2002. It examines the historical, social, cultural, and economic factors that drive the nursing shortage. A new framework, namely a continuum of responses, is offered for understanding the myriad activities being undertaken in response to the problem, pointing the way to long-term, sustainable solutions. Recommendations and implications for nursing leaders are discussed.

  19. [Urgent laparoscopic adrenalectomy in acute crisis caused by pheochromocytoma].

    PubMed

    Bereczky, Bíborka; Madách, Krisztina; Gál, János; István, Gábor; Sugár, István; Ondrejka, Pál; Vörös, Attila

    2014-06-01

    Esetismertetés: A szerzők egy 30 éves nőbeteg esetét mutatják be, akinek intenzív osztályos felvételére hypertoniás krízist kísérő mellkasi panaszok, cardialis decompensatio, progrediáló acut légzési elégtelenség és tudatzavar miatt került sor. A gyors kivizsgálás mellett azonnal megkezdett intenzív terápia ellenére a felvételt követő harmadik napra többszervi elégtelenség képe alakult ki. Miután a kórkép kialakulása a bal oldali mellékvese térfoglaló folyamatára volt visszavezethető, a multidiszciplináris konzílium acut laparoscopos adrenalectomia végzése mellett foglalt állást. Az eltávolított képlet szövettani diagnózisa phaeochromocytoma volt. A postoperativ időszakban a beteg állapota fokozatosan javult, tünetei, panaszai regrediáltak, majd gyógyultan távozott. Megbeszélés: A phaeochromocytoma diagnózisa nehéz feladat, az általa kiváltott tünetek és panaszok sok egyéb kórképre is utalhatnak. Az acut phaeochromocytomás krízis általában belgyógyászati, intenzív terápiás eszközökkel uralható. A súlyos, többszervi elégtelenséghez vezető esetekben indokolt az acut műtéti beavatkozás. Az ilyen beavatkozások rizikója igen magas, de korrekt intra- és postoperativ észleléssel, megfelelő intenzív terápiával a laparoscopos műtét ezekben az esetekben választható megoldás lehet.

  20. Making sense of the global health crisis: policy narratives, conflict, and global health governance.

    PubMed

    Ney, Steven

    2012-04-01

    Health has become a policy issue of global concern. Worried that the unstructured, polycentric, and pluralist nature of global health governance is undermining the ability to serve emergent global public health interests, some commentators are calling for a more systematic institutional response to the "global health crisis." Yet global health is a complex and uncertain policy issue. This article uses narrative analysis to explore how actors deal with these complexities and how uncertainties affect global health governance. By comparing three narratives in terms of their basic assumptions, the way they define problems as well as the solutions they propose, the analysis shows how the unstructured pluralism of global health policy making creates a wide scope of policy conflict over the global health crisis. This wide scope of conflict enables effective policy-oriented learning about global health issues. The article also shows how exclusionary patterns of cooperation and competition are emerging in health policy making at the global level. These patterns threaten effective learning by risking both polarization of the policy debate and unanticipated consequences of health policy. Avoiding these pitfalls, the analysis suggests, means creating global health governance regimes that promote openness and responsiveness in deliberation about the global health crisis.

  1. The wealth, health and wellbeing of Ireland’s older people before and during the economic crisis

    PubMed Central

    Barrett, A.; O’Sullivan, V.

    2014-01-01

    The economic crisis of 2008/9 was felt more acutely in Ireland relative to elsewhere and culminated in the international bailout in 2010. Given the economic collapse, Ireland provides an ideal case-study of the link between wealth collapses and movements in variables such as health and well-being. Using nationally-representative samples of older people collected before and during the crisis, we show that mean net assets fell by 45 percent between 2006/7 and 2012/13. In spite of this massive fall in wealth, measures of health and well-being remained broadly unchanged. However, expectations about future living standards became less optimistic. The results tend to support the findings of other recent studies that recessions do not have widespread negative effects on health and well-being. PMID:26478710

  2. Ventricular Tachycardia and Resembling Acute Coronary Syndrome During Pheochromocytoma Crisis

    PubMed Central

    Li, Shi-jun; Wang, Tao; Wang, Lin; Pang, Zhan-qi; Ma, Ben; Li, Ya-wen; Yang, Jian; Dong, He

    2016-01-01

    Abstract Pheochromocytomas are neuroendocrine tumors, and its cardiac involvement may include transient myocardial dysfunction, acute coronary syndrome (ACS), and even ventricular arrhythmias. A patient was referred for evaluation of stuttering chest pain, and his electrocardiogram showed T-wave inversion over leads V1 to V4. Coronary angiography showed 90% stenosis in the mid-left anterior descending coronary artery (LAD), which was stented. Five days later, the patient had ventricular tachycardia, and severe hypertension, remarkable blood pressure fluctuation between 224/76 and 70/50 mm Hg. The patient felt abdominal pain and his abdominal ultrasound showed suspicious right adrenal gland tumor. Enhanced computed tomography of adrenal gland conformed that there was a tumor in right adrenal gland accompanied by an upset level of aldosterone. The tumor was removed by laparoscope, and the pathological examination showed pheochromocytoma. After the surgery, the blood pressure turned normal gradually. There was no T-wave inversion in lead V1-V4. Our case illustrates a rare pheochromocytoma presentation with a VT and resembling ACS. In our case, the serious stenosis in the mid of LAD could be explained by worsen the clinical course of myocardial ischemia or severe coronary vasospasm by the excessive amounts of catecholamines released from the tumor. Coronary vasospasm was possible because he had no classic coronary risk factors (e.g. family history and smoking habit, essential hypertension, hyperglycemia and abnormal serum lipoprotein, high body mass index). Thus, pheochromocytoma was missed until he revealed the association of his symptoms with abdominalgia. As phaeochromocytomas that present with cardiovascular complications can be fatal, it is necessary to screen for the disease when patients present with symptoms indicating catecholamine excess. PMID:27057898

  3. The phenomenon of resilience in crisis care mental health clinicians.

    PubMed

    Edward, Karen-leigh

    2005-06-01

    The purpose of this study, undertaken in 2003, was to explore the phenomenon of resilience as experienced by Australian crisis care mental health clinicians working in a highly demanding, complex, specialized and stressful environment. For the purpose of this research, the term 'resilience' was defined as the ability of an individual to bounce back from adversity and persevere through difficult times. The six participants for this study were drawn from Melbourne metropolitan mental health organizations - the disciplines of nursing, allied health and medicine. A number of themes were explicated from the participants' interview transcripts - Participants identified the experience of resilience through five exhaustive descriptions, which included: 'The team is a protective veneer to the stress of the work'; Sense of self; Faith and hope; Having insight; and Looking after yourself. These exhaustive descriptions were integrated into a fundamental structure of resilience for clinicians in this role. The study's findings have the potential to inform organizations in mental health to promote resilience in clinicians, with the potential to reduce the risk of burnout and hence staff attrition, and promote staff retention and occupational mental health.

  4. Environmental Sanitation Crisis: More than just a health issue

    PubMed Central

    Harvey, Peter A.

    2008-01-01

    The global environmental sanitation crisis cannot be denied: well over a century after the sanitary revolution in 19th century Europe, 40% of the world’s population still lacks access to improved sanitation. Important lessons from the past must be applied today if the crisis is to be averted. Sanitation has suffered from a lack of prioritization for as long as it has remained the poor relation to water supply. The International Year of Sanitation 2008 provides an opportunity to separate the two and give sanitation the emphasis it requires. The economic argument for sanitation must be articulated and non-health incentives for improved sanitation exploited. Environmental sanitation results in a multitude of socio-economic benefits and can contribute positively to all the Millennium Development Goals. Community-led bottom-up approaches, rather than supply-led or technology-driven approaches, are most effective in increasing and sustaining access to sanitation but need to be implemented at scale. Targeted strategies for urban and school sanitation are also required. Evidence-based advocacy can help develop the political will that is now needed to ensure sufficient public sector investment, leadership, legislation and regulation to ensure that the fundamental human right of access to sanitation is realized. PMID:21572832

  5. Environmental Sanitation Crisis: More than just a health issue.

    PubMed

    Harvey, Peter A

    2008-01-01

    THE GLOBAL ENVIRONMENTAL SANITATION CRISIS CANNOT BE DENIED: well over a century after the sanitary revolution in 19th century Europe, 40% of the world's population still lacks access to improved sanitation. Important lessons from the past must be applied today if the crisis is to be averted. Sanitation has suffered from a lack of prioritization for as long as it has remained the poor relation to water supply. The International Year of Sanitation 2008 provides an opportunity to separate the two and give sanitation the emphasis it requires. The economic argument for sanitation must be articulated and non-health incentives for improved sanitation exploited. Environmental sanitation results in a multitude of socio-economic benefits and can contribute positively to all the Millennium Development Goals. Community-led bottom-up approaches, rather than supply-led or technology-driven approaches, are most effective in increasing and sustaining access to sanitation but need to be implemented at scale. Targeted strategies for urban and school sanitation are also required. Evidence-based advocacy can help develop the political will that is now needed to ensure sufficient public sector investment, leadership, legislation and regulation to ensure that the fundamental human right of access to sanitation is realized. PMID:21572832

  6. A Novel Mental Health Crisis Service – Outcomes of Inpatient Data

    PubMed Central

    McGlennon, D; McDonnell, C

    2016-01-01

    Introduction Northern Ireland has high mental health needs and a rising suicide rate. Our area has suffered a 32% reduction of inpatient beds consistent with the national drive towards community based treatment. Taking these factors into account, a new Mental Health Crisis Service was developed incorporating a high fidelity Crisis Response Home Treatment Team (CRHTT), Acute Day Care facility and two inpatient wards. The aim was to provide alternatives to inpatient admission. The new service would facilitate transition between inpatient and community care while decreasing bed occupancy and increasing treatment in the community. Methods All services and processes were reviewed to assess deficiencies in current care. There was extensive consultation with internal and external stakeholders and process mapping using the COBRAs framework as a basis for the service improvement model. The project team set the service criteria and reviewed progress. Results In the original service model, the average inpatient occupancy rate was 106.6%, admission rate was 48 patients per month and total length of stay was 23.4 days. After introducing the inpatient consultant hospital model, the average occupancy rate decreased to 90%, admissions to 43 per month and total length of stay to 22 days. The results further decreased to 83% occupancy, 32 admissions per month and total length of stay 12 days after CRHTT initiation. Discussion The Crisis Service is still being evaluated but currently the model has provided safe alternatives to inpatient care. Involvement with patients, carers and all multidisciplinary teams is maximised to improve the quality and safety of care. Innovative ideas including structured weekly timetable and regular interface meetings have improved communication and allowed additional time for patient care. PMID:27158159

  7. The crisis of capitalism and the marketisation of health care: the implications for public health professionals.

    PubMed

    McKee, Martin; Stuckler, David

    2012-12-28

    The current economic crisis in Europe has challenged the basis of the economic model that currently prevails in much of the industrialised world. It has revealed a system that is managed not for the benefit of the people but rather for the corporations and the small elite who lead them, and which is clearly unsustainable in its present form. Yet, there is a hidden consequence of this system: an unfolding crisis in health care, driven by the greed of corporations whose profit-seeking model is also failing. Proponents of commodifying healthcare simultaneously argue that the cost of providing care for ageing populations is unaffordable while working to create demand for their health care products among those who are essentially healthy. Will healthcare be the next profit-fuelled investor bubble? In this paper, we call on health professionals to heed the warnings from the economic crisis and, rather than stand by while a crisis unfolds, act now to redirect increasingly market-oriented health systems to serve the common good.

  8. The Crisis of Capitalism and the Marketisation of Health Care: the Implications for Public Health Professionals

    PubMed Central

    McKee, Martin; Stuckler, David

    2012-01-01

    The current economic crisis in Europe has challenged the basis of the economic model that currently prevails in much of the industrialised world. It has revealed a system that is managed not for the benefit of the people but rather for the corporations and the small elite who lead them, and which is clearly unsustainable in its present form. Yet, there is a hidden consequence of this system: an unfolding crisis in health care, driven by the greed of corporations whose profit-seeking model is also failing. Proponents of commodifying healthcare simultaneously argue that the cost of providing care for ageing populations is unaffordable while working to create demand for their health care products among those who are essentially healthy. Will healthcare be the next profit-fuelled investor bubble? In this paper, we call on health professionals to heed the warnings from the economic crisis and, rather than stand by while a crisis unfolds, act now to redirect increasingly market-oriented health systems to serve the common good. PMID:25170470

  9. Plasmapheresis for hemolytic crisis and impending acute liver failure in Wilson disease.

    PubMed

    Asfaha, Samuel; Almansori, Mohammed; Qarni, Uwais; Gutfreund, Klaus S

    2007-01-01

    Wilsonian crisis is fatal unless copper removal is initiated early and liver transplantation is performed for patients that fulfill criteria for a poor outcome. We report a patient presenting with severe hemolysis and impending acute liver failure that made a rapid recovery with prompt initiation of plasmapheresis and chelation therapy. Rapid copper removal by plasmapheresis alleviated hemolysis and liver injury. A review of the literature was performed examining the use of plasmapheresis and albumin dialysis with continuous veno-venous hemodialysis or molecular adsorbents and recirculating system.

  10. [The economic-financial crisis and health in Spain. Evidence and viewpoints. SESPAS report 2014].

    PubMed

    Cortès-Franch, Imma; González López-Valcárcel, Beatriz

    2014-06-01

    The objectives of the SESPAS 2014 Report are as follows: a) to analyze the impact of the economic crisis on health and health-related behaviors, on health inequalities, and on the determinants of health in Spain; b) to describe the changes in the Spanish health system following measures to address the crisis and assess its potential impact on health; c) to review the evidence on the health impact of economic crises in other countries, as well as policy responses; and d) to suggest policy interventions alternative to those carried out to date with a population health perspective and scientific evidence in order to help mitigate the impact of the economic downturn on health and health inequalities. The report is organized in five sections: 1) the economic, financial and health crisis: causes, consequences, and contexts; 2) the impact on structural determinants of health and health inequalities; 3) the impact on health and health-related behaviors, and indicators for monitoring; 4) the impact on health systems; and 5) the impact on specific populations: children, seniors, and immigrants. There is some evidence on the relationship between the crisis and the health of the Spanish population, health inequalities, some changes in lifestyle, and variations in access to health services. The crisis has impacted many structural determinants of health, particularly among the most vulnerable population groups. Generally, policy responses on how to manage the crisis have not taken the evidence into account. The crisis may contribute to making public policy vulnerable to corporate action, thus jeopardizing the implementation of healthy policies.

  11. People-centred health systems: building more resilient health systems in the wake of the Ebola crisis.

    PubMed

    Martineau, Fred P

    2016-09-01

    The 2014-2016 West African Ebola outbreak demonstrated the extent to which local social and political dynamics shape health system responses to crises such as epidemics. Many post-Ebola health system strengthening programmes are framed around a notion of health system 'resilience' that focuses on global rather than local priorities and fails to account for key local social dynamics that shape crisis responses. Post-crisis health system strengthening efforts require a shift towards a more 'people-centred' understanding of resilience that attends to the people, relationships and local contexts that constitute health systems and the practices that produce crisis responses.

  12. People-centred health systems: building more resilient health systems in the wake of the Ebola crisis.

    PubMed

    Martineau, Fred P

    2016-09-01

    The 2014-2016 West African Ebola outbreak demonstrated the extent to which local social and political dynamics shape health system responses to crises such as epidemics. Many post-Ebola health system strengthening programmes are framed around a notion of health system 'resilience' that focuses on global rather than local priorities and fails to account for key local social dynamics that shape crisis responses. Post-crisis health system strengthening efforts require a shift towards a more 'people-centred' understanding of resilience that attends to the people, relationships and local contexts that constitute health systems and the practices that produce crisis responses. PMID:27620922

  13. The impact of economic crisis on health-care consumption in Korea.

    PubMed

    Yang, B M; Prescott, N; Bae, E Y

    2001-12-01

    This study uses urban household income-expenditure survey data, national health insurance claims data, and public health centre surveys to examine the impact of economic crisis on the consumption of health services in Korea. The analysis shows that the health-care consumption of Korean households has been adversely affected by the recent economic crisis, as measured by amount of expenditure on health. Distributional implications for health sector use are also found. Whereas the use of medical services by upper income groups is only slightly affected by the economic crisis, lower income groups are spending relatively less on medical services. Of all households, unemployed households are hit hardest by the crisis. Analysis shows that for all households, the rate of expenditure decrease is relatively higher for drug expenditure than for expenditure on medical services. That is, facing declining income, people cut their spending in the area where the need is non-essential or less inevitable.

  14. The Relationship between Caregiver Capacity and Intensive Community Treatment for Children with a Mental Health Crisis

    ERIC Educational Resources Information Center

    Epstein, Richard A.; Jordan, Neil; Rhee, Yong Joo; McClelland, Gary M.; Lyons, John S.

    2009-01-01

    We studied 9,220 children referred to a comprehensive mental health crisis stabilization program to examine the impact of caregiver capacity on crisis worker decisions to refer children for intensive community-based treatment as opposed to inpatient psychiatric hospitalization. Due to the different role of caregivers in the child welfare system,…

  15. National Suicide Prevention Lifeline: Enhancing Mental Health Care for Suicidal Individuals and Other People in Crisis

    ERIC Educational Resources Information Center

    Gould, Madelyn S.; Munfakh, Jimmie L. H.; Kleinman, Marjorie; Lake, Alison M.

    2012-01-01

    Linking at-risk callers to ongoing mental health care is a key goal of crisis hotline interventions that has not often been addressed in evaluations of hotlines' effectiveness. We conducted telephone interviews with 376 suicidal and 278 nonsuicidal crisis callers to the National Suicide Prevention Lifeline (Lifeline) to assess rates of mental…

  16. Crisis, neoliberal health policy, and political processes in Mexico.

    PubMed

    Laurell, A C

    1991-01-01

    The Mexican case represents an orthodox neoliberal health policy in the context of the structural adjustment adopted by the Mexican government in 1983. The social costs of this strategy are very high, including an increase in unemployment, wage depression, regressive redistribution of wealth, and profound changes in social policies. These transformations are reflected in the health sector, where the four main axes of neoliberal policy--expenditure restrictions, targeting, decentralization, and privatization--have been implemented. This represents a change in social policy from a model based on citizens' social rights and the state's obligation to guarantee them, to a model characterized by selective public charity. This strategy has been imposed on society as a result of the Mexican corporative political regime based on a state party system. Since 1985, however, there has been a growing process of independent organization of civil society. This led in the presidential elections of 1988 to the defeat of the candidate of the governing party by the candidate of a popular-democratic opposition front. Although the government party imposed its candidate through electoral fraud, social mobilization against neoliberal policies continues in the midst of an important political crisis that can only be resolved by profound democratization of Mexican society. PMID:1917206

  17. Crisis, neoliberal health policy, and political processes in Mexico.

    PubMed

    Laurell, A C

    1991-01-01

    The Mexican case represents an orthodox neoliberal health policy in the context of the structural adjustment adopted by the Mexican government in 1983. The social costs of this strategy are very high, including an increase in unemployment, wage depression, regressive redistribution of wealth, and profound changes in social policies. These transformations are reflected in the health sector, where the four main axes of neoliberal policy--expenditure restrictions, targeting, decentralization, and privatization--have been implemented. This represents a change in social policy from a model based on citizens' social rights and the state's obligation to guarantee them, to a model characterized by selective public charity. This strategy has been imposed on society as a result of the Mexican corporative political regime based on a state party system. Since 1985, however, there has been a growing process of independent organization of civil society. This led in the presidential elections of 1988 to the defeat of the candidate of the governing party by the candidate of a popular-democratic opposition front. Although the government party imposed its candidate through electoral fraud, social mobilization against neoliberal policies continues in the midst of an important political crisis that can only be resolved by profound democratization of Mexican society.

  18. SHPPS 2006 School Health Policies and Programs Study--Crisis Preparedness, Response, and Recovery

    ERIC Educational Resources Information Center

    Centers for Disease Control and Prevention, 2007

    2007-01-01

    The School Health Policies and Programs Study (SHPPS) is a national survey periodically conducted to assess school health policies and programs at the state, district, school, and classroom levels. This brief presents data on crisis preparedness, response, and recovery as it pertains to health services, mental health and social services, nutrition…

  19. Politics and Public Health: The Flint Drinking Water Crisis.

    PubMed

    Gostin, Lawrence O

    2016-07-01

    The Flint, Michigan, lead drinking water crisis is perhaps the most vivid current illustration of health inequalities in the United States. Since 2014, Flint citizens-among the poorest in America, mostly African American-had complained that their tap water was foul and discolored. But city, state, and federal officials took no heed. In March 2016, an independent task force found fault at every level of government and also highlighted what may amount to criminal negligence for workers who seemingly falsified water-quality results, allowing the people of Flint to continue to be exposed to water well above the federally allowed lead levels. It would have been possible to prevent lead seeping into the drinking water by treating the pipes with federally approved anticorrosives for around $100 per day. But today the cost of repairing the Flint water system is estimated at $1.5 billion, and fixing the ageing and lead-laden system across the United States would cost at least $1.3 trillion. How will Flint residents get justice and fair compensation for the wrongs caused by individual and systemic failures? And how will governments rebuild a water infrastructure that is causing and will continue to cause toxic conditions, particularly in economically marginalized cities and towns across America?

  20. Politics and Public Health: The Flint Drinking Water Crisis.

    PubMed

    Gostin, Lawrence O

    2016-07-01

    The Flint, Michigan, lead drinking water crisis is perhaps the most vivid current illustration of health inequalities in the United States. Since 2014, Flint citizens-among the poorest in America, mostly African American-had complained that their tap water was foul and discolored. But city, state, and federal officials took no heed. In March 2016, an independent task force found fault at every level of government and also highlighted what may amount to criminal negligence for workers who seemingly falsified water-quality results, allowing the people of Flint to continue to be exposed to water well above the federally allowed lead levels. It would have been possible to prevent lead seeping into the drinking water by treating the pipes with federally approved anticorrosives for around $100 per day. But today the cost of repairing the Flint water system is estimated at $1.5 billion, and fixing the ageing and lead-laden system across the United States would cost at least $1.3 trillion. How will Flint residents get justice and fair compensation for the wrongs caused by individual and systemic failures? And how will governments rebuild a water infrastructure that is causing and will continue to cause toxic conditions, particularly in economically marginalized cities and towns across America? PMID:27417861

  1. Health Alert: Adrenal Crisis Causes Death in Some People Who Were Treated with hGH

    MedlinePlus

    ... Organizations (PDF, 269 KB). Alternate Language URL Health Alert: Adrenal Crisis Causes Death in Some People Who ... a medical ID card and wear a Medic-Alert bracelet to tell emergency workers that you lack ...

  2. Impact of the east Asian economic crisis on health and health care: Malaysia's response.

    PubMed

    Suleiman, A B; Lye, M S; Yon, R; Teoh, S C; Alias, M

    1998-01-01

    In the wake of the east Asian economic crisis, the health budget for the public sector in Malaysia was cut by 12%. The Ministry of Health responded swiftly with a series of broad-based and specific strategies. There was a careful examination of the operating expenditure and where possible measures were taken to minimise the effects of the budget constraints at the service interface. The MOH reprioritised the development of health projects. Important projects such as rural health projects and training facilities, and committed projects, were continued. In public health, population-based preventive and promotive activities were expected to experience some form of curtailment. There is a need to refocus priorities, maximise the utilisation of resources, and increase productivity at all levels and in all sectors, both public and private, in order to minimise the impact of the economic downturn on health.

  3. The mental health focus in rape crisis services: tensions and recommendations.

    PubMed

    Woody, Jane D; Beldin, Kerry L

    2012-01-01

    In the evolution of rape crisis services, tensions persist between rape crisis service programs and mental health professionals. Changes within these programs and professions have brought the embedded concerns to the surface, but they remain unexamined and unresolved. Recent research on rape trauma and survivors' mental health needs has added to tensions by calling for description and evaluation of rape crisis services and timely psychological treatment for survivors. This article offers a new perspective by discussing the tensions in an open but balanced way so as to promote discussion and solutions. Recommendations and action steps are offered for promoting constructive dialogue and change to improve direct services for survivors. PMID:22455187

  4. The mental health focus in rape crisis services: tensions and recommendations.

    PubMed

    Woody, Jane D; Beldin, Kerry L

    2012-01-01

    In the evolution of rape crisis services, tensions persist between rape crisis service programs and mental health professionals. Changes within these programs and professions have brought the embedded concerns to the surface, but they remain unexamined and unresolved. Recent research on rape trauma and survivors' mental health needs has added to tensions by calling for description and evaluation of rape crisis services and timely psychological treatment for survivors. This article offers a new perspective by discussing the tensions in an open but balanced way so as to promote discussion and solutions. Recommendations and action steps are offered for promoting constructive dialogue and change to improve direct services for survivors.

  5. Crisis averted: How consumers experienced a police and clinical early response (PACER) unit responding to a mental health crisis.

    PubMed

    Evangelista, Eloisa; Lee, Stuart; Gallagher, Angela; Peterson, Violeta; James, Jo; Warren, Narelle; Henderson, Kathryn; Keppich-Arnold, Sandra; Cornelius, Luke; Deveny, Elizabeth

    2016-08-01

    When mental health crisis situations in the community are poorly handled, it can result in physical and emotional injuries. The purpose of this study was to ascertain the experiences and opinions of consumers about the way police and mental health services worked together, specifically via the Alfred Police and Clinical Early Response (A-PACER) model, to assist people experiencing a mental health crisis. Semi-structured in-depth interviews were conducted with 12 mental health consumers who had direct contact with the A-PACER team between June 2013 and March 2015. The study highlighted that people who encountered the A-PACER team generally valued and saw the benefit of a joint police-mental health clinician team response to a mental health crisis situation in the community. In understanding what worked well in how the A-PACER team operated, consumers perspectives can be summarized into five themes: communication and de-escalation, persistence of the A-PACER team, providing a quick response and working well under pressure, handover of information, and A-PACER helped consumers achieve a preferred outcome. All consumers acknowledged the complementary roles of the police officer and mental health clinician, and described the A-PACER team's supportive approach as critical in gaining their trust, engagement and in de-escalating the crises. Further education and training for police officers on how to respond to people with a mental illness, increased provision of follow-up support to promote rehabilitation and prevent future crises, and measures to reduce public scrutiny for the consumer when police responded, were proposed opportunities for improvement. PMID:26931611

  6. Crisis averted: How consumers experienced a police and clinical early response (PACER) unit responding to a mental health crisis.

    PubMed

    Evangelista, Eloisa; Lee, Stuart; Gallagher, Angela; Peterson, Violeta; James, Jo; Warren, Narelle; Henderson, Kathryn; Keppich-Arnold, Sandra; Cornelius, Luke; Deveny, Elizabeth

    2016-08-01

    When mental health crisis situations in the community are poorly handled, it can result in physical and emotional injuries. The purpose of this study was to ascertain the experiences and opinions of consumers about the way police and mental health services worked together, specifically via the Alfred Police and Clinical Early Response (A-PACER) model, to assist people experiencing a mental health crisis. Semi-structured in-depth interviews were conducted with 12 mental health consumers who had direct contact with the A-PACER team between June 2013 and March 2015. The study highlighted that people who encountered the A-PACER team generally valued and saw the benefit of a joint police-mental health clinician team response to a mental health crisis situation in the community. In understanding what worked well in how the A-PACER team operated, consumers perspectives can be summarized into five themes: communication and de-escalation, persistence of the A-PACER team, providing a quick response and working well under pressure, handover of information, and A-PACER helped consumers achieve a preferred outcome. All consumers acknowledged the complementary roles of the police officer and mental health clinician, and described the A-PACER team's supportive approach as critical in gaining their trust, engagement and in de-escalating the crises. Further education and training for police officers on how to respond to people with a mental illness, increased provision of follow-up support to promote rehabilitation and prevent future crises, and measures to reduce public scrutiny for the consumer when police responded, were proposed opportunities for improvement.

  7. Health outcomes during the 2008 financial crisis in Europe: systematic literature review

    PubMed Central

    Parmar, Divya; Ioannidis, John P A

    2016-01-01

    Objective To systematically identify, critically appraise, and synthesise empirical studies about the impact of the 2008 financial crisis in Europe on health outcomes. Design Systematic literature review. Data sources Structural searches of key databases, healthcare journals, and organisation based websites. Review methods Empirical studies reporting on the impact of the financial crisis on health outcomes in Europe, published from January 2008 to December 2015, were included. All selected studies were assessed for risk of bias. Owing to the heterogeneity of studies in terms of study design and analysis and the use of overlapping datasets across studies, studies were analysed thematically per outcome, and the evidence was synthesised on different health outcomes without formal meta-analysis. Results 41 studies met the inclusion criteria, and focused on suicide, mental health, self rated health, mortality, and other health outcomes. Of those studies, 30 (73%) were deemed to be at high risk of bias, nine (22%) at moderate risk of bias, and only two (5%) at low risk of bias, limiting the conclusions that can be drawn. Although there were differences across countries and groups, there was some indication that suicides increased and mental health deteriorated during the crisis. The crisis did not seem to reverse the trend of decreasing overall mortality. Evidence on self rated health and other indicators was mixed. Conclusions Most published studies on the impact of financial crisis on health in Europe had a substantial risk of bias; therefore, results need to be cautiously interpreted. Overall, the financial crisis in Europe seemed to have had heterogeneous effects on health outcomes, with the evidence being most consistent for suicides and mental health. There is a need for better empirical studies, especially those focused on identifying mechanisms that can mitigate the adverse effects of the crisis. PMID:27601477

  8. Lead poisoning in China: a health and human rights crisis.

    PubMed

    Cohen, Jane E; Amon, Joseph J

    2012-12-15

    Acute and chronic lead poisoning is occurring throughout China and is a major cause of childhood morbidity. The Chinese government's emphasis on industrial development and poverty reduction has, over the past three decades, decreased by 500 million the number of people surviving on less than one dollar per day, but has caused significant environmental degradation that threatens public health. Drawing upon in-depth interviews conducted in 2009 and 2010 with families affected by lead poisoning, environmental activists, journalists, government and civil society organization officials in Shaanxi, Henan, Hunan, and Yunnan provinces, as well as a review of scientific and Chinese media, and health and environmental legal and policy analysis, we examine the intersection of civil, political, economic, and social rights related to access to information, screening, treatment, and remediation related to lead poisoning. In-depth interviews in each province uncovered: censorship and intimidation of journalists, environmental activists, and parents seeking information about sources and prevention of lead poisoning; denial of screening for lead poisoning, often based upon arbitrary eligibility criteria; and inadequate and inappropriate treatment being promoted and provided by health facilities. Over the past decade, the Chinese government has prioritized health care and invested billions of dollars towards universal health coverage, and strengthened environmental to address industrial pollution and guarantee access to information on the environment. Yet, despite these reforms, information remains constrained and citizens seeking information and redress are sometimes arrested, in violation of Chinese and international law. Local government officials and national environmental policies continue to prioritize economic development over environmental protection. To effectively address lead poisoning requires an emphasis on prevention, and to combat industrial pollution requires

  9. Lead poisoning in China: a health and human rights crisis.

    PubMed

    Cohen, Jane E; Amon, Joseph J

    2012-01-01

    Acute and chronic lead poisoning is occurring throughout China and is a major cause of childhood morbidity. The Chinese government's emphasis on industrial development and poverty reduction has, over the past three decades, decreased by 500 million the number of people surviving on less than one dollar per day, but has caused significant environmental degradation that threatens public health. Drawing upon in-depth interviews conducted in 2009 and 2010 with families affected by lead poisoning, environmental activists, journalists, government and civil society organization officials in Shaanxi, Henan, Hunan, and Yunnan provinces, as well as a review of scientific and Chinese media, and health and environmental legal and policy analysis, we examine the intersection of civil, political, economic, and social rights related to access to information, screening, treatment, and remediation related to lead poisoning. In-depth interviews in each province uncovered: censorship and intimidation of journalists, environmental activists, and parents seeking information about sources and prevention of lead poisoning; denial of screening for lead poisoning, often based upon arbitrary eligibility criteria; and inadequate and inappropriate treatment being promoted and provided by health facilities. Over the past decade, the Chinese government has prioritized health care and invested billions of dollars towards universal health coverage, and strengthened environmental to address industrial pollution and guarantee access to information on the environment. Yet, despite these reforms, information remains constrained and citizens seeking information and redress are sometimes arrested, in violation of Chinese and international law. Local government officials and national environmental policies continue to prioritize economic development over environmental protection. To effectively address lead poisoning requires an emphasis on prevention, and to combat industrial pollution requires

  10. Heart block and acute kidney injury due to hyperparathyroidism-induced hypercalcemic crisis.

    PubMed

    Brown, Taylor C; Healy, James M; McDonald, Mary J; Hansson, Joni H; Quinn, Courtney E

    2014-12-01

    We describe a patient who presented with multi-system organ failure due to extreme hypercalcemia (serum calcium 19.8 mg/dL), resulting from primary hyperparathyroidism. He was found to have a 4.8 cm solitary atypical parathyroid adenoma. His course was complicated by complete heart block, acute kidney injury, and significant neurocognitive disturbances. Relevant literature was reviewed and discussed. Hyperparathyroidism-induced hypercalcemic crisis (HIHC) is a rare presentation of primary hyperparathyroidism and only a small minority of these patients develop significant cardiac and renal complications. In cases of HIHC, a multidisciplinary effort can facilitate rapid treatment of life-threatening hypercalcemia and definitive treatment by surgical resection. As such, temporary transvenous cardiac pacing and renal replacement therapy can provide a life-saving bridge to definitive parathyroidectomy in cases of HIHC.

  11. The global financial crisis and psychological health in a sample of Australian older adults: a longitudinal study.

    PubMed

    Sargent-Cox, Kerry; Butterworth, Peter; Anstey, Kaarin J

    2011-10-01

    Economic stress and uncertainty is argued to increase older adults' vulnerability to physical health decline and mental distress. Nevertheless, there is a paucity of research that examines the relationship between a large historical economic event, such as the recent global financial crisis (GFC), and health outcomes for older adults. This study provides a unique opportunity to compare self-reported health status and psychological functioning (number of depression and anxiety symptoms) in 1973 older Australian adults (mean age of 66.58 years (SD = 1.5)) prior to the GFC (2005-2006), with their status four years later during the GFC period (2009-2010). Latent difference score models revealed a significant difference in depression and anxiety symptoms over the two measurement occasions, indicating poorer psychological functioning for those who reported an impact as a result of the economic slowdown. These effects were not explained by demographic or socio-economic factors. Interaction effects showed that those participants who were surveyed within the acute salience period of the GFC (April to September 2009) were significantly less likely to report poorer psychological health over time compared to those who were surveyed after September 2009. This interesting timing effect is discussed in terms of potential time-lags in the negative effects of economic stress on health outcomes, as well as the possible protective effects of social norms that may be created by a large scale economic crisis. PMID:21831493

  12. Uncharted Waters: Communicating Health Risks During the 2014 West Virginia Water Crisis.

    PubMed

    Thomas, Tracey L; Friedman, Daniela B; Brandt, Heather M; Spencer, S Melinda; Tanner, Andrea

    2016-09-01

    This study is among the first to examine how health risks are communicated through traditional and social media during a public health crisis. Using an innovative research approach, the study combined a content analysis with in-depth interviews to examine and understand how stakeholders involved in crisis response perceived media coverage after a chemical spill contaminated the drinking water of 300,000 West Virginia residents. A content analysis of print, television, and online media stories and tweets revealed that health risk information was largely absent from crisis coverage. Although traditional media stories were significantly more likely to include health information compared to tweets, public health sources were underutilized in traditional media coverage. Instead, traditional media favored the use of government sources outside the public health field, which stakeholders suggested was problematic because of a public distrust of officials and official information during the crisis. Results also indicated that Twitter was not a common or reliable source for health information but was important in the spread of other types of information. Ultimately, the study highlights a need for more deliberate media coverage of health risks and provides insight into how Twitter is used to spread crisis information.

  13. Uncharted Waters: Communicating Health Risks During the 2014 West Virginia Water Crisis.

    PubMed

    Thomas, Tracey L; Friedman, Daniela B; Brandt, Heather M; Spencer, S Melinda; Tanner, Andrea

    2016-09-01

    This study is among the first to examine how health risks are communicated through traditional and social media during a public health crisis. Using an innovative research approach, the study combined a content analysis with in-depth interviews to examine and understand how stakeholders involved in crisis response perceived media coverage after a chemical spill contaminated the drinking water of 300,000 West Virginia residents. A content analysis of print, television, and online media stories and tweets revealed that health risk information was largely absent from crisis coverage. Although traditional media stories were significantly more likely to include health information compared to tweets, public health sources were underutilized in traditional media coverage. Instead, traditional media favored the use of government sources outside the public health field, which stakeholders suggested was problematic because of a public distrust of officials and official information during the crisis. Results also indicated that Twitter was not a common or reliable source for health information but was important in the spread of other types of information. Ultimately, the study highlights a need for more deliberate media coverage of health risks and provides insight into how Twitter is used to spread crisis information. PMID:27565193

  14. The Banner Psychiatric Center: A Model for Providing Psychiatric Crisis Care to the Community while Easing Behavioral Health Holds in Emergency Departments

    PubMed Central

    Little-Upah, Pat; Carson, Chris; Williamson, Robert; Williams, Tom; Cimino, Michael; Mehta, Neena; Buehrle, Jeff; Kisiel, Steve

    2013-01-01

    Banner Health in the Phoenix, AZ, metropolitan area provides individuals in a behavioral health crisis with an alternative to presenting to an Emergency Department (ED). By implementing a process to quickly move patients out of our ED, our health care system has been able to greatly reduce the hold time for behavioral health patients. Through access to psychiatric clinicians around the clock at the Banner Psychiatric Center, patients now receive the appropriate treatment and needed care in a timely manner. Finally, disposition of patients into appropriate levels of care has freed up acute care Level 1 beds to be available to patients who meet those criteria. PMID:23596368

  15. Mental Health Services to Rural Consumers. Lessons Learned from a Four Year Iowa Farm Crisis Project.

    ERIC Educational Resources Information Center

    Link, Emerson A.

    The Southwest Iowa Mental Health Center recently completed a 4-year project to increase use of mental health services by normally reluctant rural populations and to increase coping ability among persons affected by the farm crisis. During the first 2 years, program goals included aggressive outreach to potential patients, mental health education…

  16. In the Wake of Hurricane Katrina: Delivering Crisis Mental Health Services to Host Communities

    ERIC Educational Resources Information Center

    Marbley, Aretha Faye

    2007-01-01

    Throughout the country and especially in Texas, local communities opened their arms to hurricane Katrina evacuees. Like the federal government, emergency health and mental health entities were unprepared for the massive numbers of people needing assistance. Mental health professionals, though armed with a wealth of crisis intervention information,…

  17. [Sexual and reproductive health and the economic crisis in Spain. SESPAS report 2014].

    PubMed

    Larrañaga, Isabel; Martín, Unai; Bacigalupe, Amaia

    2014-06-01

    Sexual and reproductive health (SRH) is protected by the public authorities to ensure that people enjoy a free, satisfying, and safe sexual life. Despite the approval of the National Sexual and Reproductive Health Strategy in 2011, the progress achieved may be jeopardized by recent proposals for legislative changes affecting this area (abortion Law and 16/2012 Law) and by the impact of the current economic crisis. This article aims to describe the current situation of sexual and reproductive health in the Spanish population and to identify the potential impact of the economic crisis. To this end, we used the following information sources: the National Sexual Health Survey, the DAPHNE surveys, births and fetal deaths statistics from the Spanish National Institute of Statistics, the Registry of Voluntary Pregnancy Interruptions, reports from the National Epidemiology Center, and the National AIDS Registry. Sexual health and the availability of information are rated as good by the Spanish population. Among young people, schools and health services have become less important as information sources and the internet has become more important. Since the beginning of the crisis, contraceptive use and fertility have declined and maternity has been delayed. The economic crisis seems to have affected some indicators of sexual and reproductive health. However, the potential effects on other indicators should continue to be monitored because insufficient time may have passed for accurate determination of the full effect of the crisis.

  18. [Successes and failures in the management of public health crisis in Spain].

    PubMed

    Gérvas, Juan; Hernández-Aguado, Ildefonso

    2009-01-01

    Health crises shock the population and overwhelm the health services. This article analyzes 30 years of health crises in Spain from a multifaceted perspective: population, patients, clinicians, public health practitioners, politicians, the media and other groups involved. The interaction among all stakeholders shapes the response and management of any health crisis. Heterogeneity of management and of health effects-contributing to inequalities in health-is common. The participation and coordination of the health services is crucial in detection of the crisis and in modulating the population reactions. Public health services characterized by their low public profile could gain public influence by their role in coordinating politicians and the media when solving important health problems. Analyzing the mistakes and successes in previous crises together with risk and vulnerability assessments, research and drills are essential to give a quick and adequate response to future crises.

  19. Responding to the public health consequences of the Ukraine crisis: an opportunity for global health diplomacy

    PubMed Central

    Mackey, Tim K; Strathdee, Steffanie A

    2015-01-01

    Introduction Peace and stability in Eastern Europe is now at a crossroads with the rapidly deteriorating foreign policy crisis continuing to unfold in the Ukraine. However, largely overlooked in the context of other foreign policy and diplomatic priorities are the serious public health consequences for the region following the annexation of Crimea and the subsequent decision to ban opioid substitution therapy in the disputed territory. Discussion On 1 May 2014, the Republic of Crimea officially announced it would end access to opioid substitution therapy, an essential harm reduction tool recognized by international organizations and virtually all other European countries. The policy development marks a critical reversal in the region’s fight against its growing HIV epidemic and also threatens years of public health gains aimed at providing evidence-based and integrated treatment approaches to combat drug dependence and HIV. Beyond these risks, the Ukrainian conflict could also negatively impact control of other infectious diseases that are converging with HIV and injection drug use, such as multidrug-resistant tuberculosis and hepatitis C virus. The continuing conflict is also likely to have a significant negative impact on Ukraine’s fragile public health system leading to even worse population health outcomes than currently experienced by the country. Conclusions In response to this crisis, the application of global health diplomacy principles represents a possible route of advocacy to ensure that HIV prevention, humane treatment of substance using populations, and improving public health outcomes in the region are pursued among concerned international stakeholders. In order to be effective, global health diplomacy efforts must be coordinated and advocated in all forms of diplomatic engagement, including at the core, multistakeholder and informal levels and through existing channels such as the different human rights bodies of the United Nations as well as

  20. The impact of the 1997-98 East Asian economic crisis on health and health care in Indonesia.

    PubMed

    Waters, Hugh; Saadah, Fadia; Pradhan, Menno

    2003-06-01

    This article identifies the effects of the 1997-98 East Asian economic crisis on health care use and health status in Indonesia. The article places the findings in the context of a framework showing the complex cause and effect relationships underlying the effects of economic downturns on health and health care. The results are based on primary analysis of Indonesian household survey data and review of a wide range of sources from the Indonesian government and international organizations. Comparisons are drawn with the effects of the crisis in Thailand. The devaluation of the Indonesian currency, the Rupiah, led to inflation and reduced real public expenditures on health. Households' expenditures on health also decreased, both in absolute terms and as a percentage of overall spending. Self-reported morbidity increased sharply from 1997 to 1998 in both rural and urban areas of Indonesia. The crisis led to a substantial reduction in health service utilization during the same time period, as the proportion of household survey respondents reporting an illness or injury that sought care from a modern health care provider declined by 25%. In contrast to Indonesia, health care utilization in Thailand actually increased during the crisis, corresponding to expansion in health insurance coverage. The results suggest that social protection programmes play a critical role in protecting populations against the adverse effects of economic downturns on health and health care.

  1. [The impact of the economic crisis on health systems of OECD countries].

    PubMed

    Paris, Valérie

    2014-10-01

    This paper describes measures adopted by OECD countries in the health sector in response to the economic crisis which began in 2008: increase and diversification of revenues collected for health, increases in user charges, reductions in staff, salaries and prices of health goods and services; and policies aiming to increase health systems efficiency. It then reviews the impact of these policies on health spending trends. PMID:25311027

  2. The financial crisis, health and health inequities in Europe: the need for regulations, redistribution and social protection

    PubMed Central

    2014-01-01

    In 2009, Europe was hit by one of the worst debt crises in history. Although the Eurozone crisis is often depicted as an effect of government mismanagement and corruption, it was a consequence of the 2008 U.S. banking crisis which was caused by more than three decades of neoliberal policies, financial deregulation and widening economic inequities. Evidence indicates that the Eurozone crisis disproportionately affected vulnerable populations in society and caused sharp increases of suicides and deaths due to mental and behavioral disorders especially among those who lost their jobs, houses and economic activities because of the crisis. Although little research has, so far, studied the effects of the crisis on health inequities, evidence showed that the 2009 economic downturn increased the number of people living in poverty and widened income inequality especially in European countries severely hit by the debt crisis. Data, however, also suggest favorable health trends and a reduction of traffic deaths fatalities in the general population during the economic recession. Moreover, egalitarian policies protecting the most disadvantaged populations with strong social protections proved to be effective in decoupling the link between job losses and suicides. Unfortunately, policy responses after the crisis in most European countries have mainly consisted in bank bailouts and austerity programs. These reforms have not only exacerbated the debt crisis and widened inequities in wealth but also failed to address the root causes of the crisis. In order to prevent a future financial downturn and promote a more equitable and sustainable society, European governments and international institutions need to adopt new regulations of banking and finance as well as policies of economic redistribution and investment in social protection. These policy changes, however, require the abandonment of the neoliberal ideology to craft a new global political economy where markets and gross

  3. The financial crisis, health and health inequities in Europe: the need for regulations, redistribution and social protection.

    PubMed

    De Vogli, Roberto

    2014-01-01

    In 2009, Europe was hit by one of the worst debt crises in history. Although the Eurozone crisis is often depicted as an effect of government mismanagement and corruption, it was a consequence of the 2008 U.S. banking crisis which was caused by more than three decades of neoliberal policies, financial deregulation and widening economic inequities.Evidence indicates that the Eurozone crisis disproportionately affected vulnerable populations in society and caused sharp increases of suicides and deaths due to mental and behavioral disorders especially among those who lost their jobs, houses and economic activities because of the crisis. Although little research has, so far, studied the effects of the crisis on health inequities, evidence showed that the 2009 economic downturn increased the number of people living in poverty and widened income inequality especially in European countries severely hit by the debt crisis. Data, however, also suggest favorable health trends and a reduction of traffic deaths fatalities in the general population during the economic recession. Moreover, egalitarian policies protecting the most disadvantaged populations with strong social protections proved to be effective in decoupling the link between job losses and suicides.Unfortunately, policy responses after the crisis in most European countries have mainly consisted in bank bailouts and austerity programs. These reforms have not only exacerbated the debt crisis and widened inequities in wealth but also failed to address the root causes of the crisis. In order to prevent a future financial downturn and promote a more equitable and sustainable society, European governments and international institutions need to adopt new regulations of banking and finance as well as policies of economic redistribution and investment in social protection. These policy changes, however, require the abandonment of the neoliberal ideology to craft a new global political economy where markets and gross

  4. The financial crisis, health and health inequities in Europe: the need for regulations, redistribution and social protection.

    PubMed

    De Vogli, Roberto

    2014-07-25

    In 2009, Europe was hit by one of the worst debt crises in history. Although the Eurozone crisis is often depicted as an effect of government mismanagement and corruption, it was a consequence of the 2008 U.S. banking crisis which was caused by more than three decades of neoliberal policies, financial deregulation and widening economic inequities.Evidence indicates that the Eurozone crisis disproportionately affected vulnerable populations in society and caused sharp increases of suicides and deaths due to mental and behavioral disorders especially among those who lost their jobs, houses and economic activities because of the crisis. Although little research has, so far, studied the effects of the crisis on health inequities, evidence showed that the 2009 economic downturn increased the number of people living in poverty and widened income inequality especially in European countries severely hit by the debt crisis. Data, however, also suggest favorable health trends and a reduction of traffic deaths fatalities in the general population during the economic recession. Moreover, egalitarian policies protecting the most disadvantaged populations with strong social protections proved to be effective in decoupling the link between job losses and suicides.Unfortunately, policy responses after the crisis in most European countries have mainly consisted in bank bailouts and austerity programs. These reforms have not only exacerbated the debt crisis and widened inequities in wealth but also failed to address the root causes of the crisis. In order to prevent a future financial downturn and promote a more equitable and sustainable society, European governments and international institutions need to adopt new regulations of banking and finance as well as policies of economic redistribution and investment in social protection. These policy changes, however, require the abandonment of the neoliberal ideology to craft a new global political economy where markets and gross

  5. Economic crisis, restrictive policies, and the population's health and health care: the Greek case.

    PubMed

    Kondilis, Elias; Giannakopoulos, Stathis; Gavana, Magda; Ierodiakonou, Ioanna; Waitzkin, Howard; Benos, Alexis

    2013-06-01

    The global economic crisis has affected the Greek economy with unprecedented severity, making Greece an important test of the relationship between socioeconomic determinants and a population's well-being. Suicide and homicide mortality rates among men increased by 22.7% and 27.6%, respectively, between 2007 and 2009, and mental disorders, substance abuse, and infectious disease morbidity showed deteriorating trends during 2010 and 2011. Utilization of public inpatient and primary care services rose by 6.2% and 21.9%, respectively, between 2010 and 2011, while the Ministry of Health's total expenditures fell by 23.7% between 2009 and 2011. In a time of economic turmoil, rising health care needs and increasing demand for public services collide with austerity and privatization policies, exposing Greece's population health to further risks.

  6. Economic crisis, restrictive policies, and the population's health and health care: the Greek case.

    PubMed

    Kondilis, Elias; Giannakopoulos, Stathis; Gavana, Magda; Ierodiakonou, Ioanna; Waitzkin, Howard; Benos, Alexis

    2013-06-01

    The global economic crisis has affected the Greek economy with unprecedented severity, making Greece an important test of the relationship between socioeconomic determinants and a population's well-being. Suicide and homicide mortality rates among men increased by 22.7% and 27.6%, respectively, between 2007 and 2009, and mental disorders, substance abuse, and infectious disease morbidity showed deteriorating trends during 2010 and 2011. Utilization of public inpatient and primary care services rose by 6.2% and 21.9%, respectively, between 2010 and 2011, while the Ministry of Health's total expenditures fell by 23.7% between 2009 and 2011. In a time of economic turmoil, rising health care needs and increasing demand for public services collide with austerity and privatization policies, exposing Greece's population health to further risks. PMID:23597358

  7. Health protection in times of economic crisis: challenges and opportunities for Europe.

    PubMed

    McDaid, David; Quaglio, Gianluca; Correia de Campos, António; Dario, Claudio; Van Woensel, Lieve; Karapiperis, Theodoros; Reeves, Aaron

    2013-11-01

    STOA, the European Parliament's technology assessment body, and the European Observatory on Health Systems and Policies recently organised a workshop on the impacts of the economic crisis on European health systems. Evidence of the impact of the recent financial crisis on health outcomes is only just beginning to emerge. Data suggests that this latest recession has led to more frequent poor health status, rising incidence of some communicable diseases, and higher suicide rates. Further, available data are likely to underestimate the broader mental health crisis linked to increased rates of stress, anxiety, and depression among the economically vulnerable. Not only does recession affect factors that determine health, but it also affects the financial capacity to respond. Many European governments have reduced public expenditure on health services during the financial crisis, while introducing or increasing user charges. The recession has driven structural reforms, and has affected the priority given to public policies that could be used to help protect population health. The current economic climate, while challenging, presents an opportunity for reforming and restructuring health promotion actions and taking a long-term perspective.

  8. Health protection in times of economic crisis: challenges and opportunities for Europe.

    PubMed

    McDaid, David; Quaglio, Gianluca; Correia de Campos, António; Dario, Claudio; Van Woensel, Lieve; Karapiperis, Theodoros; Reeves, Aaron

    2013-11-01

    STOA, the European Parliament's technology assessment body, and the European Observatory on Health Systems and Policies recently organised a workshop on the impacts of the economic crisis on European health systems. Evidence of the impact of the recent financial crisis on health outcomes is only just beginning to emerge. Data suggests that this latest recession has led to more frequent poor health status, rising incidence of some communicable diseases, and higher suicide rates. Further, available data are likely to underestimate the broader mental health crisis linked to increased rates of stress, anxiety, and depression among the economically vulnerable. Not only does recession affect factors that determine health, but it also affects the financial capacity to respond. Many European governments have reduced public expenditure on health services during the financial crisis, while introducing or increasing user charges. The recession has driven structural reforms, and has affected the priority given to public policies that could be used to help protect population health. The current economic climate, while challenging, presents an opportunity for reforming and restructuring health promotion actions and taking a long-term perspective. PMID:23986120

  9. Economic crisis and counter-reform of universal health care systems: Spanish case

    PubMed Central

    Fortes, Paulo Antônio de Carvalho; Carvalho, Regina Ribeiro Parizi; Louvison, Marília Cristina Prado

    2015-01-01

    The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities. PMID:26083942

  10. Our Crisis in Children's Mental Health: Frameworks for Understanding and Action.

    ERIC Educational Resources Information Center

    Burke, Robert W.; Myers, Barbara Kimes

    2002-01-01

    Introduces this theme issue's articles, which provide a variety of frameworks for understanding and action in relation to the crisis in child and adolescent mental health. Further emphasizes the challenge to provide resources for all children and to provide ideas for the integration of information between education and mental health professionals.…

  11. Social Media Messages in an Emerging Health Crisis: Tweeting Bird Flu.

    PubMed

    Vos, Sarah C; Buckner, Marjorie M

    2016-01-01

    Limited research has examined the messages produced about health-related crises on social media platforms and whether these messages contain content that would allow individuals to make sense of a crisis and respond effectively. This study uses the crisis and emergency risk communication (CERC) framework to evaluate the content of messages sent via Twitter during an emerging crisis. Using manual and computer-driven content analysis methods, the study analyzed 25,598 tweets about the H7N9 virus that were produced in April 2013. The study found that a large proportion of messages contained sensemaking information. However, few tweets contained efficacy information that would help individuals respond to the crisis appropriately. Implications and recommendations for practice and future study are discussed.

  12. The financial crisis and global health: the International Monetary Fund's (IMF) policy response.

    PubMed

    Ruckert, Arne; Labonté, Ronald

    2013-09-01

    In this article, we interrogate the policy response of the International Monetary Fund (IMF) to the global financial crisis, and discuss the likely global health implications, especially in low-income countries. In doing so, we ask if the IMF has meaningfully loosened its fiscal deficit targets in light of the economic challenges posed by the financial crisis and adjusted its macro-economic policy advice to this new reality; or has the rhetoric of counter-cyclical spending failed to translate into additional fiscal space for IMF loan-recipient countries, with negative health consequences? To answer these questions, we assess several post-crisis IMF lending agreements with countries requiring financial assistance, and draw upon recent academic studies and civil society reports examining policy conditionalities still being prescribed by the IMF. We also reference recent studies examining the health impacts of these conditionalities. We demonstrate that while the IMF has been somewhat more flexible in its crisis response than in previous episodes of financial upheaval, there has been no meaningful rethinking in the application of dominant neoliberal macro-economic policies. After showing some flexibility in the initial crisis response, the IMF is pushing for excessive contraction in most low and middle-income countries. We conclude that there remains a wide gap between the rhetoric and the reality of the IMF's policy and programming advice, with negative implications for global health. PMID:22504946

  13. The financial crisis and global health: the International Monetary Fund's (IMF) policy response.

    PubMed

    Ruckert, Arne; Labonté, Ronald

    2013-09-01

    In this article, we interrogate the policy response of the International Monetary Fund (IMF) to the global financial crisis, and discuss the likely global health implications, especially in low-income countries. In doing so, we ask if the IMF has meaningfully loosened its fiscal deficit targets in light of the economic challenges posed by the financial crisis and adjusted its macro-economic policy advice to this new reality; or has the rhetoric of counter-cyclical spending failed to translate into additional fiscal space for IMF loan-recipient countries, with negative health consequences? To answer these questions, we assess several post-crisis IMF lending agreements with countries requiring financial assistance, and draw upon recent academic studies and civil society reports examining policy conditionalities still being prescribed by the IMF. We also reference recent studies examining the health impacts of these conditionalities. We demonstrate that while the IMF has been somewhat more flexible in its crisis response than in previous episodes of financial upheaval, there has been no meaningful rethinking in the application of dominant neoliberal macro-economic policies. After showing some flexibility in the initial crisis response, the IMF is pushing for excessive contraction in most low and middle-income countries. We conclude that there remains a wide gap between the rhetoric and the reality of the IMF's policy and programming advice, with negative implications for global health.

  14. The global financial crisis and health equity: Early experiences from Canada

    PubMed Central

    2014-01-01

    Background It is widely acknowledged that austerity measures in the wake of the global financial crisis are starting to undermine population health results. Yet, few research studies have focused on the ways in which the financial crisis and the ensuing ‘Great Recession’ have affected health equity, especially through their impact on social determinants of health; neither has much attention been given to the health consequences of the fiscal austerity regime that quickly followed a brief period of counter-cyclical government spending for bank bailouts and economic stimulus. Canada has not remained insulated from these developments, despite its relative success in maneuvering the global financial crisis. Methods The study draws on three sources of evidence: A series of semi-structured interviews in Ottawa and Toronto, with key informants selected on the basis of their expertise (n = 12); an analysis of recent (2012) Canadian and Ontario budgetary impacts on social determinants of health; and documentation of trend data on key social health determinants pre- and post the financial crisis. Results The findings suggest that health equity is primarily impacted through two main pathways related to the global financial crisis: austerity budgets and associated program cutbacks in areas crucial to addressing the inequitable distribution of social determinants of health, including social assistance, housing, and education; and the qualitative transformation of labor markets, with precarious forms of employment expanding rapidly in the aftermath of the global financial crisis. Preliminary evidence suggests that these tendencies will lead to a further deepening of existing health inequities, unless counter-acted through a change in policy direction. Conclusions This article documents some of the effects of financial crisis and severe economic decline on health equity in Canada. However, more research is necessary to study policy choices that could mitigate this effect

  15. The health implications of financial crisis: A review of the evidence

    PubMed Central

    Stuckler, David; Basu, Sanjay; Suhrcke, Marc; McKee, Martin

    2009-01-01

    What will the current economic crisis mean for the health of the people of Northern Ireland? We review the experience of three major economic crises in the 20th century: the Great Depression (1929), the Post-communist Depression (early 1990s) and the East Asian financial crisis (late 1990s). Available evidence suggests that health is at risk in times of rapid economic change, in both booms and busts. However the impact on mortality is exacerbated where people have easy access to the means to harm themselves and is ameliorated by the presence of strong social cohesion and social protection systems. On this basis, Northern Ireland may escape relatively unscathed in the short term but as every crisis also provides an opportunity, this is an appropriate time for the Northern Ireland Executive to reflect on whether they are making a sufficient investment in the long term health of their population. PMID:19907678

  16. Was the economic crisis of 2008 good for Icelanders? Impact on health behaviors.

    PubMed

    Ásgeirsdóttir, Tinna Laufey; Corman, Hope; Noonan, Kelly; Ólafsdóttir, Þórhildur; Reichman, Nancy E

    2014-03-01

    This study uses the 2008 economic crisis in Iceland to identify the effects of a macroeconomic downturn on a range of health behaviors. We use longitudinal survey data that include pre- and post-reports from the same individuals on a range of health-compromising and health-promoting behaviors. We find that the crisis led to large and significant reductions in health-compromising behaviors (such as smoking, drinking alcohol or soft drinks, and eating sweets) and certain health-promoting behaviors (consumption of fruits and vegetables), but to increases in other health-promoting behaviors (consumption of fish oil and recommended sleep). The magnitudes of effects for smoking are somewhat larger than what has been found in past research in other contexts, while those for alcohol, fruits, and vegetables are in line with estimates from other studies. Changes in work hours, real income, financial assets, mortgage debt, and mental health, together, explain the effects of the crisis on some behaviors (such as consumption of sweets and fast food), while the effects of the crisis on most other behaviors appear to have operated largely through price increases. PMID:23659821

  17. Economic Crisis, Restrictive Policies, and the Population’s Health and Health Care: The Greek Case

    PubMed Central

    Giannakopoulos, Stathis; Gavana, Magda; Ierodiakonou, Ioanna; Waitzkin, Howard; Benos, Alexis

    2013-01-01

    The global economic crisis has affected the Greek economy with unprecedented severity, making Greece an important test of the relationship between socioeconomic determinants and a population’s well-being. Suicide and homicide mortality rates among men increased by 22.7% and 27.6%, respectively, between 2007 and 2009, and mental disorders, substance abuse, and infectious disease morbidity showed deteriorating trends during 2010 and 2011. Utilization of public inpatient and primary care services rose by 6.2% and 21.9%, respectively, between 2010 and 2011, while the Ministry of Health’s total expenditures fell by 23.7% between 2009 and 2011. In a time of economic turmoil, rising health care needs and increasing demand for public services collide with austerity and privatization policies, exposing Greece’s population health to further risks. PMID:23597358

  18. [After the crisis is before the crisis: Coping-strategies for public health emergency situations on different levels--experiences of the German E. coli outbreak 2011].

    PubMed

    Auschra, Carolin; Kielstein, Jan T; Tecklenburg, Andreas; Müller-Seitz, Gordon

    2014-12-15

    The German E. coli crisis in 2011 posed multifaceted challenges to the actors of the German health care system. This paper analyzes the outbreak from a multidisciplinary perspective. It offers best practices and general recommendations for future public health emergencies for hospitals as well as at the federal and local level, addressing medical practitioners as well as health care managers.

  19. [After the crisis is before the crisis: Coping-strategies for public health emergency situations on different levels--experiences of the German E. coli outbreak 2011].

    PubMed

    Auschra, Carolin; Kielstein, Jan T; Tecklenburg, Andreas; Müller-Seitz, Gordon

    2014-12-15

    The German E. coli crisis in 2011 posed multifaceted challenges to the actors of the German health care system. This paper analyzes the outbreak from a multidisciplinary perspective. It offers best practices and general recommendations for future public health emergencies for hospitals as well as at the federal and local level, addressing medical practitioners as well as health care managers. PMID:26153590

  20. [Indicators to monitor the evolution of the economic crisis and its effects on health and health inequalities. SESPAS report 2014].

    PubMed

    Pérez, Glòria; Rodríguez-Sanz, Maica; Domínguez-Berjón, Felicitas; Cabeza, Elena; Borrell, Carme

    2014-06-01

    The economic crisis has adverse effects on determinants of health and health inequalities. The aim of this article was to present a set of indicators of health and its determinants to monitor the effects of the crisis in Spain. On the basis of the conceptual framework proposed by the Commission for the Reduction of Social Health Inequalities in Spain, we searched for indicators of social, economic, and political (structural and intermediate) determinants of health, as well as for health indicators, bearing in mind the axes of social inequality (gender, age, socioeconomic status, and country of origin). The indicators were mainly obtained from official data sources published on the internet. The selected indicators are periodically updated and are comparable over time and among territories (among autonomous communities and in some cases among European Union countries), and are available for age groups, gender, socio-economic status, and country of origin. However, many of these indicators are not sufficiently reactive to rapid change, which occurs in the economic crisis, and consequently require monitoring over time. Another limitation is the lack of availability of indicators for the various axes of social inequality. In conclusion, the proposed indicators allow for progress in monitoring the effects of the economic crisis on health and health inequalities in Spain.

  1. [Indicators to monitor the evolution of the economic crisis and its effects on health and health inequalities. SESPAS report 2014].

    PubMed

    Pérez, Glòria; Rodríguez-Sanz, Maica; Domínguez-Berjón, Felicitas; Cabeza, Elena; Borrell, Carme

    2014-06-01

    The economic crisis has adverse effects on determinants of health and health inequalities. The aim of this article was to present a set of indicators of health and its determinants to monitor the effects of the crisis in Spain. On the basis of the conceptual framework proposed by the Commission for the Reduction of Social Health Inequalities in Spain, we searched for indicators of social, economic, and political (structural and intermediate) determinants of health, as well as for health indicators, bearing in mind the axes of social inequality (gender, age, socioeconomic status, and country of origin). The indicators were mainly obtained from official data sources published on the internet. The selected indicators are periodically updated and are comparable over time and among territories (among autonomous communities and in some cases among European Union countries), and are available for age groups, gender, socio-economic status, and country of origin. However, many of these indicators are not sufficiently reactive to rapid change, which occurs in the economic crisis, and consequently require monitoring over time. Another limitation is the lack of availability of indicators for the various axes of social inequality. In conclusion, the proposed indicators allow for progress in monitoring the effects of the economic crisis on health and health inequalities in Spain. PMID:24864001

  2. The burden of acute respiratory infections in crisis-affected populations: a systematic review

    PubMed Central

    2010-01-01

    Crises due to armed conflict, forced displacement and natural disasters result in excess morbidity and mortality due to infectious diseases. Historically, acute respiratory infections (ARIs) have received relatively little attention in the humanitarian sector. We performed a systematic review to generate evidence on the burden of ARI in crises, and inform prioritisation of relief interventions. We identified 36 studies published since 1980 reporting data on the burden (incidence, prevalence, proportional morbidity or mortality, case-fatality, attributable mortality rate) of ARI, as defined by the International Classification of Diseases, version 10 and as diagnosed by a clinician, in populations who at the time of the study were affected by natural disasters, armed conflict, forced displacement, and nutritional emergencies. We described studies and stratified data by age group, but did not do pooled analyses due to heterogeneity in case definitions. The published evidence, mainly from refugee camps and surveillance or patient record review studies, suggests very high excess morbidity and mortality (20-35% proportional mortality) and case-fatality (up to 30-35%) due to ARI. However, ARI disease burden comparisons with non-crisis settings are difficult because of non-comparability of data. Better epidemiological studies with clearer case definitions are needed to provide the evidence base for priority setting and programme impact assessments. Humanitarian agencies should include ARI prevention and control among infants, children and adults as priority activities in crises. Improved data collection, case management and vaccine strategies will help to reduce disease burden. PMID:20181220

  3. The burden of acute respiratory infections in crisis-affected populations: a systematic review.

    PubMed

    Bellos, Anna; Mulholland, Kim; O'Brien, Katherine L; Qazi, Shamim A; Gayer, Michelle; Checchi, Francesco

    2010-01-01

    Crises due to armed conflict, forced displacement and natural disasters result in excess morbidity and mortality due to infectious diseases. Historically, acute respiratory infections (ARIs) have received relatively little attention in the humanitarian sector. We performed a systematic review to generate evidence on the burden of ARI in crises, and inform prioritisation of relief interventions. We identified 36 studies published since 1980 reporting data on the burden (incidence, prevalence, proportional morbidity or mortality, case-fatality, attributable mortality rate) of ARI, as defined by the International Classification of Diseases, version 10 and as diagnosed by a clinician, in populations who at the time of the study were affected by natural disasters, armed conflict, forced displacement, and nutritional emergencies. We described studies and stratified data by age group, but did not do pooled analyses due to heterogeneity in case definitions. The published evidence, mainly from refugee camps and surveillance or patient record review studies, suggests very high excess morbidity and mortality (20-35% proportional mortality) and case-fatality (up to 30-35%) due to ARI. However, ARI disease burden comparisons with non-crisis settings are difficult because of non-comparability of data. Better epidemiological studies with clearer case definitions are needed to provide the evidence base for priority setting and programme impact assessments. Humanitarian agencies should include ARI prevention and control among infants, children and adults as priority activities in crises. Improved data collection, case management and vaccine strategies will help to reduce disease burden. PMID:20181220

  4. Practical legal and ethical considerations for the provision of acute disaster mental health services.

    PubMed

    Call, John A; Pfefferbaum, Betty; Jenuwine, Michael J; Flynn, Brian W

    2012-01-01

    Mental health professionals who provide emergency psychosocial assistance in the immediate aftermath of disasters do so in the midst of crisis and chaos. Common roles undertaken by disaster mental health professionals include treating existing conditions of disaster survivors and providing psychosocial support to front line responders and those acutely affected. Other roles include participating in multidisciplinary health care teams as well as monitoring and supporting team members' mental health. When, in the immediate aftermath of a disaster, mental health professionals provide such assistance, they may take on legal and ethical responsibilities that they are not fully aware of or do not fully comprehend. Unfortunately, not much has been written about these obligations, and professional organizations have provided little guidance. Thus, the purpose of the present article is to outline and discuss an analysis framework and suggest recommendations that mental health professionals can use to help guide their actions during the chaos immediate post disaster.

  5. Defining and Acting on Global Health: The Case of Japan and the Refugee Crisis

    PubMed Central

    Leppold, Claire; Ozaki, Akihiko; Shimada, Yuki; Morita, Tomohiro; Tanimoto, Tetsuya

    2016-01-01

    What counts as global health? There has been limited discourse to date on the ways in which country-level contexts may shape positioning in global health agendas. By reviewing Japan’s response to the refugee crisis, we demonstrate a clash between rhetoric and action on global responsibility, and suggest that cultural and historical factors may be related to the ways of perceiving and acting upon global health. PMID:27694658

  6. Defining and Acting on Global Health: The Case of Japan and the Refugee Crisis

    PubMed Central

    Leppold, Claire; Ozaki, Akihiko; Shimada, Yuki; Morita, Tomohiro; Tanimoto, Tetsuya

    2016-01-01

    What counts as global health? There has been limited discourse to date on the ways in which country-level contexts may shape positioning in global health agendas. By reviewing Japan’s response to the refugee crisis, we demonstrate a clash between rhetoric and action on global responsibility, and suggest that cultural and historical factors may be related to the ways of perceiving and acting upon global health.

  7. A Suffering Generation: Six Factors Contributing to the Mental Health Crisis in North American Higher Education

    ERIC Educational Resources Information Center

    Kruisselbrink Flatt, Alicia

    2013-01-01

    The number of students on university and college campuses that are struggling with depression, anxiety, suicidal thoughts, and psychosis across North America is rising (Gallagher, 2008). This intensification of students' psychological needs has become a mental health crisis. The age at which many mental disorders manifest themselves is…

  8. Meeting the challenges of the African health crisis in the decade of the nineties.

    PubMed

    Monekosso, G L

    1993-12-01

    Africa is suffering from a health crisis brought about by the economic disarray of many African economies which occurred in the wake of the world economic recession of the 1980s and by the phenomenon of AIDS. After the period of colonization was over, many African nations made great strides during the 1960s and 1970s in extending health services to rural areas and in expanding the training of medical personnel. Health development came to a halt in the 1980s, and basic survival is now an issue in a situation where the misery of recurring epidemics has been compounded by drought and famine. Economic set-backs created a crisis in health services manifested by such problems as a reduction in services and an inability to maintain facilities. This is the setting which gave birth to the AIDS epidemic. In order to foster health development, local activities in well defined districts need to be well managed and supervised in order to result in health improvements. Such a health development framework (as adopted by the Ministries of Health of the African region of the World Health Organization in 1985) would require operational, technical, and strategic support. National health institutions organized according to this framework would provide medical care in hospitals, would promote public health in health centers, and would promote health related activities in communities. Universities can help in this effort by providing student and staff consultants to work in a partnership arrangement with community members on multi-sectoral, multidisciplinary health and development committees at the local, intermediate, and central levels. The contribution of universities to the crucial efforts to resolve the African health crisis will be most important.

  9. Policy Options for Addressing Health System and Human Resources for Health Crisis in Liberia Post-Ebola Epidemic

    PubMed Central

    Budy, Fidel C.T.

    2015-01-01

    Qualified healthcare workers within an effective health system are critical in promoting and achieving greater health outcomes such as those espoused in the Millennium Development Goals. Liberia is currently struggling with the effects of a brutal 14-year long civil war that devastated health infrastructures and caused most qualified health workers to flee and settle in foreign countries. The current output of locally trained health workers is not adequate for the tasks at hand. The recent Ebola Virus Disease (EVD) exposed the failings of the Liberian healthcare system. There is limited evidence of policies that could be replicated in Liberia to encourage qualified diaspora Liberian health workers to return and contribute to managing the phenomenon. This paper reviews the historical context for the human resources for health crisis in Liberia; it critically examines two context-specific health policy options to address the crisis, and recommends reverse brain drain as a policy option to address the immediate and critical crisis facing the health care sector in Liberia. PMID:27622002

  10. Policy Options for Addressing Health System and Human Resources for Health Crisis in Liberia Post-Ebola Epidemic

    PubMed Central

    Budy, Fidel C.T.

    2015-01-01

    Qualified healthcare workers within an effective health system are critical in promoting and achieving greater health outcomes such as those espoused in the Millennium Development Goals. Liberia is currently struggling with the effects of a brutal 14-year long civil war that devastated health infrastructures and caused most qualified health workers to flee and settle in foreign countries. The current output of locally trained health workers is not adequate for the tasks at hand. The recent Ebola Virus Disease (EVD) exposed the failings of the Liberian healthcare system. There is limited evidence of policies that could be replicated in Liberia to encourage qualified diaspora Liberian health workers to return and contribute to managing the phenomenon. This paper reviews the historical context for the human resources for health crisis in Liberia; it critically examines two context-specific health policy options to address the crisis, and recommends reverse brain drain as a policy option to address the immediate and critical crisis facing the health care sector in Liberia.

  11. Policy Options for Addressing Health System and Human Resources for Health Crisis in Liberia Post-Ebola Epidemic.

    PubMed

    Budy, Fidel C T

    2015-01-01

    Qualified healthcare workers within an effective health system are critical in promoting and achieving greater health outcomes such as those espoused in the Millennium Development Goals. Liberia is currently struggling with the effects of a brutal 14-year long civil war that devastated health infrastructures and caused most qualified health workers to flee and settle in foreign countries. The current output of locally trained health workers is not adequate for the tasks at hand. The recent Ebola Virus Disease (EVD) exposed the failings of the Liberian healthcare system. There is limited evidence of policies that could be replicated in Liberia to encourage qualified diaspora Liberian health workers to return and contribute to managing the phenomenon. This paper reviews the historical context for the human resources for health crisis in Liberia; it critically examines two context-specific health policy options to address the crisis, and recommends reverse brain drain as a policy option to address the immediate and critical crisis facing the health care sector in Liberia. PMID:27622002

  12. Policy Options for Addressing Health System and Human Resources for Health Crisis in Liberia Post-Ebola Epidemic.

    PubMed

    Budy, Fidel C T

    2015-01-01

    Qualified healthcare workers within an effective health system are critical in promoting and achieving greater health outcomes such as those espoused in the Millennium Development Goals. Liberia is currently struggling with the effects of a brutal 14-year long civil war that devastated health infrastructures and caused most qualified health workers to flee and settle in foreign countries. The current output of locally trained health workers is not adequate for the tasks at hand. The recent Ebola Virus Disease (EVD) exposed the failings of the Liberian healthcare system. There is limited evidence of policies that could be replicated in Liberia to encourage qualified diaspora Liberian health workers to return and contribute to managing the phenomenon. This paper reviews the historical context for the human resources for health crisis in Liberia; it critically examines two context-specific health policy options to address the crisis, and recommends reverse brain drain as a policy option to address the immediate and critical crisis facing the health care sector in Liberia.

  13. Similar but different: health and economic crisis in 1990s Cuba and Russia.

    PubMed

    Borowy, Iris

    2011-05-01

    The collapse of the Soviet Bloc caused devastating economic crises in Cuba and in the Russian Federation but triggered remarkably different public health responses: while mortality rates in Russia increased substantially the crisis was barely visible in Cuban public health statistics. Fundamental social, political and cultural differences in the two countries and the respective specificities of the crisis in either country seem responsible, including different long-term health trajectories and different traditions of health-related agenda setting. Cuban policies combined traditional top down activism with grass root activities, strengthening social capital, while the "shock therapy" adopted in Russia had a corrosive effect on society, increasing psycho-social pressure and weakening support.

  14. Financial crisis and austerity measures in Greece: their impact on health promotion policies and public health care.

    PubMed

    Ifanti, Amalia A; Argyriou, Andreas A; Kalofonou, Foteini H; Kalofonos, Haralabos P

    2013-11-01

    This review study explores the available data relating to the impact of financial crisis and subsequently applied austerity measures on the health care, social services and health promotion policies in Greece. It is evident that Greece is affected more than any other European country by the financial crisis. Unemployment, job insecurity, income reduction, poverty and increase of mental disorders are among the most serious consequences of crisis in the socioeconomic life. The health system is particularly affected by the severe austerity measures. The drastic curtailing of government spending has significantly affected the structure and functioning of public hospitals that cope with understaffing, deficits, drug shortage and basic medical supplies. Moreover, health promotion policies are constrained, inhibiting thus the relevant initiatives toward disease prevention and health promotion education practices. Overall, the current economic situation in Greece and its impact on real life and health care is quite concerning. Policy makers should not disregard the implications that austerity and fiscal policies have on the health sector. Greater attention is needed in order to ensure that individuals would continue getting public health care and having access to preventive and social support services. To face the economic hardship, policy makers are expected to implement human-centered approaches, safeguarding the human dignity and the moral values. PMID:23790265

  15. Financial crisis and austerity measures in Greece: their impact on health promotion policies and public health care.

    PubMed

    Ifanti, Amalia A; Argyriou, Andreas A; Kalofonou, Foteini H; Kalofonos, Haralabos P

    2013-11-01

    This review study explores the available data relating to the impact of financial crisis and subsequently applied austerity measures on the health care, social services and health promotion policies in Greece. It is evident that Greece is affected more than any other European country by the financial crisis. Unemployment, job insecurity, income reduction, poverty and increase of mental disorders are among the most serious consequences of crisis in the socioeconomic life. The health system is particularly affected by the severe austerity measures. The drastic curtailing of government spending has significantly affected the structure and functioning of public hospitals that cope with understaffing, deficits, drug shortage and basic medical supplies. Moreover, health promotion policies are constrained, inhibiting thus the relevant initiatives toward disease prevention and health promotion education practices. Overall, the current economic situation in Greece and its impact on real life and health care is quite concerning. Policy makers should not disregard the implications that austerity and fiscal policies have on the health sector. Greater attention is needed in order to ensure that individuals would continue getting public health care and having access to preventive and social support services. To face the economic hardship, policy makers are expected to implement human-centered approaches, safeguarding the human dignity and the moral values.

  16. The Kurt Cobain suicide crisis: perspectives from research, public health, and the news media.

    PubMed

    Jobes, D A; Berman, A L; O'Carroll, P W; Eastgard, S; Knickmeyer, S

    1996-01-01

    The suicide of rock star Kurt Cobain in 1994 raised immediate concerns among suicidologists and the public at large about the potential for his death to spark copycat suicides, especially among vulnerable youth. The Seattle community, where Cobain lived and died, was especially affected by his sudden death. An overview of Cobain's life and death is presented and various crisis center and community-based interventions that occurred are discussed. Preliminary data collected from the Seattle Medical Examiner's Office and from the Seattle Crisis Center to assess the potential impact of Cobain's death on completed suicides and the incidence of suicide crisis calls are presented. The data obtained from the Seattle King County area suggest that the expected "Werther effect" apparently did not occur, but there was a significant increase in suicide crisis calls following his death. It is hypothesized that the lack of an apparent copycat effect in Seattle may be due to various aspects of the media coverage, the method used in Cobain's suicide, and the crisis center and community outreach interventions that occurred. The Cobain suicide and the role of media influence on copycat suicides are further discussed in commentaries from public health and news media perspectives.

  17. The Kurt Cobain suicide crisis: perspectives from research, public health, and the news media.

    PubMed

    Jobes, D A; Berman, A L; O'Carroll, P W; Eastgard, S; Knickmeyer, S

    1996-01-01

    The suicide of rock star Kurt Cobain in 1994 raised immediate concerns among suicidologists and the public at large about the potential for his death to spark copycat suicides, especially among vulnerable youth. The Seattle community, where Cobain lived and died, was especially affected by his sudden death. An overview of Cobain's life and death is presented and various crisis center and community-based interventions that occurred are discussed. Preliminary data collected from the Seattle Medical Examiner's Office and from the Seattle Crisis Center to assess the potential impact of Cobain's death on completed suicides and the incidence of suicide crisis calls are presented. The data obtained from the Seattle King County area suggest that the expected "Werther effect" apparently did not occur, but there was a significant increase in suicide crisis calls following his death. It is hypothesized that the lack of an apparent copycat effect in Seattle may be due to various aspects of the media coverage, the method used in Cobain's suicide, and the crisis center and community outreach interventions that occurred. The Cobain suicide and the role of media influence on copycat suicides are further discussed in commentaries from public health and news media perspectives. PMID:8897665

  18. Balancing in a crisis? Bioterrorism, public health and privacy.

    PubMed

    Goldman, Janlori

    2005-01-01

    Post-September 11, the government has been rapidly funding public health initiatives to bolster the Nation's ability to respond to bioterrorist attacks. While the infusion of money into the public health system is laudable, the pressure to enact legislation quickly has resulted in laws and policies that ignore privacy and civil liberties and that favor anti-bioterror initiatives over more common public health concerns. A public health agenda that ignores privacy and civil liberties will undermine public trust, leading people to not fully participate in critical public health activities. Our Nation is far more likely to succeed in preventing and responding to a potential act of bioterrorism if we embrace the principle that advancing public health and preserving individual liberties are symbiotic and inextricable.

  19. Public health surveillance and meaningful use regulations: a crisis of opportunity.

    PubMed

    Lenert, Leslie; Sundwall, David N

    2012-03-01

    The Health Information Technology for Economic and Clinical Health Act is intended to enhance reimbursement of health care providers for meaningful use of electronic health records systems. This presents both opportunities and challenges for public health departments. To earn incentive payments, clinical providers must exchange specified types of data with the public health system, such as immunization and syndromic surveillance data and notifiable disease reporting. However, a crisis looms because public health's information technology systems largely lack the capabilities to accept the types of data proposed for exchange. Cloud computing may be a solution for public health information systems. Through shared computing resources, public health departments could reap the benefits of electronic reporting within federal funding constraints. PMID:22390523

  20. Scleroderma renal crisis-like acute renal failure associated with mucopolysaccharide accumulation in renal vessels in a patient with scleromyxedema.

    PubMed

    Lee, Young H; Sahu, Joya; O'Brien, Marie S; D'Agati, Vivette D; Jimenez, Sergio A

    2011-09-01

    Scleromyxedema is a systemic disease characterized by lichenoid papules, nodules, and plaques on the skin and often diffuse skin induration resembling the cutaneous involvement of systemic sclerosis. The systemic involvement affects the musculoskeletal, pulmonary, cardiovascular, gastrointestinal, and central nervous systems, and the disorder is commonly associated with a paraproteinemia. Involvement of the kidney is rare and not considered a feature of the disease. Here, we describe an unusual case of scleromyxedema complicated by the development of scleroderma renal crisis-like acute renal failure with a marked intimal deposition of mucin, mucopolysaccharides, and hyaluronic acid in the intrarenal vessels.

  1. Health Impacts from Acute Radiation Exposure

    SciTech Connect

    Strom, Daniel J.

    2003-09-30

    Absorbed doses above1-2 Gy (100-200 rads) received over a period of a day or less lead to one or another of the acute radiation syndromes. These are the hematopoietic syndrome, the gastrointestinal (GI) syndrome, the cerebrovascular (CV) syndrome, the pulmonary syndrome, or the cutaneous syndrome. The dose that will kill about 50% of the exposed people within 60 days with minimal medical care, LD50-60, is around 4.5 Gy (450 rads) of low-LET radiation measured free in air. The GI syndrome may not be fatal with supportive medical care and growth factors below about 10 Gy (1000 rads), but above this is likely to be fatal. Pulmonary and cutaneous syndromes may or may not be fatal, depending on many factors. The CV syndrome is invariably fatal. Lower acute doses, or protracted doses delivered over days or weeks, may lead to many other health outcomes than death. These include loss of pregnancy, cataract, impaired fertility or temporary or permanent sterility, hair loss, skin ulceration, local tissue necrosis, developmental abnormalities including mental and growth retardation in persons irradiated as children or fetuses, radiation dermatitis, and other symptoms listed in Table 2 on page 12. Children of parents irradiated prior to conception may experience heritable ill-health, that is, genetic changes from their parents. These effects are less strongly expressed than previously thought. Populations irradiated to high doses at high dose rates have increased risk of cancer incidence and mortality, taken as about 10-20% incidence and perhaps 5-10% mortality per sievert of effective dose of any radiation or per gray of whole-body absorbed dose low-LET radiation. Cancer risks for non-uniform irradiation will be less.

  2. Impact of the 2008 Economic and Financial Crisis on Child Health: A Systematic Review

    PubMed Central

    Rajmil, Luis; Fernandez de Sanmamed, María-José; Choonara, Imti; Faresjö, Tomas; Hjern, Anders; Kozyrskyj, Anita L.; Lucas, Patricia J.; Raat, Hein; Séguin, Louise; Spencer, Nick; Taylor-Robinson, David

    2014-01-01

    The aim of this study was to provide an overview of studies in which the impact of the 2008 economic crisis on child health was reported. Structured searches of PubMed, and ISI Web of Knowledge, were conducted. Quantitative and qualitative studies reporting health outcomes on children, published since 2007 and related to the 2008 economic crisis were included. Two reviewers independently assessed studies for inclusion. Data were synthesised as a narrative review. Five hundred and six titles and abstracts were reviewed, from which 22 studies were included. The risk of bias for quantitative studies was mixed while qualitative studies showed low risk of bias. An excess of 28,000–50,000 infant deaths in 2009 was estimated in sub-Saharan African countries, and increased infant mortality in Greece was reported. Increased price of foods was related to worsening nutrition habits in disadvantaged families worldwide. An increase in violence against children was reported in the U.S., and inequalities in health-related quality of life appeared in some countries. Most studies suggest that the economic crisis has harmed children’s health, and disproportionately affected the most vulnerable groups. There is an urgent need for further studies to monitor the child health effects of the global recession and to inform appropriate public policy responses. PMID:25019121

  3. Impact of the 2008 economic and financial crisis on child health: a systematic review.

    PubMed

    Rajmil, Luis; Fernandez de Sanmamed, María-José; Choonara, Imti; Faresjö, Tomas; Hjern, Anders; Kozyrskyj, Anita L; Lucas, Patricia J; Raat, Hein; Séguin, Louise; Spencer, Nick; Taylor-Robinson, David

    2014-06-01

    The aim of this study was to provide an overview of studies in which the impact of the 2008 economic crisis on child health was reported. Structured searches of PubMed, and ISI Web of Knowledge, were conducted. Quantitative and qualitative studies reporting health outcomes on children, published since 2007 and related to the 2008 economic crisis were included. Two reviewers independently assessed studies for inclusion. Data were synthesised as a narrative review. Five hundred and six titles and abstracts were reviewed, from which 22 studies were included. The risk of bias for quantitative studies was mixed while qualitative studies showed low risk of bias. An excess of 28,000-50,000 infant deaths in 2009 was estimated in sub-Saharan African countries, and increased infant mortality in Greece was reported. Increased price of foods was related to worsening nutrition habits in disadvantaged families worldwide. An increase in violence against children was reported in the U.S., and inequalities in health-related quality of life appeared in some countries. Most studies suggest that the economic crisis has harmed children's health, and disproportionately affected the most vulnerable groups. There is an urgent need for further studies to monitor the child health effects of the global recession and to inform appropriate public policy responses. PMID:25019121

  4. Impact of the 2008 economic and financial crisis on child health: a systematic review.

    PubMed

    Rajmil, Luis; Fernandez de Sanmamed, María-José; Choonara, Imti; Faresjö, Tomas; Hjern, Anders; Kozyrskyj, Anita L; Lucas, Patricia J; Raat, Hein; Séguin, Louise; Spencer, Nick; Taylor-Robinson, David

    2014-06-01

    The aim of this study was to provide an overview of studies in which the impact of the 2008 economic crisis on child health was reported. Structured searches of PubMed, and ISI Web of Knowledge, were conducted. Quantitative and qualitative studies reporting health outcomes on children, published since 2007 and related to the 2008 economic crisis were included. Two reviewers independently assessed studies for inclusion. Data were synthesised as a narrative review. Five hundred and six titles and abstracts were reviewed, from which 22 studies were included. The risk of bias for quantitative studies was mixed while qualitative studies showed low risk of bias. An excess of 28,000-50,000 infant deaths in 2009 was estimated in sub-Saharan African countries, and increased infant mortality in Greece was reported. Increased price of foods was related to worsening nutrition habits in disadvantaged families worldwide. An increase in violence against children was reported in the U.S., and inequalities in health-related quality of life appeared in some countries. Most studies suggest that the economic crisis has harmed children's health, and disproportionately affected the most vulnerable groups. There is an urgent need for further studies to monitor the child health effects of the global recession and to inform appropriate public policy responses.

  5. Action needed now to prevent another public health crisis.

    PubMed

    2016-08-31

    It stands to reason: if you want to improve the nation's health, surely there is no better way than to start young. That means persuading expectant mothers to stop smoking, normalising breastfeeding, running an effective health visiting service and seeing children safely and healthily into adulthood. PMID:27577270

  6. The Popeye principle: selling child health in the first nutrition crisis.

    PubMed

    Lovett, Laura

    2005-10-01

    The cartoon character Popeye the Sailor was capable of superhuman feats of strength after eating a can of spinach. Popeye ate spinach because the association of spinach with strength was a product of the first national nutrition crisis in the United States: the 1920s fight against child malnutrition. Spanning the first three decades of the twentieth century, the malnutrition crisis arose from the confluence of many different events including the invention of nutrition science and new standards for height and weight; international food crises created by world war; the rise of consumerism, advertising, and new forms of mass media; and Progressive reformers' conviction that education was a key component of any solution. The history of the malnutrition crisis presented in this essay synthesizes disparate histories concerning advertising, public health, education, consumerism, philanthropy, and Progressive Era reform with original analysis of a major nutrition education program sponsored by the Commonwealth Fund in the 1920s. Because the character of Popeye came to embody one of the nutritional norms advocated in the 1920s, I refer to the influence of culturally constructed social norms on children's beliefs about health and nutrition as the Popeye Principle. The history of the malnutrition crisis demonstrates the importance of understanding the cultural and economic conditions surrounding childhood nutrition, the use and influence of numerical norms, and the mutually reinforcing influences on children's nutritional norms from their parents, peers, teachers, and culture.

  7. The Popeye principle: selling child health in the first nutrition crisis.

    PubMed

    Lovett, Laura

    2005-10-01

    The cartoon character Popeye the Sailor was capable of superhuman feats of strength after eating a can of spinach. Popeye ate spinach because the association of spinach with strength was a product of the first national nutrition crisis in the United States: the 1920s fight against child malnutrition. Spanning the first three decades of the twentieth century, the malnutrition crisis arose from the confluence of many different events including the invention of nutrition science and new standards for height and weight; international food crises created by world war; the rise of consumerism, advertising, and new forms of mass media; and Progressive reformers' conviction that education was a key component of any solution. The history of the malnutrition crisis presented in this essay synthesizes disparate histories concerning advertising, public health, education, consumerism, philanthropy, and Progressive Era reform with original analysis of a major nutrition education program sponsored by the Commonwealth Fund in the 1920s. Because the character of Popeye came to embody one of the nutritional norms advocated in the 1920s, I refer to the influence of culturally constructed social norms on children's beliefs about health and nutrition as the Popeye Principle. The history of the malnutrition crisis demonstrates the importance of understanding the cultural and economic conditions surrounding childhood nutrition, the use and influence of numerical norms, and the mutually reinforcing influences on children's nutritional norms from their parents, peers, teachers, and culture. PMID:16477789

  8. Responding to a crisis: a stakeholder analysis of community health organizations.

    PubMed

    Savage, Grant T; Dunkin, Jeri W; Ford, David M

    2004-01-01

    On May 11, 2001, the Bureau of Primary Health Care notified West Alabama Health Services, doing business as Family HealthCare of Alabama, that it was terminating $6 million in grants due to non-compliance and amid allegations of financial mismanagement and fraud. West Alabama Health Services, a not-for-profit organization, operated 19 community health centers that provided preventive and primary care services for 17 counties in Alabama. This disruption of health services engendered considerable stakeholder debate. Within this context, the authors examine how a small, newly established rural health center and a well-established, federally qualified community health center responded to this crisis. The authors use a stakeholder analysis framework to highlight how key relationships with stakeholders may change with the perceived credibility of the organizational leaders and the legitimacy of their actions. PMID:15704640

  9. Future of the animal health industry at a time of food crisis.

    PubMed

    Campbell, William C; Conder, George A; Marchiondo, Alan A

    2009-08-01

    It is popular in some quarters to say that there is no food crisis; that there is food aplenty; and that the problem is one of distribution or other over-arching technical difficulty. To the starving, however, there is a food crisis; and it neither speaks well nor bodes well for humanity if we dismiss their plight so glibly. The United Nations has called for a large and rapid increase in food production. Veterinary parasitologists and industry leaders can contribute to the production of healthier livestock and the expansion of aquaculture, but enhanced production and better delivery of plant foods may provide faster relief. Although livestock farming is not the most energy-efficient way of producing food, meat will remain a significant component of the global diet for the foreseeable future. New measures for parasite control will be needed, and we must improve our methods of inventing them. They need not act directly against the parasite. In the distant future lie other threats to the inhabitants of planet Earth, and here we must acknowledge the cogency of the no-food-crisis argument. In the long term, the production of animal foods and animal feeds will be revamped in ways that depend on how (or whether) we solve the energy crisis, the environmental crisis, the increasingly dire regional population crises, and the current world financial crisis. Throughout the 20th century, the animal health industry had to adapt to industrialization and expansive agribusiness. It will have to adapt to even greater changes in the 21st century and beyond.

  10. Homicide among young Black men in Toronto: an unrecognized public health crisis?

    PubMed

    Khenti, Akwatu A

    2013-01-08

    This commentary addresses the high homicide rates among young Black men in Toronto, Ontario. It posits that homicide among this population is an unrecognized major public health crisis that should be a priority for the field. The author suggests that the dramatic rate of Black homicides in Toronto is a consequence of income inequality, poverty, poor quality of life, mental health risks, and sustained racism. The commentary calls upon public health scientists to prioritize research about violence and homicide among young Black men in Toronto. It suggests that current and future policy making would be better served by their enquiries into the nature and causes of the persisting dilemma.

  11. Equity during an economic crisis: financing of the Argentine health system.

    PubMed

    Cavagnero, Eleonora; Bilger, Marcel

    2010-07-01

    This article analyses the redistributive effect caused by health financing and the distribution of healthcare utilization in Argentina before and during the severe 2001/2002 economic crisis. Both dramatically changed during this period: the redistributive effect became much more positive and utilization shifted from pro-poor to pro-rich. This clearly demonstrates that when utilization is contingent on financing, changes can occur rapidly; and that an integrated approach is required when monitoring equity. From a policy perspective, the Argentine health system appears vulnerable to economic downturns mainly due to high reliance on out-of-pocket payments and the strong link between health insurance and employment. PMID:20452070

  12. Equity during an economic crisis: financing of the Argentine health system.

    PubMed

    Cavagnero, Eleonora; Bilger, Marcel

    2010-07-01

    This article analyses the redistributive effect caused by health financing and the distribution of healthcare utilization in Argentina before and during the severe 2001/2002 economic crisis. Both dramatically changed during this period: the redistributive effect became much more positive and utilization shifted from pro-poor to pro-rich. This clearly demonstrates that when utilization is contingent on financing, changes can occur rapidly; and that an integrated approach is required when monitoring equity. From a policy perspective, the Argentine health system appears vulnerable to economic downturns mainly due to high reliance on out-of-pocket payments and the strong link between health insurance and employment.

  13. Crisis, leadership, consensus: the past and future federal role in health.

    PubMed

    Boufford, J I

    1999-06-01

    This paper touches on patterns of federal government involvement in the health sector since the late 18th century to the present and speculates on its role in the early decades of the 21st century. Throughout the history of the US, government involvement in the health sector came only in the face of crisis, only when there was widespread consensus, and only through sustained leadership. One of the first health-related acts of Congress came about as a matter of interstate commerce regarding the dilemma as to what to do about treating merchant seamen who had no affiliation with any state. Further federal actions were implemented to address epidemics, such as from yellow fever, that traveled from state to state through commercial ships. Each federal action was met with concern and resistance from states' rights advocates, who asserted that the health of the public was best left to the states and localities. It was not until the early part of the 20th century that a concern for social well-being, not merely commerce, drove the agenda for public health action. Two separate campaigns for national health insurance, as well as a rapid expansion of programs to serve the specific health needs of specific populations, led finally to the introduction of Medicaid and Medicare in the 1960s, the most dramatic example of government intervention in shaping the personal health care delivery system in the latter half of the 20th century. As health costs continued to rise and more and more Americans lacked adequate health insurance, a perceived crisis led President Clinton to launch his 1993 campaign to insure every American--the third attempt in this century to provide universal coverage. While the crisis was perceived by many, there was no consensus on action, and leadership outside government was missing. Today, the health care crisis still looms. Despite an economic boom, 1 million Americans lose their health insurance each year, with 41 million Americans, or 15% of the population

  14. Public health approaches to community-based needs. Boston's infant mortality crisis as a case study.

    PubMed

    Rorie, J A; Richardson, K A; Gardner, R

    1997-01-01

    In light of a 10-year infant mortality crisis in Boston, a comprehensive public health approach was undertaken in which an extensive community-based needs assessment was used to develop a citywide maternal and child health improvement agenda. On the basis of the needs assessment, recommendations were made calling for community-based perinatal initiatives and midwifery services as critical elements in care for underserved communities and enhancement of perinatal services. A case description of one perinatal initiative illustrates the challenges of public health practice and describes a practice setting in which midwives provided leadership and guidance by using an interdisciplinary team approach in the implementation of a community empowerment project.

  15. Pathogens, prejudice, and politics: the role of the global health community in the European refugee crisis.

    PubMed

    Khan, Mishal S; Osei-Kofi, Anna; Omar, Abbas; Kirkbride, Hilary; Kessel, Anthony; Abbara, Aula; Heymann, David; Zumla, Alimuddin; Dar, Osman

    2016-08-01

    Involuntary migration is a crucially important global challenge from an economic, social, and public health perspective. The number of displaced people reached an unprecedented level in 2015, at a total of 60 million worldwide, with more than 1 million crossing into Europe in the past year alone. Migrants and refugees are often perceived to carry a higher load of infectious diseases, despite no systematic association. We propose three important contributions that the global health community can make to help address infectious disease risks and global health inequalities worldwide, with a particular focus on the refugee crisis in Europe. First, policy decisions should be based on a sound evidence base regarding health risks and burdens to health systems, rather than prejudice or unfounded fears. Second, for incoming refugees, we must focus on building inclusive, cost-effective health services to promote collective health security. Finally, alongside protracted conflicts, widening of health and socioeconomic inequalities between high-income and lower-income countries should be acknowledged as major drivers for the global refugee crisis, and fully considered in planning long-term solutions. PMID:27339456

  16. The painful effects of the financial crisis on Spanish health care.

    PubMed

    Bosch, Xavier; Moreno, Pedro; López-Soto, Alfonso

    2014-01-01

    Spain has an advanced, integrated health care system that has achieved remarkable results, including substantially improved health outcomes, over a relatively short time. Measures introduced by central and regional governments to combat the financial crisis may be severely affecting the health sector, with proposed changes potentially threatening the principles of equity and social cohesion underlying the welfare state. This article examines recent developments in Spanish health care, focusing on the austerity measures introduced since 2010. In Spain, as in other countries, evaluation of health care changes is difficult due to the paucity of data and because the effects of measures often lag well behind their introduction, meaning the full effects of changes on access to care or health outcomes only become apparent years later. However, some effects are already clear. With exceptions, Spain has not used the crisis as an opportunity to increase efficiency and quality, rationalize and reorganize health services, increase productivity, and regain public trust. We argue that immediate health care cuts may not be the best long-term answer and suggest evidence-driven interventions that involve the portfolio of free services and the private sector, while ensuring that the most vulnerable are protected.

  17. Pathogens, prejudice, and politics: the role of the global health community in the European refugee crisis.

    PubMed

    Khan, Mishal S; Osei-Kofi, Anna; Omar, Abbas; Kirkbride, Hilary; Kessel, Anthony; Abbara, Aula; Heymann, David; Zumla, Alimuddin; Dar, Osman

    2016-08-01

    Involuntary migration is a crucially important global challenge from an economic, social, and public health perspective. The number of displaced people reached an unprecedented level in 2015, at a total of 60 million worldwide, with more than 1 million crossing into Europe in the past year alone. Migrants and refugees are often perceived to carry a higher load of infectious diseases, despite no systematic association. We propose three important contributions that the global health community can make to help address infectious disease risks and global health inequalities worldwide, with a particular focus on the refugee crisis in Europe. First, policy decisions should be based on a sound evidence base regarding health risks and burdens to health systems, rather than prejudice or unfounded fears. Second, for incoming refugees, we must focus on building inclusive, cost-effective health services to promote collective health security. Finally, alongside protracted conflicts, widening of health and socioeconomic inequalities between high-income and lower-income countries should be acknowledged as major drivers for the global refugee crisis, and fully considered in planning long-term solutions.

  18. The crisis as catalyst for reframing health care policies in the European Union.

    PubMed

    Helderman, Jan-Kees

    2015-01-01

    Seen from the perspective of health, the global financial crisis (GFC) may be conceived of as an exogenous factor that has undermined the fiscal sustainability of European welfare states and consequently, their (expanding) health systems as well. Being one of the core programs of European welfare states, health care has always belonged to the sovereignty of European Member States. However, in past two decades, European welfare states have in fact become semi-sovereign states and the European Union (EU) no longer is an exogenous actor in European health policy making. Today, the EU not only puts limits to unsustainable growth levels in health care spending, it also acts as an health policy agenda setter. Since the outbreak of the GFC, it does so in an increasingly coercive and persuasive way, claiming authority over health system reforms alongside the responsibilities of its Member States.

  19. The crisis as catalyst for reframing health care policies in the European Union.

    PubMed

    Helderman, Jan-Kees

    2015-01-01

    Seen from the perspective of health, the global financial crisis (GFC) may be conceived of as an exogenous factor that has undermined the fiscal sustainability of European welfare states and consequently, their (expanding) health systems as well. Being one of the core programs of European welfare states, health care has always belonged to the sovereignty of European Member States. However, in past two decades, European welfare states have in fact become semi-sovereign states and the European Union (EU) no longer is an exogenous actor in European health policy making. Today, the EU not only puts limits to unsustainable growth levels in health care spending, it also acts as an health policy agenda setter. Since the outbreak of the GFC, it does so in an increasingly coercive and persuasive way, claiming authority over health system reforms alongside the responsibilities of its Member States. PMID:25662196

  20. Florida public health nurse workforce initiative: opportunity through crisis.

    PubMed

    2005-06-01

    The National Public Health Leadership Institute (NPHLI), a partnership between the Centers for Disease Control and Prevention and the University of North Carolina at Chapel Hill invites public health professionals to participate in a 2 year leadership program. Three Florida nurses participated in the NPHLI along with a cadre of 40 to 50 participants from the United States and foreign countries. Part of the commitment involved implementing a leadership project. This team chose to address the nursing shortage by developing and piloting mentorship program. Baseline research included a basic review of the literature and involvement in several work groups addressing various aspects of employing and retaining qualified public health nurses in Florida. During their NPHLI scholar year, team members sought input from a variety of professional sources on the reasons for the shortage of public health nurses in Florida. Based on responses from nurses, professional association members, and employees in the Florida Department of Health, team members developed a nursing mentorship project designed to address public health nursing retention and education. The goal was to develop a two-pronged mentorship program, which supported the attainment of clinical competence and workplace confidence while also improving the public health theoretical knowledge base of more experienced nurses. Nursing leadership at both the state and local levels agreed and embraced the concept. The Florida Team developed a Mentorship Handbook, which contains recruitment criteria, baseline, midterm and end of project assessment tools, and numerous other documents. The Team gained endorsement for the project and a commitment to see it through from the Department of Health's Nursing Office. The Florida Nurses Association partnered with the team to initiate the kickoff and involve team members in important discussion groups. In effecting change it is vital to have engaged and included the targeted "community" in

  1. HIV health crisis and African Americans: a cultural perspective.

    PubMed

    Plowden, K; Miller, J L; James, T

    2000-01-01

    While incidence of new HIV infections have decreased in the overall population, the numbers continue to rise in African-Americans creating a serious health emergency. Studies seem to imply that part of the rise is due to HIV beliefs and high risk behaviors among African Americans. Due to certain societal factors, African Americans appear to be at greater risk for contracting the virus. This article will examine these critical social factors and their impact on this current state of emergency in the African American community using Leininger's theory of Culture Care and Universality. Implications for health providers are also addressed. PMID:11760310

  2. Mental health crisis at home: service user perspectives on what helps and what hinders.

    PubMed

    Hopkins, C; Niemiec, S

    2007-05-01

    This paper presents data which emerged during the process of a participatory research study to identify the perspectives of previous users of a home treatment service. Feedback was sought in order to establish the criteria for the development of a service evaluation questionnaire. Seven themes emerged from the data which were then used as a framework for the evaluation questionnaire. These themes have also been used within this paper to present what our participants told us was important to them when they received a service at home at a time of mental health crisis. Although what is described here is the experience of one group of service users in the North of England, we hope that the views of these participants will create a resonance with providers of other home treatment services and expand the knowledge about which aspects of care at home during mental health crisis are viewed as helpful and those aspects which are not.

  3. Using AASL's "Health and Wellness" and "Crisis Toolkits"

    ERIC Educational Resources Information Center

    Logan, Debra Kay

    2009-01-01

    Whether a school library program is the picture of good health in a state that mandates a professionally staffed library media center in every building or is suffering in a low-wealth district that is facing drastic cuts, the recently launched toolkits by the American Association of School Librarians (AASL) are stocked with useful strategies and…

  4. The global financial crisis and health: scaling up our effort.

    PubMed

    Labonté, Ronald

    2009-01-01

    Economic events of the past year are beginning to create hardships for tens of thousands of Canadians. There are likely to be health effects as well, to the extent that unemployment and poverty rates rise. Conditions, however, will be much worse for those living in poorer countries. High-income countries are committing trillions of dollars in countercyclical spending and banking bail-outs. Poorer countries need to do the same, but lack the resources to do so. Yet foreign aid and fairer trade are widely expected to be among the first high-income country victims of the recession fallout as nations turn inwards and protectionist. This is neither good for global health nor necessary given the scale of untaxed (or unfairly taxed) wealth that could be harnessed for a truly global rescue package. Policy choices confront us. The Canadian public health community must hold our political leadership accountable for making those choices that will improve health globally and not further imperil the well-being of much of the world's population in efforts to secure our own future economic revival.

  5. Early Childhood Dental Caries: A Rising Dental Public Health Crisis

    ERIC Educational Resources Information Center

    Gomez, Grace Felix

    2013-01-01

    The aim of this article is to examine the literature and review the risk factors and disparities contributing to early childhood caries (ECC), which is a major health problem among preschoolers in the United States of America. A search was conducted using MEDLINE, PubMed, Google Scholar, and the Cochrane Library databases and the key terms…

  6. Sick Schools 2009: America's Continuing Environmental Health Crisis for Children

    ERIC Educational Resources Information Center

    Healthy Schools Network, Inc., 2010

    2010-01-01

    Everybody knows that healthy school buildings contribute to student learning, reduce health and operating costs, and ultimately, increase school quality and competitiveness. However, 55 million of the nation's children attend public and private K-12 schools where poor air quality, hazardous chemicals and other unhealthy conditions make students…

  7. A Systems-Crisis Model of Mental Health Consultation.

    ERIC Educational Resources Information Center

    Halpern, Howard A.; Bellamy, Cheryl A.

    While much of the development of consultation programs in mental health centers has been independent of the traditional treatment program, this document describes a consultation program which is closely integrated with an agency's treatment program. The emphasis is on system change and the development of prevention programming. The system-crisis…

  8. Zika Virus: Anatomy of a Global Health Crisis.

    PubMed

    Fellner, Chris

    2016-04-01

    Zika virus infection has emerged as the world's newest health threat, linked to microcephaly in infants and Guillain-Barré syndrome in adults. We address the rapid global spread of this disease, and the prospects for successful prevention and treatment.

  9. The global financial crisis and health: scaling up our effort.

    PubMed

    Labonté, Ronald

    2009-01-01

    Economic events of the past year are beginning to create hardships for tens of thousands of Canadians. There are likely to be health effects as well, to the extent that unemployment and poverty rates rise. Conditions, however, will be much worse for those living in poorer countries. High-income countries are committing trillions of dollars in countercyclical spending and banking bail-outs. Poorer countries need to do the same, but lack the resources to do so. Yet foreign aid and fairer trade are widely expected to be among the first high-income country victims of the recession fallout as nations turn inwards and protectionist. This is neither good for global health nor necessary given the scale of untaxed (or unfairly taxed) wealth that could be harnessed for a truly global rescue package. Policy choices confront us. The Canadian public health community must hold our political leadership accountable for making those choices that will improve health globally and not further imperil the well-being of much of the world's population in efforts to secure our own future economic revival. PMID:19507716

  10. Database of Pesticides and Off-flavors for Health Crisis Management.

    PubMed

    Ueda, Yasuhito; Itoh, Mitsuo

    2016-01-01

    In this experiment, 351 pesticides and 441 different organic compounds were analyzed by GC/MS, and a database of retention time, retention index, monoisotopic mass, two selected ions, molecular formula, and CAS numbers was created. The database includes compounds such as alcohols, aldehydes, carboxylic acids, esters, ethers and hydrocarbons with unpleasant odors. This database is expected to be useful for health crisis management in the future. PMID:27211918

  11. Health Care Austerity Measures in Times of Crisis: The Perspectives of Primary Health Care Physicians in Madrid, Spain.

    PubMed

    Heras-Mosteiro, Julio; Sanz-Barbero, Belén; Otero-Garcia, Laura

    2016-01-01

    The current financial crisis has seen severe austerity measures imposed on the Spanish health care system, including reduced public spending, copayments, salary reductions, and reduced services for undocumented migrants. However, the impacts have not been well-documented. We present findings from a qualitative study that explores the perceptions of primary health care physicians in Madrid, Spain. This article discusses the effects of austerity measures implemented in the public health care system and their potential impacts on access and utilization of primary health care services. This is the first study, to our knowledge, exploring the health care experiences during the financial crisis of general practitioners in Madrid, Spain. The majority of participating physicians disapproved of austerity measures implemented in Spain. The findings of this study suggest that undocumented migrants should regain access to health care services; copayments should be minimized and removed for patients with low incomes; and health care professionals should receive additional help to avoid burnout. Failure to implement these measures could result in the quality of health care further deteriorating and could potentially have long-term negative consequences on population health.

  12. Health Care Austerity Measures in Times of Crisis: The Perspectives of Primary Health Care Physicians in Madrid, Spain.

    PubMed

    Heras-Mosteiro, Julio; Sanz-Barbero, Belén; Otero-Garcia, Laura

    2016-01-01

    The current financial crisis has seen severe austerity measures imposed on the Spanish health care system, including reduced public spending, copayments, salary reductions, and reduced services for undocumented migrants. However, the impacts have not been well-documented. We present findings from a qualitative study that explores the perceptions of primary health care physicians in Madrid, Spain. This article discusses the effects of austerity measures implemented in the public health care system and their potential impacts on access and utilization of primary health care services. This is the first study, to our knowledge, exploring the health care experiences during the financial crisis of general practitioners in Madrid, Spain. The majority of participating physicians disapproved of austerity measures implemented in Spain. The findings of this study suggest that undocumented migrants should regain access to health care services; copayments should be minimized and removed for patients with low incomes; and health care professionals should receive additional help to avoid burnout. Failure to implement these measures could result in the quality of health care further deteriorating and could potentially have long-term negative consequences on population health. PMID:26825100

  13. Targeting the poor in times of crisis: the Indonesian health card.

    PubMed

    Sparrow, Robert

    2008-05-01

    This paper looks at targeting performance of the Indonesian health card programme that was implemented in August 1998 to protect access to health care for the poor during the Indonesian economic crisis. By February 1999, 22 million people had received a health card. The health card provided a user fee waiver for public health care. Targeting of the health card was pro-poor, but with considerable leakage to the non-poor. Utilization of the health card for outpatient care was also pro-poor, but conditional on ownership, the middle quintiles were more likely to use the card. Targeting of the health card followed a decentralized design combining geographic targeting with community-based targeting instruments. This design facilitated the rapid implementation of the programme, but targeting performance suffered from a lack of information on the regional impact of the crisis, while at local level not all barriers to accessing health care services were overcome by the health card. Indirect and direct costs of seeking health care seem to be the main deterrent to using the health card, and are higher in more remote areas. Micro-simulations show that geographic targeting can contribute considerably to improving targeting performance, but most of the targeting gains are to be made at the local level, with district programme management and public health care providers. This study highlights the need for adequate and up-to-date social welfare indicators. In addition, further research would need to focus on how local knowledge can be utilized for signalling poverty dynamics and local barriers to access.

  14. [Crisis and the independence of public health policies. SESPAS report 2014].

    PubMed

    Hernández Aguado, Ildefonso; Lumbreras Lacarra, Blanca

    2014-06-01

    Independence in the formulation of public health policies can be affected by various agents with objectives contrary to population health, such as large corporations. This lack of independence may be exacerbated by the economic crisis due to lower funding for health regulatory bodies or other measures designed to protect health. Large corporations have influenced the formulation of certain policies with an impact on health, such as those related to the tobacco industry, the chemical industry, nutrition, alcohol, pharmaceuticals, and health technology. The main areas in which these companies can influence policies are science, education, politics, and society in general. In this scenario, public health associations should take an active role in ensuring the independence of political decisions via actions such as the following: supporting strategies that guarantee the independence of public health policies and apply criteria of impartiality and transparency; rejecting those public-private partnerships launched to prevent health problems partly caused by these corporations; establishing partnerships to achieve independent training of health professionals and an institution with scientific authority in order to improve public health communication and counteract the lack of sound public health information; promoting a critical analysis of the definition of health problems and their solutions, and establishing related agendas (scientific, political and media) and alliances, so that continuing training for health professionals is independent.

  15. Substandard drugs: a potential crisis for public health

    PubMed Central

    Johnston, Atholl; Holt, David W

    2014-01-01

    Poor-quality medicines present a serious public health problem, particularly in emerging economies and developing countries, and may have a significant impact on the national clinical and economic burden. Attention has largely focused on the increasing availability of deliberately falsified drugs, but substandard medicines are also reaching patients because of poor manufacturing and quality-control practices in the production of genuine drugs (either branded or generic). Substandard medicines are widespread and represent a threat to health because they can inadvertently lead to healthcare failures, such as antibiotic resistance and the spread of disease within a community, as well as death or additional illness in individuals. This article reviews the different aspects of substandard drug formulation that can occur (for example, pharmacological variability between drug batches or between generic and originator drugs, incorrect drug quantity and presence of impurities). The possible means of addressing substandard manufacturing practices are also discussed. A concerted effort is required on the part of governments, drug manufacturers, charities and healthcare providers to ensure that only drugs of acceptable quality reach the patient. PMID:24286459

  16. Assessing and Planning Health Actions During a Crisis.

    PubMed

    Suner, Selim

    2015-10-01

    Initial stage of a disaster is managed with existing resources. The following stages of disaster response often involve assistance from outside of the disaster zone. This may consist of mutual aid from neighboring communities for small-scale incidents but in major disasters, the response is from federal or international agencies or often both. Rapid needs assessment after an incident is a collaborative effort between responding agencies and local emergency preparedness and health authorities. Ideally, a team from responding agencies with intimate knowledge and experience regarding the capabilities and assets of the responding entity along with local authorities, with decision making capacity, who have knowledge of the community, the limitations of the responding agencies and can obtain near real-time information about the incident and subject matter experts (engineering, medical, law enforcement, etc.) comprise the needs assessment team. PMID:27437526

  17. The "childhood obesity epidemic": health crisis or social construction?

    PubMed

    Moffat, Tina

    2010-03-01

    There has been a meteoric rise over the past two decades in the medical research and media coverage of the so-called global childhood obesity epidemic. Recently, in response to this phenomenon, there has been a spate of books and articles in the fields of critical sociology and cultural studies that have argued that this "epidemic" is socially constructed, what Natalie Boero (2007) dubs a "postmodern epidemic." As an anthropologist who has studied child nutrition and obesity in relation to poverty and the school environment, I am concerned about both the lack of reflexivity among medical researchers as well as critical scholars' treatment of the problem as entirely socially constructed. In this article I present both sides of this debate and then discuss how wee can attempt to navigate a middle course that recognizes this health issue but also offers alternative approaches to those set by the biomedical agenda.

  18. Effect of pregnancy during TMI crisis on mothers' mental health and their child's development.

    PubMed

    Houts, P S; Tokuhata, G K; Bratz, J; Bartholomew, M J; Sheffer, K W

    1991-03-01

    Five years after the Three Mile Island nuclear accident, the mental health of women who had been pregnant and living within 10 miles of Three Mile Island at the time of the accident was similar to that of women from the same area who became pregnant after the accident. Ratings of the development of the two groups of children when they were 5 years old were also similar. However, women who were pregnant during the crisis and had been "extremely disturbed" about their pregnancies rated their children's health as poorer than did the women who were pregnant later. PMID:1994750

  19. Effect of pregnancy during TMI crisis on mothers' mental health and their child's development

    SciTech Connect

    Houts, P.S.; Tokuhata, G.K.; Bratz, J.; Bartholomew, M.J.; Sheffer, K.W. )

    1991-03-01

    Five years after the Three Mile Island nuclear accident, the mental health of women who had been pregnant and living within 10 miles of Three Mile Island at the time of the accident was similar to that of women from the same area who became pregnant after the accident. Ratings of the development of the two groups of children when they were 5 years old were also similar. However, women who were pregnant during the crisis and had been extremely disturbed about their pregnancies rated their children's health as poorer than did the women who were pregnant later.

  20. Acute blast crisis in a patient with chronic lymphocytic leukemia. Immunoperoxidase study.

    PubMed

    Laurent, G; Gourdin, M F; Flandrin, G; Kuhlein, E; Pris, J; Reyes, F

    1981-01-01

    Using a case study of a blastic crisis supervening on chronic lymphocytic leukemia, we were able to determine that the cells in question were B cells derived from the same clone by using immunofluorescence and immunoperoxidase techniques. The immunoperoxidase technique provided excellent morphological details and enhanced the phenotype study. PMID:6791439

  1. The drugs stop here: a public health framework to address the drug shortage crisis.

    PubMed

    Hoffman, Sharona

    2012-01-01

    Drug shortages are emerging as a major public health threat. Grave concern has been expressed by the medical community and government officials, and the crisis has been highlighted in recent media stories. Nevertheless, little has been written to date in the legal literature about the drug shortage crisis, and this timely article begins to fill this gap. It provides a thorough analysis of the origins and implications of the drug shortage problem and formulates a multi-layered approach to addressing it. The article argues that drug shortages result from a combination of market failures and regulatory constraints. It proposes a blend of legislative, regulatory, and private-sector interventions that should deter undesirable conduct on the part of manufacturers and provide appropriate incentives to combat the drug shortage phenomenon.

  2. A Framework and Methodology for Navigating Disaster and Global Health in Crisis Literature

    PubMed Central

    Chan, Jennifer L.; Burkle, Frederick M.

    2013-01-01

    Both ‘disasters’ and ‘global health in crisis’ research has dramatically grown due to the ever-increasing frequency and magnitude of crises around the world. Large volumes of peer-reviewed literature are not only a testament to the field’s value and evolution, but also present an unprecedented outpouring of seemingly unmanageable information across a wide array of crises and disciplines. Disaster medicine, health and humanitarian assistance, global health and public health disaster literature all lie within the disaster and global health in crisis literature spectrum and are increasingly accepted as multidisciplinary and transdisciplinary disciplines. Researchers, policy makers, and practitioners now face a new challenge; that of accessing this expansive literature for decision-making and exploring new areas of research. Individuals are also reaching beyond the peer-reviewed environment to grey literature using search engines like Google Scholar to access policy documents, consensus reports and conference proceedings. What is needed is a method and mechanism with which to search and retrieve relevant articles from this expansive body of literature. This manuscript presents both a framework and workable process for a diverse group of users to navigate the growing peer-reviewed and grey disaster and global health in crises literature. Methods: Disaster terms from textbooks, peer-reviewed and grey literature were used to design a framework of thematic clusters and subject matter ‘nodes’. A set of 84 terms, selected from 143 curated terms was organized within each node reflecting topics within the disaster and global health in crisis literature. Terms were crossed with one another and the term ‘disaster’. The results were formatted into tables and matrices. This process created a roadmap of search terms that could be applied to the PubMed database. Each search in the matrix or table results in a listed number of articles. This process was applied to

  3. Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis.

    PubMed

    Lanzkron, Sophie; Carroll, C Patrick; Hill, Peter; David, Mandy; Paul, Nicklaine; Haywood, Carlton

    2015-05-01

    Most adults with sickle cell disease (SCD) receive care for their acute painful episodes in an emergency department (ED) setting. The purpose of this article is to describe the impact of opening a dedicated treatment center for adults with SCD [Sickle Cell Infusion Clinic (SCIC)] on patient outcomes and on hospital discharges for SCD. Descriptive data including demographics, time to first dose of narcotic, and pain scores were collected on patients presenting to the SCIC and ED. Maryland hospital discharge data were obtained from the Maryland Health Services Cost Review Commission. Analyses were conducted using T tests, χ(2) tests, and simple generalized estimating equation regression models accounting for the clustered nature of observations, as appropriate. There were 3,874 visits to the SCIC by 361 unique patients; 85% of those visits resulted in the patient being sent home. During the same time period, there were 3,408 visits to the ED by 558 unique patients with SCD. The overall admission rate from the ED for these patients was 35.9% but decreased significantly over the time period with a rate of 20% in December 2011. There was a significant decrease in readmissions over time for the entire Baltimore Metro area with the likelihood of readmission decreasing by 7% over time. The SCIC model provides adults with SCD access to high quality care that decreases the need for hospital admission. Further research needs to be done to evaluate the cost effectiveness of this model.

  4. Gaps in Crisis Mental Health: Suicide and Homicide-Suicide.

    PubMed

    Carretta, Carrie M; Burgess, Ann W; Welner, Michael

    2015-10-01

    Gaps in crises of mental health emerge from poor distinction between the qualities of people who suicide and those who murder and then kill themselves. The role, if any, that substance use has in such lethal violence is an example of such a lack of distinction. In this study, a sample of medical examiner investigative and toxicology reports from Los Angeles and Orange counties in California were available for analysis for 432 suicide cases and 193 homicide-suicide cases. This informed clearer toxicological and pharmacological distinction of suicide from homicide-suicide. Blood alcohol levels were higher in persons committing suicide than in homicide-suicide perpetrators (p=.004). Homicide-suicide perpetrators had almost twice the level of stimulants in their system than people who suicide (p=.022) but did not have comparatively elevated levels of drugs or alcohol. Predictors of suicide included the following: substance abuse history, high number of drugs in system, death inside a house, and legal impairment by alcohol. Predictors of homicide-suicide included gunshot as the cause of death, female gender, domestic conflict, children living in the home, and prior arrest for substance abuse. PMID:26397439

  5. Health, economic crisis, and austerity: A comparison of Greece, Finland and Iceland.

    PubMed

    Tapia Granados, José A; Rodriguez, Javier M

    2015-07-01

    Reports have attributed a public health tragedy in Greece to the Great Recession and the subsequent application of austerity programs. It is also claimed that the comparison of Greece with Iceland and Finland-where austerity policies were not applied-reveals the harmful effect of austerity on health and that by protecting spending in health and social budgets, governments can offset the harmful effects of economic crises on health. We use data on life expectancy, mortality rates, incidence of infectious diseases, rates of vaccination, self-reported health and other measures to examine the evolution of population health and health services performance in Greece, Finland and Iceland since 1990-2011 or 2012-the most recent years for which data are available. We find that in the three countries most indicators of population health continued improving after the Great Recession started. In terms of population health and performance of the health care system, in the period after 2007 for which data are available, Greece did as good as Iceland and Finland. The evidence does not support the claim that there is a health crisis in Greece. On the basis of the extant evidence, claims of a public health tragedy in Greece seem overly exaggerated.

  6. Public health impact of Rwandan refugee crisis: what happened in Goma, Zaire, in July, 1994? Goma Epidemiology Group.

    PubMed

    1995-02-11

    The flight of 500,000-800,000 Rwandan refugees into the North Kivu region of Zaire in July, 1994, overwhelmed the world's response capacity. During the first month after the influx, almost 50,000 refugees died, an average crude mortality rate of 20-35 per 10,000 per day. This death rate was associated with explosive epidemics of diarrhoeal disease caused by Vibrio cholerae 01 and Shigella dysenteriae type 1. 3-4 weeks after the influx of refugees, acute malnutrition rates among children under 5 years old ranged between 18 and 23%. Children with a recent history of dysentery and those in households headed by women were at higher risk of malnutrition. A well-coordinated relief programme, based on rapidly acquired health data and effective interventions, was associated with a steep decline in death rates to 5 to 8 per 10,000 per day by the second month of the crisis. The prevention of high mortality due to diarrhoeal disease epidemics in displaced populations relies primarily on the prompt provision of adequate quantities of disinfected water, basic sanitation, community outreach, and effective case management of ill patients. In the emergency phase, effective, low-technology measures include bucket chlorination at untreated water sources, designated defaecation areas, active case-finding through community outreach, and oral rehydration. Relief agencies must place increased emphasis on training personnel in relevant skills to address major public health emergencies caused by population displacement.

  7. Mental health nurses' perceptions of good work in an acute setting.

    PubMed

    Cleary, Michelle; Horsfall, Jan; O'Hara-Aarons, Maureen; Jackson, Debra; Hunt, Glenn E

    2012-10-01

    Frequently, research and conference papers explore difficult or problematic areas of practice that can inadvertently render daily nursing accomplishments invisible and create the perception of a discipline in crisis. In this qualitative study, we explore the views of registered nurses about achievements in the workplace and good nursing work in an acute inpatient mental health setting in Sydney, Australia. Mental health nurses were asked a series of questions about their experiences and understanding of what constitutes good nursing work as well as their sense of optimism about their work. A total of 40 structured face-to-face interviews were completed. Among the responses to questions about achievements and good nursing practice, five broad themes were identified: i) teamwork; (ii) interpersonal interactions with patients; (iii) providing practical and holistic support to patients; (iv) patients' mental health improvements; and (v) optimism-pessimism continuum. Findings contribute to a discussion of good nursing work in acute mental health settings, as well as self-perceptions of optimism and hopefulness, which are important contributors to positive, supportive health-care settings and patient recovery.

  8. A framework for assessing health system resilience in an economic crisis: Ireland as a test case

    PubMed Central

    2013-01-01

    Background The financial crisis that hit the global economy in 2007 was unprecedented in the post war era. In general the crisis has created a difficult environment for health systems globally. The purpose of this paper is to develop a framework for assessing the resilience of health systems in terms of how they have adjusted to economic crisis. Resilience can be understood as the capacity of a system to absorb change but continue to retain essentially the same identity and function. The Irish health system is used as a case study to assess the usefulness of this framework. Methods The authors identify three forms of resilience: financial, adaptive and transformatory. Indicators of performance are presented to allow for testing of the framework and measurement of system performance. Both quantitative and qualitative methods were used to yield data for the Irish case study. Quantitative data were collected from government documents and sources to understand the depth of the recession and the different dimensions of the response. Semi-structured interviews were conducted with key decision makers to understand the reasons for decisions made. Results In the Irish case there is mixed evidence on resilience. Health funding was initially protected but was then followed by deep cuts as the crisis deepened. There is strong evidence for adaptive resilience, with the health system showing efficiency gains from the recession. Nevertheless, easy efficiencies have been made and continued austerity will mean cuts in entitlements and services. The prospects for building and maintaining transformatory resilience are unsure. While the direction of reform is clear, and has been preserved to date, it is not certain whether it will remain manageable given continued austerity, some loss of sovereignty and capacity limitations. Conclusions The three aspects of resilience proved a useful categorisation of performance measurement though there is overlap between them. Transformatory

  9. [Acute hemolytic crisis followed by fulminant hepatic failure with fatal outcome, as a first clinical manifestation of Wilson's disease].

    PubMed

    de Andrade Júnior, D R; Fujita Neto, F G; Vieira, G S; Tibério, I F; Warth, M P; Calich, I

    1994-01-01

    We describe in this work a clinical case of a female patient aged 21 years, bearer of Wilson's disease, a first clinical manifestation of the disease occurred as an acute hemolytic crisis followed by fulminant hepatic failure evolving to death after 26 days' internment. The definitive diagnosis was obtained only as a quantitative measurement of hepatic copper from the necropsy material. The search for Kayser-Fleischer ring was negative and the serum ceruloplasmin level was 9 mg/dl (15 to 60). No involvement of the central nervous system was noted from the pathologic analysis. The patient presented two Coombs negative hemolytic crises during the internment; the first on being admitted to hospital and the second after a transjugular hepatic biopsy carried out on the 16th day after internment. The last hemolytic crisis was accompanied by an increase of serum and urinary copper levels. On this occasion the patient evolved to a progressive hepatic failure with severe jaundice and hepatic encephalopathy. We are presenting the clinical-biochemical evolution of the patient and we shall discuss the existent hypotheses to the pathophysiology of this rare form for manifestation of the Wilson's disease as well the diagnostic difficulties.

  10. Medical supplies shortages and burnout among greek health care workers during economic crisis: a pilot study.

    PubMed

    Rachiotis, George; Kourousis, Christos; Kamilaraki, Maria; Symvoulakis, Emmanouil K; Dounias, George; Hadjichristodoulou, Christos

    2014-01-01

    Greece has been seriously affected by the economic crisis. In 2011 there were reports of 40% reduction to public hospital budgets. Occasional shortages of medical supplies have been reported in mass media. We attempted to pivotally investigate the frequency of medical supplies shortages in two Greek hospital units of the National Health System and to also assess their possible impact on burnout risk of health care workers. We conducted a cross-sectional study (n=303) of health care workers in two Greek hospitals who were present at the workplace during a casually selected working day (morning shift work). The Maslach Burnout Inventory (MBI) was used as the measure of burnout. An additional questionnaire was used about demographics, and working conditions (duration of employment, cumulative night shifts, type of hospital including medical supplies shortages and their impact on quality of healthcare. The prevalence of emotional exhaustion, depersonalization and low personal accomplishment was 44.5%, 43.2% and 51.5%, respectively. Medical supply shortages were significantly associated with emotional exhaustion and depersonalization. This finding provides preliminary evidence that austerity has affected health care in Greece. Moreover, the medical supply shortages in Greek hospitals may reflect the unfolding humanitarian crisis of the country.

  11. Medical supplies shortages and burnout among greek health care workers during economic crisis: a pilot study.

    PubMed

    Rachiotis, George; Kourousis, Christos; Kamilaraki, Maria; Symvoulakis, Emmanouil K; Dounias, George; Hadjichristodoulou, Christos

    2014-01-01

    Greece has been seriously affected by the economic crisis. In 2011 there were reports of 40% reduction to public hospital budgets. Occasional shortages of medical supplies have been reported in mass media. We attempted to pivotally investigate the frequency of medical supplies shortages in two Greek hospital units of the National Health System and to also assess their possible impact on burnout risk of health care workers. We conducted a cross-sectional study (n=303) of health care workers in two Greek hospitals who were present at the workplace during a casually selected working day (morning shift work). The Maslach Burnout Inventory (MBI) was used as the measure of burnout. An additional questionnaire was used about demographics, and working conditions (duration of employment, cumulative night shifts, type of hospital including medical supplies shortages and their impact on quality of healthcare. The prevalence of emotional exhaustion, depersonalization and low personal accomplishment was 44.5%, 43.2% and 51.5%, respectively. Medical supply shortages were significantly associated with emotional exhaustion and depersonalization. This finding provides preliminary evidence that austerity has affected health care in Greece. Moreover, the medical supply shortages in Greek hospitals may reflect the unfolding humanitarian crisis of the country. PMID:24688306

  12. Unemployment in Scandinavia during an economic crisis: cross-national differences in health selection.

    PubMed

    Heggebø, Kristian

    2015-04-01

    Are people with ill health more prone to unemployment during the ongoing economic crisis? Is this health selection more visible among people with low education, women, or the young? The current paper investigates these questions in the Scandinavian context using the longitudinal part of the EU-SILC data material. Generalized least squares analysis indicates that people with ill health are laid off to a higher degree than their healthy counterparts in Denmark, but not in Norway and Sweden. Additionally, young individuals (<30 years) with ill health have a higher probability of unemployment in both Norway and Sweden, but not in Denmark. Neither women with ill health, nor individuals with low educational qualifications and ill health, are more likely to lose their jobs in Scandinavia. Individual level (and calendar year) fixed effects analysis confirms the existence of health selection out of employment in Denmark, whereas there is no suggestion of health selection in Sweden and Norway, except among young individuals. This finding could be related to the differing labor market demand the three Scandinavian countries have experienced during and preceding the study period (2007-2010). Another possible explanation for the cross-national differences is connected to the Danish "flexicurity" model, where the employment protection is rather weak. People with ill health, and hence more unstable labor market attachment, could be more vulnerable in such an arrangement.

  13. From bioterrorism exercise to real-life public health crisis: lessons for emergency hotline operations.

    PubMed

    Uscher-Pines, Lori; Bookbinder, Sylvia H; Miro, Suzanne; Burke, Thomas

    2007-01-01

    Although public health agencies routinely operate hotlines to communicate key messages to the public, they are rarely evaluated to improve hotline management. Since its creation in 2003, the New Jersey Department of Health & Senior Services' Emergency Communications Center has confronted two large-scale incidents that have tested its capabilities in this area. The influenza vaccine shortage of 2004 and the April 2005 TOPOFF 3 full-scale bioterrorism exercise provided both real-life and simulated crisis situations from which to derive general insights into the strengths and weaknesses of hotline administration. This article identifies problems in the areas of staff and message management by analyzing call volume data and the qualitative observations of group feedback sessions and semistructured interviews with hotline staff. It also makes recommendations based on lessons learned to improve future hotline operations in public health emergencies. PMID:17149095

  14. Health protection during the Ebola crisis: the Defence Medical Services approach.

    PubMed

    Bricknell, Martin; Terrell, A; Ross, D; White, D

    2016-06-01

    This paper is a narrative of the policies, procedures, mitigations and observations of the application of Force Health Protection measures applied by the Ministry of Defence (MOD) for the deployment of military personnel to West Africa as part of the UK contribution to the international response to the Ebola crisis from July 2014 to July 2015. The MOD divided the threat into three risk categories: risk from disease and non-battle injury, Ebola risk for non-clinical duties and Ebola risk for healthcare workers. Overall risk management was directed and monitored by the OP GRITROCK Force Health Protection Board. There were six cases of malaria, four outbreaks of gastrointestinal disease, two needlestick injuries in Ebola-facing healthcare workers, one MOD Ebola case and five non-needlestick, high-risk exposures. This experience reinforces the requirement for the Defence Medical Services to have a high level of organisational competence to advise on Force Health Protection for the MOD.

  15. A Framework for Training Public Health Practitioners in Crisis Decision-Making.

    PubMed

    Kayman, Harvey; Logar, Tea

    2016-02-01

    Three sets of issues tend to be overlooked in public health emergency preparedness and response, which can be addressed with new training protocols. The first issue is procedural and concerns the often intuitive (as opposed to deliberative) nature of effective crisis decision-making. The second issue is substantive and pertains to the incorporation and prioritization of ethical, political, and logistical concerns in public health emergency guidelines. The third issue is affective and concerns human feelings and human frailty, which can derail the most well designed and best practiced procedural and substantive approaches to emergency response. This article offers an outline for a decision-making framework for public health emergencies that addresses and incorporates these issues within relevant guidelines and training.

  16. From bioterrorism exercise to real-life public health crisis: lessons for emergency hotline operations.

    PubMed

    Uscher-Pines, Lori; Bookbinder, Sylvia H; Miro, Suzanne; Burke, Thomas

    2007-01-01

    Although public health agencies routinely operate hotlines to communicate key messages to the public, they are rarely evaluated to improve hotline management. Since its creation in 2003, the New Jersey Department of Health & Senior Services' Emergency Communications Center has confronted two large-scale incidents that have tested its capabilities in this area. The influenza vaccine shortage of 2004 and the April 2005 TOPOFF 3 full-scale bioterrorism exercise provided both real-life and simulated crisis situations from which to derive general insights into the strengths and weaknesses of hotline administration. This article identifies problems in the areas of staff and message management by analyzing call volume data and the qualitative observations of group feedback sessions and semistructured interviews with hotline staff. It also makes recommendations based on lessons learned to improve future hotline operations in public health emergencies.

  17. Health protection during the Ebola crisis: the Defence Medical Services approach.

    PubMed

    Bricknell, Martin; Terrell, A; Ross, D; White, D

    2016-06-01

    This paper is a narrative of the policies, procedures, mitigations and observations of the application of Force Health Protection measures applied by the Ministry of Defence (MOD) for the deployment of military personnel to West Africa as part of the UK contribution to the international response to the Ebola crisis from July 2014 to July 2015. The MOD divided the threat into three risk categories: risk from disease and non-battle injury, Ebola risk for non-clinical duties and Ebola risk for healthcare workers. Overall risk management was directed and monitored by the OP GRITROCK Force Health Protection Board. There were six cases of malaria, four outbreaks of gastrointestinal disease, two needlestick injuries in Ebola-facing healthcare workers, one MOD Ebola case and five non-needlestick, high-risk exposures. This experience reinforces the requirement for the Defence Medical Services to have a high level of organisational competence to advise on Force Health Protection for the MOD. PMID:26744191

  18. [Health promotion and prevention in the economic crisis: the role of the health sector. SESPAS report 2014].

    PubMed

    Márquez-Calderón, Soledad; Villegas-Portero, Román; Gosalbes Soler, Victoria; Martínez-Pecino, Flora

    2014-06-01

    This article reviews trends in lifestyle factors and identifies priorities in the fields of prevention and health promotion in the current economic recession. Several information sources were used, including a survey of 30 public health and primary care experts. Between 2006 and 2012, no significant changes in lifestyle factors were detected except for a decrease in habitual alcohol drinking. There was a slight decrease in the use of illegal drugs and a significant increase in the use of psychoactive drugs. Most experts believe that decision-making about new mass screening programs and changes in vaccination schedules needs to be improved by including opportunity cost analysis and increasing the transparency and independence of the professionals involved. Preventive health services are contributing to medicalization, but experts' opinions are divided on the need for some preventive activities. Priorities in preventive services are mental health and HIV infection in vulnerable populations. Most experts trust in the potential of health promotion to mitigate the health effects of the economic crisis. Priority groups are children, unemployed people and other vulnerable groups. Priority interventions are community health activities (working in partnership with local governments and other sectors), advocacy, and mental health promotion. Effective tools for health promotion that are currently underused are legislation and mass media. There is a need to clarify the role of the healthcare sector in intersectorial activities, as well as to acknowledge that social determinants of health depend on other sectors. Experts also warn of the consequences of austerity and of policies that negatively impact on living conditions.

  19. Consulting to children in crisis.

    PubMed

    Looney, J; Rahe, R; Harding, R; Ward, H; Liu, W

    1979-01-01

    Although community consultation is common for psychiatrists, such activity is usually carried out on an elective rather than emergency basis. In a world troubled by community disaster situations--children are often at risk. Psychiatrists, through the use of skillful crisis consultation, can be of great help to these young people. This report describes the effort of a mental health consultation team to meet the needs of a large population of children under acute stress. PMID:467132

  20. Oral sildenafil as a rescue therapy in presumed acute pulmonary hypertensive crisis.

    PubMed

    Maxted, Andrew Peter; Hill, Abigail; Davies, Patrick

    2013-02-01

    A 23-week-old baby, born at 26(+2) weeks, presented to the hospital with critical respiratory failure, which was impossible to stabilize. She had unstable oxygen saturations between 35% and 95%. A presumptive diagnosis of bronchopulmonary dysplasia with associated pulmonary hypertensive crisis was made. In the absence of inhaled nitric oxide, 2 oral doses of 1 mg/kg sildenafil were given, with a dramatic improvement 30 to 45 minutes later. Her oxygenation index fell from 43 to 14. She made a full recovery and was discharged from the hospital 2 weeks later.

  1. The language of compassion in acute mental health care.

    PubMed

    Crawford, Paul; Gilbert, Paul; Gilbert, Jean; Gale, Corinne; Harvey, Kevin

    2013-06-01

    In this article we examine the language of compassion in acute mental health care in the United Kingdom. Compassion is commonly defined as being sensitive to the suffering of others and showing a commitment to relieve it, yet we know little about how this is demonstrated in health professional language and how it is situated in the context of acute mental health care services. We report on a corpus-assisted discourse analysis of 20 acute mental health practitioner interview narratives about compassion and find a striking depletion in the use of "compassionate mentality" words, despite the topic focus. The language used by these practitioners placed more emphasis on time pressures, care processes, and organizational tensions in a way that might compromise best practice and point to the emergence of a "production-line mentality."

  2. The differential impact of the financial crisis on Health in Ireland and Greece: A quasi-experimental approach

    PubMed Central

    Hessel, P; Vandoros, S; Avendano, M

    2015-01-01

    Objectives Greece and Ireland suffered an economic recession of similar magnitude, but whether their health has deteriorated as a result has not yet been well established. Study design Based on five waves (2006-2010) of the European Union Statistics of Income and Living Conditions (EU-SILC) survey we implemented a difference-in-differences (DID) approach that compared trends in self-rated health in Greece and Ireland before and after the crisis with trends in a control population (Poland) that did not experience a recession and had health trends comparable to both countries before the crisis. Methods Logistic regression using a difference-in-differences (DID) approach. Results A simple examination of trends suggests that there was no significant change in health in Greece or Ireland following the onset of the financial crisis. However, DID estimates that incorporated a control population suggest an increase in the prevalence of poor-self rated health in Greece (OR=1.216; CI=1.11 - 1.32). Effects were most pronounced for older individuals and those living in high-density areas, but effects in Greece were overwhelmingly consistent in different population sub-groups. In contrast, DID estimates revealed no effect of the financial crisis in Ireland (OR=0.97; CI=0.81-1.16). Conclusions Contradicting results from a simple comparison of single-country trends, DID estimates suggest that the financial crisis has led to deterioration of population health trends in Greece but not in Ireland, where policies may have prevented a worsening of health as a result of the recent economic crisis. PMID:25369355

  3. A descriptive evaluation of the Seattle Police Department's crisis response team officer/mental health professional partnership pilot program.

    PubMed

    Helfgott, Jacqueline B; Hickman, Matthew J; Labossiere, Andre P

    2016-01-01

    The Seattle Police Department (SPD) recently enhanced their response to individuals in behavioral crisis through a pilot Crisis Response Team (CRT) consisting of dedicated Crisis Intervention Team (CIT) officers (OFC) paired with a Mental Health Professional (MHP). This study presents results of an incident-based descriptive evaluation of the SPD's CRT pilot program, implemented from 2010 to 2012. The purpose of the evaluation was to determine the value-added by the MHP in cases involving individuals in behavioral crisis as well as the effectiveness of the CRT program with regard to resolution time, repeat contacts, and referral to services. Data were collected from SPD general offense and supplemental reports for a 12-month segment of the program. Key variables included incident location, case clearance, repeat contacts, linkages to services, and case disposition. Results of analyses of general offense and supplemental reports are presented and implications for future development of the OFC/MHP partnership are discussed. PMID:26314890

  4. A descriptive evaluation of the Seattle Police Department's crisis response team officer/mental health professional partnership pilot program.

    PubMed

    Helfgott, Jacqueline B; Hickman, Matthew J; Labossiere, Andre P

    2016-01-01

    The Seattle Police Department (SPD) recently enhanced their response to individuals in behavioral crisis through a pilot Crisis Response Team (CRT) consisting of dedicated Crisis Intervention Team (CIT) officers (OFC) paired with a Mental Health Professional (MHP). This study presents results of an incident-based descriptive evaluation of the SPD's CRT pilot program, implemented from 2010 to 2012. The purpose of the evaluation was to determine the value-added by the MHP in cases involving individuals in behavioral crisis as well as the effectiveness of the CRT program with regard to resolution time, repeat contacts, and referral to services. Data were collected from SPD general offense and supplemental reports for a 12-month segment of the program. Key variables included incident location, case clearance, repeat contacts, linkages to services, and case disposition. Results of analyses of general offense and supplemental reports are presented and implications for future development of the OFC/MHP partnership are discussed.

  5. The health, mental health, and well-being benefits of rape crisis counseling.

    PubMed

    Westmarland, Nicole; Alderson, Sue

    2013-11-01

    There is very little research on interventions to alleviate the distress experienced following rape. This action research project developed and piloted the "Taking Back Control" tool that measured the impact of rape crisis counseling over time. Five rape crisis centers in the North of England agreed to pilot the tool, which was administered by the client's counselor, either on Week 1 or 2, and then repeated every 6 weeks until the end of counseling. Eighty-seven clients completed at least two questionnaires. This allowed us to measure change from their first compared with their last data collection point. The most change was made in relation to the statement "I feel empowered and in control of my life," where 61% strongly/disagreed at the first data collection point compared with 31% at the last data collection point. Large shifts were also seen in relation to "I have 'flashbacks' about what happened" and "I have panic attacks." Overall, some degree of positive change was seen for all measures. This research, despite some limitations, begins to develop an evidence base for rape crisis centers to demonstrate their benefits and to assess and develop their own practice.

  6. The health, mental health, and well-being benefits of rape crisis counseling.

    PubMed

    Westmarland, Nicole; Alderson, Sue

    2013-11-01

    There is very little research on interventions to alleviate the distress experienced following rape. This action research project developed and piloted the "Taking Back Control" tool that measured the impact of rape crisis counseling over time. Five rape crisis centers in the North of England agreed to pilot the tool, which was administered by the client's counselor, either on Week 1 or 2, and then repeated every 6 weeks until the end of counseling. Eighty-seven clients completed at least two questionnaires. This allowed us to measure change from their first compared with their last data collection point. The most change was made in relation to the statement "I feel empowered and in control of my life," where 61% strongly/disagreed at the first data collection point compared with 31% at the last data collection point. Large shifts were also seen in relation to "I have 'flashbacks' about what happened" and "I have panic attacks." Overall, some degree of positive change was seen for all measures. This research, despite some limitations, begins to develop an evidence base for rape crisis centers to demonstrate their benefits and to assess and develop their own practice. PMID:23926218

  7. The refugee crisis in Africa and implications for health and disease: a political ecology approach.

    PubMed

    Kalipeni, E; Oppong, J

    1998-06-01

    Political violence in civil war and ethnic conflicts has generated millions of refugees across the African continent with unbelievable pictures of suffering and unnecessary death. Using a political ecology framework, this paper examines the geographies of exile and refugee movements and the associated implications for re-emerging and newly emerging infectious diseases in great detail. It examines how the political ecologic circumstances underlying the refugee crisis influences health services delivery and the problems of disease and health in refugee camps. It has four main themes, namely, an examination of the geography of the refugee crisis: the disruption of health services due to political ecologic forces that produce refugees; the breeding of disease in refugee camps due to the prevailing desperation and destitution; and the creation of an optimal environment for emergence and spread of disease due to the chaotic nature of war and violence that produces refugees. We argue in this paper that there is great potential of something more virulent than cholera and Ebola emerging and taking a big toll before being identified and controlled. We conclude by noting that once such a disease is out in the public rapid diffusion despite political boundaries is likely, a fact that has a direct bearing on global health. The extensive evidence presented in this paper of the overriding role of political factors in the refugee health problem calls for political reform and peace accords, engagement and empowerment of Pan-African organizations, foreign policy changes by Western governments and greater vigilance of non-governmental organizations (NGOs) in the allocation and distribution of relief aid.

  8. Public procurement of health technologies in Greece in an era of economic crisis.

    PubMed

    Kastanioti, Catherine; Kontodimopoulos, Nick; Stasinopoulos, Dionysis; Kapetaneas, Nikolaos; Polyzos, Nikolaos

    2013-01-01

    Public procurement is generally an important sector of the economy and, in most countries, is controlled by the introduction of regulatory and policy mechanisms. In the Greek healthcare sector, recent legislation redefined centralized procurement through the reestablishment of a state Health Procurement Committee (EPY), with an aim to formulate a plan to reduce procurement costs of medical devices and pharmaceuticals, improve payment time, make uniform medical requests, transfer redundant materials from one hospital to another and improve management of expired products. The efforts described in this paper began in early 2010, under the co-ordination of the Ministry of Health (MoH) and with the collaboration of senior staff from the International Monetary Fund (IMF), the European Commission (EC) and the European Central Bank (ECB). The procurement practices and policies set forth by EPY and the first measurable outcomes, in terms of cost savings, resulting from these policies are presented. The importance of these measures is discussed in light of the worst economic crisis faced by Greece since the restoration of democracy in 1974, as a result of both the world financial crisis and uncontrolled government spending.

  9. Public procurement of health technologies in Greece in an era of economic crisis.

    PubMed

    Kastanioti, Catherine; Kontodimopoulos, Nick; Stasinopoulos, Dionysis; Kapetaneas, Nikolaos; Polyzos, Nikolaos

    2013-01-01

    Public procurement is generally an important sector of the economy and, in most countries, is controlled by the introduction of regulatory and policy mechanisms. In the Greek healthcare sector, recent legislation redefined centralized procurement through the reestablishment of a state Health Procurement Committee (EPY), with an aim to formulate a plan to reduce procurement costs of medical devices and pharmaceuticals, improve payment time, make uniform medical requests, transfer redundant materials from one hospital to another and improve management of expired products. The efforts described in this paper began in early 2010, under the co-ordination of the Ministry of Health (MoH) and with the collaboration of senior staff from the International Monetary Fund (IMF), the European Commission (EC) and the European Central Bank (ECB). The procurement practices and policies set forth by EPY and the first measurable outcomes, in terms of cost savings, resulting from these policies are presented. The importance of these measures is discussed in light of the worst economic crisis faced by Greece since the restoration of democracy in 1974, as a result of both the world financial crisis and uncontrolled government spending. PMID:22502936

  10. [The impact of the economic crisis on the health and healthcare of the immigrant population. SESPAS report 2014].

    PubMed

    Vázquez, María Luisa; Vargas, Ingrid; Aller, Marta-Beatriz

    2014-06-01

    Despite the economic crisis, the immigrant population of Spain continues to be high, with 5.7 million persons (11.4%). This population, whose health needs are similar to those of the general population, is more vulnerable due to their exposure to worse social determinants (living and working conditions together with a higher risk of exclusion from social services). In this article, we analyze how the economic crisis affects or can affect the health of the immigrant population in Spain by examining distinct population-specific or institutional factors that influence the effects of the crisis and the available data. The available evidence is limited, but several effects can be identified: firstly, some social determinants, such as higher unemployment rates and worse working conditions, have deteriorated, which can be expected to lead to a worsening of health status. These consequences have already been described for mental health or have been estimated for infectious diseases. Secondly, political decisions have had a direct impact, excluding-with some exceptions-undocumented immigrants from the right to health care. Finally, the lower priority given to adapting health services to the specific characteristics of the immigrant population (most of whom are documented) together with the introduction of new barriers, has hampered or will hamper access to health care. As a result, the economic crisis can be expected to have a greater impact on the immigrant population.

  11. The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: a longitudinal study before and during the financial crisis.

    PubMed

    Drydakis, Nick

    2015-03-01

    The current study uses six annual waves of the Longitudinal Labor Market Study (LLMS) covering the 2008-2013 period to obtain longitudinal estimations suggesting statistically significant negative effects from unemployment on self-reported health and mental health in Greece. The specifications suggest that unemployment results in lower health and the deterioration of mental health during the 2008-2009 period compared with the 2010-2013 period, i.e., a period in which the country's unemployment doubled as a consequence of the financial crisis. Unemployment seems to be more detrimental to health/mental health in periods of high unemployment, suggesting that the unemployment crisis in Greece is more devastating as it concerns more people. Importantly, in all specifications, comparable qualitative patterns are found by controlling for unemployment due to firm closure, which allows us to minimize potential bias due to unemployment-health related reverse causality. Moreover, in all cases, women are more negatively affected by unemployment in relation to their health and mental health statuses than are men. Greece has been more deeply affected by the financial crisis than any other EU country, and this study contributes by offering estimates for before and during the financial crisis and considering causality issues. Because health and mental health indicators increase more rapidly in a context of higher surrounding unemployment, policy action must place greater emphasis on unemployment reduction and supporting women's employment.

  12. The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: a longitudinal study before and during the financial crisis.

    PubMed

    Drydakis, Nick

    2015-03-01

    The current study uses six annual waves of the Longitudinal Labor Market Study (LLMS) covering the 2008-2013 period to obtain longitudinal estimations suggesting statistically significant negative effects from unemployment on self-reported health and mental health in Greece. The specifications suggest that unemployment results in lower health and the deterioration of mental health during the 2008-2009 period compared with the 2010-2013 period, i.e., a period in which the country's unemployment doubled as a consequence of the financial crisis. Unemployment seems to be more detrimental to health/mental health in periods of high unemployment, suggesting that the unemployment crisis in Greece is more devastating as it concerns more people. Importantly, in all specifications, comparable qualitative patterns are found by controlling for unemployment due to firm closure, which allows us to minimize potential bias due to unemployment-health related reverse causality. Moreover, in all cases, women are more negatively affected by unemployment in relation to their health and mental health statuses than are men. Greece has been more deeply affected by the financial crisis than any other EU country, and this study contributes by offering estimates for before and during the financial crisis and considering causality issues. Because health and mental health indicators increase more rapidly in a context of higher surrounding unemployment, policy action must place greater emphasis on unemployment reduction and supporting women's employment. PMID:25589031

  13. From universal health insurance to universal healthcare? The shifting health policy landscape in Ireland since the economic crisis.

    PubMed

    Burke, Sara Ann; Normand, Charles; Barry, Sarah; Thomas, Steve

    2016-03-01

    Ireland experienced one of the most severe economic crises of any OECD country. In 2011, a new government came to power amidst unprecedented health budget cuts. Despite a retrenchment in the ability of health resources to meet growing need, the government promised a universal, single-tiered health system, with access based solely on medical need. Key to this was introducing universal free GP care by 2015 and Universal Health Insurance from 2016 onwards. Delays in delivering universal access and a new health minister in 2014 resulted in a shift in language from 'universal health insurance' to 'universal healthcare'. During 2014 and 2015, there was an absence of clarity on what government meant by universal healthcare and divergence in policy measures from their initial intent of universalism. Despite the rhetoric of universal healthcare, years of austerity resulted in poorer access to essential healthcare and little extension of population coverage. The Irish health system is at a critical juncture in 2015, veering between a potential path to universal healthcare and a system, overwhelmed by years of austerity, which maintains the status quo. This papers assesses the gap between policy intent and practice and the difficulties in implementing major health system reform especially while emerging from an economic crisis.

  14. From universal health insurance to universal healthcare? The shifting health policy landscape in Ireland since the economic crisis.

    PubMed

    Burke, Sara Ann; Normand, Charles; Barry, Sarah; Thomas, Steve

    2016-03-01

    Ireland experienced one of the most severe economic crises of any OECD country. In 2011, a new government came to power amidst unprecedented health budget cuts. Despite a retrenchment in the ability of health resources to meet growing need, the government promised a universal, single-tiered health system, with access based solely on medical need. Key to this was introducing universal free GP care by 2015 and Universal Health Insurance from 2016 onwards. Delays in delivering universal access and a new health minister in 2014 resulted in a shift in language from 'universal health insurance' to 'universal healthcare'. During 2014 and 2015, there was an absence of clarity on what government meant by universal healthcare and divergence in policy measures from their initial intent of universalism. Despite the rhetoric of universal healthcare, years of austerity resulted in poorer access to essential healthcare and little extension of population coverage. The Irish health system is at a critical juncture in 2015, veering between a potential path to universal healthcare and a system, overwhelmed by years of austerity, which maintains the status quo. This papers assesses the gap between policy intent and practice and the difficulties in implementing major health system reform especially while emerging from an economic crisis. PMID:26777302

  15. Assessment of alcohol use in health professionals during the economic crisis.

    PubMed

    Saridi, Maria; Karra, Aphrodite; Kourakos, Michael; Souliotis, Kyriakos

    The aim of this study was to investigate the use of alcohol in health professionals during the economic crisis in Greece. The sample included 579 health professionals. Despite the fact that alcohol consumption was low and women held more negative views on the effectiveness of its use compared to men, they consumed more than men both in quantity (mean 1.57 vs 1.46, p=0.291) and in frequency (mean 1.98 vs 1.73, p=0.132). Employees with a higher level of education expressed more opposition to the use of alcohol than those with a basic level of education (93.5% vs 66.7%, p=0.004). There was a significant positive correlation between the amount of alcohol consumed after a stressful event and the frequency with which this amount of alcohol consumption occurred in workers. PMID:27081734

  16. Acute Cardiac Failure in a Pregnant Woman due to Thyrotoxic Crisis

    PubMed Central

    Okuda, Nao; Onodera, Mutsuo; Tsunano, Yumiko; Nakataki, Emiko; Oto, Jun; Imanaka, Hideaki; Nishimura, Masaji

    2012-01-01

    Introduction. Cardiac failure during pregnancy is usually related to preeclampsia/eclampsia, rarely to hyperthyroidism. While hyperthyroidism can easily lead to hypertensive cardiac failure and may harm the fetus, it is sometimes difficult to distinguish hyperthyroidism from normal pregnancy. Case Presentation. We encountered a case of 41-year-old pregnant woman with hypertensive cardiac failure. Because we initially diagnosed as pre-eclampsia/eclampsia, Caesarian section was performed. However, her symptoms still persisted after delivery. After thyroid function test results taken on the day of admission were obtained on the fourth day, we could diagnose that her cardiac failure was caused by thyrotoxic crisis. Conclusions. Hypertensive cardiac failure due to hyperthyroidism during pregnancy is rare and difficult to diagnose because of similar presentation of normal pregnancy. However, physicians should be aware of the risks posed by hyperthyroidism during pregnancy. PMID:24804110

  17. Food insecurity and mental health: surprising trends among community health volunteers in Addis Ababa, Ethiopia during the 2008 food crisis.

    PubMed

    Maes, Kenneth C; Hadley, Craig; Tesfaye, Fikru; Shifferaw, Selamawit

    2010-05-01

    The 2008 food crisis may have increased household food insecurity and caused distress among impoverished populations in low-income countries. Policy researchers have attempted to quantify the impact that a sharp rise in food prices might have on population wellbeing by asking what proportion of households would drop below conventional poverty lines given a set increase in prices. Our understanding of the impact of food crises can be extended by conducting micro-level ethnographic studies. This study examined self-reported household food insecurity (FI) and common mental disorders (CMD) among 110 community health AIDS care volunteers living in Addis Ababa, Ethiopia during the height of the 2008 food crisis. We used generalized estimating equations that account for associations between responses given by the same participants over 3 survey rounds during 2008, to model the longitudinal response profiles of FI, CMD symptoms, and socio-behavioral and micro-economic covariates. To help explain the patterns observed in the response profiles and regression results, we examine qualitative data that contextualize the cognition and reporting behavior of AIDS care volunteers, as well as potential observation biases inherent in longitudinal, community-based research. Our data show that food insecurity is highly prevalent, that is it associated with household economic factors, and that it is linked to mental health. Surprisingly, the volunteers in this urban sample did not report increasingly severe FI or CMD during the peak of the 2008 food crisis. This is a counter-intuitive result that would not be predicted in analyses of population-level data such as those used in econometrics simulations. But when these results are linked to real people in specific urban ecologies, they can improve our understanding of the psychosocial consequences of food price shocks. PMID:20189698

  18. Food insecurity and mental health: surprising trends among community health volunteers in Addis Ababa, Ethiopia during the 2008 food crisis.

    PubMed

    Maes, Kenneth C; Hadley, Craig; Tesfaye, Fikru; Shifferaw, Selamawit

    2010-05-01

    The 2008 food crisis may have increased household food insecurity and caused distress among impoverished populations in low-income countries. Policy researchers have attempted to quantify the impact that a sharp rise in food prices might have on population wellbeing by asking what proportion of households would drop below conventional poverty lines given a set increase in prices. Our understanding of the impact of food crises can be extended by conducting micro-level ethnographic studies. This study examined self-reported household food insecurity (FI) and common mental disorders (CMD) among 110 community health AIDS care volunteers living in Addis Ababa, Ethiopia during the height of the 2008 food crisis. We used generalized estimating equations that account for associations between responses given by the same participants over 3 survey rounds during 2008, to model the longitudinal response profiles of FI, CMD symptoms, and socio-behavioral and micro-economic covariates. To help explain the patterns observed in the response profiles and regression results, we examine qualitative data that contextualize the cognition and reporting behavior of AIDS care volunteers, as well as potential observation biases inherent in longitudinal, community-based research. Our data show that food insecurity is highly prevalent, that is it associated with household economic factors, and that it is linked to mental health. Surprisingly, the volunteers in this urban sample did not report increasingly severe FI or CMD during the peak of the 2008 food crisis. This is a counter-intuitive result that would not be predicted in analyses of population-level data such as those used in econometrics simulations. But when these results are linked to real people in specific urban ecologies, they can improve our understanding of the psychosocial consequences of food price shocks.

  19. [Economic crisis and mental health: effects on the prevalence of common mental disorders].

    PubMed

    Economou, M; Peppou, L; Fousketaki, S; Theleritis, Ch; Patelakis, A; Alexiou, T; Madianos, M; Stefanis, C

    2013-01-01

    Economic crises have been found to bring adverse repercussions on physical and mental health internationally through various pathways. Research corroborates a link between financial distress and common mental disorders. In this context, the University Mental Health Research Institute conducted epidemiological nationwide surveys in an endeavour to gauge the impact of the ongoing financial crisis on the mental health of the Greek population. The purpose of the present analysis pertains to investigating changes in the prevalence of common mental disorders in the population as a whole as well as in various population sub-groups between years 2009 and 2011. In addition, the association of financial strain with common mental disorders was also explored. For investigating the particular research objectives, two cross-sectional surveys following the same methodology were conducted. A random and representative sample of 2192 respondents in 2009 and 2256 respondents in 2011 took part in telephone interviews. Generalized anxiety disorder and major depression were assessed with the germane modules of Structured Clinical Interview, while financial difficulties with the Index of Personal Economic Distress (IPED), an original scale developed for the purposes of the particular surveys. All measures displayed good psychometric properties. Between the two years, a noteworthy, albeit non-significant, increase in one-prevalence of major depression was documented. On the other hand, the prevalence of generalized anxiety disorder remained largely unchanged. Statistically significant differences in the prevalence of both disorders were reported for particular population subgroups, with married persons and employed people emerging as the most afflicted individuals. Regarding financial distress, it was found to bear a statistically significant association with major depression but not with generalized anxiety disorder. For mitigating the mental health effects of the crisis on the general

  20. Beyond police crisis intervention: moving "upstream" to manage cases and places of behavioral health vulnerability.

    PubMed

    Wood, Jennifer D; Beierschmitt, Laura

    2014-01-01

    Law enforcement officers continue to serve on the front lines as mental health interventionists, and as such have been subject to a wave of "first generation" reform designed to enhance their crisis response capabilities. Yet, this focus on crisis intervention has not answered recent calls to move "upstream" and bolster early intervention in the name of long-term recovery. This paper reports on findings from an action research project in Philadelphia aimed at exploring opportunities for enhanced upstream engagement. Study methods include spatial analyses of police mental health transportations from an eight year period (2004-2011) and qualitative data from twenty-three "framing conversations" with partners and other stakeholders, seven focus groups with police and outreach workers, five key informant interviews as well as document reviews of the service delivery system in Philadelphia. Recommendations include the need to move beyond a focus on what police can do to a wider conception of city agencies and business stakeholders who can influence vulnerable people and vulnerable spaces of the city. We argue for the need to develop shared principles and rules of engagement that clarify roles and stipulate how best to enlist city resources in a range of circumstances. Since issues of mental health, substance use and disorder are so tightly coupled, we stress the importance of establishing a data-driven approach to crime and disorder reduction in areas of the city we term "hotspots of vulnerability". In line with a recovery philosophy, such an approach should reduce opportunities for anti-social behavior among the "dually labeled" in ways consistent with "procedural justice". Furthermore, crime and disorder data flowing from police and security to behavioral health analysts could contribute to a more focused case management of "repeat utilizers" across the two systems. Our central argument is that a twin emphasis on "case management" and "place management" may provide

  1. Developing a Nuclear Global Health Workforce Amid the Increasing Threat of a Nuclear Crisis.

    PubMed

    Burkle, Frederick M; Dallas, Cham E

    2016-02-01

    This study argues that any nuclear weapon exchange or major nuclear plant meltdown, in the categories of human systems failure and conflict-based crises, will immediately provoke an unprecedented public health emergency of international concern. Notwithstanding nuclear triage and management plans and technical monitoring standards within the International Atomic Energy Agency and the World Health Organization (WHO), the capacity to rapidly deploy a robust professional workforce with the internal coordination and collaboration capabilities required for large-scale nuclear crises is profoundly lacking. A similar dilemma, evident in the early stages of the Ebola epidemic, was eventually managed by using worldwide infectious disease experts from the Global Outbreak Alert and Response Network and multiple multidisciplinary WHO-supported foreign medical teams. This success has led the WHO to propose the development of a Global Health Workforce. A strategic format is proposed for nuclear preparedness and response that builds and expands on the current model for infectious disease outbreak currently under consideration. This study proposes the inclusion of a nuclear global health workforce under the technical expertise of the International Atomic Energy Agency and WHO's Radiation Emergency Medical Preparedness and Assistance Network leadership and supported by the International Health Regulations Treaty. Rationales are set forth for the development, structure, and function of a nuclear workforce based on health outcomes research that define the unique health, health systems, and public health challenges of a nuclear crisis. Recent research supports that life-saving opportunities are possible, but only if a rapidly deployed and robust multidisciplinary response component exists. PMID:26527407

  2. Developing a Nuclear Global Health Workforce Amid the Increasing Threat of a Nuclear Crisis.

    PubMed

    Burkle, Frederick M; Dallas, Cham E

    2016-02-01

    This study argues that any nuclear weapon exchange or major nuclear plant meltdown, in the categories of human systems failure and conflict-based crises, will immediately provoke an unprecedented public health emergency of international concern. Notwithstanding nuclear triage and management plans and technical monitoring standards within the International Atomic Energy Agency and the World Health Organization (WHO), the capacity to rapidly deploy a robust professional workforce with the internal coordination and collaboration capabilities required for large-scale nuclear crises is profoundly lacking. A similar dilemma, evident in the early stages of the Ebola epidemic, was eventually managed by using worldwide infectious disease experts from the Global Outbreak Alert and Response Network and multiple multidisciplinary WHO-supported foreign medical teams. This success has led the WHO to propose the development of a Global Health Workforce. A strategic format is proposed for nuclear preparedness and response that builds and expands on the current model for infectious disease outbreak currently under consideration. This study proposes the inclusion of a nuclear global health workforce under the technical expertise of the International Atomic Energy Agency and WHO's Radiation Emergency Medical Preparedness and Assistance Network leadership and supported by the International Health Regulations Treaty. Rationales are set forth for the development, structure, and function of a nuclear workforce based on health outcomes research that define the unique health, health systems, and public health challenges of a nuclear crisis. Recent research supports that life-saving opportunities are possible, but only if a rapidly deployed and robust multidisciplinary response component exists.

  3. Coping strategies of health personnel during economic crisis: A case study from cameroon

    PubMed

    Israr

    2000-04-01

    objectives Severe economic crisis compelled many governments in Sub-Saharan Africa to adopt structural adjustment programmes. This was accompanied by price increases and cuts in the salaries of civil servants. We explored how health personnel in one province of Cameroon coped with this situation, and what the perceived effects on service quality were. methods Key informant and focus group interviews with government and mission (church) health personnel; interviews with service users to validate the findings. results Government health personnel had experienced larger cuts in salaries than their mission counterparts; they no longer received allowances and incentives still available to mission personnel and appeared more demotivated. Most government and mission personnel reported legal after-hours income raising activities. Government personnel frequently reported additional 'survival strategies' such as parallel selling of drugs, requesting extra charges for services, and running private practices during work hours. There was a high level of self criticism among government personnel indicating a dissonance between their attitude and practices. They considered these practices negative and harmful for service users. conclusion Remedial action is urgent. Options include reinstating allowances for good performance and ensuring regular supervision without blaming individual health workers for problems caused by the state of the health system.

  4. Crisis into opportunity: setting up community mental health services in post-tsunami Aceh.

    PubMed

    Jones, L M; Ghani, H A; Mohanraj, A; Morrison, S; Smith, P; Stube, D; Asare, J

    2007-01-01

    The Asian Tsunami killed more than 130,000 people and made 400,000 homeless in Aceh, an area in Indonesia already affected by over thirty years of conflict. This paper examines an approach taken by an International Non-Governmental Organisation (INGO) to address emergency mental health and psychosocial needs in an integrated way, by providing a continuum of care incorporating psychosocial support for the wider community and clinical services for the more severely affected. The model included outreach to the indigenous system. Psychosocial activities were developed in partnership with the local communities. Community-based clinical mental health services were established by identifying and building locally-based capacity at the primary health care level, and potentially sustainable services were established in collaboration with the Ministry of Health. By December 2005, four hundred and eighty three patients had been seen. More than one third suffered from serious mental disorders that predated the Tsunami. Thus, crisis provided an opportunity to address longstanding community mental health needs. The lessons learned from this approach are also discussed.

  5. The global increase in dental caries. A pending public health crisis.

    PubMed

    Bagramian, Robert A; Garcia-Godoy, Franklin; Volpe, Anthony R

    2009-02-01

    A current review of the available epidemiological data from many countries clearly indicates that there is a marked increase in the prevalence of dental caries. This global increase in dental caries prevalence affects children as well as adults, primary as well as permanent teeth, and coronal as well as root surfaces. This increase in dental caries signals a pending public health crisis. Although there are differences of opinion regarding the cause of this global dental caries increase, the remedy is well known: a return to the public health strategies that were so successful in the past, a renewed campaign for water fluoridation, topical fluoride application, the use of fluoride rinses, a return to school oral health educational programs, an emphasis on proper tooth brushing with a fluoride dentifrice, as well as flossing, a proper diet and regular dental office visits. If these remedies are not initiated, there could be a serious negative impact upon the future oral health (and systemic health) of the global community, as well as a strain on the dental profession along with a major increase in the cost of dental services.

  6. Older adults experiences of rehabilitation in acute health care.

    PubMed

    Atwal, Anita; Tattersall, Kirsty; Murphy, Susana; Davenport, Neil; Craik, Christine; Caldwell, Kay; McIntyre, Anne

    2007-09-01

    Rehabilitation is a key component of nursing and allied healthcare professionals' roles in most health and social care settings. This paper reports on stage 2 of an action research project to ascertain older adult's experience of rehabilitation. Twenty postdischarge interviews were conducted and the interview transcripts were analysed using thematic content analysis. All older adults discharged from an acute older acute rehabilitation ward to their own homes in the community were eligible to participate. The only exclusion criterion was older adults who were thought to be unable to give consent to participate by the nurse in charge and the researcher. Whilst 92 older adults were eligible to participate in this research study, only 20 were interviewed. The findings from this study suggest that older adults valued communication with health professionals but were aware of their time constraints that hindered communication. This study suggests that both nurses and allied health professionals are not actively providing rehabilitative services to promote health and well-being, which contradicts the focus of active ageing. Furthermore, there was evidence of unmet needs on discharge, and older adults unable to recall the professions that were involved in their interventions and the rationale for therapy input. It is suggested that further research is needed to explore the effectiveness of allied health rehabilitation in the acute setting. This study highlights the need for further research into older adults' perceptions of the rehabilitation process in the acute setting.

  7. Effects of the Global Financial Crisis on Health in High-Income Oecd Countries: A Narrative Review.

    PubMed

    Karanikolos, Marina; Heino, Pia; McKee, Martin; Stuckler, David; Legido-Quigley, Helena

    2016-01-01

    A growing body of evidence documents how economic crises impact aspects of health across countries and over time. We performed a systematic narrative review of the health effects of the latest economic crisis based on studies of high-income countries. Papers published between January 2009 and July 2015 were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. Ultimately, 122 studies were selected and their findings summarized. The review finds that the 2008 financial crisis had negative effects on mental health, including suicide, and to a varying extent on some non-communicable and communicable diseases and access to care. Although unhealthy behaviors such as hazardous drinking and tobacco use appeared to decline during the crisis, there have been increases in some groups, typically those already at greatest risk. The health impact was greatest in countries that suffered the largest economic impact of the crisis or prolonged austerity. The Great Recessions in high-income countries have had mixed impacts on health. They tend to be worse when economic impacts are more severe, prolonged austerity measures are implemented, and there are pre-existing problems of substance use among vulnerable groups. PMID:27076651

  8. Effects of the Global Financial Crisis on Health in High-Income Oecd Countries: A Narrative Review.

    PubMed

    Karanikolos, Marina; Heino, Pia; McKee, Martin; Stuckler, David; Legido-Quigley, Helena

    2016-01-01

    A growing body of evidence documents how economic crises impact aspects of health across countries and over time. We performed a systematic narrative review of the health effects of the latest economic crisis based on studies of high-income countries. Papers published between January 2009 and July 2015 were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. Ultimately, 122 studies were selected and their findings summarized. The review finds that the 2008 financial crisis had negative effects on mental health, including suicide, and to a varying extent on some non-communicable and communicable diseases and access to care. Although unhealthy behaviors such as hazardous drinking and tobacco use appeared to decline during the crisis, there have been increases in some groups, typically those already at greatest risk. The health impact was greatest in countries that suffered the largest economic impact of the crisis or prolonged austerity. The Great Recessions in high-income countries have had mixed impacts on health. They tend to be worse when economic impacts are more severe, prolonged austerity measures are implemented, and there are pre-existing problems of substance use among vulnerable groups.

  9. A Coordinated Mental Health Crisis Response: Lessons Learned from Three Colorado School Shootings

    ERIC Educational Resources Information Center

    Crepeau-Hobson, Franci; Sievering, Kathryn S.; Armstrong, Charlotte; Stonis, Julie

    2012-01-01

    This article describes a crisis response framework based on the authors' first-hand experience following three Colorado school shootings. During each crisis response, one or more of the authors joined school and/or district crisis teams, providing direct assistance and leadership. The authors' experiences helped guide subsequent responses and…

  10. Impact of the economic crisis on children's health in Catalonia: a before–after approach

    PubMed Central

    Rajmil, Luis; Medina-Bustos, Antonia; Fernández de Sanmamed, María-José; Mompart-Penina, Anna

    2013-01-01

    Objectives To analyse changes in the family living conditions of children in Catalonia between 2006 and the 2010–2012 period, and to study associations between these changes and health outcomes. Design A before–after analysis of two cross-sectional surveys. Setting Population younger than 15 years of age from Catalonia, Spain. Participants Representative samples of children in the 2006 Catalan Health Survey (ESCA), baseline, before the crisis; n=2200) and the first four waves of ESCA 2010–2012 (after start of the crisis, n=1967). Main outcome measures Overweight/obesity, health behaviour, mental health and health-related quality of life (HRQOL). Logistic regression and multiple linear regression models were used to analyse the influence of changes in family conditions on outcome measures, including interaction terms to describe the potential influence of the study period on the results. Results The percentage of unemployed families rose from 9.1% (2006) to 20.6% (2010–2012), with inequalities by level of education. Overweight/obesity increased from 18.4% (95% CI 16.5% to 20.4%) to 26.9% (24.6% to 29.2%) in 2010–2012, and inequalities related to maternal education and employment status persisted. Eating habits have improved in 2010–2012 in disadvantaged families (ie, junk food consumption improved in families with a maternal primary education level; beta (B)=2.85; 0.83 to 4.88, for the survey interaction by primary education level). An improvement in HRQOL was found in the second survey (B=6.07; 4.15 to 7.99), although children whose mothers had a primary education showed poorer HRQOL scores in this survey than in 2006 (B=−4.14; −7.17 to −1.12). Conclusions Although some health-related behaviour improved during the study period, childhood obesity increased and inequalities in HRQOL appeared. Policy measures that fight against these inequalities should be urgently implemented to avoid their negative impact on the health of future generations of

  11. [Health promotion and prevention in the economic crisis: the role of the health sector. SESPAS report 2014].

    PubMed

    Márquez-Calderón, Soledad; Villegas-Portero, Román; Gosalbes Soler, Victoria; Martínez-Pecino, Flora

    2014-06-01

    This article reviews trends in lifestyle factors and identifies priorities in the fields of prevention and health promotion in the current economic recession. Several information sources were used, including a survey of 30 public health and primary care experts. Between 2006 and 2012, no significant changes in lifestyle factors were detected except for a decrease in habitual alcohol drinking. There was a slight decrease in the use of illegal drugs and a significant increase in the use of psychoactive drugs. Most experts believe that decision-making about new mass screening programs and changes in vaccination schedules needs to be improved by including opportunity cost analysis and increasing the transparency and independence of the professionals involved. Preventive health services are contributing to medicalization, but experts' opinions are divided on the need for some preventive activities. Priorities in preventive services are mental health and HIV infection in vulnerable populations. Most experts trust in the potential of health promotion to mitigate the health effects of the economic crisis. Priority groups are children, unemployed people and other vulnerable groups. Priority interventions are community health activities (working in partnership with local governments and other sectors), advocacy, and mental health promotion. Effective tools for health promotion that are currently underused are legislation and mass media. There is a need to clarify the role of the healthcare sector in intersectorial activities, as well as to acknowledge that social determinants of health depend on other sectors. Experts also warn of the consequences of austerity and of policies that negatively impact on living conditions. PMID:24656990

  12. A patient with possible TRALI who developed pulmonary hypertensive crisis and acute pulmonary edema during cardiac surgery.

    PubMed

    Kojima, Taiki; Nishisako, Ryo; Sato, Hideo

    2012-06-01

    There are very few case reports of transfusion-related acute lung injury (TRALI) under close hemodynamic monitoring. We encountered a case of possible TRALI during on-pump coronary artery bypass grafting (CABG). A 66-year-old man who had undergone on-pump CABG was administered fresh frozen plasma (FFP). One hour after FFP transfusion, pulmonary hypertensive crisis and subsequent hypoxic decompensation occurred. A second cardiopulmonary bypass (CPB) was needed for circulatory and respiratory deterioration. Extracorporeal life support (ECLS), intraaortic balloon pumping (IABP), and nitric oxide therapy were required after the surgery. Despite the severity of the initial state, his recovery was comparatively smooth. ECLS and IABP were removed on postoperative day (POD)1; the patient was extubated and discharged from the ICU on POD7 and POD12, respectively. The diagnosis of TRALI was confirmed by human leukocyte antigen antibody detection in the administered FFP. In addition, lymphocytic immunofluorescence test showed that a cross-match of the plasma from the pooled FFP against the recipient leukocytes was positive. The clinical course of the pulmonary artery hypertension was followed by a decrease in dynamic lung compliance. The mechanism of this phenomenon is unclear. However, it might suggest the possibility of vasoconstriction or obstruction of the peripheral pulmonary artery preceding lung damage, as in the case in animal models reported previously.

  13. A bioecological systems approach for navigating the college mental health crisis.

    PubMed

    Pinder-Amaker, Stephanie; Bell, Catherine

    2012-01-01

    McLean Hospital's College Mental Health Program was established four years ago as an institutional response to escalating, national college mental health concerns. The critical factors underlying the college mental health crisis in this country have been debated, examined, and addressed almost exclusively within college and university settings. McLean Hospital is the first psychiatric hospital to develop a comprehensive college student program that bridges the gap between a psychiatric hospital and multiple campus settings as an attempt to address the specific needs of college student-patients across levels of psychiatric care and diagnostic areas/programs. Using a bioecological systems framework, this review examines (1) the strategic clinical, education/outreach, and research efforts that collectively represent a paradigm shift to extend responsibility for addressing serious college mental health challenges beyond college and university campuses, (2) the challenges and benefits of creating stronger multi-campus/hospital collaborations in order to improve our understanding of college students with serious mental illness, and (3) the progress in addressing these needs more effectively and in establishing documented best practices and policies through effective and innovative partnerships.

  14. Acute Health Delivery, Energy Impact, and Rural Texas.

    ERIC Educational Resources Information Center

    Milburn, Lonna; And Others

    To examine what changes occurred in the acute health care delivery systems of rural Texas energy impact communities from 1978 to 1983, a retrospective survey was used to acquire data from which a database could be generated that could provide information for community and state policy decisions. From a pool of communities chosen by a panel of…

  15. An agenda for advancing research on crisis intervention teams for mental health emergencies.

    PubMed

    Cross, Amanda Brown; Mulvey, Edward P; Schubert, Carol A; Griffin, Patricia A; Filone, Sarah; Winckworth-Prejsnar, Katy; DeMatteo, David; Heilbrun, Kirk

    2014-04-01

    The popularity of crisis intervention teams (CITs) for law enforcement agencies has grown dramatically over the past decade. Law enforcement agencies and advocates for individuals with mental illness view the model as a clear improvement in the way the criminal justice system handles individuals with mental illness. There is, however, only limited empirical support for the perceived effectiveness of CITs. This Open Forum analyzes research needs in this area and offers recommendations. Two major gaps in CIT research are identified: verifying that changes in officers' attitudes and skills translate into behavioral change and determining how criminal justice-mental health partnerships affect officers' behavior. Research addressing these gaps could help set benchmarks of success and identify evidence-based practices for CIT, substantially increasing the empirical base of support for CIT.

  16. HIV-AIDS Information and the American Library Community: An Overview of Responses to the HIV-AIDS Health Crisis.

    ERIC Educational Resources Information Center

    Lukenbill, W. Bernard

    This paper presents an overview of how American libraries have responded to the health crisis caused by HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome). AIDS information dissemination practices of libraries and the social role which American librarians have articulated regarding their special responsibilities are…

  17. Addressing the human resources crisis: a case study of the Namibian health service

    PubMed Central

    McCourt, Willy; Awases, Magda

    2007-01-01

    Background This paper addresses an important practical challenge to staff management. In 2000 the United Nations committed themselves to the ambitious targets embodied in the Millennium Development Goals (MDGs). Only five years later, it was clear that poor countries were not on track to achieve them. It was also clear that achieving the three out of the eight MDGs that concern health would only be possible if the appropriate human resources (HR) were in place. Methods We use a case study based on semi-structured interview data to explore the steps that Namibia, a country facing severe health problems that include an alarmingly high AIDS infection rate, has taken to manage its health workers. Results In the fifteen years since independence, Namibia has patiently built up a relatively good strategic framework for health policy in the context of government policy as a whole, including strong training arrangements at every level of health staffing, and it has brought HIV/AIDS under the strategic umbrella through its National Strategic Plan for HIV/AIDS. Its major weakness is that it has not kept pace with the rise in HIV/AIDS and TB infection: the community counselling service, still at the pilot stage at the time of this study, was the only specific response. That has created a tension between building long-term capacity in a strategic context and responding to the short-term demands of the AIDS and TB crisis, which in turn affects the ability of HR to contribute to improving health outcomes. Conclusion It is suggested that countries like Namibia need a new paradigm for staffing their health services. Building on the existing strategic framework, it should target the training of 'mid-level cadres'. Higher-level cadres should take on the role of supporting and monitoring the mid-level cadres. To do that, they will need management training and a performance management framework for staff support and monitoring. PMID:17224048

  18. Effects of the financial crisis and Troika austerity measures on health and health care access in Portugal.

    PubMed

    Legido-Quigley, Helena; Karanikolos, Marina; Hernandez-Plaza, Sonia; de Freitas, Cláudia; Bernardo, Luís; Padilla, Beatriz; Sá Machado, Rita; Diaz-Ordaz, Karla; Stuckler, David; McKee, Martin

    2016-07-01

    Although Portugal has been deeply affected by the global financial crisis, the impact of the recession and subsequent austerity on health and to health care has attracted relatively little attention. We used several sources of data including the European Union Statistics for Income and Living Conditions (EU-SILC) which tracks unmet medical need during the recession and before and after the Troika's austerity package. Our results show that the odds of respondents reporting having an unmet medical need more than doubled between 2010 and 2012 (OR=2.41, 95% CI 2.01-2.89), with the greatest impact on those in employment, followed by the unemployed, retired, and other economically inactive groups. The reasons for not seeking care involved a combination of factors, with a 68% higher odds of citing financial barriers (OR=1.68, 95% CI 1.32-2.12), more than twice the odds of citing waiting times and inability to take time off work or family responsibilities (OR 2.18, 95% CI 1.20-3.98), and a large increase of reporting delaying care in the hope that the problem would resolve on its own (OR=13.98, 95% CI 6.51-30.02). Individual-level studies from Portugal also suggest that co-payments at primary and hospital level are having a negative effect on the most vulnerable living in disadvantaged areas, and that health care professionals have concerns about the impact of recession and subsequent austerity measures on the quality of care provided. The Portuguese government no longer needs external assistance, but these findings suggest that measures are now needed to mitigate the damage incurred by the crisis and austerity. PMID:27263063

  19. Effects of the financial crisis and Troika austerity measures on health and health care access in Portugal.

    PubMed

    Legido-Quigley, Helena; Karanikolos, Marina; Hernandez-Plaza, Sonia; de Freitas, Cláudia; Bernardo, Luís; Padilla, Beatriz; Sá Machado, Rita; Diaz-Ordaz, Karla; Stuckler, David; McKee, Martin

    2016-07-01

    Although Portugal has been deeply affected by the global financial crisis, the impact of the recession and subsequent austerity on health and to health care has attracted relatively little attention. We used several sources of data including the European Union Statistics for Income and Living Conditions (EU-SILC) which tracks unmet medical need during the recession and before and after the Troika's austerity package. Our results show that the odds of respondents reporting having an unmet medical need more than doubled between 2010 and 2012 (OR=2.41, 95% CI 2.01-2.89), with the greatest impact on those in employment, followed by the unemployed, retired, and other economically inactive groups. The reasons for not seeking care involved a combination of factors, with a 68% higher odds of citing financial barriers (OR=1.68, 95% CI 1.32-2.12), more than twice the odds of citing waiting times and inability to take time off work or family responsibilities (OR 2.18, 95% CI 1.20-3.98), and a large increase of reporting delaying care in the hope that the problem would resolve on its own (OR=13.98, 95% CI 6.51-30.02). Individual-level studies from Portugal also suggest that co-payments at primary and hospital level are having a negative effect on the most vulnerable living in disadvantaged areas, and that health care professionals have concerns about the impact of recession and subsequent austerity measures on the quality of care provided. The Portuguese government no longer needs external assistance, but these findings suggest that measures are now needed to mitigate the damage incurred by the crisis and austerity.

  20. Perceptions of crisis care in populations who self-referred to a telephone-based mental health triage service.

    PubMed

    Sands, Natisha; Elsom, Stephen; Keppich-Arnold, Sandra; Henderson, Kathryn; Thomas, Phillipa A

    2016-04-01

    Although psychiatric crises are very common in people with mental illness, little is known about consumer perceptions of mental health crisis care. Given the current emphasis on recovery-oriented approaches, shared decision-making, and partnering with consumers in planning and delivering care, this knowledge gap is significant. Since the late 1990s, access to Australian mental health services has been facilitated by 24/7 telephone-based mental health triage systems, which provide initial psychiatric assessment, referral, support, and advice. A significant proportion of consumers access telephone-based mental health triage services in a state of crisis, but to date, there has been no published studies that specifically report on consumer perceptions on the quality and effectiveness of the care provided by these services. This article reports on a study that investigated consumer perceptions of accessing telephone-based mental health triage services. Seventy-five mental health consumers participated in a telephone interview about their triage service use experience. An eight-item survey designed to measure the responsiveness of mental health services was used for data collection. The findings reported here focus on the qualitative data produced in the study. Consumer participants shared a range of perspectives on telephone-based mental health triage that provide invaluable insights into the needs, expectations, and service use experiences of consumers seeking assistance with a mental health problem. Consumer perceptions of crisis care have important implications for practice. Approaches and interventions identified as important to quality care can be used to inform educational and practice initiatives that promote person-centred, collaborative crisis care.

  1. Forging partnerships to solve the global health workforce crisis and achieve the health MDGs.

    PubMed

    Cometto, Giorgio; Sheikh, Mubashar

    2010-01-01

    The health workforce is in many countries the weakest link in the effective and equitable delivery of quality health services, and the largest impediment to the achievement of health Millennium Development Goals. The Kampala Declaration and Agenda for Global Action, championed by the Global Health Workforce Alliance, provide an effective overarching framework for the bold, concerted and sustained action which is required at the international, national and local level.

  2. Plasma exchange for hemolytic crisis and acute liver failure in Wilson disease.

    PubMed

    Verma, Nishant; Pai, Gautham; Hari, Pankaj; Lodha, Rakesh

    2014-05-01

    Wilson disease (WD) is a rare autosomal recessive disorder of copper metabolism which primarily involves the liver and the central nervous system. Rarely, WD can present as acute liver failure (ALF) and this disease is universally fatal in the absence of liver transplantation. The authors report a young girl with WD ALF, who showed signs of recovery after prompt initiation of plasma exchange (PE) and chelation therapy. Though liver transplantation could not be done in this child and the child died 8 d after stopping PE, this case highlights that PE can be a successful medical treatment in WD ALF and should be considered as a therapeutic measure to stabilize a patient by decreasing serum copper, reducing hemolysis, and helping to prevent renal tubular injury from copper and copper complexes until liver transplantation is possible.

  3. Maintenance Crisis vs Solutions.

    ERIC Educational Resources Information Center

    Haggard, Susie

    Industrial maintenance in Northeast Georgia is facing an acute crisis. Contributing factors are economic development that is depleting the work force, aging of the population, downsizing of the military, and lack of technical school graduates. Solutions to the crisis fall into three categories: short-term, mid-term, and long-term. For short-term…

  4. [Crisis and nurses].

    PubMed

    Martínez Riera, José Ramón

    2012-02-01

    Nobody can escape that we are in crisis. Already are responsible every day media, risk agencies and abstract but crucial markets reminded us. In this crisis, deep, prolonged and distressing health systems have been in the spotlight of national Governments and corporations, as key elements of building and resolution of the crisis. Generation because it interprets its inefficiency is responsible for much of the crisis. Resolution because it is understood that actions that envelope the same are carried out they shall foster the output. So then we have two key elements: crisis and health systems, which combine very differently but which inevitably and unfortunately have been associated on a permanent basis. To understand this symbiosis and try to analyze it I operate the simple formula of semantically understanding what is crisis and what health crisis.

  5. Formaldehyde exposure and acute health effects study

    SciTech Connect

    Quackenboss, J.J.; Lebowitz, M.D.; Michaud, J.P.; Bronnimann, D. )

    1989-01-01

    To assess the effects of formaldehyde exposures on health, exposure groups were defined using baseline exposure and health questionnaires. Formaldehyde concentrations were poorly correlated with these exposure classifications, perhaps due to the time delay between classification and monitoring. The 151 households reported here had a mean HCHO concentration of 35 (S.E. 1.5 and median 30) {mu}g/m{sup 3}. Passive samplers prepared in our lab were calibrated in a chamber to derive an estimated sampling rate of 0.311 {mu}g/(mg {center dot} m{sup {minus}3} {center dot} hr). They were also compared to commercially available samplers inside of the homes, with a correlation coefficient of 0.896 and mean difference of 2.6 {mu}g/m{sup 3}. In this report of initial findings from an ongoing study, daily symptoms and peak expiratory flow measurements were compared with an HCHO exposure classification based on the median measured concentrations. None of the symptoms groups were related to HCHO exposure when controlling for age and sex. There was a significant relationship between HCHO exposure and variability in peak expiratory flows that was dependent on age group. It may be especially important to assess the variability in reactive individuals and children to determine the short-term effects of HCHO exposures and possible long-term consequences.

  6. Delayed diagnosis with autoimmune polyglandular syndrome type 2 causing acute adrenal crisis

    PubMed Central

    Wang, Xiaojing; Ping, Fan; Qi, Cuijuan; Xiao, Xinhua

    2016-01-01

    Abstract Background: Autoimmune polyglandular syndrome type 2 (APS-2), also known as Schmidt's syndrome, is an uncommon disorder characterized by the coexistence of Addison's disease with thyroid autoimmune disease and/or type 1 diabetes mellitus. Addison's disease as the obligatory component is potentially life-threatening. Unfortunately, the delayed diagnosis of Addison's disease is common owing to its rarity and the nonspecific clinical manifestation. Methods: Here we reported a case of 38-year-old female patient who presented with 2 years’ history of Hashimoto's thyroiditis and received levothyroxine replacement. One year later, skin hyperpigmentation, fatigue, loss of appetite, and muscle soreness occurred. She was advised to increase the dose of levothyroxine, but the symptoms were not relieved. After 4 months, the patient accompanied with dizziness, nausea, nonbloody vomiting, and fever. However, she was diagnosed with acute gastroenteritis and fell into shock and ventricular fibrillation subsequently. Further evaluation in our hospital revealed elevated adrenocorticotrophic hormone and low morning serum cortisol, associated with hyponatremia and atrophic adrenal gland. Hypergonadotropic hypogonadism and Hashimoto's thyroiditis were also demonstrated. Results: After the supplementation with hydrocortisone and fludrocortisone was initiated, the physical discomforts were alleviated and plasma electrolytes were back to normal. Conclusion: The uncommon case involving 3 endocrine organs reinforced the significance of a timely diagnosis and appropriate treatment of APS-2, and physicians needed to sharpen their awareness of the potentially life-threatening disease. PMID:27759634

  7. Application of a general health policy model in the American health care crisis.

    PubMed

    Kaplan, R M

    1993-05-01

    There is near consensus that the US health care system requires reform. Only a quarter of the American public has faith in the current system. Health care was one of the major issues considered in the 1992 US presidential election and the search for innovative solutions has transcended administrations.

  8. Acute Health Impact of Air Pollution in China

    NASA Astrophysics Data System (ADS)

    Feng, T.; Zhao, Y.; Zheng, M.

    2014-12-01

    Air pollution not only has long term health impact, but can affect health through acute exposure. This paper, using air pollution index (API) as overall evaluation of air quality, blood pressure and vital capacity as health outcomes, focuses on the acute health impact of air pollution in China. Current result suggests that after controlling smoking history, occupational exposure, income and education, API is positively associated with blood pressure and negatively associated with vital capacity. The associations became stronger for people with hypertension or pulmonary functional diseases, which indicates that these people are more sensitive to air pollution. Among three pollutants which API measures, that is inhalable particles (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2), PM10 is most statistically associated with blood pressure increase and vital capacity decrease. Further study will focusing on the following two questions. The first question is how various time lags affect the associations among API, blood pressure and vital capacity. The second question is how differently people in various cohorts reacts to acute exposure to air pollution. The differences in reactions of blood pressure and vital capacity between people in urban and rural areas, genders, various age cohorts, distinct income and education groups will be further studied.

  9. Ventricular Tachycardia and Resembling Acute Coronary Syndrome During Pheochromocytoma Crisis: A Case Report.

    PubMed

    Li, Shi-Jun; Wang, Tao; Wang, Lin; Pang, Zhan-Qi; Ma, Ben; Li, Ya-Wen; Yang, Jian; Dong, He

    2016-04-01

    Pheochromocytomas are neuroendocrine tumors, and its cardiac involvement may include transient myocardial dysfunction, acute coronary syndrome (ACS), and even ventricular arrhythmias.A patient was referred for evaluation of stuttering chest pain, and his electrocardiogram showed T-wave inversion over leads V1 to V4. Coronary angiography showed 90% stenosis in the mid-left anterior descending coronary artery (LAD), which was stented. Five days later, the patient had ventricular tachycardia, and severe hypertension, remarkable blood pressure fluctuation between 224/76 and 70/50 mm Hg. The patient felt abdominal pain and his abdominal ultrasound showed suspicious right adrenal gland tumor. Enhanced computed tomography of adrenal gland conformed that there was a tumor in right adrenal gland accompanied by an upset level of aldosterone.The tumor was removed by laparoscope, and the pathological examination showed pheochromocytoma. After the surgery, the blood pressure turned normal gradually. There was no T-wave inversion in lead V1-V4. Our case illustrates a rare pheochromocytoma presentation with a VT and resembling ACS. In our case, the serious stenosis in the mid of LAD could be explained by worsen the clinical course of myocardial ischemia or severe coronary vasospasm by the excessive amounts of catecholamines released from the tumor. Coronary vasospasm was possible because he had no classic coronary risk factors (e.g. family history and smoking habit, essential hypertension, hyperglycemia and abnormal serum lipoprotein, high body mass index). Thus, pheochromocytoma was missed until he revealed the association of his symptoms with abdominalgia.As phaeochromocytomas that present with cardiovascular complications can be fatal, it is necessary to screen for the disease when patients present with symptoms indicating catecholamine excess. PMID:27057898

  10. The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners

    PubMed Central

    Watson, Amy C.; Fulambarker, Anjali J.

    2013-01-01

    As persons with mental illnesses and law enforcement become increasingly entangled, the collaboration of police and mental health service providers has become critical to appropriately serving the needs of individuals experiencing mental health crises. This article introduces the Crisis Intervention Team (CIT) Model as a collaborative approach to safely and effectively address the needs of persons with mental illnesses, link them to appropriate services, and divert them from the criminal justice system if appropriate. We discuss the key elements of the CIT model, implementation and its related challenges, as well as variations of the model. While this model has not undergone enough research to be deemed an Evidence-Based Practice, it has been successfully utilized in many law enforcement agencies worldwide and is considered a “Best Practice” model in law enforcement. This primer for mental health practitioners serves as an introduction to a model that may already be utilized in their community or serve as a springboard for the development CIT programs where they do not currently exist. PMID:24039557

  11. The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners.

    PubMed

    Watson, Amy C; Fulambarker, Anjali J

    2012-12-01

    As persons with mental illnesses and law enforcement become increasingly entangled, the collaboration of police and mental health service providers has become critical to appropriately serving the needs of individuals experiencing mental health crises. This article introduces the Crisis Intervention Team (CIT) Model as a collaborative approach to safely and effectively address the needs of persons with mental illnesses, link them to appropriate services, and divert them from the criminal justice system if appropriate. We discuss the key elements of the CIT model, implementation and its related challenges, as well as variations of the model. While this model has not undergone enough research to be deemed an Evidence-Based Practice, it has been successfully utilized in many law enforcement agencies worldwide and is considered a "Best Practice" model in law enforcement. This primer for mental health practitioners serves as an introduction to a model that may already be utilized in their community or serve as a springboard for the development CIT programs where they do not currently exist.

  12. The impact of the financial crisis on human resources for health policies in three southern-Europe countries.

    PubMed

    Correia, Tiago; Dussault, Gilles; Pontes, Carla

    2015-12-01

    The public health sector has been the target of austerity measures since the global financial crisis started in 2008, while health workforce costs have been a source of rapid savings in most European Union countries. This article aims to explore how health workforce policies have evolved in three southern European countries under external constraints imposed by emergency financial programmes agreed with the International Monetary Fund, Central European Bank and European Commission. The selected countries, Greece, Portugal and Cyprus, show similarities with regard to corporatist systems of social protection and comprehensive welfare mechanisms only recently institutionalized. Based on document analysis of the Memoranda of Understanding agreed with the Troika, our results reveal broadly similar policy responses to the crisis but also important differences. In Cyprus, General Practitioners have a key position in reducing public expenditure through gatekeeping and control of users' access, while Portugal and Greece seeks to achieve cost containment by constraining the decision-making powers of professionals. All three countries lack innovation as well as monitoring and assessment of the effects of the financial crisis in relation to the health workforce. Consequently, there is a need for health policy development to use human resources more efficiently in healthcare. PMID:26319095

  13. The impact of the financial crisis on human resources for health policies in three southern-Europe countries.

    PubMed

    Correia, Tiago; Dussault, Gilles; Pontes, Carla

    2015-12-01

    The public health sector has been the target of austerity measures since the global financial crisis started in 2008, while health workforce costs have been a source of rapid savings in most European Union countries. This article aims to explore how health workforce policies have evolved in three southern European countries under external constraints imposed by emergency financial programmes agreed with the International Monetary Fund, Central European Bank and European Commission. The selected countries, Greece, Portugal and Cyprus, show similarities with regard to corporatist systems of social protection and comprehensive welfare mechanisms only recently institutionalized. Based on document analysis of the Memoranda of Understanding agreed with the Troika, our results reveal broadly similar policy responses to the crisis but also important differences. In Cyprus, General Practitioners have a key position in reducing public expenditure through gatekeeping and control of users' access, while Portugal and Greece seeks to achieve cost containment by constraining the decision-making powers of professionals. All three countries lack innovation as well as monitoring and assessment of the effects of the financial crisis in relation to the health workforce. Consequently, there is a need for health policy development to use human resources more efficiently in healthcare.

  14. Mental Health Crisis in Northeast Fukushima after the 2011 Earthquake, Tsunami and Nuclear Disaster.

    PubMed

    Fukunaga, Hisanori; Kumakawa, Hiromi

    2015-01-01

    The great earthquake of 11 March 2011 and resulting tsunami caused serious damage to various areas of the Pacific coast in northeast Fukushima, and all the residents faced fears of meltdown of the reactors at the Fukushima Daiichi Nuclear Power Plant. One of the most seriously affected areas was the district of Soso, located in the northeast part of Fukushima prefecture, with 12 municipalities (Soma City, Minamisoma City, Shinchi Town, Namie Town, Futaba Town, Ōkuma Town, Tomioka Town, Naraha Town, Hirono Town, Iitate Village, Katsurao Village and Kawauchi Village). The district of Soso is home to approximately 200,000 residents, many of whom were seriously affected by the threefold disaster. During the subsequent four years, the population of Soso decreased by nearly 10%. In March 2011 before the disaster, five hospitals and two clinics for psychiatric patients, along with 712 inpatients, were operating in the district of Soso. However, as of March 2015, there were only one hospital and three clinics, along with approximately 50 inpatients, although a new mental health clinic in Soma City was opened in 2012 for supporting victims suffering from the disaster. We hereby suggest that the patients and residents of northeast Fukushima may be undergoing mental health crisis. In fact, disaster-related psychological stress could have induced several physical and mental disorders. The mid- and long-term supports are urgently needed not only for psychiatric patients but also for all residents in the district of Soso.

  15. Mental Health Crisis in Northeast Fukushima after the 2011 Earthquake, Tsunami and Nuclear Disaster.

    PubMed

    Fukunaga, Hisanori; Kumakawa, Hiromi

    2015-01-01

    The great earthquake of 11 March 2011 and resulting tsunami caused serious damage to various areas of the Pacific coast in northeast Fukushima, and all the residents faced fears of meltdown of the reactors at the Fukushima Daiichi Nuclear Power Plant. One of the most seriously affected areas was the district of Soso, located in the northeast part of Fukushima prefecture, with 12 municipalities (Soma City, Minamisoma City, Shinchi Town, Namie Town, Futaba Town, Ōkuma Town, Tomioka Town, Naraha Town, Hirono Town, Iitate Village, Katsurao Village and Kawauchi Village). The district of Soso is home to approximately 200,000 residents, many of whom were seriously affected by the threefold disaster. During the subsequent four years, the population of Soso decreased by nearly 10%. In March 2011 before the disaster, five hospitals and two clinics for psychiatric patients, along with 712 inpatients, were operating in the district of Soso. However, as of March 2015, there were only one hospital and three clinics, along with approximately 50 inpatients, although a new mental health clinic in Soma City was opened in 2012 for supporting victims suffering from the disaster. We hereby suggest that the patients and residents of northeast Fukushima may be undergoing mental health crisis. In fact, disaster-related psychological stress could have induced several physical and mental disorders. The mid- and long-term supports are urgently needed not only for psychiatric patients but also for all residents in the district of Soso. PMID:26329988

  16. Crisis intervention models in the French-speaking countries.

    PubMed

    De Clercq, M; Dubois, V

    2001-01-01

    The article presents the crisis intervention model devised by Andreoli (Geneva) which is currently being developed in most crisis units and emergency services in the French-speaking countries of Europe. Two clinical examples are presented: the Short Therapy Centre (Geneva, Switzerland) and the crisis unit of the Saint-Luc Clinic (Brussels, Belgium). The following aspects of these approaches are discussed: (a) the need for crisis intervention rather than a simple answer to emergency, (b) the need for crisis intervention in all acute psychiatric disorders and not only in psychosocial problems, (c) the need to integrate psychiatric hospitalization into a coherent mental health policy, (d) the need for well-trained and round-the-clock teams, (e) the need for continuity of care.

  17. Hypertensive crisis in children.

    PubMed

    Chandar, Jayanthi; Zilleruelo, Gastón

    2012-05-01

    Hypertensive crisis is rare in children and is usually secondary to an underlying disease. There is strong evidence that the renin-angiotensin system plays an important role in the genesis of hypertensive crisis. An important principle in the management of children with hypertensive crisis is to determine if severe hypertension is chronic, acute, or acute-on-chronic. When it is associated with signs of end-organ damage such as encephalopathy, congestive cardiac failure or renal failure, there is an emergent need to lower blood pressures to 25-30% of the original value and then accomplish a gradual reduction in blood pressure. Precipitous drops in blood pressure can result in impairment of perfusion of vital organs. Medications commonly used to treat hypertensive crisis in children are nicardipine, labetalol and sodium nitroprusside. In this review, we discuss the pathophysiology, differential diagnosis and recent developments in management of hypertensive crisis in children.

  18. The global financial crisis has led to a slowdown in growth of funding to improve health in many developing countries.

    PubMed

    Leach-Kemon, Katherine; Chou, David P; Schneider, Matthew T; Tardif, Annette; Dieleman, Joseph L; Brooks, Benjamin P C; Hanlon, Michael; Murray, Christopher J L

    2012-01-01

    How has funding to developing countries for health improvement changed in the wake of the global financial crisis? The question is vital for policy making, planning, and advocacy purposes in donor and recipient countries alike. We measured the total amount of financial and in-kind assistance that flowed from both public and private channels to improve health in developing countries during the period 1990-2011. The data for the years 1990-2009 reflect disbursements, while the numbers for 2010 and 2011 are preliminary estimates. Development assistance for health continued to grow in 2011, but the rate of growth was low. We estimate that assistance for health grew by 4 percent each year from 2009 to 2011, reaching a total of $27.73 billion. This growth was largely driven by the World Bank's International Bank for Reconstruction and Development and appeared to be a deliberate strategy in response to the global economic crisis. Assistance for health from bilateral agencies grew by only 4 percent, or $444.08 million, largely because the United States slowed its development assistance for health. Health funding through UN agencies stagnated, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria announced that it would make no new grants for the next two years because of declines in funding. Given the international community's focus on meeting the Millennium Development Goals by 2015 and persistent economic hardship in donor countries, continued measurement of development assistance for health is essential for policy making.

  19. Statutory caps: an involuntary contribution to the medical malpractice insurance crisis or a reasonable mechanism for obtaining affordable health care?

    PubMed

    Chupkovich, P J

    1993-01-01

    extremely important in light of proposed health care legislation entitled the Health Care Liability Reform and Quality of Care Improvement Act of 1992 [the "Health Care Bill"]. This Comment critically examines the constitutionality of statutory caps on damages in medical malpractice actions. It focuses on the public policy behind the caps and the constitutional issues embodied in limiting an individual's recovery. It also analyzes the impact of the Health Care Bill on statutory caps. Part I outlines the medical malpractice insurance crisis, describes the statutory reforms and discusses the public policy behind tort reform. Part II examines the constitutionality of statutory caps and summarizes the arguments of the proponents and the opponents of these caps. Part III discusses the Health Care Bill and its impact on medical malpractice legislation with respect to statutory caps. This Comment concludes that a compromise must be reached that addresses both the growing health care insurance crisis and the protection of individual rights. The Health Care Liability Reform and Quality of Care Improvement Act of 1992 attempts to achieve this compromise.

  20. The coming health crisis: indirect health effects of global climate change

    PubMed Central

    Bernstein, Aaron

    2011-01-01

    Global climate change threatens the health of hundreds of millions of people. While much has been written about the direct impacts of climate change on health as a result of more severe storms, more intense heat stress, changes in the distribution of infectious disease, and reduced air quality, we are concerned that the indirect impacts of a disrupted climate system may be orders of magnitude more important in terms of the human suffering they cause. Because these indirect effects will result from changes in biophysical systems, which are inherently complex, there is significant uncertainty about their magnitude, timing, and location. However, the uncertainty that shrouds this issue should not be cause for complacency; rather it should serve as an organizing principle for adaptation to its ill effects. PMID:21399764

  1. The coming health crisis: indirect health effects of global climate change.

    PubMed

    Myers, Samuel S; Bernstein, Aaron

    2011-02-01

    Global climate change threatens the health of hundreds of millions of people. While much has been written about the direct impacts of climate change on health as a result of more severe storms, more intense heat stress, changes in the distribution of infectious disease, and reduced air quality, we are concerned that the indirect impacts of a disrupted climate system may be orders of magnitude more important in terms of the human suffering they cause. Because these indirect effects will result from changes in biophysical systems, which are inherently complex, there is significant uncertainty about their magnitude, timing, and location. However, the uncertainty that shrouds this issue should not be cause for complacency; rather it should serve as an organizing principle for adaptation to its ill effects.

  2. A Crisis Intervention Approach Stressing Early Interpretation of Unconscious Guilt.

    ERIC Educational Resources Information Center

    Nichols, Nicholas H.

    This paper presents an approach to crisis intervention which was developed for use with acutely disturbed patients requesting therapeutic services at the Marin County Community Mental Health Center in California. Assumptions of the intervention approach which center on the crucial role played by unconscious guilt in both psychopathology and…

  3. The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution

    PubMed Central

    2011-01-01

    Background Bangladesh is identified as one of the countries with severe health worker shortages. However, there is a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors in Bangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs of the population. This paper attempts to fill in this knowledge gap by using data from a nationally representative sample survey conducted in 2007. Methods The study population in this survey comprised all types of currently active health care providers (HCPs) in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with a comparable average population of approximately 25 000) which were proportionally allocated based on a 'Probability Proportion to Size' sampling technique for the six divisions and distribution areas. A simple free listing was done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking with community was done for confirmation and to avoid duplication. This exercise yielded the required list of different HCPs by union/ward. Results HCP density was measured per 10 000 population. There were approximately five physicians and two nurses per 10 000, the ratio of nurse to physician being only 0.4. Substantial variation among different divisions was found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualified village doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across the country. Also, there were twice as many community health workers (CHWs) from the non-governmental sector than the government sector and an overwhelming number of traditional birth attendants. The village doctors (predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, while the paraprofessionals were concentrated in the urban areas. Other data

  4. Worrying About Terrorism and Other Acute Environmental Health Hazard Events

    PubMed Central

    Babcock-Dunning, Lauren

    2012-01-01

    Objectives. To better understand why some people worry more about terrorism compared with others, we measured how much US residents worried about a terrorist event in their area and examined the association of their fears with their concerns about acute and chronic hazards and other correlates. Methods. In 2008 (n = 600) and 2010 (n = 651), we performed a random-digit dialing national landline telephone survey. We asked about worries about terrorism and 5 other environmental health hazard issues. We also collected demographic and socioeconomic data. Results. Only 15% worried “a great deal” about a terrorist event in their area and 18% to 33% were greatly concerned about other environmental issues. Fear about acute hazard events was a stronger predictor of a great deal of concern about terrorism than were age, race/ethnicity, gender, educational achievement, and other correlates. Conclusions. Those who worried most about acute environmental health hazard events were most likely to worry about terrorism. Also, those who were older, poorer, Blacks, or Latinos, or who lived in populous urban areas felt they were most vulnerable to terrorist attacks. We recommend methods to involve US citizens as part of disaster planning. PMID:22397346

  5. Toxicological dose assessment and acute health effect criteria

    SciTech Connect

    Stalker, A.C.; White, B.

    1992-01-01

    The use of hazardous materials requires the means of assessing doses from postulated accidental exposures to the hazardous materials. Hazardous materials include radiological and toxicological substances. Health effects are often divided into either acute (short term exposure) or chronic (long-term-exposure)-categories. Dose assessments and health effects are used in Hazard Classification, Safety Analysis Reports and Unreviewed Safety Question Determinations. The use of hazardous substances requires a means of assessing the potential health effects from exposure. Two types of toxicological data exist. The first is measured effects from human exposure, either accidentally or studies. The second consists of data from toxicity and lethality studies on mammals, often mice or rats. Because the data for human exposure is severely limited, an approach is needed that uses basic toxicity and lethality data from animal studies to estimate acute health effects in humans. The approach chosen is the one suggested jointly by the EPA, FEMA, and DOT in their Technical Guidance for Hazards Analysis'', December 1987.

  6. Toxicological dose assessment and acute health effect criteria

    SciTech Connect

    Stalker, A.C.; White, B.

    1992-09-01

    The use of hazardous materials requires the means of assessing doses from postulated accidental exposures to the hazardous materials. Hazardous materials include radiological and toxicological substances. Health effects are often divided into either acute (short term exposure) or chronic (long-term-exposure)-categories. Dose assessments and health effects are used in Hazard Classification, Safety Analysis Reports and Unreviewed Safety Question Determinations. The use of hazardous substances requires a means of assessing the potential health effects from exposure. Two types of toxicological data exist. The first is measured effects from human exposure, either accidentally or studies. The second consists of data from toxicity and lethality studies on mammals, often mice or rats. Because the data for human exposure is severely limited, an approach is needed that uses basic toxicity and lethality data from animal studies to estimate acute health effects in humans. The approach chosen is the one suggested jointly by the EPA, FEMA, and DOT in their ``Technical Guidance for Hazards Analysis``, December 1987.

  7. Assessing the impact of the monetary crisis and natural disasters on women's health and nutrition in Indonesia.

    PubMed

    Iskandar, M

    1998-05-01

    This article assesses the impact of the monetary crisis and natural disasters on women's health and nutrition in Indonesia as described by Dr. Meiwita Iskandar. Since there is a deficit in funding, the author claims, it is likely that hospitals will refuse operations. This will increase the risk of maternal death due to the inaccessibility of obstetric care facilities. As the cost of medicinesincluding oral contraceptiveshas doubled, more women are expected to patronize traditional healers and medicines, as these will be cheaper. Furthermore, an increase in food prices will severely affect the health and nutrition of low-income women and girls. As a result of the crisis, young women will be married off and even forced into prostitution in order to earn money for the family. Thus, the author urges the Ministry of Health and other government ministries to take action in planning interventions in anticipation of these health impacts. There is a need for them to create public health programs, health care services, subsidies for food and medicines, and job creation strategies. The rights of women workers need to be better protected by the law, and the private sector must be encouraged to help provide affordable food and basic health services.

  8. Confronting the Growing Crisis of Cardiovascular Disease and Heart Health Among Aboriginal Peoples in Canada.

    PubMed

    Reading, Jeffrey

    2015-09-01

    Although the prevalence of cardiovascular disease (CVD) has been decreasing worldwide, Aboriginal populations of Canada (including First Nations, Métis, and Inuit Peoples) continue to experience a rapidly growing burden of CVD morbidity and mortality. This article provides a succinct summary of the current crisis of CVD among Canadian Aboriginal peoples, including how and why it originated, elucidates the underlying population health risks driving higher rates of aboriginal CVD, and articulates the urgent need for community-engagement solutions and innovations in the areas of prevention, treatment and care, rehabilitation services, aboriginal-specific CVD surveillance, and advanced knowledge. In the past, particularly in rural and remote communities, Aboriginal Peoples' survival depended (and often still does) on hunting, fishing, and other forms of traditional food-gathering. However, the traditional life is being changed for many Aboriginal communities, resulting in significantly impaired dietary options and the undermining of a long-established way of life that was healthy and physically active. Reclaiming CVD health and well-being requires replacement of the calorie-dense and nutritionally inadequate diets of highly processed store-bought foods with fresh and nutritionally balanced diets and addressing the physically inactive lifestyles that together have contributed to an increase in CVD prevalence. Furthermore, disparities exist for hospital-based treatment experiences for patients from areas with high proportions of Aboriginal Peoples vs those with low proportions of Aboriginal Peoples. It is crucial to investigate and develop concrete plans to reduce the burden of CVDs among Aboriginal Peoples by improved prevention and treatment in a community-centred way.

  9. Impact of the economic crisis on the health of older persons in Spain: research clues based on an analysis of mortality. SESPAS report 2014.

    PubMed

    Benmarhnia, Tarik; Zunzunegui, Maria-Victoria; Llácer, Alicia; Béland, Francois

    2014-06-01

    Older adults are seldom considered in studies on the health impact of economic recessions or crises. However, they constitute a population group that is highly vulnerable to decreases in investment in health and social services and social security. Our aim is to examine the relationship between the economic crisis starting in 2008 and the health status of older adults in Spain. More specifically, we analyze changes in trends of mortality in relation to the crisis, the specific impact of winter on mortality and gender differences in the crisis' impact on mortality. Using data from the National Institute of Statistics of Spain on people over 60 years of age, the number of monthly deaths by age and sex from January 2005 to December 2012 was analyzed. Interrupted time series analyses and the "difference in differences" method were used. During the crisis, for adults 60 years and older: 1) the observed mortality seems to be decreasing at a slower rate than what would have been expected in the absence of the crisis; 2) there has been an increase in winter mortality; 3) the impact of the crisis has been greater for female than for male mortality. These results suggest sizable effects of the economic crisis on the mortality of older adults and argue for research done using more detailed analyses integrating economic indicators.

  10. Acute adrenal crisis

    MedlinePlus

    ... condition that occurs when there is not enough cortisol. This is a hormone produced by the adrenal ... parts. The outer portion, called the cortex, produces cortisol. This is an important hormone for controlling blood ...

  11. Crisis, What Crisis?

    ERIC Educational Resources Information Center

    Jones, Ken

    2010-01-01

    Responding to the recent work of Andrew Gamble, the article discusses the extent to which the British situation can be described in terms of crisis. It suggests that an essential element of crisis is that of political and social contestation, and explores the terms on which contestation is taking shape in and around British education.

  12. Provision of healthcare in the context of financial crisis: approaches to the Greek health system and international implications.

    PubMed

    Milionis, Charalampos

    2013-01-01

    Both healthcare professionals and the healthcare system must defend each patient's health individually while simultaneously seeking to protect the population's health in general. Nowadays, there is an important increase in the cost of healthcare supply, mainly due to the developments of medical science, the public's expectations and the demographic ageing. Since healthcare resources are not unlimited, it is obvious that immoderate consumption of them by certain patients limits the use of the same funds by others. Therefore, we have to seek an optimal distribution of the existing resources in order to manage a constriction of expenses, especially under the circumstances of the modern economic crisis. The criteria of effectiveness and efficiency should be used. Health policies focus on both the public's behaviour and the rules of medical practice. Under the modern challenges the physician's role is particularly important for the protection of the patient's health and the promotion of public health.

  13. Addressing the human resource for health crisis in Tanzania: the lost in transition syndrome.

    PubMed

    Sirili, Nathanael; Kiwara, Angwara; Nyongole, Obadia; Frumence, Gasto; Semakafu, Avemaria; Hurtig, Anna-Karin

    2014-04-01

    Tanzania is experiencing a serious Human Resource for Health (HRH) crisis. Shortages are 87.5% and 67% in private and public hospitals, respectively. Mal-distribution and brain drain compound the shortage. The objective of this study was to improve knowledge on the HRH status in Tanzania by analyzing what happens to the number of medical doctors (MD) and doctor of dental surgery (DDS) degree graduates during the transition period from graduation, internship to appointment. We analyzed secondary data to get the number of MDs and DDS; who graduated from 2001 to 2010, the number registered for internship from 2005 to 2010 and the number allowed for recruitment by government permits from 2006 to 2010. Self administered questionnaires were provided to 91 MDs and DDS who were pursuing postgraduate studies at Muhimbili University of Health and Allied Sciences during this study who went through the graduation-internship-appointment (GIA) period to get the insight of the challenges surrounding the MDs and DDS during the GIA period. From 2001 to 2010 a total of 2,248 medical doctors and 198 dental surgeons graduated from five local training institutions and abroad. From 2005 to 2010 a total of 1691 (97.13%) and 186 (126.53%) of all graduates in MD and DDS, respectively, registered for internship. The 2007/2008 recruitment permit allowed only 37.7% (80/218) and 25.0% (7/27) of the MDs and DDS graduated in 2006, respectively. The 2009/20 10 recruitment permit allowed 265 MDs (85.48%) out of 310 graduates of 2008. In 2010/2011 permission for MDs was 57.58% (190/ 330) of graduates of 2009 and in 2011/2012 permission for MDs was for 61.03% ((249/408) graduates of 2010. From this analysis the recruitment permits in 2007/2008, 2009/2010, 2010/2011 1nd 2011/2012 could not offer permission for employment of 482 (38.10%) of all MDs graduated in the subsequent years. Major challenges associated with the GIA period included place of accommodation, allowance (for internship) or salary

  14. An examination of contemporary financing practices and the global financial crisis on nonprofit multi-hospital health systems.

    PubMed

    Stewart, Louis J; Smith, Pamela C

    2011-01-01

    This study examines the impact of the 2008 global financial crisis on large US nonprofit health systems. We proceed from an analysis of the contemporary capital financing practices of 25 of the nation's largest nonprofit hospitals and health systems. We find that these institutions relied on operating cash flows, public issues of insured variable rate debt, and accumulated investment to meet their capital financing needs. The combined use of these three financial instruments provided these organizations with $22.4 billion of long-term capital at favorable terms and the lowest interest rates. Our analysis further indicates that the extensive utilization of bond insurance, auction rate debt, and interest rate derivatives created significant risk exposures for these health systems. These risks were realized by the broader global financial crisis of 2008. Findings indicate these health systems incurred large losses from the early retirement of their variable rate debt. In addition, many organizations were forced to post nearly $1 billion of liquid collateral due to the falling values of their interest rate derivatives. Finally, the investment portfolios of these large nonprofit health systems suffered millions of dollars of unrealized capital losses, which may minimize their ability to finance future capital investment requirements.

  15. An examination of contemporary financing practices and the global financial crisis on nonprofit multi-hospital health systems.

    PubMed

    Stewart, Louis J; Smith, Pamela C

    2011-01-01

    This study examines the impact of the 2008 global financial crisis on large US nonprofit health systems. We proceed from an analysis of the contemporary capital financing practices of 25 of the nation's largest nonprofit hospitals and health systems. We find that these institutions relied on operating cash flows, public issues of insured variable rate debt, and accumulated investment to meet their capital financing needs. The combined use of these three financial instruments provided these organizations with $22.4 billion of long-term capital at favorable terms and the lowest interest rates. Our analysis further indicates that the extensive utilization of bond insurance, auction rate debt, and interest rate derivatives created significant risk exposures for these health systems. These risks were realized by the broader global financial crisis of 2008. Findings indicate these health systems incurred large losses from the early retirement of their variable rate debt. In addition, many organizations were forced to post nearly $1 billion of liquid collateral due to the falling values of their interest rate derivatives. Finally, the investment portfolios of these large nonprofit health systems suffered millions of dollars of unrealized capital losses, which may minimize their ability to finance future capital investment requirements. PMID:21528830

  16. Cancer screening and health system resilience: keys to protecting and bolstering preventive services during a financial crisis.

    PubMed

    Martin-Moreno, Jose M; Anttila, Ahti; von Karsa, Lawrence; Alfonso-Sanchez, Jose L; Gorgojo, Lydia

    2012-09-01

    The aim of this paper is to elucidate the rationale for sustaining and expanding cost-effective, population-based screening services for breast, cervical and colorectal cancers in the context of the current financial crisis. Our objective is not only to promote optimal delivery of high-quality secondary cancer prevention services, but also to underline the importance of strengthening comprehensive cancer control, and with it, health system response to the complex care challenges posed by all chronic diseases. We focus primarily on issues surrounding planning, organisation, implementation and resources, arguing that given the growing cancer burden, policymakers have ample justification for establishing and expanding population-based programmes that are well-organised, well-resourced and well-executed. In a broader economic context of rescue packages, deficits and cutbacks to government entitlements, health professionals must intensify their advocacy for the protection of vital preventive health services by fighting for quality services with clear benefits for population health outcomes.

  17. The health effects of the foreclosure crisis and unaffordable housing: A systematic review and explanation of evidence.

    PubMed

    Downing, Janelle

    2016-08-01

    The foreclosure crisis was detrimental to the financial well-being of many households, yet the non-economic consequences are still poorly understood. This systematic review aims to understand the direct and spillover effect of foreclosures on several health-related outcomes by synthesizing evidence from 40 studies. First, this study identifies research gaps using a schema to organize studies by line of inquiry, health-related outcome, and measure of homeowner financial distress. In order to provide context for the findings, four pathways - stress, effect-budgeting, frustration-aggression, and trust - evoked in the literature are described to explain the relationship between foreclosures and health. The research suggests that experiencing a foreclosure and living near foreclosures are associated with poor psychological and behavioral morbidities, namely anxiety and violent behavior, and declining health utilization. Evidence is sparse on suicide, substance abuse, somatic morbidities, and mortality. Future research is needed to fill the gaps and explicitly test the mechanisms proposed. PMID:27343818

  18. Health care time of crisis, crises in health care--current reality in B&H Health Care System.

    PubMed

    Salihovic, H; Kulenovic, F; Tanovic-Mikulec, E

    2001-01-01

    In the period from 1945 till 1992 the health protection had constant growth of coverage, availability and quality of protection in the promotion of health care of the inhabitants, and the health care activity noticed spreading of the network of health care institutions, evidently staff improving of all profiles of health care workers, and supplying of equipment so said in the accordance with the movements in for developed countries. The detaching for health care in 1990 amounted 6.9 per cent of that time BDP. The period from 1991 till 1955 is difficulty to analyze, because of the disturbances which appear in all sphere of life and work, and the period from 1996 till 1999 can be analyzed, from the already known reasons, only for the area of the Federation. The correct amount of the means of payment spent for health care in the postwar period is impossible incorrectly to confirm, except detaching from BDP (1999 3.7 per cent) arrived the donations in equipment, drugs, sanitary material, training of staff, free of charge experts, means for the reconstruction of objects, to this in the future cannot be considered. Besides that the rate of detaching for the health care from BDP is less than before the war, BDP by it self is far lesser what means that the means of payment detached are far lesser. It is necessary the URGENT reform of health care financing system, evaluation strategy of the reform of health care which up-to-now did not show shifts, the bringing of instruments of planning in the health care, instruments of quality control, the legislator must define clearly the relations between the private practice, patients and state funds.

  19. The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain.

    PubMed

    Giovanella, Lígia; Stegmüller, Klaus

    2014-11-01

    The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date), and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms' impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems. PMID:25493982

  20. Crisis Reliability Indicators Supporting Emergency Services (CRISES): A Framework for Developing Performance Measures for Behavioral Health Crisis and Psychiatric Emergency Programs.

    PubMed

    Balfour, Margaret E; Tanner, Kathleen; Jurica, Paul J; Rhoads, Richard; Carson, Chris A

    2016-01-01

    Crisis and emergency psychiatric services are an integral part of the healthcare system, yet there are no standardized measures for programs providing these services. We developed the Crisis Reliability Indicators Supporting Emergency Services (CRISES) framework to create measures that inform internal performance improvement initiatives and allow comparison across programs. The framework consists of two components-the CRISES domains (timely, safe, accessible, least-restrictive, effective, consumer/family centered, and partnership) and the measures supporting each domain. The CRISES framework provides a foundation for development of standardized measures for the crisis field. This will become increasingly important as pay-for-performance initiatives expand with healthcare reform.

  1. Effectiveness on Mental Health of Psychological Debriefing for Crisis Intervention in Schools

    ERIC Educational Resources Information Center

    Wei, Yifeng; Szumilas, Magdalena; Kutcher, Stan

    2010-01-01

    The purpose of this paper is to provide a summary of evidence for the effectiveness and safety of commonly used crisis interventions in schools, such as critical incident stress debriefing (CISD), critical incident stress management (CISM), and psychological debriefing (PD). Two researchers independently searched relevant databases for reviews and…

  2. Effects of the 2008 Global Economic Crisis on National Health Indicators: Results from the Korean National Health and Nutrition Examination Survey

    PubMed Central

    Shin, Jung-Hyun; Lee, Gyeongsil; Kim, Jun-Suk; Oh, Hyung-Seok; Lee, Keun-Seung; Hur, Yong

    2015-01-01

    Background The relationship between economics and health has been of great interest throughout the years. The accumulated data is not sufficient enough to carry out long-term studies from the viewpoint of morbidity, although Korea National Health and Nutrition Examination Survey (KNHANES) was carried out yearly since 1998 in Korea. Thus, we investigated the effect of the 2008 global economic crisis on health indicators of Korea. Methods Health indicators were selected by paired t-test based on 2007 and 2009 KNHANES data. Age, gender, body mass index (BMI), smoking, drinking, exercise, education, income, working status, and stress were used as confounding factors, which were analyzed with logistic and probit analyses. Validation was done by comparing gross domestic product (GDP) growth rates and probit analyses results of 2007-2012 KNHANES data. Results Among several health indicators, the prevalence of hypertension and stress perception was higher after the economic crisis. Factors related with higher hypertension prevalence include older age, male gender, higher BMI, no current tobacco use, recent drinking, lower education levels, and stress perception. Factors related with more stress perception were younger age, female gender, current smoking, lower education levels, and lower income. GDP growth rates, a macroeconomic indicator, are inversely associated with hypertension prevalence with a one-year lag, and also inversely associated with stress perception without time lag. Conclusion The economic crisis increased the prevalence of hypertension and stress perception. In the case of GDP growth rate change, hypertension was an inversely lagging indicator and stress perception was an inversely-related coincident indicator. PMID:26217479

  3. The effects of the financial crisis and austerity measures on the Spanish health care system: a qualitative analysis of health professionals' perceptions in the region of Valencia.

    PubMed

    Cervero-Liceras, Francisco; McKee, Martin; Legido-Quigley, Helena

    2015-01-01

    The recent financial crisis has seen severe austerity measures imposed on the Spanish health care system. However, the impacts are not yet well documented. We describe the findings from a qualitative study that explored health care professionals' perception of the effects of austerity measures in the Spanish Autonomous Community of Valencia. A total of 21 semi-structured interviews were conducted with health professionals, recorded and fully transcribed. We coded all interviews using an inductive approach, drawing on techniques used in the constant comparative method. Health professionals reported increases in mental health conditions and malnutrition linked to a loss of income from employment and cuts to social support services. Health care professionals perceived that the quality of health care had become worse and health outcomes had deteriorated as a result of austerity measures. Interviewees also suggested that increased copayments meant that a growing number of patients could not afford necessary medication. While a few supported reforms and policies, such as the increase in copayments for pharmaceuticals, most opposed the privatization of health care facilities, and the newly introduced Royal Decree-law 16/2012, particularly the exclusion of non-residents from the health care system. The prevailing perception is that austerity measures are having negative effects on the quality of the health care system and population health. In light of this evidence there is an urgent need to evaluate the austerity measures recently introduced and to consider alternatives such as the derogation of the Royal Decree-law 16/2012.

  4. The "early life" origins of obesity-related health disorders: new discoveries regarding the intergenerational transmission of developmentally programmed traits in the global cardiometabolic health crisis.

    PubMed

    Benyshek, Daniel C

    2013-12-01

    Popular media reports concerning the causes of the current global obesity pandemic and its related sequelae-the cardiometabolic syndrome-are often couched in terms of dramatic changes in diet and lifestyle around the world; namely, drastically increasing dietary intakes of high energy foods and plummeting levels of daily physical activity-the hallmarks of the so called "nutrition transition." Far less attention is generally drawn to the important role phenotypic plasticity during early life (i.e., "developmental programming") plays in the cardiometabolic health crisis. Recently, however, researchers working within the field of the developmental origins of health and disease (DOHaD) and epigenetics have extended our understanding of the role played by these developmental processes and capacities in health and disease even further by investigating the transmissible nature of developmentally programmed cardiometabolic traits to subsequent generations. In this review, after briefly revisiting the fundamental discoveries of first-generation DOHaD research, I consider how recent discoveries regarding the transmissibility of developmentally acquired traits are providing new insights into the current global cardiometabolic pandemic, and how a better understanding of developmental programming-including transmissibility-are essential for the conceptualization and implementation of public health initiatives aimed at stemming this global health crisis.

  5. Profile of acute poisoning in three health districts of Botswana

    PubMed Central

    Kasule, Mary

    2009-01-01

    ABSTRACT Background This study sought to characterise acute poisoning cases seen in three health districts of Botswana. Method A retrospective review of patients’ records was conducted and included patients treated from January 2004 to December 2005. Data on the demographic status of the patients, information about the poisonous agent(s) involved, and the circumstances and outcomes of the poisoning incidents were recorded on a pre-tested data collection form. Results A total of 590 cases of acute poisoning were included in the analysis. The most affected age category was that of children aged less than six years, who constituted 33.4% of the cases. Most incidents were recorded in the urban district of Gaborone. Seventy-eight percent (78%) of the incidents were accidental, with the remainder being intentional. The poisonous agents involved were pharmaceuticals (26.6%), natural toxins (25.6%), household products (14.6%), foods (14.4%), alcohol (6.9%), traditional medicines (4.7%), unspecified agents (3.2%), and agrochemicals (2.7%). The most common route of poison exposure was by oral (82.2%), followed by dermal contact (16.5%), while the inhalation of gases occurred in 1.2% of cases. An incidence rate of 4.7/1000, a case fatality rate of 3.8/100, and 1.5% of deaths were recorded over the two-year period. Conclusion In conclusion, it can be stated that acute poisoning involved mainly young children and resulted in an incidence rate of 4.7/1000, a case fatality rate of 3.8/100, and 1.5% of deaths over the two-year period. There were differences based on age category, gender and residence of the victims, the types of toxic agents involved, as well as the circumstances and the outcomes of the poisoning incidents. Given the fact that pharmaceuticals, natural toxins, household products and foods were the agents most commonly involved, targeted interventions should take these differences into account in addressing the problem of acute poisoning.

  6. The H1N1 crisis: a case study of the integration of mental and behavioral health in public health crises.

    PubMed

    Pfefferbaum, Betty; Schonfeld, David; Flynn, Brian W; Norwood, Ann E; Dodgen, Daniel; Kaul, Rachel E; Donato, Darrin; Stone, Brook; Brown, Lisa M; Reissman, Dori B; Jacobs, Gerard A; Hobfoll, Stevan E; Jones, Russell T; Herrmann, Jack; Ursano, Robert J; Ruzek, Josef I

    2012-03-01

    In substantial numbers of affected populations, disasters adversely affect well-being and influence the development of emotional problems and dysfunctional behaviors. Nowhere is the integration of mental and behavioral health into broader public health and medical preparedness and response activities more crucial than in disasters such as the 2009-2010 H1N1 influenza pandemic. The National Biodefense Science Board, recognizing that the mental and behavioral health responses to H1N1 were vital to preserving safety and health for the country, requested that the Disaster Mental Health Subcommittee recommend actions for public health officials to prevent and mitigate adverse behavioral health outcomes during the H1N1 pandemic. The subcommittee's recommendations emphasized vulnerable populations and concentrated on interventions, education and training, and communication and messaging. The subcommittee's H1N1 activities and recommendations provide an approach and template for identifying and addressing future efforts related to newly emerging public health and medical emergencies. The many emotional and behavioral health implications of the crisis and the importance of psychological factors in determining the behavior of members of the public argue for a programmatic integration of behavioral health and science expertise in a comprehensive public health response.

  7. The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science.

    PubMed

    Flaherty, Dennis K

    2011-10-01

    In 1998, Dr. Andrew Wakefield, a British gastroenterologist, described a new autism phenotype called the regressive autism-enterocolitis syndrome triggered by environmental factors such as measles, mumps, and rubella (MMR) vaccination. The speculative vaccination-autism connection decreased parental confidence in public health vaccination programs and created a public health crisis in England and questions about vaccine safety in North America. After 10 years of controversy and investigation, Dr. Wakefield was found guilty of ethical, medical, and scientific misconduct in the publication of the autism paper. Additional studies showed that the data presented were fraudulent. The alleged autism-vaccine connection is, perhaps, the most damaging medical hoax of the last 100 years. PMID:21917556

  8. The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science.

    PubMed

    Flaherty, Dennis K

    2011-10-01

    In 1998, Dr. Andrew Wakefield, a British gastroenterologist, described a new autism phenotype called the regressive autism-enterocolitis syndrome triggered by environmental factors such as measles, mumps, and rubella (MMR) vaccination. The speculative vaccination-autism connection decreased parental confidence in public health vaccination programs and created a public health crisis in England and questions about vaccine safety in North America. After 10 years of controversy and investigation, Dr. Wakefield was found guilty of ethical, medical, and scientific misconduct in the publication of the autism paper. Additional studies showed that the data presented were fraudulent. The alleged autism-vaccine connection is, perhaps, the most damaging medical hoax of the last 100 years.

  9. Veterans Crisis Line

    MedlinePlus

    ... also access and download the Veterans Crisis Line Branding Guidelines for guidance on how to consistently apply ... Program ADMINISTRATION Veterans Health Administration Veterans Benefits Administration National Cemetery Administration U.S. Department of Veterans Affairs | 810 ...

  10. Acute health effects of accidental chlorine gas exposure

    PubMed Central

    2014-01-01

    Objectives This study was conducted to report the course of an accidental release of chlorine gas that occurred in a factory in Gumi-si, South Korea, on March 5, 2013. We describe the analysis results of 2 patients hospitalized because of chlorine-induced acute health problems, as well as the clinical features of 209 non-hospitalized patients. Methods We analyzed the medical records of the 2 hospitalized patients admitted to the hospital, as well as the medical records and self-report questionnaires of 209 non-hospitalized patients completed during outpatient treatment. Results Immediately after the exposure, the 2 hospitalized patients developed acute asthma-like symptoms such as cough and dyspnea, and showed restrictive and combined pattern ventilatory defects on the pulmonary function test. The case 1 showed asthma-like symptoms over six months and diurnal variability in peak expiratory flow rate was 56.7%. In case 2, his FEV1 after treatment (93%) increased by 25% compared to initial FEV1 (68%). Both cases were diagnosed as chlorine-induced reactive airways dysfunction syndrome (RADS) on the basis of these clinical features. The most frequent chief complaints of the 209 non-hospitalized patients were headache (22.7%), followed by eye irritation (18.2%), nausea (11.2%), and sore throat (10.8%), with asymptomatic patients accounting for 36.5%. The multiple-response analysis of individual symptom revealed headache (42.4%) to be the most frequent symptom, followed by eye irritation (30.5%), sore throat (30.0%), cough (29.6%), nausea (27.6%), and dizziness (27.3%). Conclusions The 2 patients hospitalized after exposure to chlorine gas at the leakage site showed a clinical course corresponding to RADS. All of the 209 non-hospitalized patients only complained of symptoms of the upper airways and mucous membrane irritation. PMID:25852940

  11. A pilot investigation in constructing crisis communications: what leads to best practice?

    PubMed

    Firestone, Rachel M; Everly, George S

    2013-01-01

    Crisis communications can play an important role in mitigating, or exacerbating, the psychological and behavioral reactions to critical incidents and disasters. Effective crisis communications can serve to mitigate anxiogenesis and direct rapid and focused rescue, recovery, and rehabilitative operations. Ambiguous and/or deceptive communications can serve to worsen mental health reactions and delay operational response and recovery (Everly, Strouse, & Everly, 2010). It seems, therefore, that inquiry into the content of acute crisis communications would be warranted Said more simply, given limited time, cryptic messaging in social media, and the "sound bite" mentality that seems to govern news dissemination, it is important to identify the most important content to convey in the wake of critical incidents and disasters. This paper reports on a pilot investigation into "best practices" for the construction of acute crisis communications.

  12. [Impact of the crisis on the relationship between housing and health. Policies for good practice to reduce inequalities in health related to housing conditions].

    PubMed

    Novoa, Ana M; Bosch, Jordi; Díaz, Fernando; Malmusi, Davide; Darnell, Mercè; Trilla, Carme

    2014-06-01

    Housing conditions can impact on physical and mental health through 4 interrelated dimensions: 1) the home (the emotional housing conditions), 2) the physical housing conditions, and 3) the physical environment, and 4) the social (community) environment of the neighborhood where the house is located. In Spain, the use of the construction market as an engine for economic growth and the promotion of private property as the main type of housing tenure has led to the use of housing as a speculative good instead of its being considered a first-necessity good. While Spain is the Organisation for Economic Co-operation and Development (OECD) country with the largest housing stock per inhabitant, this stock is highly underutilized, thus excluding the most deprived sector of the population from access to housing. The impact of the current economic crisis on housing has mainly been due to a reduction in household income, which has increased the number of families or persons struggling to cover their housing costs or being evicted. Evidence indicates that this type of problem has a negative impact on health, especially on mental health, but financial problems also make it difficult to meet other basic needs such as eating. There are several instruments to reduce the impact of the economic crisis, such as debt financing or deed of assignment in payment. In the long-term, the creation of a social housing stock should be promoted, as well as rental assistance mechanisms. PMID:24863993

  13. [Impact of the crisis on the relationship between housing and health. Policies for good practice to reduce inequalities in health related to housing conditions].

    PubMed

    Novoa, Ana M; Bosch, Jordi; Díaz, Fernando; Malmusi, Davide; Darnell, Mercè; Trilla, Carme

    2014-06-01

    Housing conditions can impact on physical and mental health through 4 interrelated dimensions: 1) the home (the emotional housing conditions), 2) the physical housing conditions, and 3) the physical environment, and 4) the social (community) environment of the neighborhood where the house is located. In Spain, the use of the construction market as an engine for economic growth and the promotion of private property as the main type of housing tenure has led to the use of housing as a speculative good instead of its being considered a first-necessity good. While Spain is the Organisation for Economic Co-operation and Development (OECD) country with the largest housing stock per inhabitant, this stock is highly underutilized, thus excluding the most deprived sector of the population from access to housing. The impact of the current economic crisis on housing has mainly been due to a reduction in household income, which has increased the number of families or persons struggling to cover their housing costs or being evicted. Evidence indicates that this type of problem has a negative impact on health, especially on mental health, but financial problems also make it difficult to meet other basic needs such as eating. There are several instruments to reduce the impact of the economic crisis, such as debt financing or deed of assignment in payment. In the long-term, the creation of a social housing stock should be promoted, as well as rental assistance mechanisms.

  14. Putting the "community" back into "mental health": the challenge of a great crisis in the health and well-being of children and families.

    PubMed

    Melton, Gary B

    2010-03-01

    For more than a generation, the levels of anxiety, depression, and misconduct among young people in the United States have been steadily increasing. So too have isolation, alienation, mistrust, and boredom, with the result that ongoing social support has been diminishing, particularly for young people. These trends constitute a national public health crisis affecting young people in general, those already defined as having mental health problems, and their families. To respond adequately, the child mental health system must change dramatically--away from the provision of units of service defined by protocols, time, and professionals' presence and toward the engagement of primary community institutions in the creation and maintenance of new norms of giving and receiving help. Initial evidence suggests that such a shift requires massive effort but that it is feasible and potentially effective.

  15. Acute acromioclavicular dislocation: a cheaper, easier and all-arthroscopic system. Is it effective in nowadays economical crisis?

    PubMed

    Sastre, Sergi; Dada, Michelle; Santos, Simon; Lozano, Lluis; Alemany, Xavier; Peidro, Lluis

    2015-03-01

    The objective of this manuscript is to show an effective, easier and cheaper way to reduce acute acromioclavicular (AC) dislocation type III and V (Rockwood classification). Numerous procedures have been described for surgical management of acromioclavicular joint disruption. Newest devices involve an arthroscopic technique that allows nonrigid anatomic fixation of the acromioclavicular joint. Arthroscopically assisted treatment of acute AC joint dislocation is advantageous because it provides good clinical results and few complications. It also allows reviewing glenohumeral associated lesions. This surgical technique requires no specific implants to achieve a correct AC reduction. Actually, economical advantages are very important factors to decide the use of determinate surgical techniques.

  16. Health utility indexes in patients with acute coronary syndromes

    PubMed Central

    Gencer, Baris; Rodondi, Nicolas; Auer, Reto; Nanchen, David; Räber, Lorenz; Klingenberg, Roland; Pletscher, Mark; Jüni, Peter; Windecker, Stephan; Matter, Christian M; Lüscher, Thomas F; Mach, François; Perneger, Thomas V; Girardin, François R

    2016-01-01

    Background Acute coronary syndromes (ACS) have been associated with lower health utilities (HUs) compared with the general population. Given the prognostic improvements after ACS with the implementation of coronary angiography (eg, percutaneous coronary intervention (PCI)), contemporary HU values derived from patient-reported outcomes are needed. Methods We analysed data of 1882 patients with ACS 1 year after coronary angiography in a Swiss prospective cohort. We used the EuroQol five-dimensional questionnaire (EQ-5D) and visual analogue scale (VAS) to derive HU indexes. We estimated the effects of clinical factors on HU using a linear regression model and compared the observed HU with the average values of individuals of the same sex and age in the general population. Results Mean EQ-5D HU 1-year after coronary angiography for ACS was 0.82 (±0.16) and mean VAS was 0.77 (±0.18); 40.9% of participants exhibited the highest utility values. Compared with population controls, the mean EQ-5D HU was similar (expected mean 0.82, p=0.58) in patients with ACS, but the mean VAS was slightly lower (expected mean 0.79, p<0.001). Patients with ACS who are younger than 60 years had lower HU than the general population (<0.001). In patients with ACS, significant differences were found according to the gender, education and employment status, diabetes, obesity, heart failure, recurrent ischaemic or incident bleeding event and participation in cardiac rehabilitation (p<0.01). Conclusions At 1 year, patients with ACS with coronary angiography had HU indexes similar to a control population. Subgroup analyses based on patients' characteristics and further disease-specific instruments could provide better sensitivity for detecting smaller variations in health-related quality of life. PMID:27252878

  17. Indonesian heath care and the economic crisis: is managed care the needed reform?

    PubMed

    Hotchkiss, D R; Jacobalis, S

    1999-03-01

    The ramifications of the current economic crisis are being felt throughout Asia, but problems are particularly acute in Indonesia; in the midst of high inflation and unemployment the government is considering expanding managed care reform. In this paper, we discuss the impact of the recent economic crisis on the health sector in Indonesia, and analyze the potential for implementing effective reform following the managed care model. The health sector is discussed, highlighting pre-existing problems in the health care supply environment. The determinants of the economic crisis are summarized, and the broad impacts of the crisis to date on the health sector are assessed. Next the prospects for success of current managed-care reform proposals are examined in some detail: viability of expanded managed care reform measures are assessed in light of the continuing crisis and its likely impacts on the consumers and suppliers of health care. Analysis of the potential impact of the continuing crisis focuses on key participants in health care reform: households, the government, and private health care providers. In conclusion the potential viability of managed care appears poor, given the current economic, political, and institutional conditions and likely future impacts, and suggest some alternative reform measures.

  18. Indonesian heath care and the economic crisis: is managed care the needed reform?

    PubMed

    Hotchkiss, D R; Jacobalis, S

    1999-03-01

    The ramifications of the current economic crisis are being felt throughout Asia, but problems are particularly acute in Indonesia; in the midst of high inflation and unemployment the government is considering expanding managed care reform. In this paper, we discuss the impact of the recent economic crisis on the health sector in Indonesia, and analyze the potential for implementing effective reform following the managed care model. The health sector is discussed, highlighting pre-existing problems in the health care supply environment. The determinants of the economic crisis are summarized, and the broad impacts of the crisis to date on the health sector are assessed. Next the prospects for success of current managed-care reform proposals are examined in some detail: viability of expanded managed care reform measures are assessed in light of the continuing crisis and its likely impacts on the consumers and suppliers of health care. Analysis of the potential impact of the continuing crisis focuses on key participants in health care reform: households, the government, and private health care providers. In conclusion the potential viability of managed care appears poor, given the current economic, political, and institutional conditions and likely future impacts, and suggest some alternative reform measures. PMID:10351668

  19. The U.S. health care system is in crisis: implications for academic medical centers and their missions.

    PubMed

    Lofgren, Richard; Karpf, Michael; Perman, Jay; Higdon, Courtney M

    2006-08-01

    The medical care system in the United States is in crisis. Health care costs are escalating and threatening coverage for millions of people. Concerns about the quality of care and patient safety are heightening; patients and payers now publicly share these concerns and want to make providers more accountable. Traditionally, the response to rising health care costs has been to modify reimbursement models and incentives. Currently there is a movement to shift the responsibility of cost containment to the patients. The authors express doubts about the overall effectiveness of this strategy and propose reengineering the health care system to improve quality and efficiency. Leaders of academic medical centers must understand the forces and dynamics of change, and the potential institutional response to improve the quality and efficiency of their delivery systems and to preserve their missions: clinical care, education, research, and community service. As they suggest the operational changes needed to respond to this evolving health care environment, the authors discuss the implications for the various missions. The graduates of training programs must be prepared to function within multidisciplinary teams and constantly seek ways to improve quality and efficiency to ensure that care is accessible, affordable, and safe. Academic medical centers need to expand their research agenda to develop more expertise in quality and process improvement research. Additionally, they must provide the leadership to foster the transition from an era of "managed care" to an era of "organized systems of care."

  20. Student Discipline Intervention Strategies: A Case Study of Two Institutions' Processes Utilized to Resolve Misconduct of Students Who Concomitantly Experience a Mental Health Crisis

    ERIC Educational Resources Information Center

    Dickstein, Gary G.

    2011-01-01

    This study contributes to the research regarding processes and procedures utilized by two institutions of higher education to respond to students who participate in inappropriate behavior and who are concomitantly experiencing a mental health crisis. A case study analysis of two institutions of higher education was used to examine this issue. The…

  1. The impact of the housing crisis on self-reported health in Europe: multilevel longitudinal modelling of 27 EU countries

    PubMed Central

    Reeves, Aaron; Loopstra, Rachel; McKee, Martin; Dorling, Danny; Stuckler, David

    2016-01-01

    Background: Many EU nations experienced a significant housing crisis during the Great Recession of 2008–10. We evaluated the consequences of housing payment problems for people’s self-reported overall health. Methods: We used longitudinal data from the EU Statistics on Income and Living Conditions survey covering 27 countries from 2008 to 2010 to follow a baseline sample of persons who did not have housing debt and who were employed (45 457 persons, 136 371 person–years). Multivariate linear regression and multilevel models were used to evaluate the impact of transitions into housing arrears on self-reported health, correcting for the presence of chronic illness, health limitations, and other potential socio-demographic confounders. Results: Persons who transitioned into housing arrears experienced a significant deterioration in self-reported overall health by − 0.03 U (95% CI − 0.01 to − 0.04), even after correcting for chronic illness, disposable income and employment status, and individual fixed effects. This association was independent and similar in magnitude to that for job loss (−0.02, 95% CI: −0.01 to − 0.04). We also found that the impact of housing arrears was significantly worse among renters, corresponding to a mean 0.11 unit additional drop in health as compared with owner-occupiers. These adverse associations were only evident in persons below the 75th percentile of disposable income. Discussion: Our analysis demonstrates that persons who suffer housing arrears experience increased risk of worsening self-reported health, especially among those who rent. Future research is needed to understand the role of alternative housing support systems and available strategies for preventing the health consequences of housing insecurity. PMID:27221606

  2. Hemolytic crisis

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/003270.htm Hemolytic crisis To use the sharing features on this page, please enable JavaScript. Hemolytic crisis occurs when large numbers of red blood cells ...

  3. The widening U.S. health care crisis three years after the passage of 'Obamacare'.

    PubMed

    Rao, Birju; Hellander, Ida

    2014-01-01

    This report presents information on the state of the U.S. health system in 2012 and early 2013, specifically the period prior to the implementation of the individual mandate and full rollout of the Affordable Care Act's online health exchanges. The authors include data on the uninsured and underinsured and their access to health care, on socioeconomic inequality in health care, the rising costs of the U.S. health system, and the role of corporate money in health care, with special reference to the pharmaceutical industry. They also provide updates on Medicare health maintenance organizations, Medicaid, and a prelude to the complete implementation of the Affordable Care Act. In addition, the authors include some results from public opinion polls on health systems and international system comparisons. The article concludes with an assessment of the rapid consolidation in the delivery of health care being driven by the Affordable Care Act.

  4. The widening U.S. health care crisis three years after the passage of 'Obamacare'.

    PubMed

    Rao, Birju; Hellander, Ida

    2014-01-01

    This report presents information on the state of the U.S. health system in 2012 and early 2013, specifically the period prior to the implementation of the individual mandate and full rollout of the Affordable Care Act's online health exchanges. The authors include data on the uninsured and underinsured and their access to health care, on socioeconomic inequality in health care, the rising costs of the U.S. health system, and the role of corporate money in health care, with special reference to the pharmaceutical industry. They also provide updates on Medicare health maintenance organizations, Medicaid, and a prelude to the complete implementation of the Affordable Care Act. In addition, the authors include some results from public opinion polls on health systems and international system comparisons. The article concludes with an assessment of the rapid consolidation in the delivery of health care being driven by the Affordable Care Act. PMID:24919300

  5. Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis

    PubMed Central

    Garcia-Subirats, Irene; Vargas, Ingrid; Sanz-Barbero, Belén; Malmusi, Davide; Ronda, Elena; Ballesta, Mónica; Vázquez, María Luisa

    2014-01-01

    Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012. PMID:25272078

  6. Hemorheological risk factors of acute chest syndrome and painful vaso-occlusive crisis in children with sickle cell disease

    PubMed Central

    Lamarre, Yann; Romana, Marc; Waltz, Xavier; Lalanne-Mistrih, Marie-Laure; Tressières, Benoît; Divialle-Doumdo, Lydia; Hardy-Dessources, Marie-Dominique; Vent-Schmidt, Jens; Petras, Marie; Broquere, Cedric; Maillard, Frederic; Tarer, Vanessa; Etienne-Julan, Maryse; Connes, Philippe

    2012-01-01

    Background Little is known about the effects of blood rheology on the occurrence of acute chest syndrome and painful vaso-occlusive crises in children with sickle cell anemia and hemoglobin SC disease. Design and Methods To address this issue, steady-state hemorheological profiles (blood viscosity, red blood cell deformability, aggregation properties) and hematologic parameters were assessed in 44 children with sickle cell anemia and 49 children with hemoglobin SC disease (8-16 years old) followed since birth. Clinical charts were retrospectively reviewed to determine prior acute chest syndrome or vaso-occlusive episodes, and rates of these complications were calculated. Results Multivariate analysis revealed that: 1) a higher steady-state blood viscosity was associated with a higher rate of vaso-occlusive crises in children with sickle cell anemia, but not in children with hemoglobin SC disease; 2) a higher steady-state red blood cell disaggregation threshold was associated with previous history of acute chest syndrome in children with hemoglobin SC disease and boys with sickle cell anemia. Conclusions Our results indicate for the first time that the red blood cell aggregation properties may play a role in the pathophysiology of acute chest syndrome in children with hemoglobin SC disease and boys with sickle cell anemia. In addition, whereas greater blood viscosity is associated with a higher rate of vaso-occlusive crises in children with sickle cell anemia, no association was found in children with hemoglobin SC disease, underscoring differences in the etiology of vaso-occlusive crises between sickle cell anemia and hemoglobin SC disease. PMID:22689686

  7. Self-reported acute health symptoms and exposure to companion animals

    EPA Science Inventory

    Background: In order to understand the etiological burden of disease associated with acute health symptoms (e.g. gastrointestinal [GI], respiratory, dermatological), it is important to understand how common exposures influence these symptoms. Exposures to familiar and unfamiliar ...

  8. The U.S. Health Care Crisis Five Years After Passage of the Affordable Care Act: A Data Snapshot.

    PubMed

    Hellander, Ida

    2015-01-01

    Despite passage of the Affordable Care Act in 2010, the U.S. health care crisis continues. While coverage has been expanded, the reform will leave 27 million people uninsured in 2024, according to the Congressional Budget Office. Much of the new coverage is of low actuarial value with high cost-sharing requirements, creating barriers to access. Choice of physician is restricted to narrow networks of providers. Recent measures of uninsurance, underinsurance, access to care, and health care costs are given. Changes in Medicare, particularly privatization and the rise of specialty drug tiers that limit access to medically necessary medications, are reviewed. Data on a new wave of consolidation among hospitals, medical groups, insurers, and drug companies are presented. The rise of ultra-high-price drugs, such as Solvadi, is raising pharmaceutical costs, particularly in Medicaid, the program for low-income Americans. International health comparisons continue to show the United States performing poorly in relation to other countries. Recent polling data are presented, showing support for more fundamental reform. PMID:26251349

  9. The U.S. Health Care Crisis Five Years After Passage of the Affordable Care Act: A Data Snapshot.

    PubMed

    Hellander, Ida

    2015-01-01

    Despite passage of the Affordable Care Act in 2010, the U.S. health care crisis continues. While coverage has been expanded, the reform will leave 27 million people uninsured in 2024, according to the Congressional Budget Office. Much of the new coverage is of low actuarial value with high cost-sharing requirements, creating barriers to access. Choice of physician is restricted to narrow networks of providers. Recent measures of uninsurance, underinsurance, access to care, and health care costs are given. Changes in Medicare, particularly privatization and the rise of specialty drug tiers that limit access to medically necessary medications, are reviewed. Data on a new wave of consolidation among hospitals, medical groups, insurers, and drug companies are presented. The rise of ultra-high-price drugs, such as Solvadi, is raising pharmaceutical costs, particularly in Medicaid, the program for low-income Americans. International health comparisons continue to show the United States performing poorly in relation to other countries. Recent polling data are presented, showing support for more fundamental reform.

  10. Crisis and Emergency Risk Messaging in Mass Media News Stories: Is the Public Getting the Information They Need to Protect Their Health?

    PubMed

    Parmer, John; Baur, Cynthia; Eroglu, Dogan; Lubell, Keri; Prue, Christine; Reynolds, Barbara; Weaver, James

    2016-10-01

    The mass media provide an important channel for delivering crisis and emergency risk information to the public. We conducted a content analysis of 369 newspaper and television broadcast stories covering natural disaster and foodborne outbreak events and coded for seven best practices in crisis and emergency risk messaging. On average, slightly less than two (1.86) of the seven best practices were included in each story. The proportion of stories including individual best practices ranged from 4.6% for "expressing empathy" to 83.7% for "explaining what is known" about the event's impact to human health. Each of the other five best practices appeared in less than 25% of stories. These results suggest much of the risk messaging the public receives via mass media does not follow best practices for effective crisis and emergency communication, potentially compromising public understanding and actions in response to events.

  11. Crisis and Emergency Risk Messaging in Mass Media News Stories: Is the Public Getting the Information They Need to Protect Their Health?

    PubMed

    Parmer, John; Baur, Cynthia; Eroglu, Dogan; Lubell, Keri; Prue, Christine; Reynolds, Barbara; Weaver, James

    2016-10-01

    The mass media provide an important channel for delivering crisis and emergency risk information to the public. We conducted a content analysis of 369 newspaper and television broadcast stories covering natural disaster and foodborne outbreak events and coded for seven best practices in crisis and emergency risk messaging. On average, slightly less than two (1.86) of the seven best practices were included in each story. The proportion of stories including individual best practices ranged from 4.6% for "expressing empathy" to 83.7% for "explaining what is known" about the event's impact to human health. Each of the other five best practices appeared in less than 25% of stories. These results suggest much of the risk messaging the public receives via mass media does not follow best practices for effective crisis and emergency communication, potentially compromising public understanding and actions in response to events. PMID:26940247

  12. Beyond police crisis intervention: Moving “upstream” to manage cases and places of behavioral health vulnerability

    PubMed Central

    Wood, Jennifer; Beierschmitt, Laura

    2014-01-01

    Law enforcement officers continue to serve on the front lines as mental health interventionists, and as such have been subject to a wave of “first generation” reform designed to enhance their crisis response capabilities. Yet, this focus on crisis intervention has not answered recent calls to move “upstream” and bolster early intervention in the name of long-term recovery. This paper reports on findings from an action research project in Philadelphia aimed at exploring opportunities for enhanced upstream engagement. Study methods include spatial analyses of police mental health transportations from an eight year period (2004–2011) and qualitative data from twenty-three “framing conversations” with partners and other stakeholders, seven focus groups with police and outreach workers, five key informant interviews as well as document reviews of the service delivery system in Philadelphia. Recommendations include the need to move beyond a focus on what police can do to a wider conception of city agencies and business stakeholders who can influence vulnerable people and vulnerable spaces of the city. We argue for the need to develop shared principles and rules of engagement that clarify roles and stipulate how best to enlist city resources in a range of circumstances. Since issues of mental health, substance use and disorder are so tightly coupled, we stress the importance of establishing a data-driven approach to crime and disorder reduction in areas of the city we term “hotspots of vulnerability”. In line with a recovery philosophy, such an approach should reduce opportunities for anti-social behavior among the “dually labeled” in ways consistent with “procedural justice”. Furthermore, crime and disorder data flowing from police and security to behavioral health analysts could contribute to a more focused case management of “repeat utilizers” across the two systems. Our central argument is that a twin emphasis on “case management” and

  13. The end of the era of generosity? Global health amid economic crisis

    PubMed Central

    Schneider, Kammerle; Garrett, Laurie

    2009-01-01

    In the past decade donor commitments to health have increased by 200 percent. Correspondingly, there has been a swell of new players in the global health landscape. The unprecedented, global response to a single disease, HIV/AIDS, has been responsible for a substantial portion of this boon. Numerous health success have followed this windfall of funding and attention, yet the food, fuel, and economic crises of 2008 have shown the vulnerabilities of health and development initiatives focused on short term wins and reliant on a constant flow of foreign funding. For too long, the international community has responded to global health and development challenges with emergency solutions that often reflect the donor's priorities, values, and political leanings, rather than funding durable health systems that can withstand crises. Progress towards achieving the Millennium Development Goals has stalled in many countries. Disease specific initiatives have weakened health systems and limited efforts to improve maternal and child health. As we enter this era of scarce resources, there is a need to return to the foundations of the Alma Ata Declaration signed thirty years ago with the goal of providing universal access to primary healthcare. The global health community must now objectively evaluate how we can most effectively respond to the crises of 2008 and take advantage of this moment of extraordinary attention for global health and translate it into long term, sustainable health improvements for all. PMID:19134211

  14. [Crisis intervention].

    PubMed

    Stein, Claudius

    2012-01-01

    The Austrian Program for Suicide Prevention defines as Point 2: "Support and treatment". The suicide-preventive outcome of the development of psychotherapeutic-psychosocial care in Austria has been proved. This means, that the further development of institutions with focus on crisis intervention is a central agenda of Suicide prevention Austria (SUPRA). First, in this article are defined the terms crisis and crisis intervention, also the close connection to programs of suicide prevention is pointed out. Furthermore general aims and standards for crisis intervention are defined and the current situation of crisis intervention in Austria is described. Finally recommendations for practical aims and their implementation in the context of SUPRA are made.

  15. Seeking fluid possibility and solid ground: space and movement in mental health service users' experiences of 'crisis'.

    PubMed

    McGrath, Laura; Reavey, Paula

    2015-03-01

    Since the closure of the UK asylums, 'the community' has become short hand for describing a variety of disparate and complex spaces, in which service users manage their experiences of distress. An examination of such spaces here forms the basis of an analysis of the way in which service users move through and within space, to establish agency and dis/order while distressed. Seventeen participants, with various experiences of mental distress took part in a qualitative study, and a further textual analysis was conducted on eight published autobiographies. In the context of the interviews, participants presented drawings of the spaces they occupy during times of crisis, wellbeing and recovery. All texts were analysed using a thematic approach, informed by theories of embodiment and relational space. In this paper, the focus is directed towards two key patterns of movement, in order to explore ways in which participants experiencing various forms of mental health crisis used space in order to maintain and manage feelings of agency. Firstly, incidents where participants described moving towards fluid, outside spaces are explored, with agency being established through seeking, and utilising, greater possibilities for action and engaging others. In addition, the opposite pattern of movement is also explored, using incidents where participants described moving indoors, using the private space of the home to establish order and restore feelings of agency and strength, in contrast to overwhelming experiences in public space. Connections between these patterns of movement and particular forms of distress are discussed. It is argued that community and private spaces are integral to the ways in which selfhood, agency and action is experienced in mental distress, which in turn has implications for policy, treatment and community action.

  16. Ethical decision making in a crisis: a case study of ethics in public health emergencies.

    PubMed

    Thomas, James C; MacDonald, Pia D M; Wenink, Emily

    2009-01-01

    Public health emergencies, such as hurricanes and the constant threat of an influenza pandemic, present public health responders with many ethical issues and little time to think them through. We interviewed 13 responders in the Epidemiology Section of the North Carolina Division of Public Health to learn how they have identified and addressed ethical issues in public health emergencies affecting the state and to identify potential means of improving those processes for North Carolina and other states. The Epidemiology Section staff demonstrated an awareness of several ethical issues in public health emergencies and an ability to identify and address issues through group interactions. However, few study participants in the section had received any training in public health ethics. Perhaps for this reason, the range of ethical issues they identified excluded several mentioned in the Public Health Code of Ethics. Moreover, their ethical decision making could be enhanced by a more detailed understanding of the ethical issues they named. We recommend seven practical steps that the Epidemiology Section can take to improve their ability to identify and address ethical issues in a public health emergency. The recommendations are likely relevant to many state, city, and county public health departments throughout the United States.

  17. The International Monetary Fund's effects on global health: before and after the 2008 financial crisis.

    PubMed

    Stuckler, David; Basu, Sanjay

    2009-01-01

    In April 2009, the G20 countries committed US $750 billion to the International Monetary Fund (IMF), which has assumed a central role in global economic management. The IMF provides loans to financially ailing countries, but with strict conditions, typically involving a mix of privatization, liberalization, and fiscal austerity programs. These loan conditions have been extremely controversial. In principle, they are designed to help countries balance their books. In practice, they often translate into reductions in social spending, including spending on public health and health care delivery. As more countries are being exposed to IMF policies, there is a need to establish what we know and do not know about the IMF's effects on global health. This article introduces a series in which contributors review the evidence on the relationship between the IMF and public health and discuss potential ways to improve the Fund's effects on health. While more evidence is needed for some regions, there is sufficient evidence to indicate that IMF programs have been significantly associated with weakened health care systems, reduced effectiveness of health-focused development aid, and impeded efforts to control tobacco, infectious diseases, and child and maternal mortality. Reforms are urgently needed to prevent the current wave of IMF programs from further undermining public health in financially ailing countries and limiting progress toward the health Millennium Development Goals. PMID:19927414

  18. [Clinical application of blood matching with hemolytic test in vitro for transfusion treatment of crisis puerpera with acute hemolytic anemia].

    PubMed

    Yuan, Min; Tang, Cong-Hai; Gan, Wei-Wei; Wu, A-Yang; Yang, Hui-Cong; Zhang, Tian-Xin; Huang, Yan Xue; Qiu, Lu-Zhen; Chen, Hong-Pu; Lin, Feng-Li

    2014-08-01

    This study was aimed to establish the matching method of hemolytic test in vitro, and to guide the transfusion treatment for puerpera with acute hemolytic disease. The donor's erythrocytes were sensibilized by all the antibodies in plasma of patient in vitro and were added with complement, after incubation for 6.5 hours at 38 °C, the hemolysis or no hemolysis were observed. It is safe to transfuse if the hemolysis did not occur. The results showed that when the matching difficulty happened to puerpera with acute hemolytic disease, the compatible donor could be screened by hemolytic test in vitro. There were no untoward effects after transfusion of 6 U leukocyte-depleted erythrocyte suspension. The all hemoglobin, total bilirubins, indirect bilirubin, reticulocyte, D-dimex and so on were rapidly improved in patient after transfusion , showing obvious clinical efficacy of treatment. It is concluded that when the matching results can not judge accurately compatible or incompatible through the routine method of cross matching, the agglutinated and no-hemolytic erythrocytes can be screened by hemolytic test in vitro and can be transfused with good efficacy; the hemoglobin level can be promoted rapidly, and no untoward effects occur. PMID:25130835

  19. The Hidden Crisis in Mental Health and Education: The Gap between Student Needs and Existing Supports

    ERIC Educational Resources Information Center

    Malti, Tina; Noam, Gil G.

    2008-01-01

    The authors provide a selected review of mental health and educational concerns evident in U.S. middle schools and describes promising and important strategies to ameliorate the high rates of students with mental health and academic difficulties. Despite some promising and important strategies, service systems are fragmented, and comprehensive…

  20. The impact of the economic crisis and the US embargo on health in Cuba.

    PubMed Central

    Garfield, R; Santana, S

    1997-01-01

    OBJECTIVES: This paper examines the combined effects of a severe economic decline since 1989 and a tightening of the US embargo in 1992 on health and health care in Cuba. METHODS: Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were reviewed. These sources were supplemented with utilization data from the national health system and interviews with health leaders. RESULTS: Changes in Cuba include declining nutritional levels, rising rates of infectious diseases and violent death, and a deteriorating public health infrastructure. But despite these threats, mortality levels for children and women remain low. Instead, much of the health impact of the economic decline of Cuba has fallen on adult men and the elderly. CONCLUSIONS: To be consistent with international humanitarian law, embargoes must not impede access to essential humanitarian goods. Yet this embargo has raised the cost of medical supplies and food Rationing, universal access to primary health services, a highly educated population, and preferential access to scarce goods for women and children help protect most Cubans from what otherwise might have been a health disaster. PMID:9065219

  1. Mental health and addiction workforce development: federal leadership is needed to address the growing crisis.

    PubMed

    Hoge, Michael A; Stuart, Gail W; Morris, John; Flaherty, Michael T; Paris, Manuel; Goplerud, Eric

    2013-11-01

    The mental health and addiction workforce has long been plagued by shortages, high turnover, a lack of diversity, and concerns about its effectiveness. This article presents a framework to guide workforce policy and practice, emphasizing the need to train other health care providers as well as individuals in recovery to address behavioral health needs; strengthen recruitment, retention, and training of specialist behavioral health providers; and improve the financial and technical assistance infrastructure to better support and sustain the workforce. The pressing challenge is to scale up existing plans and strategies and to implement them in ways that have a meaningful impact on the size and effectiveness of the workforce. The aging and increasing diversity of the US population, combined with the expanded access to services that will be created by health reform, make it imperative to take immediate action.

  2. Palestinian women's sexual and reproductive health rights in a longstanding humanitarian crisis.

    PubMed

    Bosmans, Marleen; Nasser, Dina; Khammash, Umaiyeh; Claeys, Patricia; Temmerman, Marleen

    2008-05-01

    This paper results from a study conducted in the Occupied Palestinian Territory in September 2002 to test the usefulness of a guide for a comprehensive approach to sexual and reproductive health rights and needs of refugee women. In-depth interviews with key informants from 19 organisations and two focus group discussions were carried out in the West Bank and Gaza. Three refugee camps were visited as well as five health facilities. The findings revealed that severe restrictions on mobility had reduced access to health facilities for both staff and patients in a significant way. For pregnant women, this had resulted in decreased access to antenatal and post-natal care and an increasing number of home deliveries, induced deliveries and deliveries at military checkpoints. Lack of donor interest and withdrawal of donor support were mentioned as hampering the implementation of the National Reproductive Health Guidelines, and the sustainability and quality of existing sexual and reproductive health services. Family planning had become a politically sensitive issue, and there were indications of increased gender-based violence. Lack of access to reproductive health services was the most visible aspect of the impact of the conflict on women's sexual and reproductive health. Little attention is paid to the less visible evidence that women's reproductive rights have been subordinated to the political situation. PMID:18513612

  3. The silence of the unblown whistle: the Nevada hepatitis C public health crisis.

    PubMed

    Leary, Elizabeth; Diers, Donna

    2013-03-01

    In 2008, one of the worst public health crises occurred in the state of Nevada, where authorities discovered up to 63,000 patients were potentially exposed to hepatitis C infection, largely due to substandard infection control and other negligent practices at two endoscopy clinics in Las Vegas. In the subsequent grand jury proceedings that followed, it was discovered that several clinic employees not only participated in these egregious practices, but doctors, nurses, and other health care professionals witnessed yet failed to report these incidents, largely due to fears of whistleblower retaliation. In response, the Nevada state legislature attempted to strengthen whistleblower protection laws, but it remains unclear if such laws actually protect employees who attempt to report patient safety concerns. As the push for quality patient outcomes becomes more prominent with health care reform, whistleblower concerns must be effectively addressed to ensure that health care professionals can report patient safety concerns without fear of retaliation.

  4. The multidisciplinary approach to mental health crisis management: an Australian example.

    PubMed

    Webster, S; Harrison, L

    2004-02-01

    Changes within the Australian health care system have led many people with mental health disorders to use emergency departments as the point of access to mental health services. Staff in emergency departments are not necessarily equipped to assess the needs of such clients. This paper briefly describes the development of a multidisciplinary mental health liaison team, within the emergency department of one hospital in Sydney, which was designed to assist both staff and clients. Available evidence suggests the implementation of the team has been a success, however, more research is required to confirm the effectiveness of this approach. Questions are raised about appropriate referral and follow-up for some clients. The study also found deficiencies in the method of routine data collection (Emergency Department Identification System), which makes formal auditing of the team and the services it provides a difficult task.

  5. The silence of the unblown whistle: the Nevada hepatitis C public health crisis.

    PubMed

    Leary, Elizabeth; Diers, Donna

    2013-03-01

    In 2008, one of the worst public health crises occurred in the state of Nevada, where authorities discovered up to 63,000 patients were potentially exposed to hepatitis C infection, largely due to substandard infection control and other negligent practices at two endoscopy clinics in Las Vegas. In the subsequent grand jury proceedings that followed, it was discovered that several clinic employees not only participated in these egregious practices, but doctors, nurses, and other health care professionals witnessed yet failed to report these incidents, largely due to fears of whistleblower retaliation. In response, the Nevada state legislature attempted to strengthen whistleblower protection laws, but it remains unclear if such laws actually protect employees who attempt to report patient safety concerns. As the push for quality patient outcomes becomes more prominent with health care reform, whistleblower concerns must be effectively addressed to ensure that health care professionals can report patient safety concerns without fear of retaliation. PMID:23483090

  6. The Aroman food crisis: a fable with a lesson for national health insurance.

    PubMed

    Seidman, L S

    1978-05-01

    An analogy is always imperfect. Nevertheless, at times it is an effective way to communicate an insight. This paper uses an analogy to examine the consequences of attempting to achieve health sector efficiency through regulation, instead of consumer cost-sharing. It is suggested that as long as hospital care continues to be virtually "free" to patients at the time of use, such regulation may well do more harm than good. Moreover, a national health insurance plan that would make all medical care "free" to patients, and would pay for all health care through taxes (the proposed Health Security Act), would not only generate significant inefficiency; but, in contrast to the intentions of its supporters, would prove harmful to the poor and the elderly, by shifting scarce Federal tax dollars away from the programs that assist them in order to pay the medical bills of middle and upper income households. It is therefore urged that we enact income-related catastrophic national health insurance, that would place a ceiling, which varies with household income, on the financial burden a household must bear; but at the same time, would require most families to pay part of their own medical cost out-of-pocket, so that consumer cost-consciousness can help promote health sector efficiency.

  7. [Hospital governance: between crisis management and implementation of public health policy].

    PubMed

    Bréchat, Pierre-Henri; Antoine, Leenhardt; Mathieu-Grenouilleau, Marie-Christine; Rymer, Roland; Matisse, François; Baraille, Denis; Beaufils, Philippe

    2010-01-01

    The implementation of the recent act to amend the law on hospitals, patient health and territories (HPST Law) completes the reform of the organization and governance of health facilities, which was announced in 2002 by the "Hospital 2007" plan. What kind of assessments and perspectives can be considered and envisaged for these Hospital Activity Poles? We compared our experience with a review of the professional and scientific literature in order to stimulate answers to these questions for advocacy purposes prior to the Act's implementation. The hospital's cluster of activities should reinforce--not call into question the core activities and the financial stability of the facility, while respecting the contract on agreed objectives and the necessary means and resources to meet the health needs of the catchment population as well as national priorities. Although significant, but limited, successes exist, five obstacles to hospital reorganization can be identified. These include, for example: lack of delegation of management and centralization of decisions, the heterogeneity of numerous Hospital Activity Poles or problems related to timing. These obstacles may cause strain, or put the Hospital Activity Poles and the health facilities in a difficult situation with respect to their dynamics. This may show that the State and social health insurance should steer and direct public health policy and that the delegation of management roles and responsibilities to the Hospital Activity Poles should be addressed.

  8. Structural Factors of the Middle East Respiratory Syndrome Coronavirus Outbreak as a Public Health Crisis in Korea and Future Response Strategies

    PubMed Central

    Kim, Dong-Hyun

    2015-01-01

    The recent Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak has originated from a failure in the national quarantine system in the Republic of Korea as most basic role of protecting the safety and lives of its citizens. Furthermore, a number of the Korean healthcare system’s weaknesses seem to have been completely exposed. The MERS-CoV outbreak can be considered a typical public health crisis in that the public was not only greatly terrorized by the actual fear of the disease, but also experienced a great impact to their daily lives, all in a short period of time. Preparedness for and an appropriate response to a public health crisis require comprehensive systematic public healthcare measures to address risks comprehensively with an all-hazards approach. Consequently, discussion regarding establishment of post-MERS-CoV improvement measures must focus on the total reform of the national quarantine system and strengthening of the public health infrastructure. In addition, the Korea Centers for Disease Control and Prevention must implement specific strategies of action including taking on the role of “control tower” in a public health emergency, training of Field Epidemic Intelligence Service officers, establishment of collaborative governance between central and local governments for infection prevention and control, strengthening the roles and capabilities of community-based public hospitals, and development of nationwide crisis communication methods. PMID:26639738

  9. Structural Factors of the Middle East Respiratory Syndrome Coronavirus Outbreak as a Public Health Crisis in Korea and Future Response Strategies.

    PubMed

    Kim, Dong-Hyun

    2015-11-01

    The recent Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak has originated from a failure in the national quarantine system in the Republic of Korea as most basic role of protecting the safety and lives of its citizens. Furthermore, a number of the Korean healthcare system's weaknesses seem to have been completely exposed. The MERS-CoV outbreak can be considered a typical public health crisis in that the public was not only greatly terrorized by the actual fear of the disease, but also experienced a great impact to their daily lives, all in a short period of time. Preparedness for and an appropriate response to a public health crisis require comprehensive systematic public healthcare measures to address risks comprehensively with an all-hazards approach. Consequently, discussion regarding establishment of post-MERS-CoV improvement measures must focus on the total reform of the national quarantine system and strengthening of the public health infrastructure. In addition, the Korea Centers for Disease Control and Prevention must implement specific strategies of action including taking on the role of "control tower" in a public health emergency, training of Field Epidemic Intelligence Service officers, establishment of collaborative governance between central and local governments for infection prevention and control, strengthening the roles and capabilities of community-based public hospitals, and development of nationwide crisis communication methods. PMID:26639738

  10. Self-reported acute health symptoms and exposure to companion animals#

    EPA Science Inventory

    Self-reported acute health symptoms and exposure to companion animalsWhitney S. Krueger1,2, Elizabeth D. Hilborn2, Timothy J. Wade21Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA2Environmental Public Health Division, Office of Research and Development, U...

  11. Global health and national borders: the ethics of foreign aid in a time of financial crisis

    PubMed Central

    2012-01-01

    Background The governments and citizens of the developed nations are increasingly called upon to contribute financially to health initiatives outside their borders. Although international development assistance for health has grown rapidly over the last two decades, austerity measures related to the 2008 and 2011 global financial crises may impact negatively on aid expenditures. The competition between national priorities and foreign aid commitments raises important ethical questions for donor nations. This paper aims to foster individual reflection and public debate on donor responsibilities for global health. Methods We undertook a critical review of contemporary accounts of justice. We selected theories that: (i) articulate important and widely held moral intuitions; (ii) have had extensive impact on debates about global justice; (iii) represent diverse approaches to moral reasoning; and (iv) present distinct stances on the normative importance of national borders. Due to space limitations we limit the discussion to four frameworks. Results Consequentialist, relational, human rights, and social contract approaches were considered. Responsibilities to provide international assistance were seen as significant by all four theories and place limits on the scope of acceptable national autonomy. Among the range of potential aid foci, interventions for health enjoyed consistent prominence. The four theories concur that there are important ethical responsibilities to support initiatives to improve the health of the worst off worldwide, but offer different rationales for intervention and suggest different implicit limits on responsibilities. Conclusions Despite significant theoretical disagreements, four influential accounts of justice offer important reasons to support many current initiatives to promote global health. Ethical argumentation can complement pragmatic reasons to support global health interventions and provide an important foundation to strengthen

  12. The deepening crisis in U.S. health care: a review of data, Spring 2008.

    PubMed

    Hellander, Ida

    2008-01-01

    This report presents information on the state of U.S. health care in early 2008. The numbers of uninsured and underinsured continue to rise, and the proportion of people covered by employer-sponsored private coverage decreases. For 29 percent of low- and middle-income households with credit card debt, medical bills are a contributor to their current balance. Health spending in the United States is on the increase, and projected spending in 2008 will consume 16.6 percent of gross domestic product. Health insurance premiums grew 78 percent between 2002 and 2007. Meanwhile, safety-net hospitals are facing deep deficits and service cuts across the country. Pharmaceutical and insurance companies spend millions lobbying Congress. Health industry CEOs continue to be richly rewarded, even as companies come under investigation or face fines for claims denials, manipulation of data, or violations of claims-handling regulations. Average monthly premiums for Medicare Part D increase while plans are reducing coverage for high-cost drugs. And research shows how private plans such as Medicare Advantage hurt Medicare. According to opinion polls, the majority of Americans and physicians support a single-payer health care system. PMID:19069283

  13. Is shale gas drilling an energy solution or public health crisis?

    PubMed

    Rafferty, Margaret A; Limonik, Elena

    2013-01-01

    High-volume horizontal hydraulic fracturing, a controversial new mining technique used to drill for shale gas, is being implemented worldwide. Chemicals used in the process are known neurotoxins, carcinogens, and endocrine disruptors. People who live near shale gas drilling sites report symptoms that they attribute to contaminated air and water. When they seek help from clinicians, a diagnosis is often elusive because the chemicals to which the patients have been exposed are a closely guarded trade secret. Many nurses have voiced grave concern about shale gas drilling safety. Full disclosure of the chemicals used in the process is necessary in order for nurses and other health professionals to effectively care for patients. The economic exuberance surrounding natural gas has resulted in insufficient scrutiny into the health implications. Nursing research aimed at determining what effect unconventional drilling has on human health could help fill that gap. Public health nurses using the precautionary principle should advocate for a more concerted transition from fossil fuels to sustainable energy. Any initiation or further expansion of unconventional gas drilling must be preceded by a comprehensive Health Impact Assessment (HIA).

  14. Cognitive influences on health symptoms from acute chemical exposure.

    PubMed

    Dalton, P

    1999-11-01

    Symptom reports, perceived adverse health effects, and public health concerns are increasingly precipitated by the perception of chemical odors. This study examined the interaction between health cognitions, odor perception, and symptom reports. A group of 180 healthy men and women were exposed to 1 of 3 ambient odors, normatively rated as healthful (methyl salicylate, or wintergreen), harmful (butanol or alcohol), and ambiguous (isobomyl acetate, or balsam), after receiving 1 of 3 odorant characterizations (harmful, healthful, and neutral). Individuals given a harmful bias reported significantly more health symptoms following exposure and more intense odor and irritation during exposure than did those given a neutral or healthful bias. The overall pattern of results suggests that many of the health-related effects of exposure to odorants are mediated not by a direct agency of odors but by cognitive variables, such as mental models of the relationship between environmental odors and health.

  15. Enhancing behavioral health treatment and crisis management through mobile ecological momentary assessment and SMS messaging.

    PubMed

    Smith, Brad; Harms, William D; Burres, Stephanie; Korda, Holly; Rosen, Howard; Davis, Jamie

    2012-12-01

    Many veterans returning from service in Afghanistan or Iraq suffer from post-traumatic stress disorder or mild traumatic brain injury. Treating these conditions can be challenging because of high rates of relapse and associated memory impairments. We report on a pilot study that assessed the utility of mobile health (mHealth) technologies, including personal digital assistant-based ecological momentary assessment and two-way interactive text (SMS) messaging, for providing treatment feedback to clinicians, encouraging and motivating veterans throughout treatment, and monitoring participants for relapse after treatment discharge. The results of the pilot suggest that mHealth technologies are feasible adjuncts to traditional mental treatment in the veteran population. Additional work is needed to establish the degree of clinical and economic value.

  16. Is the tobacco control movement misrepresenting the acute cardiovascular health effects of secondhand smoke exposure? An analysis of the scientific evidence and commentary on the implications for tobacco control and public health practice

    PubMed Central

    Siegel, Michael

    2007-01-01

    While chronic exposure to secondhand smoke has been well recognized as a cause of heart disease in nonsmokers, there has been recent speculation about the potential acute cardiovascular effects of transient exposure to secondhand smoke among nonsmokers; in particular, the possibility that such exposure could increase the risk of acute myocardial infarction even in an otherwise healthy nonsmoker. This paper reviews the claims being made by a number of anti-smoking and public health groups regarding the acute cardiovascular effects of secondhand smoke exposure among otherwise healthy adults, analyzes the validity of these claims based on a review of the scientific evidence, and discusses the implications of the findings for tobacco control and public health practice. Based on the analysis, it appears that a large number of anti-smoking organizations are making inaccurate claims that a single, acute, transient exposure to secondhand smoke can cause severe and even fatal cardiovascular events in healthy nonsmokers. The dissemination of inaccurate information by anti-smoking groups to the public in support of smoking bans is unfortunate because it may harm the tobacco control movement by undermining its credibility, reputation, and effectiveness. Disseminating inaccurate information also represents a violation of basic ethical principles that are a core value of public health practice that cannot and should not be sacrificed, even for a noble end such as protecting nonsmokers from secondhand smoke exposure. How the tobacco control movement responds to this crisis of credibility will go a long way towards determining the future effectiveness of the movement and its ability to continue to save lives and protect the public's health. PMID:17927828

  17. Differential Perception of Life Crisis Events by Sex, Diagnosis and Ethnicity in Rural Mental Health Clients.

    ERIC Educational Resources Information Center

    Swanda, Rex M.; Kahn, Marvin W.

    1986-01-01

    Describes study in which 146 rural mental health clinic clients reported moderate to extreme stress levels for all demographic and diagnostic groupings. Indicates younger patients had higher stress levels than older and significantly different stress events differentiated alcoholic, male, and Hispanic-American patients. Discusses implications for…

  18. Confusion, Crisis, and Opportunity: Professional School Counselors' Role in Responding to Student Mental Health Issues

    ERIC Educational Resources Information Center

    Walley, Cynthia; Grothaus, Tim; Craigen, Laurie

    2009-01-01

    With the array of challenges facing today's youth, school counselors are in a unique position to recognize and respond to the diverse mental health needs of students. After a brief examination of the challenges and some promising responses, this article will consider the use of advocacy, collaboration, and professional development to aid school…

  19. The Kurt Cobain Suicide Crisis: Perspectives from Research, Public Health, and the News Media.

    ERIC Educational Resources Information Center

    Jobes, David A.; And Others

    1996-01-01

    Provides a brief overview of musician Kurt Cobain's life and one community's response to his suicide. Comments on the apparent lack of possible copycat suicides following the suicide. Presents two perspectives, drawn from public health and the news media, regarding the role of media influence on copycat suicides. (RJM)

  20. Health Education Efforts in Uncertain Times: Helping to Ensure Healthy Pregnancies in a Time of Crisis

    ERIC Educational Resources Information Center

    Flores, Alina L.; Weber, Mary Kate; Kilker, Katie P.; Dang, Elizabeth P.; Lindsey, Lisa L. Massi

    2007-01-01

    Hurricane Katrina caused immense upheaval and disrupted many lives. Among those affected were pregnant women. A public service announcement, website content, and a fact sheet were developed to inform pregnant women about the issues that could potentially affect their health and that of their babies. The aim of these products was to provide health…

  1. Towards Healthy Schools 2015: Progress on America's Environmental Health Crisis for Children

    ERIC Educational Resources Information Center

    Healthy Schools Network, Inc., 2013

    2013-01-01

    States compel children to attend school; in fact, 98% of all school-age children attend schools--irrespective of conditions. Yet the environmental conditions of decayed facilities or facilities close to hazards can damage children's health and ability to learn. At the same time, it is well documented that healthy school facilities can help…

  2. Turning Crisis into Opportunity: Nature of Science and Scientific Inquiry as Illustrated in the Scientific Research on Severe Acute Respiratory Syndrome

    NASA Astrophysics Data System (ADS)

    Wong, Siu Ling; Kwan, Jenny; Hodson, Derek; Yung, Benny Hin Wai

    2009-01-01

    Interviews with key scientists who had conducted research on Severe Acute Respiratory Syndrome (SARS), together with analysis of media reports, documentaries and other literature published during and after the SARS epidemic, revealed many interesting aspects of the nature of science (NOS) and scientific inquiry in contemporary scientific research in the rapidly growing field of molecular biology. The story of SARS illustrates vividly some NOS features advocated in the school science curriculum, including the tentative nature of scientific knowledge, theory-laden observation and interpretation, multiplicity of approaches adopted in scientific inquiry, the inter-relationship between science and technology, and the nexus of science, politics, social and cultural practices. The story also provided some insights into a number of NOS features less emphasised in the school curriculum—for example, the need to combine and coordinate expertise in a number of scientific fields, the intense competition between research groups (suspended during the SARS crisis), the significance of affective issues relating to intellectual honesty and the courage to challenge authority, the pressure of funding issues on the conduct of research and the ‘peace of mind’ of researchers, These less emphasised elements provided empirical evidence that NOS knowledge, like scientific knowledge itself, changes over time. They reflected the need for teachers and curriculum planners to revisit and reconsider whether the features of NOS currently included in the school science curriculum are fully reflective of the practice of science in the 21st century. In this paper, we also report on how we made use of extracts from the news reports and documentaries on SARS, together with episodes from the scientists’ interviews, to develop a multimedia instructional package for explicitly teaching the prominent features of NOS and scientific inquiry identified in the SARS research.

  3. Concussions and youth football: using a public health law framework to head off a potential public health crisis

    PubMed Central

    Baugh, Christine M.; Shapiro, Zachary E.

    2015-01-01

    Concussion from sport is increasingly recognized as a public health priority. In response, all states and the District of Columbia have enacted youth concussion legislation. This paper first examines key developments in concussion-related policy and legislation and then uses the findings from recent scientific studies to highlight the need to incorporate evolving scientific evidence into concussion legislation in order to better protect youth and adolescent athletes. Next, the paper discusses the framework of empirical health law research and why it should be applied in the case of concussion legislation. Finally, this paper argues that empirical health law research should be considered in any decision about whether legislation can help improve the health and safety of young players, a particularly vulnerable population whose unique needs have not yet been adequately addressed. PMID:27774206

  4. Crisis in Health Care: The Missouri Experience. Hearing before the Subcommittee on Health and Long-Term Care of the Select Committee on Aging. House of Representatives, Ninety-Ninth Congress, First Session (Jefferson City, MO).

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. House Select Committee on Aging.

    This is a report of a Congressional hearing held in Jefferson City, Missouri on the crisis in health care for the elderly in Missouri. Representative Ike Skelton's opening statement notes that the purpose of the series of hearings being held around the country, of which this is one, is to examine the effect of changes in the Medicare program on…

  5. Addressing the American health-care cost crisis: role of the oncology community.

    PubMed

    Ramsey, Scott D; Ganz, Patricia A; Shankaran, Veena; Peppercorn, Jeffrey; Emanuel, Ezekiel

    2013-12-01

    Health-care cost growth is unsustainable, and the current level of spending is harming our economy and our patients. This commentary describes the scope of the health-care spending problem and the particular factors in cancer care that contribute to the problem, reflecting in part presentations and discussions from an Institute of Medicine National Cancer Policy Forum Workshop held in October 2012. Presenters at the workshop identified a number of steps that the oncology community can take to reduce the rate of growth in cancer-care costs while maintaining or improving upon the quality of care. This commentary aims to highlight opportunities for the oncology community to take a leadership role in delivering affordable, high-quality cancer care. PMID:24226096

  6. Impact of the global economic crisis on the health of unemployed autoworkers.

    PubMed

    Bartfay, Wally Joseph; Bartfay, Emma; Wu, Terry

    2013-09-01

    A phenomenological investigation was undertaken to examine the effects of the 2008-09 global economic recession on the health of unemployed blue-collar autoworkers in the Canadian province of Ontario between September and November 2009. A total of 22 men and 12 women took part. Participants completed a quantitative demographic and financial questionnaire. The qualitative aspect of the study consisted of a phenomenological component comprising semi-structured focus group sessions lasting 2 to 2.5 hours. The number of years employed ranged from 2 to 31.7 with a mean of 15 +/- 8. Participants reported high levels of stress, anxiety, and depression; increased physical pain and discomfort; changes in weight and sexual function; and financial hardships, including inability to purchase prescribed medications. The authors conclude that unemployment associated with the global recession has negative health effects on autoworkers in Ontario. PMID:24236372

  7. [Principles and methods of mental health resource assessment in military personnel under conditions of demographic crisis].

    PubMed

    Vorona, A A; Syrkin, L D

    2011-03-01

    The article is devoted to developing the principles and methods of resource assessment of mental health military contingent in terms of demographic decline and reform of the Armed Forces of the Russian Federation. From the standpoint of the concept of the mutual influence of the value-semantic components and the level of psychological adaptation resources demonstrates the possibility of evaluating resource capabilities of the psyche of military contingent.

  8. Cholera in Zimbabwe: Developing an Educational Response to a Health Crisis

    ERIC Educational Resources Information Center

    Mandikonza, Caleb; Musindo, Beatrice; Taylor, Jim

    2011-01-01

    In February 2009, the World Health Organization (WHO) reported that the cholera epidemic in Zimbabwe had claimed 3,300 lives and infected 66,000 people--greater than the toll of that disease in the whole of Africa in most years. How is it possible that a disease such as cholera can have such a devastating effect in modern times? How should one…

  9. Autarchy, market disintegration, and health: the mortality and nutritional crisis in Nazi Germany, 1933-1937.

    PubMed

    Baten, Jörg; Wagner, Andrea

    2003-01-01

    Trends in mortality, nutritional status and food supply are compared to other living standard indicators for the Weimar Republic (1919-1933) and for the early years of the Nazi regime (1933-1937). The results imply that Germany experienced a substantial increase in mortality rates in most age groups in the mid-1930s, even relative to those of 1932, the worst year of the Great Depression. Moreover, children's heights--an indicator of the quality of nutrition and health--were generally stagnating between 1933 and 1938, but had increased significantly during the 1920s. Persecution, by itself, does not explain such an adverse development in biological welfare; the non-persecuted segments of the German population were affected as well. The reason for this adverse development was caused by the fact that military expenditures increased at the expense of public health measures. In addition, food imports were curtailed, and prices of many agricultural products were controlled. There is ample evidence that this set of economic policies had an adverse effect on the health and nutritional status of the population. The highly developed areas of Germany with large urban sectors and the coastal regions of the Northwest were affected most from the policy of restricting imports of protein-rich agricultural products. PMID:15463961

  10. Crisis of conscience: reconciling religious health care providers' beliefs and patients' rights.

    PubMed

    White, K A

    1999-07-01

    In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to "sensitive" services like abortion, family planning, HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers' right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White's analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients' right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal "bypass" legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts. PMID:10558539

  11. Autarchy, market disintegration, and health: the mortality and nutritional crisis in Nazi Germany, 1933-1937.

    PubMed

    Baten, Jörg; Wagner, Andrea

    2003-01-01

    Trends in mortality, nutritional status and food supply are compared to other living standard indicators for the Weimar Republic (1919-1933) and for the early years of the Nazi regime (1933-1937). The results imply that Germany experienced a substantial increase in mortality rates in most age groups in the mid-1930s, even relative to those of 1932, the worst year of the Great Depression. Moreover, children's heights--an indicator of the quality of nutrition and health--were generally stagnating between 1933 and 1938, but had increased significantly during the 1920s. Persecution, by itself, does not explain such an adverse development in biological welfare; the non-persecuted segments of the German population were affected as well. The reason for this adverse development was caused by the fact that military expenditures increased at the expense of public health measures. In addition, food imports were curtailed, and prices of many agricultural products were controlled. There is ample evidence that this set of economic policies had an adverse effect on the health and nutritional status of the population. The highly developed areas of Germany with large urban sectors and the coastal regions of the Northwest were affected most from the policy of restricting imports of protein-rich agricultural products.

  12. High food prices and the global financial crisis have reduced access to nutritious food and worsened nutritional status and health.

    PubMed

    Brinkman, Henk-Jan; de Pee, Saskia; Sanogo, Issa; Subran, Ludovic; Bloem, Martin W

    2010-01-01

    A global economic and financial crisis is engulfing the developing world, coming on top of high food and fuel prices. This paper assesses the impact of the crises on food consumption, nutrition, and health. Several methods were applied, including risk analysis using the cost of the food basket, assessment surveys, simulations, regression analysis using a food consumption score (FCS), reflecting diet frequency and diversity, and a review of the impact of such dietary changes on nutritional status and health. The cost of the food basket increased in several countries, forcing households to reduce quality and quantity of food consumed. The FCS, which is a measure of diet diversity, is negatively correlated with food prices. Simulations show that energy consumption declined during 2006-2010 in nearly all developing regions, resulting potentially in an additional 457 million people (of 4.5 billion) at risk of being hungry and many more unable to afford the dietary quality required to perform, develop, and grow well. As a result of the crises, large numbers of vulnerable households have reduced the quality and quantity of foods they consume and are at risk of increased malnutrition. Population groups most affected are those with the highest requirements, including young children, pregnant and lactating women, and the chronically ill (particularly people with HIV/AIDS and tuberculosis). Because undernutrition during the first 2 y of life has life-long consequences, even short-term price rises will have long-term effects. Thus, measures to mitigate the impact of the crises are urgently required.

  13. Crisis and connection.

    PubMed

    Mead, Shery; Hilton, David

    2003-01-01

    Psychiatric interventions for crisis care lie at the center of the conflict between involuntary commitment and recovery/wellness systems in mental health services. Though crisis can mean completely different things to people who have the experience, the general public has been convinced by the media that people with psychiatric disabilities are to be feared. More and more this has led to social control but is erroneously still called treatment. This does nothing to help the person and in fact further confuses people already trying to make meaning of their experience. This paper offers a fundamental change in understanding and working with people in psychiatric crises. Rather than objectifying and naming the crisis experience in relation to illness, people can begin to explore the subjective experience of the person in crisis while offering their own subjective reality to the relationship. Out of this shared dynamic in which a greater sense of trust is built, the crisis can be an opportunity to create new meaning, and offer people mutually respectful relationships in which extreme emotional distress no longer has to be pathologized. The authors, who have had personal experience with psychiatric crises, have provided this kind of successful crisis counseling and planning and have designed and implemented peer support alternatives to psychiatric hospitalizations that support this model. PMID:12967238

  14. The Economic Crisis and Its Ethical Relevance for Public Health in Europe - an Analysis in the Perspective of the Capability Approach.

    PubMed

    Brall, Caroline; Schröder-Bäck, Peter; Brand, Helmut

    2016-03-01

    Policy responses to the economic crisis have manifest consequences to European population health and health systems. The aim of this article is to assess, by using the capability approach advanced by Sen, the ethical dimension of trade-offs made in health policy due to austerity measures. From a capability approach point of view, austerity measures such as reducing resources for health care, further deregulating the health care market or moving towards privatisation are ethically challenging since they limit opportunities and capabilities for individuals of a population. Public policies should thus aim to guarantee sufficient capabilities (options to access health care and possibilities to make healthy choices) for its populations. Prioritising those in need is a notion the capability approach particularly focuses on in its goal of supporting those with the least capabilities.

  15. The Economic Crisis and its Ethical Relevance for Public Health in Europe - an Analysis in the Perspective of the Capability Approach.

    PubMed

    Brall, Caroline; Schröder-Bäck, Peter; Brand, Helmut

    2016-03-01

    Policy responses to the economic crisis have manifest consequences to European population health and health systems. The aim of this article is to assess, by using the capability approach advanced by Sen, the ethical dimension of trade-offs made in health policy due to austerity measures. From a capability approach point of view, austerity measures such as reducing resources for health care, further deregulating the health care market or moving towards privatisation are ethically challenging since they limit opportunities and capabilities for individuals of a population. Public policies should thus aim to guarantee sufficient capabilities (options to access health care and possibilities to make healthy choices) for its populations. Prioritising those in need is a notion the capability approach particularly focuses on in its goal of supporting those with the least capabilities. PMID:27070963

  16. Health Care Systems and National Policy: Role of Leadership in the Obesity Crisis.

    PubMed

    Jones, Jessica Lynn; Sundwall, David

    2016-03-01

    Obesity, defined as a body mass index (BMI) of 30 or higher in adults and BMI in the 95th percentile or higher for children, is epidemic in the United States. The predominant culture of caloric excess and sedentary behaviors contributes to this problem. Obesity increases the risk of many chronic diseases and premature death. The broad response to this costly disease includes efforts from medical providers, local and federal governments, and nongovernmental agencies. Although obesity can be addressed on an individual basis, it is largely recognized as a public health issue.

  17. Public health response systems in-action: learning from local health departments' experiences with acute and emergency incidents.

    PubMed

    Hunter, Jennifer C; Yang, Jane E; Crawley, Adam W; Biesiadecki, Laura; Aragón, Tomás J

    2013-01-01

    As part of their core mission, public health agencies attend to a wide range of disease and health threats, including those that require routine, acute, and emergency responses. While each incident is unique, the number and type of response activities are finite; therefore, through comparative analysis, we can learn about commonalities in the response patterns that could improve predictions and expectations regarding the resources and capabilities required to respond to future acute events. In this study, we interviewed representatives from more than 120 local health departments regarding their recent experiences with real-world acute public health incidents, such as infectious disease outbreaks, severe weather events, chemical spills, and bioterrorism threats. We collected highly structured data on key aspects of the incident and the public health response, particularly focusing on the public health activities initiated and community partners engaged in the response efforts. As a result, we are able to make comparisons across event types, create response profiles, and identify functional and structural response patterns that have import for future public health preparedness and response. Our study contributes to clarifying the complexity of public health response systems and our analysis reveals the ways in which these systems are adaptive to the character of the threat, resulting in differential activation of functions and partners based on the type of incident. Continued and rigorous examination of the experiences of health departments throughout the nation will refine our very understanding of what the public health response system is, will enable the identification of organizational and event inputs to performance, and will allow for the construction of rich, relevant, and practical models of response operations that can be employed to strengthen public health systems. PMID:24236137

  18. Public Health Response Systems In-Action: Learning from Local Health Departments’ Experiences with Acute and Emergency Incidents

    PubMed Central

    Hunter, Jennifer C.; Yang, Jane E.; Crawley, Adam W.; Biesiadecki, Laura; Aragón, Tomás J.

    2013-01-01

    As part of their core mission, public health agencies attend to a wide range of disease and health threats, including those that require routine, acute, and emergency responses. While each incident is unique, the number and type of response activities are finite; therefore, through comparative analysis, we can learn about commonalities in the response patterns that could improve predictions and expectations regarding the resources and capabilities required to respond to future acute events. In this study, we interviewed representatives from more than 120 local health departments regarding their recent experiences with real-world acute public health incidents, such as infectious disease outbreaks, severe weather events, chemical spills, and bioterrorism threats. We collected highly structured data on key aspects of the incident and the public health response, particularly focusing on the public health activities initiated and community partners engaged in the response efforts. As a result, we are able to make comparisons across event types, create response profiles, and identify functional and structural response patterns that have import for future public health preparedness and response. Our study contributes to clarifying the complexity of public health response systems and our analysis reveals the ways in which these systems are adaptive to the character of the threat, resulting in differential activation of functions and partners based on the type of incident. Continued and rigorous examination of the experiences of health departments throughout the nation will refine our very understanding of what the public health response system is, will enable the identification of organizational and event inputs to performance, and will allow for the construction of rich, relevant, and practical models of response operations that can be employed to strengthen public health systems. PMID:24236137

  19. The mental health consequences of the economic crisis in Europe among the employed, the unemployed, and the non-employed.

    PubMed

    Buffel, Veerle; Van de Velde, Sarah; Bracke, Piet

    2015-11-01

    Applying a multi-level framework to the data from the European Social Survey's Round 3 (2006) and Round 6 (2012), we assessed the crisis by increases in rates of unemployment, while also controlling for countries' pre-crisis economic conditions. We found a positive relationship between depression and an increase in national unemployment rates. This relationship can be only partly ascribed to an increase in the number of unemployed and those employed in nonstandard job conditions-with the exception of the self-employed and women working part-time. The crisis effect is more pronounced among men and those between 35 and 49years of age. Moreover, in strongly effected countries, the crisis has changed the relationship between part-time work and depression, between depression and certain subcategories of the unemployed (looking for a job or not looking), and between depression and the non-employed.

  20. Nursing's response to the crisis of access, costs, and quality in health care.

    PubMed

    Schroeder, C

    1993-09-01

    Changes now taking place in the structure of health care delivery in the United States from regulatory models controlled by physicians to competitive models driven by traditional market forces of cost and quality are beginning to open opportunities for innovative nursing practice models. This article reports on the cost-effectiveness of a community nursing center for persons living with HIV/AIDS. The potential cost impact of the nursing center is significant because of the nurses' ability to forestall hospital admissions and readmissions, decrease prolonged lengths of stay, provide medically supportive outpatient treatments, care for clients at a low cost per client per year, attract professional and nonprofessional volunteer services and donations, and increase job satisfaction, thus reducing costly nurse turnover. The 1991 to 1992 costs of HIV/AIDS health care in the United States were used to estimate conservatively that the center has saved more than $700,000 in 1991 and over $1 million in 1992 in hospital charges for HIV/AIDS care. A rationale for the cost savings estimates is supplied by results of quantitative and qualitative evaluation research projects conducted at the center. Finally, implications of this analysis for future directions in nursing practice and education are discussed.

  1. Changes in the American health care system: crisis in the clinical laboratory.

    PubMed

    Conn, R B; Snyder, J W

    1997-11-01

    American medicine is undergoing unprecedented changes, and the resulting distortions are affecting the economics, organization and operations of all clinical laboratories. Professionals who work in these laboratories are facing administrative and economic pressures to reduce costs, to increase productivity, and to comply with proliferating new statutes and regulations. The medical 'cottage industry' in which the patient was the focus of the medical professionals' attention and endeavours is being replaced by the corporate management of many health care activities in which financial profits are being given first priority. Medical facilities, including clinical laboratories, are being bought and sold, being consolidated, or simply being closed. The clinical laboratories may be at the vortex of the maelstrom affecting American medicine. Cost pressures are encouraging further automation and retraining of laboratory staffs. If the leaders in laboratory medicine are unable to accomplish the necessary tasks to meet the new challenges, there inevitably is a non-medical, non-scientific financial manager at hand who is willing to define the changes and the desired outcome. Because of the rapidity of the changes taking place, it is not possible to predict with any confidence the modifications that will achieve a permanent status or the degree to which medical professionals will remain masters of their fates. The evolving health care system will become less costly, more technologically advanced, and a more challenging system in which to work.

  2. Overlooked, overworked: women's unpaid and paid work in the health services' "cost crisis".

    PubMed

    Glazer, N Y

    1988-01-01

    Dewaging shifts work from the marketplace to the household. The shift seems a short-term strategy used by capitalists, governmental policy-makers, and managers to reduce the wage bill for service workers in such areas as schooling, retailing, health services, and banking. In health services, the expansion of women's unpaid nursing in the household and a new labor process among paid nursing workers are necessary for new corporate and federal cost-containment strategies. Registered and licensed nurses, nurse's assistants and aides see their jobs eliminated, expanded, or moved from one work site to another. Increased use of outpatient clinics, in-and-out hospital stays of less than one day, and shortened hospital stays mean sick people in their homes, not hospitals. The work of caring for the sick does not disappear, however, though people may go without. Much nursing work is shifted to patients and to their families, and even to friends and neighbors. Within the family, women's unwaged work is central, supporting the new labor process among paid nurses. Wives, mothers, daughters, friends, etc., do the work once done for pay in clinics and hospitals. PMID:3346113

  3. Health educators in the workplace: helping companies respond to the AIDS crisis.

    PubMed

    Bauman, L J; Aberth, J

    1986-01-01

    As the number of cases of AIDS increases, more and more companies will have to decide how to handle employees with AIDS and those at high risk. AIDS creates medical, legal, and ethical issues in the workplace, all of which are emotional and complex; managers need expert assistance to guide their decision-making and policy development. This article identifies various dimensions of the AIDS-related issues emerging in corporations nationwide, including: confidentiality, the right of patients to work, benefits and insurance, HTLV-III screening, fears of contagion among workers, needs of companies to avoid financial and legal exposure, and effects on worker productivity. Health educators are in a unique position to contribute to the satisfactory resolution of AIDS-related problems in the workplace through their training and experience in education, policy development and the relevant legal and ethical issues in the health care field. However, they will have to initiate discussions with corporation executives themselves in order to reach this most important audience.

  4. [Telemedicine in acute stroke care--a health economics view].

    PubMed

    Günzel, F; Theiss, S; Knüppel, P; Halberstadt, S; Rose, G; Raith, M

    2010-05-01

    Specialized stroke units offer optimal treatment of patients with an acute stroke. Unfortunately, their installation is limited by an acute lack of experienced neurologists and the small number of stroke patients in sparsely populated rural areas. This problem is increasingly being solved by the use of telemedicine, so that neurological expertise is made available to basic and regular care. It has been demonstrated by national and international pilot studies that solidly based and rapid decisions can be made by telemedicine regrading the use of thrombolysis, as the most important acute treatment, but also of other interventions. So far studies have only evaluated improvement in the quality of care achieved by networking, but not of any lasting effect on any economic benefit. Complementary to a medical evaluation, the qualitative economic assessment presented here of German and American concepts of telemetric care indicate no difference in efficacy between various ways of networking. Most noteworthy, when comparing two large American and German studies, is the difference in their priorities. While the American networks achieved targeted improvements in efficacy of care that go beyond the immediate wishes of the doctors involved, this was of only secondary importance in the German studies. Also, in contrast to several American networks, the German telemetry networks have not tended to be organized for future growth. In terms of economic benefits, decentralized organized networks offer a greater potential of efficacy than purely local ones. Furthermore, the integration of inducements into the design of business models is a fundamental factor for achieving successful and lasting existence, especially within a highly competitive market.

  5. Firearms in Frail Hands: An ADL or A Public Health Crisis!

    PubMed

    Patel, Dupal; Syed, Quratulain; Messinger-Rapport, Barbara J; Rader, Erin

    2015-06-01

    The incidence of neurocognitive disorders, which may impair the ability of older adults to perform activities of daily living (ADLs), rises with age. Depressive symptoms are also common in older adults and may affect ADLs. Safe storage and utilization of firearms are complex ADLs, which require intact judgment, executive function, and visuospatial ability, and may be affected by cognitive impairment. Depression or cognitive impairment may cause paranoia, delusions, disinhibition, apathy, or aggression and thereby limit the ability to safely utilize firearms. These problems may be superimposed upon impaired mobility, arthritis, visual impairment, or poor balance. Inadequate attention to personal protection may also cause hearing impairment and accidents. In this article, we review the data on prevalence of firearms access among older adults; safety concerns due to age-related conditions; barriers to addressing this problem; indications prompting screening for firearms access; and resources available to patients, caregivers, and health care providers.

  6. The Leading Edge: Enduring a Campus Crisis

    ERIC Educational Resources Information Center

    Moeser, James

    2003-01-01

    On June 2003, the University of North Carolina at Chapel Hill (UNC) faced a frightening crisis when an employee was diagnosed with Severe Acute Respiratory Syndrome (SARS). In this article, the author looks back and identifies four factors that enabled the university to navigate this crisis. These factors were: (1) leadership at every level; (2)…

  7. Applying Roberts' Triple ABCD Model in the aftermath of crisis-inducing and trauma-inducing community disasters.

    PubMed

    Roberts, Albert R

    2006-01-01

    Natural and man-made community disasters, such as hurricanes, earthquakes, school shootings, and mass terrorist attacks, heavily impact the safety, mental health, and well-being of large numbers of individuals, families and groups. Millions of individuals who experience acute crisis episodes or psychological trauma are not consistently provided with the early psychological interventions they urgently need. There is a critical need for tools and a framework to quickly and effectively promote interventions. This article presents one such effort, the Roberts' Triple ABCD Model. This model is an up-to-date and integrated conceptual framework that helps to provide the foundation for developing a unified standard of care for crisis and disaster mental health interventions. This model can be useful in determining which early intervention methods and techniques are most likely to reduce traumatic stress, treat acute crisis and psychosocial symptoms, and promote recovery. PMID:16944790

  8. Applying Roberts' Triple ABCD Model in the aftermath of crisis-inducing and trauma-inducing community disasters.

    PubMed

    Roberts, Albert R

    2006-01-01

    Natural and man-made community disasters, such as hurricanes, earthquakes, school shootings, and mass terrorist attacks, heavily impact the safety, mental health, and well-being of large numbers of individuals, families and groups. Millions of individuals who experience acute crisis episodes or psychological trauma are not consistently provided with the early psychological interventions they urgently need. There is a critical need for tools and a framework to quickly and effectively promote interventions. This article presents one such effort, the Roberts' Triple ABCD Model. This model is an up-to-date and integrated conceptual framework that helps to provide the foundation for developing a unified standard of care for crisis and disaster mental health interventions. This model can be useful in determining which early intervention methods and techniques are most likely to reduce traumatic stress, treat acute crisis and psychosocial symptoms, and promote recovery.

  9. Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region

    PubMed Central

    2012-01-01

    Background Acute hospital discharge delays are a pressing concern for many health care administrators. In Canada, a delayed discharge is defined by the alternate level of care (ALC) construct and has been the target of many provincial health care strategies. Little is known on the patient characteristics that influence acute ALC length of stay. This study examines which characteristics drive acute ALC length of stay for those awaiting nursing home admission. Methods Population-level administrative and assessment data were used to examine 17,111 acute hospital admissions designated as alternate level of care (ALC) from a large Canadian health region. Case level hospital records were linked to home care administrative and assessment records to identify and characterize those ALC patients that account for the greatest proportion of acute hospital ALC days. Results ALC patients waiting for nursing home admission accounted for 41.5% of acute hospital ALC bed days while only accounting for 8.8% of acute hospital ALC patients. Characteristics that were significantly associated with greater ALC lengths of stay were morbid obesity (27 day mean deviation, 99% CI = ±14.6), psychiatric diagnosis (13 day mean deviation, 99% CI = ±6.2), abusive behaviours (12 day mean deviation, 99% CI = ±10.7), and stroke (7 day mean deviation, 99% CI = ±5.0). Overall, persons with morbid obesity, a psychiatric diagnosis, abusive behaviours, or stroke accounted for 4.3% of all ALC patients and 23% of all acute hospital ALC days between April 1st 2009 and April 1st, 2011. ALC patients with the identified characteristics had unique clinical profiles. Conclusions A small number of patients with non-medical days waiting for nursing home admission contribute to a substantial proportion of total non-medical days in acute hospitals. Increases in nursing home capacity or changes to existing funding arrangements should target the sub-populations identified in this

  10. Crisis Management Research Summaries

    ERIC Educational Resources Information Center

    Brock, Stephen E., Ed.; Zhe, Elizabeth; Torem, Chris; Comeaux, Natashia; Dempsey, Allison

    2010-01-01

    This article presents a summary of recent crisis management publications. The first research report summarized, "Predictors of PTSD," was a study of predictor variables for responses to the World Trade Center attack. The second paper, "Effective Mental Health Response to Catastrophic Events," looked at effective responses following Hurricane…

  11. Appealing to altruism: an alternative strategy to address the health workforce crisis in developing countries?

    PubMed Central

    Smith, Richard; Lagarde, Mylene; Blaauw, Duane; Goodman, Catherine; English, Mike; Mullei, Kethi; Pagaiya, Nonglak; Tangcharoensathien, Viroj; Erasmus, Ermin; Hanson, Kara

    2013-01-01

    Background Recruitment and retention of health workers is a major concern. Policy initiatives emphasize financial incentives, despite mixed evidence of their effectiveness. Qualitative studies suggest that nurses especially may be more driven by altruistic motivations, but quantitative research has overlooked such values. This paper adds to the literature through characterizing the nature and determinants of nurses’ altruism, based on a cross-country quantitative study. Methods An experimental ‘dictator game’ was undertaken with 1064 final year nursing students in Kenya, South Africa and Thailand between April 2007 and July 2008. This presents participants with a real financial endowment to split between themselves and another student, a patient or a poor person. Giving a greater share of this financial endowment to the other person is interpreted as reflecting greater altruism. Results Nursing students gave over 30% of their initial endowment to others (compared with 10% in similar experiments undertaken in other samples). Respondents in all three countries showed greater generosity to patients and the poor than to fellow students. Conclusions Consideration needs to be given to how to appeal to altruistic values as an alternative strategy to encourage nurses to enter the profession and remain, such as designing recruitment strategies to increase recruitment of altruistic individuals who are more likely to remain in the profession. PMID:22915772

  12. Menopause in crisis post-Women's Health Initiative? A view based on personal clinical experience.

    PubMed

    Neves-E-Castro, Manuel

    2003-12-01

    Menopausal women should not consider that hormonal treatment is an obligatory long-term commitment. Estrogen-based treatments are extremely effective for vasomotor symptom relief and for vaginal atrophy. HRT also is one of several effective methods for the primary prevention of osteoporosis. If trials were done early after the menopause when the endothelium is likely still to be intact, estrogen-based treatment might be shown to prevent coronary heart disease. However, greater efficacy is to be expected from smoking cessation, proper nutrition, exercise, moderate alcohol consumption, statins, beta-blockers and angiotensin-converting enzyme inhibitors. The treatment options for a menopausal woman should include non-drug-related strategies, non-hormonal pharmaceutical therapies as well as hormonal treatments. The first objective of this contribution is to call to the attention of practising physicians the fact that the Women's Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS) studies involved women much older than the early postmenopausal age groups for whom HRT is prescribed because of symptoms. The second objective is to emphasize that the attending physicians must not only treat the symptomatic women but also prevent the occurrence of diseases more prevalent after 60 years of age. Hormones can safely be used for the former, when not contraindicated, whereas for the latter non-pharmacological interventions and non-hormonal medications are preferable.

  13. Indoor air pollution: Acute adverse health effects and host susceptibility

    SciTech Connect

    Zummo, S.M.; Karol, M.H.

    1996-01-01

    Increased awareness of the poor quality of indoor air compared with outdoor air has resulted in a significant amount of research on the adverse health effects and mechanisms of action of indoor air pollutants. Common indoor air agents are identified, along with resultant adverse health effects, mechanisms of action, and likely susceptible populations. Indoor air pollutants range from biological agents (such as dust mites) to chemical irritants (such as nitrogen dioxide, carbon monoxide, sulfur dioxide, formaldehyde, and isocyanates). These agents may exert their effects through allergic as well as nonallergic mechanisms. While the public does not generally perceive poor indoor air quality as a significant health risk, increasing reports of illness related to indoor air and an expanding base of knowledge on the health effects of indoor air pollution are likely to continue pushing the issue to the forefront.

  14. Addressing the Human Resources for Health crisis in countries: How far have we gone? What can we expect to achieve by 2015?

    PubMed

    Dayrit, Manuel M; Dolea, Carmen; Dreesch, Norbert

    2011-06-01

    The World Health Report 2006 identified 57 countries world-wide whose health worker to population density fell below a critical threshold of 2.3 per 1,000 population. This meant that below this critical threshold, a country could not provide the basic health services to its population, defined here as 80% immunization coverage and 80% skilled birth attendance at delivery. Of the 57 countries, 36 are located in Africa. This article reviews the progress countries have made in addressing their health workforce crisis. It cites 3 of the most recent global studies and the indicators used to measure progress. It also features the experiences of 8 countries, namely Malawi, Peru, Ethiopia, Brazil, Thailand, Philippines, Zambia, Mali. Their situations provide a diverse picture of country efforts, challenges, and successes. The article asks the question of whether the target of 25% reduction in the number of crisis countries can be achieved by 2015. This was a goal set by the World Health Assembly in 2008. While the authors wish to remain optimistic about the striving towards this target, their optimism must be matched by an adequate level of investment in countries on HRH development. The next four years will show how much will really be achieved.

  15. Addressing the Human Resources for Health crisis in countries: How far have we gone? What can we expect to achieve by 2015?

    PubMed

    Dayrit, Manuel M; Dolea, Carmen; Dreesch, Norbert

    2011-06-01

    The World Health Report 2006 identified 57 countries world-wide whose health worker to population density fell below a critical threshold of 2.3 per 1,000 population. This meant that below this critical threshold, a country could not provide the basic health services to its population, defined here as 80% immunization coverage and 80% skilled birth attendance at delivery. Of the 57 countries, 36 are located in Africa. This article reviews the progress countries have made in addressing their health workforce crisis. It cites 3 of the most recent global studies and the indicators used to measure progress. It also features the experiences of 8 countries, namely Malawi, Peru, Ethiopia, Brazil, Thailand, Philippines, Zambia, Mali. Their situations provide a diverse picture of country efforts, challenges, and successes. The article asks the question of whether the target of 25% reduction in the number of crisis countries can be achieved by 2015. This was a goal set by the World Health Assembly in 2008. While the authors wish to remain optimistic about the striving towards this target, their optimism must be matched by an adequate level of investment in countries on HRH development. The next four years will show how much will really be achieved. PMID:21845315

  16. A safe electric medical bed for an acute inpatient behavioral health care setting.

    PubMed

    Wagner, John J; Ingram, Todd N

    2013-01-01

    The purpose of this article is to describe the process of developing a safe electric bed for a traditional acute care adult behavioral health inpatient unit. Many articles and studies exist related to creating a safe environment on acute care psychiatric units, but very few address the use of electric hospital beds. The process of adapting a traditional electric bed for inpatient use by the nursing management team of the Behavioral Health Service at the University of Iowa Hospitals and Clinics is described, including specific safety features in the prototype bed. Policy changes during implementation and safety data after 12 months of bed use on the units are also presented. Results indicate that traditional electric hospital beds can be safely adapted for use on traditional acute care psychiatric units.

  17. Crisis communications.

    PubMed

    Niewenhous, Daria; Sterling, Nancy

    2008-01-01

    Whether healthcare security is directly or indirectly involved in a crisis that will involve the media, it will pay to better familiarize yourself with the kind of planned responses discussed in this article to mitigate negative outcomes.

  18. Health Literacy and Mortality: A Cohort Study of Patients Hospitalized for Acute Heart Failure

    PubMed Central

    McNaughton, Candace D; Cawthon, Courtney; Kripalani, Sunil; Liu, Dandan; Storrow, Alan B; Roumie, Christianne L

    2015-01-01

    Background More than 30% of patients hospitalized for heart failure are rehospitalized or die within 90 days of discharge. Lower health literacy is associated with mortality among outpatients with chronic heart failure; little is known about this relationship after hospitalization for acute heart failure. Methods and Results Patients hospitalized for acute heart failure and discharged home between November 2010 and June 2013 were followed through December 31, 2013. Nurses administered the Brief Health Literacy Screen at admission; low health literacy was defined as Brief Health Literacy Screen ≤9. The primary outcome was all-cause mortality. Secondary outcomes were time to first rehospitalization and, separately, time to first emergency department visit within 90 days of discharge. Cox proportional hazards models determined their relationships with health literacy, adjusting for age, gender, race, insurance, education, comorbidity, and hospital length of stay. For the 1379 patients, average age was 63.1 years, 566 (41.0%) were female, and 324 (23.5%) had low health literacy. Median follow-up was 20.7 months (interquartile range 12.8 to 29.6 months), and 403 (29.2%) patients died. Adjusted hazard ratio for death among patients with low health literacy was 1.34 (95% CI 1.04, 1.73, P=0.02) compared to Brief Health Literacy Screen >9. Within 90 days of discharge, there were 415 (30.1%) rehospitalizations and 201 (14.6%) emergency department visits, with no evident association with health literacy. Conclusions Lower health literacy was associated with increased risk of death after hospitalization for acute heart failure. There was no evident relationship between health literacy and 90-day rehospitalization or emergency department visits. PMID:25926328

  19. Fear of Severe Acute Respiratory Syndrome (SARS) among Health Care Workers

    ERIC Educational Resources Information Center

    Ho, Samuel M. Y.; Kwong-Lo, Rosalie S. Y.; Mak, Christine W. Y.; Wong, Joe S.

    2005-01-01

    In this study, the authors examined fear related to severe acute respiratory syndrome (SARS) among 2 samples of hospital staff in Hong Kong. Sample 1 included health care workers (n = 82) and was assessed during the peak of the SARS epidemic. Sample 2 included hospital staff who recovered from SARS (n = 97). The results show that participants in…

  20. How To Prepare for and Respond to a Crisis.

    ERIC Educational Resources Information Center

    Lichtenstein, Robert; And Others

    This booklet presents information on school-crisis management, based on the work of a New Haven, Connecticut, regional crisis team that was initially created to address the mental-health needs of school children during the Persian Gulf War. The goals of the regional crisis committee were to develop a school-crisis intervention model, train…

  1. Mental and social health during and after acute emergencies: emerging consensus?

    PubMed Central

    van Ommeren, Mark; Saxena, Shekhar; Saraceno, Benedetto

    2005-01-01

    Mental health care programmes during and after acute emergencies in resource-poor countries have been considered controversial. There is no agreement on the public health value of the post-traumatic stress disorder concept and no agreement on the appropriateness of vertical (separate) trauma-focused services. A range of social and mental health intervention strategies and principles seem, however, to have the broad support of expert opinion. Despite continuing debate, there is emerging agreement on what entails good public health practice in respect of mental health. In terms of early interventions, this agreement is exemplified by the recent inclusion of a "mental and social aspects of health" standard in the Sphere handbook's revision on minimal standards in disaster response. This affirmation of emerging agreement is important and should give clear messages to health planners. PMID:15682252

  2. Public Health Consequences on Vulnerable Populations from Acute Chemical Releases

    PubMed Central

    Ruckart, Perri Zeitz; Orr, Maureen F.

    2008-01-01

    Data from a large, multi-state surveillance system on acute chemical releases were analyzed to describe the type of events that are potentially affecting vulnerable populations (children, elderly and hospitalized patients) in order to better prevent and plan for these types of incidents in the future. During 2003–2005, there were 231 events where vulnerable populations were within ¼ mile of the event and the area of impact was greater than 200 feet from the facility/point of release. Most events occurred on a weekday during times when day care centers or schools were likely to be in session. Equipment failure and human error caused a majority of the releases. Agencies involved in preparing for and responding to chemical emergencies should work with hospitals, nursing homes, day care centers, and schools to develop policies and procedures for initiating appropriate protective measures and managing the medical needs of patients. Chemical emergency response drills should involve the entire community to protect those that may be more susceptible to harm. PMID:21572842

  3. Management of acute respiratory infections by community health volunteers: experience of Bangladesh Rural Advancement Committee (BRAC).

    PubMed Central

    Hadi, Abdullahel

    2003-01-01

    OBJECTIVE: To assess the role of management practices for acute respiratory infections (ARIs) in improving the competency of community health volunteers in diagnosing and treating acute respiratory infections among children. METHODS: Data were collected by a group of research physicians who observed the performance of a sample of 120 health volunteers in 10 sub-districts in Bangladesh in which Bangladesh Rural Advancement Committee (BRAC) had run a community-based ARI control programme since mid-1992. Standardized tests were conducted until the 95% interphysician reliability on the observation of clinical examination was achieved. FINDINGS:The sensitivity, specificity, and overall agreement rates in diagnosing and treating ARIs were significantly higher among the health volunteers who had basic training and were supervised routinely than among those who had not. CONCLUSION: Diagnosis and treatment of ARIs at the household level in developing countries are possible if intensive basic training and the close supervision of service providers are ensured. PMID:12764514

  4. Comparison of Acute Health Effects From Exposures to Diesel and Biodiesel Fuel Emissions

    PubMed Central

    Mehus, Aaron A.; Reed, Rustin J.; Lee, Vivien S. T.; Littau, Sally R.; Hu, Chengcheng; Lutz, Eric A.

    2015-01-01

    Objective: To investigate the comparative acute health effects associated with exposures to diesel and 75% biodiesel/25% diesel (B75) blend fuel emissions. Methods: We analyzed multiple health endpoints in 48 healthy adults before and after exposures to diesel and B75 emissions in an underground mine setting—lung function, lung and systemic inflammation, novel biomarkers of exposure, and oxidative stress were assessed. Results: B75 reduced respirable diesel particulate matter by 20%. Lung function declined significantly more after exposure to diesel emissions. Lung inflammatory cells along with sputum and plasma inflammatory mediators increased significantly to similar levels with both exposures. Urinary 8-hydroxydeoxyguanosine, a marker of oxidative stress, was not significantly changed after either exposure. Conclusions: Use of B75 lowered respirable diesel particulate matter exposure and some associated acute health effects, although lung and systemic inflammation were not reduced compared with diesel use. PMID:26147538

  5. Acute health effects after exposure to chlorine gas released after a train derailment⋆

    PubMed Central

    Van Sickle, David; Wenck, Mary Anne; Belflower, Amy; Drociuk, Dan; Ferdinands, Jill; Holguin, Fernando; Svendsen, Erik; Bretous, Lena; Jankelevich, Shirley; Gibson, James J.; Garbe, Paul; Moolenaar, Ronald L.

    2015-01-01

    In January 2005, a train derailment on the premises of a textile mill in South Carolina released 42 to 60 tons of chlorine gas in the middle of a small town. Medical records and autopsy reports were reviewed to describe the clinical presentation, hospital course, and pathology observed in persons hospitalized or deceased as a result of chlorine gas exposure. Eight persons died before reaching medical care; of the 71 persons hospitalized for acute health effects as a result of chlorine exposure, 1 died in the hospital. The mean age of the hospitalized persons was 40 years (range, 4 months-76 years); 87% were male. The median duration of hospitalization was 4 days (range, 1-29 days). Twenty-five (35%) persons were admitted to the intensive care unit; the median length of stay was 3 days. Many surviving victims developed significant pulmonary signs and severe airway inflammation; 41 (58%) hospitalized persons met Po2/Fio2 criteria for acute respiratory distress syndrome or acute lung injury. During their hospitalization, 40 (57%) developed abnormal x-ray findings, 74% of those within the first day. Hypoxia on room air and Po2/Fio2 ratio predicted severity of outcome as assessed by the duration of hospitalization and the need for intensive care support. This community release of chlorine gas caused widespread exposure and resulted in significant acute health effects and substantial health care requirements. Pulse oximetry and arterial blood gas analysis provided early indications of outcome severity. PMID:19041527

  6. Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research.

    PubMed

    1994-12-01

    This Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline version of Acute Low Back Problems in Adults, which was developed by a private-sector panel of health care providers and consumers. The Quick Reference Guide is an example of how a clinician might implement the panel's findings and recommendations on the management of acute low back problems in working-age adults. Topics covered include the initial assessment of patients presenting with acute low back problems, identification of red flags that may indicate the presence of a serious underlying medical condition, initial management, special studies and diagnostic considerations, and further management considerations. Instructions for clinical testing for sciatic tension, recommendations for sitting and unassisted lifting, tests for identification of clinical pathology, and algorithms for patient management are included.

  7. Correlation of oral health of children with acute leukemia during the induction phase

    PubMed Central

    Dholam, Kanchan P.; Gurav, Sandeep; Dugad, Jinesh; Banavli, Shripad

    2014-01-01

    Background: Treatment of acute leukemia's- a common childhood malignancy, involves intensive and powerful multi-drug chemotherapeutic regime. Oral lesions are a common complication in these patients affecting oral health status. Aim: This study was conducted to evaluate and assess the oral health status of newly diagnosed leukemic pediatric patients during induction phase and its correlation to outcome of induction therapy. Material Methods: Oral examinations was done in 33 children between the age group of 5-15 years with acute lymphoblastic leukemia (ALL) and acute myloblastic leukemia (AML), who were undergoing chemotherapy. Oral Hygiene Index- Simplified, (OHI-S) decayed missing filled teeth index (def/DMFT), Loe and Sillness index for gingiva, and complete blood count at first and fourth week of induction phase were recorded for each patient. The changes in the oral health status were analyzed with Wilcoxon signed rank test. Results: During an induction phase it was observed that level of OHI-S (P = 0.002), Loe and Sillness index (P = 0.003), def/DMFT index (P = 0.076), platelet count (P = 0.00) increased significantly and no significant difference was noted in hemoglobin (P = 0.4) and total leucocytes count (P = 0.11). Conclusion: It was observed that, although oral health status had significantly worsened, the induction outcome was not affected. PMID:25006282

  8. Acute effects of aerobic stretching, health and happiness improving movement exercise on cortical activity of children.

    PubMed

    Choi, Hyungsoo; Park, Sangjun; Kim, Kyekyoon Kevin; Lee, Kwanghee; Rhyu, Hyun-Seung

    2016-08-01

    Acute high-intensity physical exercise is known to improve cognitive performance of children, including those with attention-deficit/hyperactivity disorder (ADHD). In this work, we investigated the acute effect of an aerobic stretching and moderate-intensity, health and happiness improving movement (HHIM) exercise on the cortical activity of children with and without ADHD using electroencephalography (EEG). Children aged 12 to 14 yr with combined-type ADHD and age-matched healthy controls participated in the study, performing two individual movements (n=79, 35 controls) and a single exercise bout (n=45, 18 controls). electroencephalographic signals were recorded before and immediately after each movement, and before and after acute exercise under resting conditions, to obtain absolute and relative power estimates for the theta (3.5-8 Hz), alpha (8-12 Hz), sensory motor rhythm (12-16 Hz), and beta (16-25 Hz) bands. After acute HHIM exercise, all children showed significant changes in their relative EEG, mainly in the theta and alpha bands. Individual movements were found to influence relative theta, alpha and beta, and theta-to-beta ratios. He presents aerobic stretching HHIM exercise has demonstrated acute effect on the cortical activity of children.

  9. Acute effects of aerobic stretching, health and happiness improving movement exercise on cortical activity of children

    PubMed Central

    Choi, Hyungsoo; Park, Sangjun; Kim, Kyekyoon Kevin; Lee, Kwanghee; Rhyu, Hyun-Seung

    2016-01-01

    Acute high-intensity physical exercise is known to improve cognitive performance of children, including those with attention-deficit/hyperactivity disorder (ADHD). In this work, we investigated the acute effect of an aerobic stretching and moderate-intensity, health and happiness improving movement (HHIM) exercise on the cortical activity of children with and without ADHD using electroencephalography (EEG). Children aged 12 to 14 yr with combined-type ADHD and age-matched healthy controls participated in the study, performing two individual movements (n=79, 35 controls) and a single exercise bout (n=45, 18 controls). electroencephalographic signals were recorded before and immediately after each movement, and before and after acute exercise under resting conditions, to obtain absolute and relative power estimates for the theta (3.5–8 Hz), alpha (8–12 Hz), sensory motor rhythm (12–16 Hz), and beta (16–25 Hz) bands. After acute HHIM exercise, all children showed significant changes in their relative EEG, mainly in the theta and alpha bands. Individual movements were found to influence relative theta, alpha and beta, and theta-to-beta ratios. He presents aerobic stretching HHIM exercise has demonstrated acute effect on the cortical activity of children. PMID:27656629

  10. Acute effects of aerobic stretching, health and happiness improving movement exercise on cortical activity of children

    PubMed Central

    Choi, Hyungsoo; Park, Sangjun; Kim, Kyekyoon Kevin; Lee, Kwanghee; Rhyu, Hyun-Seung

    2016-01-01

    Acute high-intensity physical exercise is known to improve cognitive performance of children, including those with attention-deficit/hyperactivity disorder (ADHD). In this work, we investigated the acute effect of an aerobic stretching and moderate-intensity, health and happiness improving movement (HHIM) exercise on the cortical activity of children with and without ADHD using electroencephalography (EEG). Children aged 12 to 14 yr with combined-type ADHD and age-matched healthy controls participated in the study, performing two individual movements (n=79, 35 controls) and a single exercise bout (n=45, 18 controls). electroencephalographic signals were recorded before and immediately after each movement, and before and after acute exercise under resting conditions, to obtain absolute and relative power estimates for the theta (3.5–8 Hz), alpha (8–12 Hz), sensory motor rhythm (12–16 Hz), and beta (16–25 Hz) bands. After acute HHIM exercise, all children showed significant changes in their relative EEG, mainly in the theta and alpha bands. Individual movements were found to influence relative theta, alpha and beta, and theta-to-beta ratios. He presents aerobic stretching HHIM exercise has demonstrated acute effect on the cortical activity of children.

  11. Acute effects of aerobic stretching, health and happiness improving movement exercise on cortical activity of children.

    PubMed

    Choi, Hyungsoo; Park, Sangjun; Kim, Kyekyoon Kevin; Lee, Kwanghee; Rhyu, Hyun-Seung

    2016-08-01

    Acute high-intensity physical exercise is known to improve cognitive performance of children, including those with attention-deficit/hyperactivity disorder (ADHD). In this work, we investigated the acute effect of an aerobic stretching and moderate-intensity, health and happiness improving movement (HHIM) exercise on the cortical activity of children with and without ADHD using electroencephalography (EEG). Children aged 12 to 14 yr with combined-type ADHD and age-matched healthy controls participated in the study, performing two individual movements (n=79, 35 controls) and a single exercise bout (n=45, 18 controls). electroencephalographic signals were recorded before and immediately after each movement, and before and after acute exercise under resting conditions, to obtain absolute and relative power estimates for the theta (3.5-8 Hz), alpha (8-12 Hz), sensory motor rhythm (12-16 Hz), and beta (16-25 Hz) bands. After acute HHIM exercise, all children showed significant changes in their relative EEG, mainly in the theta and alpha bands. Individual movements were found to influence relative theta, alpha and beta, and theta-to-beta ratios. He presents aerobic stretching HHIM exercise has demonstrated acute effect on the cortical activity of children. PMID:27656629

  12. Acute mental health service delivery to Indigenous women: What is known?

    PubMed

    Bradley, Pat; Dunn, Sandra; Lowell, Anne; Nagel, Tricia

    2015-12-01

    The Australian College of Mental Health Nurses directs that mental health nurses must 'enable cultural safety in practice, taking into account age, gender, spirituality, ethnicity and health values'. The present study is a review of the existing literature undertaken in order to identify current knowledge and knowledge gaps regarding the experience of Indigenous women in acute mental health inpatient facilities. In particular, studies that identified environments and practices promoting the development of culturally-safe healing spaces for Indigenous women, and studies that identified women's experience of seclusion, were sought. The results showed that there is little literature directly relevant to Indigenous women's experiences of inpatient mental health units in Australia. The present study consolidates existing knowledge and knowledge gaps, and advances the argument for gender-disaggregated future research. Implications for professional practice and service development are also noted.

  13. Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review

    PubMed Central

    Kornhaber, Rachel; Walsh, Kenneth; Duff, Jed; Walker, Kim

    2016-01-01

    Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician–patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients’ experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships. PMID:27789958

  14. Increased systolic blood pressure reactivity to acute stress is related with better self-reported health

    PubMed Central

    Wright, Bradley J.; O'Brien, Shaun; Hazi, Agnes; Kent, Stephen

    2014-01-01

    The stress reactivity hypothesis posits that the magnitude of cardiovascular reactions to acute stress tasks is related with future blood pressure status, heart hypertrophy, and atherosclerosis. We assessed the stress reactivity hypothesis and aimed to identify which physiological indices (blood pressure, heart-rate, cortisol, salivary immunoglobulin A (sIgA)) related to self-reported mental and physical health. We also assessed if physiological reactions elicited by an acute stressor were more related than basal assessments. Participants provided physiological samples, self-reported stress and health-data before and after an assessed 5–7 minute academic oral presentation. In hierarchical regression models, increased systolic and reduced sIgA reactivity was associated with better perceptions of mental health. Reactivity data were more related to self-reported data than basal data. In line with the only 2 studies to assess the reactivity hypothesis with self-perceived health, increased systolic reactivity was best associated with better perceived physical and mental health. The findings suggest that increased SBP reactivity may also be associated with positive health outcomes. Further research is required to determine if increased or decreased sIgA reactivity is most predictive of future morbidity. PMID:25391460

  15. Infectious Etiologies of Acute Febrile Illness among Patients Seeking Health Care in South-Central Cambodia

    PubMed Central

    Kasper, Matthew R.; Blair, Patrick J.; Touch, Sok; Sokhal, Buth; Yasuda, Chadwick Y.; Williams, Maya; Richards, Allen L.; Burgess, Timothy H.; Wierzba, Thomas F.; Putnam, Shannon D.

    2012-01-01

    The agents of human febrile illness can vary by region and country suggesting that diagnosis, treatment, and control programs need to be based on a methodical evaluation of area-specific etiologies. From December 2006 to December 2009, 9,997 individuals presenting with acute febrile illness at nine health care clinics in south-central Cambodia were enrolled in a study to elucidate the etiologies. Upon enrollment, respiratory specimens, whole blood, and serum were collected. Testing was performed for viral, bacterial, and parasitic pathogens. Etiologies were identified in 38.0% of patients. Influenza was the most frequent pathogen, followed by dengue, malaria, and bacterial pathogens isolated from blood culture. In addition, 3.5% of enrolled patients were infected with more than one pathogen. Our data provide the first systematic assessment of the etiologies of acute febrile illness in south-central Cambodia. Data from syndromic-based surveillance studies can help guide public health responses in developing nations. PMID:22302857

  16. Infectious etiologies of acute febrile illness among patients seeking health care in south-central Cambodia.

    PubMed

    Kasper, Matthew R; Blair, Patrick J; Touch, Sok; Sokhal, Buth; Yasuda, Chadwick Y; Williams, Maya; Richards, Allen L; Burgess, Timothy H; Wierzba, Thomas F; Putnam, Shannon D

    2012-02-01

    The agents of human febrile illness can vary by region and country suggesting that diagnosis, treatment, and control programs need to be based on a methodical evaluation of area-specific etiologies. From December 2006 to December 2009, 9,997 individuals presenting with acute febrile illness at nine health care clinics in south-central Cambodia were enrolled in a study to elucidate the etiologies. Upon enrollment, respiratory specimens, whole blood, and serum were collected. Testing was performed for viral, bacterial, and parasitic pathogens. Etiologies were identified in 38.0% of patients. Influenza was the most frequent pathogen, followed by dengue, malaria, and bacterial pathogens isolated from blood culture. In addition, 3.5% of enrolled patients were infected with more than one pathogen. Our data provide the first systematic assessment of the etiologies of acute febrile illness in south-central Cambodia. Data from syndromic-based surveillance studies can help guide public health responses in developing nations.

  17. Severe acute respiratory syndrome: a challenge for public health practice in Hong Kong

    PubMed Central

    Lee, A; Abdullah, A

    2003-01-01

    Severe acute respiratory syndrome (SARS) is now a global challenge affecting more than 8000 patients in different continents. The dictum of public health practice especially for infectious disease is "prevention better than cure". It is especially true for SARS as the treatment strategies remain diverse and experimental. Maintaining a healthy and hygienic environment can be one of the effective public health measures to combat infectious disease. The major challenge is that some of the most important public health measures are to be taken outside the health sector. The community also needs to be strengthened and equipped with the health skills to promote better health and hygiene. There is also the need to create a supportive environment conducive to health for long term sustainability. The WHO approach of promoting health through setting approach would be one possible solution to face the challenge. This paper will describe some of the public health initiatives in Hong Kong through "setting approach" and "community development model" in helping the society fight against SARS. With the emergence of SARS, this might be the time to globalise public health medicine as an important component of medical practice. PMID:12933766

  18. Crisis Management

    ERIC Educational Resources Information Center

    Brock, Stephen E., Ed.

    2011-01-01

    This paper presents summaries of four articles relevant to school crisis response. The first article, "Peritraumatic Dissociation Predicts Posttraumatic Stress in Youth Following Accidents" summarized by Jim Matthews, suggests that peritraumatic dissociation is a powerful predictor of PTSD symptoms among youth who have been in a car accident. The…

  19. Managing patients with behavioral health problems in acute care: balancing safety and financial viability.

    PubMed

    Rape, Cyndy; Mann, Tammy; Schooley, John; Ramey, Jana

    2015-01-01

    With a recent decrease in community resources for the mental health population, acute care facilities must seek creative, cost-effective ways to protect and care for these vulnerable individuals. This article describes 1 facility's journey to maintaining patient and staff safety while reducing cost. Success factors of this program include staff engagement, environmental modifications, and a nurse-driven, sitter-reduction process. PMID:25479169

  20. Self-Reported Acute Health Effects and Exposure to Companion Animals.

    PubMed

    Krueger, W S; Hilborn, E D; Dufour, A P; Sams, E A; Wade, T J

    2016-06-01

    To understand the etiological burden of disease associated with acute health symptoms [e.g. gastrointestinal (GI), respiratory, dermatological], it is important to understand how common exposures influence these symptoms. Exposures to familiar and unfamiliar animals can result in a variety of health symptoms related to infection, irritation and allergy; however, few studies have examined this association in a large-scale cohort setting. Cross-sectional data collected from 50 507 participants in the United States enrolled from 2003 to 2009 were used to examine associations between animal contact and acute health symptoms during a 10-12 day period. Fixed-effects multivariable logistic regression estimated adjusted odds ratios (AORs) and 95% confident intervals (CI) for associations between animal exposures and outcomes of GI illness, respiratory illness and skin/eye symptoms. Two-thirds of the study population (63.2%) reported direct contact with animals, of which 7.7% had contact with at least one unfamiliar animal. Participants exposed to unfamiliar animals had significantly higher odds of self-reporting all three acute health symptoms, when compared to non-animal-exposed participants (GI: AOR = 1.4, CI = 1.2-1.7; respiratory: AOR = 1.5, CI = 1.2-1.8; and skin/eye: AOR = 1.9, CI = 1.6-2.3), as well as when compared to participants who only had contact with familiar animals. Specific contact with dogs, cats or pet birds was also significantly associated with at least one acute health symptom; AORs ranged from 1.1 to 1.5, when compared to participants not exposed to each animal. These results indicate that contact with animals, especially unfamiliar animals, was significantly associated with GI, respiratory and skin/eye symptoms. Such associations could be attributable to zoonotic infections and allergic reactions. Etiological models for acute health symptoms should consider contact with companion animals, particularly exposure to unfamiliar animals

  1. Using Personal Sensors to Assess the Exposome and Acute Health Effects

    PubMed Central

    Nieuwenhuijsen, Mark J.; Donaire-Gonzalez, David; Foraster, Maria; Martinez, David; Cisneros, Andres

    2014-01-01

    Introduction: The exposome encompasses the totality of human environmental exposures. Recent developments in sensor technology have made it possible to better measure personal exposure to environmental pollutants and other factors. We aimed to discuss and demonstrate the recent developments in personal sensors to measure multiple exposures and possible acute health responses, and discuss the main challenges ahead. Methods: We searched for a range of sensors to measure air pollution, noise, temperature, UV, physical activity, location, blood pressure, heart rate and lung function and to obtain information on green space and emotional status/mood and put it on a person. Results and Conclusions: We discussed the recent developments and main challenges for personal sensors to measure multiple exposures. We found and put together a personal sensor set that measures a comprehensive set of personal exposures continuously over 24 h to assess part of the current exposome and acute health responses. We obtained data for a whole range of exposures and some acute health responses, but many challenges remain to apply the methodology for extended time periods and larger populations including improving the ease of wear, e.g., through miniaturization and extending battery life, and the reduction of costs. However, the technology is moving fast and opportunities will come closer for further wide spread use to assess, at least part of the exposome. PMID:25101766

  2. Ethical, Political and Societal Implications of the Open Access Journal Movement in the Era of Economic Crisis, with Emphasis on Public Health Pharmacogenomics.

    PubMed

    Bragazzi, Nicola Luigi

    2013-12-01

    Publication of the research outputs is a vital step of the research processes and a gateway between the laboratory and the global society. Open Access is revolutionizing the dissemination of scientific ideas, particularly in the field of public health pharmacogenomics that examines the ways in which pharmacogenomics impacts health systems and services at a societal level, rather than a narrow bench to bedside model of translation science. This manuscript argues that despite some limitations and drawbacks, open access has profound ethical, political and societal implications especially on underdeveloped and developing countries, and that it provides opportunities for science to grow in these resource-limited countries, particularly in the era of a severe economic and financial crisis that is imposing cuts and restrictions to research.

  3. Ethical, Political and Societal Implications of the Open Access Journal Movement in the Era of Economic Crisis, with Emphasis on Public Health Pharmacogenomics.

    PubMed

    Bragazzi, Nicola Luigi

    2013-12-01

    Publication of the research outputs is a vital step of the research processes and a gateway between the laboratory and the global society. Open Access is revolutionizing the dissemination of scientific ideas, particularly in the field of public health pharmacogenomics that examines the ways in which pharmacogenomics impacts health systems and services at a societal level, rather than a narrow bench to bedside model of translation science. This manuscript argues that despite some limitations and drawbacks, open access has profound ethical, political and societal implications especially on underdeveloped and developing countries, and that it provides opportunities for science to grow in these resource-limited countries, particularly in the era of a severe economic and financial crisis that is imposing cuts and restrictions to research. PMID:25045411

  4. School-Based Mental Health Program Evaluation: Children's School Outcomes and Acute Mental Health Service Use

    ERIC Educational Resources Information Center

    Kang-Yi, Christina D.; Mandell, David S.; Hadley, Trevor

    2013-01-01

    Background: This study examined the impact of school-based mental health programs on children's school outcomes and the utilization of acute mental health services. Methods: The study sample included 468 Medicaid-enrolled children aged 6 to 17 years who were enrolled 1 of 2 school-based mental health programs (SBMHs) in a metropolitan area…

  5. Explaining quality of life with crisis theory.

    PubMed

    Sprangers, Mirjam A G; Tempelaar, Reike; van den Heuvel, Wim J A; de Haes, Hanneke C J M

    2002-01-01

    Based on the premises of crisis theory, we expected cancer patients in-crisis to report a poorer quality of life (QL) and cancer patients post-crisis to report a similar level of overall QL in comparison to healthy individuals. To explain these hypothesized findings, we expected the coping resources and strategies of patients in-crisis to be equally effective and those of patients post-crisis to be more effective as compared to those of healthy individuals. The sample consisted of: (a) 217 consecutive cancer patients in the acute phases of their illness (patients in-crisis); (b) 192 disease-free cancer patients (patients post-crisis); and (c) 201 randomly selected healthy individuals. Established measures of QL, self-esteem and neuroticism (coping resources) and coping behavior (coping strategies) were mailed. As expected, patients in-crisis reported a poorer QL (p < 0.001) and patients post-crisis a similar overall QL as compared to healthy individuals. There were no significant or systematic differences between the mean levels of coping resources and strategies between the respective groups. Two-way analysis of variance indicated a group X coping resource interaction effect on overall QL for self-esteem (p < 0.01). As expected, the amount of variance of overall QL explained by self-esteem was largest for patients post-crisis (27%) and comparable for patients in-crisis and healthy individuals (10 and 11%). Patients in-crisis were not able to make their coping resources and strategies more effective, whereas patients post-crisis seemed to have enhanced the effectiveness of self-esteem in restoring their QL as compared to healthy persons.

  6. The impact of the monetary crisis and the development of a health and social safety-net with a special note on donor participation--real life experiences on the role of health services in public health.

    PubMed

    Suparmanto, S A; Sundoro, T; Stokoe, P

    1999-01-01

    South-East Asia (i.e. Indonesia) has enjoyed economic boom and rapid unbridled growth for the last decade. This rapid expansion was fuelled by cheap labour, foreign and local investments and the extensive development of the oil and non-oil sector. Dark clouds, however, loomed on the economic and financial horizons of these rapidly developing 'tiger' economies. Indonesia was not only affected by various facts-of-life elements which contributed to these grave forecasts but also by a wave of natural disasters on an unprecedented scale, with devastating social and economic effects on the poor and susceptible groups. Although economic recovery will take time, the most pressing and practical measure remains the need to create a health and social safety net to maintain the health, social and nutritional status of the "population-at-risk". This paper is an exposure of "lessons learnt" and the invaluable role of health services and public health to the negative impact of the monetary crisis experienced by various inter-sectors, which the authors believe can be used as a long-term investment measure in other countries.

  7. Pathways to catastrophic health expenditure for acute coronary syndrome in Kerala: ‘Good health at low cost’?

    PubMed Central

    2012-01-01

    Background Universal health coverage through the removal of financial and other barriers to access, particularly for people who are poor, is a global priority. This viewpoint describes the many pathways to catastrophic health expenditure (CHE) for patients with Acute Coronary Syndrome (ACS) based on two case studies and the thematic analysis of field notes regarding 210 patients and their households from a study based in Kerala, India. Discussion There is evidence of the severe financial impact of non-communicable diseases (NCDs), which is in contradiction to the widely acclaimed Kerala model: Good health at low cost. However, it is important to look beyond the out-of-pocket expenditure (OOPE) and CHE to the possible pathways and identify the triggers that make families vulnerable to CHE. The identified pathways include a primary and secondary loop. The primary pathway describes the direct path by which families experience CHE. These include: 1) factors related to the pre-event period that increase the likelihood of experiencing CHE, such as being from the lower socio-economic strata (SES), past financial losses or loans that leave families with no financial shock absorber at the time of illness; 2) factors related to the acute event, diagnosis, treatment and hospitalization and expenditures incurred for the same and; 3) factors related to the post-event period such as loss of gainful employment and means of financing both the acute period and the long-term management particularly through distress financing. The secondary pathway arises from the primary and includes: 1) the impact of distress financing and; 2) the long- and short- term consequences of CHE. These factors ultimately result in a vicious cycle of debt and poverty through non-compliance and repeat acute events. Summary This paper outlines the direct and indirect pathways by which patients with ACS and their families are trapped in a vicious cycle of debt and poverty. It also contradicts the prevailing

  8. Crisis behavior

    SciTech Connect

    Grinspoon, L.

    1984-04-01

    The Department of Defense has rules and procedures to minimize the opportunity for error and improper behavior among those with access to strategic weapons, but no psychiatric screening system can predict with assurance who will or will not behave rationally during a crisis. Personal problems and institutional decision-making pressures may destroy nuclear deterrence. Certain features of military life, including drug and alcohol abuse, heavy responsibility, tension, and group decision making, can destreoy rationality. 12 references.

  9. [Health services supply and the economic crisis: either we fund goods and services according to their value or we become bankrupt. SESPAS report 2014].

    PubMed

    Bernal-Delgado, Enrique; Campillo-Artero, Carlos; García-Armesto, Sandra

    2014-06-01

    Health policy has reacted to the financial crisis by overemphasising measures targeted at reducing unit costs, increasing barriers to access (waiting lists) or closing premises. It is too soon for scientific assessment of the impact of this reshaping of supply on equity, quality and safety, and on individual and population health. Nevertheless, the emergency measures taken to achieve fiscal stabilization have shifted the focus to resolving budget problems at the expenses of sounder and deeper initiatives aimed at deciding what must be funded and how. This article advocates a policy based on selective funding of services and benefits on the basis of their value. Other countries' experiences can serve as a useful guide, including robust methods to identify technologies (or their uses) of questionable value, prioritization criteria, and careful consideration of limitations associated with the elimination of a certain benefit, especially if it affects the founding values of the system. The necessary tools are available to the Spanish health system: the regulatory framework and technical bodies able to identify lower value care, support for decision-making, and timely evaluation of such decisions. Despite the numerous hurdles, maintaining the status quo is too expensive a choice, given the opportunity costs of effectiveness and safety losses, measured in terms of equity and the economic efficiency of the Spanish health system, which may ultimately translate into worsening of the population's health status. PMID:24666570

  10. [Health services supply and the economic crisis: either we fund goods and services according to their value or we become bankrupt. SESPAS report 2014].

    PubMed

    Bernal-Delgado, Enrique; Campillo-Artero, Carlos; García-Armesto, Sandra

    2014-06-01

    Health policy has reacted to the financial crisis by overemphasising measures targeted at reducing unit costs, increasing barriers to access (waiting lists) or closing premises. It is too soon for scientific assessment of the impact of this reshaping of supply on equity, quality and safety, and on individual and population health. Nevertheless, the emergency measures taken to achieve fiscal stabilization have shifted the focus to resolving budget problems at the expenses of sounder and deeper initiatives aimed at deciding what must be funded and how. This article advocates a policy based on selective funding of services and benefits on the basis of their value. Other countries' experiences can serve as a useful guide, including robust methods to identify technologies (or their uses) of questionable value, prioritization criteria, and careful consideration of limitations associated with the elimination of a certain benefit, especially if it affects the founding values of the system. The necessary tools are available to the Spanish health system: the regulatory framework and technical bodies able to identify lower value care, support for decision-making, and timely evaluation of such decisions. Despite the numerous hurdles, maintaining the status quo is too expensive a choice, given the opportunity costs of effectiveness and safety losses, measured in terms of equity and the economic efficiency of the Spanish health system, which may ultimately translate into worsening of the population's health status.

  11. Influence of age, previous health status, and severity of acute illness on outcome from intensive care.

    PubMed

    Le Gall, J R; Brun-Buisson, C; Trunet, P; Latournerie, J; Chantereau, S; Rapin, M

    1982-09-01

    Age, previous health status (HS), and severity of acute illness were assessed prospectively on 228 unselected patients admitted over 1 yr to the multidisciplinary ICU, to determine their influence on outcome. One hundred and fifty patients (66%) were discharged from the ICU, but the survival rate fell to 50% at 6 months, and was similar after 1 yr (49%). Over a 6-month period, there was improved HS in survivors which gradually leveled off. Compared to prior HS, the final HS was worsened in 37% of survivors. Three factors were important predictors of late survival: age under 50, good previous HS, and less than two visceral failures. We conclude that evaluation of ICU outcome should provide information on 6-month survival and HS and include important variables as age, previous HS, and severity of acute illness. PMID:7105766

  12. Assessment of the Acute and Chronic Health Hazards of Hydraulic Fracturing Fluids.

    PubMed

    Wattenberg, Elizabeth V; Bielicki, Jeffrey M; Suchomel, Ashley E; Sweet, Jessica T; Vold, Elizabeth M; Ramachandran, Gurumurthy

    2015-01-01

    There is growing concern about how hydraulic fracturing affects public health because this activity involves handling large volumes of fluids that contain toxic and carcinogenic constituents, which are injected under high pressure through wells into the subsurface to release oil and gas from tight shale formations. The constituents of hydraulic fracturing fluids (HFFs) present occupational health risks because workers may be directly exposed to them, and general public health risks because of potential air and water contamination. Hazard identification, which focuses on the types of toxicity that substances may cause, is an important step in the complex health risk assessment of hydraulic fracturing. This article presents a practical and adaptable tool for the hazard identification of HFF constituents, and its use in the analysis of HFF constituents reported to be used in 2,850 wells in North Dakota between December 2009 and November 2013. Of the 569 reported constituents, 347 could be identified by a Chemical Abstract Service Registration Number (CASRN) and matching constituent name. The remainder could not be identified either because of trade secret labeling (210) or because of an invalid CASRN (12). Eleven public databases were searched for health hazard information on thirteen health hazard endpoints for 168 identifiable constituents that had at least 25 reports of use. Health hazard counts were generated for chronic and acute endpoints, including those associated with oral, inhalation, ocular, and dermal exposure. Eleven of the constituents listed in the top 30 by total health hazard count were also listed in the top 30 by reports of use. This includes naphthalene, which along with benzyl chloride, has the highest health hazard count. The top 25 constituents reportedly used in North Dakota largely overlap with those reported for Texas and Pennsylvania, despite different geologic formations, target resources (oil vs. gas), and disclosure requirements

  13. Assessment of the Acute and Chronic Health Hazards of Hydraulic Fracturing Fluids.

    PubMed

    Wattenberg, Elizabeth V; Bielicki, Jeffrey M; Suchomel, Ashley E; Sweet, Jessica T; Vold, Elizabeth M; Ramachandran, Gurumurthy

    2015-01-01

    There is growing concern about how hydraulic fracturing affects public health because this activity involves handling large volumes of fluids that contain toxic and carcinogenic constituents, which are injected under high pressure through wells into the subsurface to release oil and gas from tight shale formations. The constituents of hydraulic fracturing fluids (HFFs) present occupational health risks because workers may be directly exposed to them, and general public health risks because of potential air and water contamination. Hazard identification, which focuses on the types of toxicity that substances may cause, is an important step in the complex health risk assessment of hydraulic fracturing. This article presents a practical and adaptable tool for the hazard identification of HFF constituents, and its use in the analysis of HFF constituents reported to be used in 2,850 wells in North Dakota between December 2009 and November 2013. Of the 569 reported constituents, 347 could be identified by a Chemical Abstract Service Registration Number (CASRN) and matching constituent name. The remainder could not be identified either because of trade secret labeling (210) or because of an invalid CASRN (12). Eleven public databases were searched for health hazard information on thirteen health hazard endpoints for 168 identifiable constituents that had at least 25 reports of use. Health hazard counts were generated for chronic and acute endpoints, including those associated with oral, inhalation, ocular, and dermal exposure. Eleven of the constituents listed in the top 30 by total health hazard count were also listed in the top 30 by reports of use. This includes naphthalene, which along with benzyl chloride, has the highest health hazard count. The top 25 constituents reportedly used in North Dakota largely overlap with those reported for Texas and Pennsylvania, despite different geologic formations, target resources (oil vs. gas), and disclosure requirements

  14. The hepatitis C crisis.

    PubMed

    St John, Tina M; Sandt, Lorren

    2005-01-01

    An estimated 170 million persons (3% of the world's population) are infected with the hepatitis C virus (HCV), and 3 to 4 million persons are newly infected each year. Of those infected, 70%-85% develop chronic viremia with the potential for devastating long-term sequelae, including chronic liver disease, cirrhosis, hepatic failure, and hepatocellular carcinoma. The passivity in the public health sector and in the medical community at large with respect to hepatitis C portends a myriad of societal, fiscal, and personal costs for the United States within the next two decades unless immediate actions are taken to intervene in the natural history of this emerging public health crisis. PMID:15822840

  15. Continuous quality improvement in acute health care: creating a holistic and integrated approach.

    PubMed

    Sewell, N

    1997-01-01

    Reviews the range of quality activity in a National Health Service hospital trust, using a staff questionnaire survey, self-assessment against the Baldrige Quality Award criteria, and the application of the SERVQUAL approach to service quality assessment. Reviews the acute health care quality programme literature. Finds that there are needs for greater integration of quality effort, to engage with patients in a more meaningful manner, and to achieve greater commitment and involvement from clinicians and managers. Identifies lack of time and resources as a major barrier to greater application of quality programmes. Explores ways of developing a more holistic and integrated programme of quality improvement. Describes the creation and implementation of a model for continuous improvement in health care quality.

  16. Hypercalcemic crisis: a clinical review.

    PubMed

    Ahmad, Shazia; Kuraganti, Gayatri; Steenkamp, Devin

    2015-03-01

    Hypercalcemia is a common metabolic perturbation. However, hypercalcemic crisis is an unusual endocrine emergency, with little clinical scientific data to support therapeutic strategy. We review the relevant scientific English literature on the topic and review current management strategies after conducting a PubMed, MEDLINE, and Google Scholar search for articles published between 1930 and June 2014 using specific keywords: "hypercalcemic crisis," "hyperparathyroid crisis," "parathyroid storm," "severe primary hyperparathyroidism," "acute hyperparathyroidism," and "severe hypercalcemia" for articles pertaining to the diagnosis, epidemiology, clinical presentation, and treatment strategies. Despite extensive clinical experience, large and well-designed clinical studies to direct appropriate clinical care are lacking. Nonetheless, morbidity and mortality rates have substantially decreased since early series reported almost universal fatality. Improved outcomes can be attributed to modern diagnostic capabilities, leading to earlier diagnosis, along with the recognition that primary hyperparathyroidism is the most common etiology for hypercalcemic crisis. Hypercalcemic crisis is an unusual endocrine emergency that portends excellent outcomes if rapid diagnosis, medical treatment, and definitive surgical treatment are expedited.

  17. Indicators of health system coverage and activity in Ireland during the economic crisis 2008-2014 - from 'more with less' to 'less with less'.

    PubMed

    Burke, Sara; Thomas, Steve; Barry, Sarah; Keegan, Conor

    2014-09-01

    A new Irish government came to power in March 2011 with the most radical proposals for health system reform in the history of the state, including improving access to healthcare, free GP care for all by 2015 and the introduction of Universal Health Insurance after 2016. All this was to be achieved amidst the most severe economic crisis experienced by Ireland since the 1930s. The authors assess how well the system coped with a downsizing of resources by an analysis of coverage and health system activity indicators. These show a health system that managed 'to do more with less' from 2008 to 2012. They also demonstrate a system that was 'doing more with less' by transferring the cost of care onto people and by significant resource cuts. From 2013, the indicators show a system that has no choice but 'to do less with less' with diminishing returns from crude cuts. This is evident in declining numbers with free care, of hospital cases and home care hours, alongside increased wait-times and expensive agency staffing. The results suggest a limited window of benefit from austerity beyond which cuts and rationing prevail which is costly, in both human and financial terms. PMID:25082466

  18. Ready, aim fire! Mental health nurses under siege in acute inpatient facilities.

    PubMed

    Ward, Louise

    2013-04-01

    It has been clearly acknowledged and well-documented that physical, emotional, and psychological violence is a central theme and an expected workplace hazard for registered nurses working in acute inpatient mental health care facilities. Limited research, however, has focused on how registered nurses have been able to cope within this environment and adequately protect themselves from harm. A critical feminist research project recently explored the lived experience of 13 Australian, female, registered nurses working in a busy metropolitan acute inpatient mental health care facility. "Fear" was exposed as the precursor to violence and aggression, both "fear as experienced by the nurse" and "fear as experienced by the patient." The participants reported experiencing a sense of fear when they could not accurately or confidently anticipate a patient response or reaction. They identified this relationship with fear as being "part of the job" and part of the unpredictable nature of caring for people experiencing complex distortions in thinking and behavior. The participants believed, however, that additional workplace pressures complicated the therapeutic environment, resulting in a distraction from patient care and observation. This distraction could lead to nurse-patient miscommunication and the potential for violence. This article discusses a major theme to emerge from this study, "Better the devil you know!" The theme highlights how mental health nurses cope with violence and why they choose to continue working in this complex care environment. PMID:23566191

  19. Mental health, duration of unemployment, and coping strategy: a cross-sectional study of unemployed migrant workers in eastern china during the economic crisis

    PubMed Central

    2012-01-01

    Background 20 million migrant workers in China lost their jobs during the economic crisis of 2008. Both urban migration and unemployment have long been documented to be associated with vulnerability to mental problems. This study aims to examine the mental health of unemployed migrant workers in Eastern China and its relation to duration of unemployment and coping strategy during the recent economic crisis. Methods The data were collected through interview-based survey with a sample of 210 unemployed migrant workers in Zhejiang Province of China from 2008 to 2009. Symptom Checklist-90-Revised, Coping Strategies Questionnaire, and seven short demographic questions were used. Results The majority of the unemployed migrant workers were found to be young male manufacturing industry workers with short-term unemployment and a relatively low education level. Nearly 50% of unemployed migrant workers were classified as mentally unhealthy and the most frequently reported symptom was depression. Compared with the adult norm of 1986, 2003, and 2007 in China, unemployed migrants had more mental problems. Long-term unemployed migrant workers had more psychiatric symptoms than the short-term unemployed workers and employed migrant workers. Unemployed migrant workers with immature coping strategies expressed significantly more psychiatric symptoms than those with mixed and mature coping strategies. Duration of unemployment and two coping strategies, problem-solving and self-blaming, predicted the mental problems of unemployed migrant workers. Conclusions The results indicated that mental health status of unemployed migrant workers in Eastern China was poorer than the national adult norm. More psychiatric symptoms are evidenced among unemployed migrant workers who lost their jobs for a long term and who had immature coping strategies. These findings can be used for prevention and intervention of mental illness among unemployed migrant workers. PMID:22856556

  20. Developing a health system approach to disaster management: A qualitative analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management

    PubMed Central

    Bayntun, Claire; Rockenschaub, Gerald; Murray, Virginia

    2012-01-01

    BACKGROUND The World Health Organisation's (WHO) sixty-fourth World Health Assembly in May 2011 adopted a resolution on ‘strengthening national health emergency and disaster management capacities and resilience of health systems’. Disaster management is a topical issue globally and countries are being encouraged to improve their disaster preparedness, along with growing international commitment to strengthening health systems. Lessons identified from disasters have not been effectively collated; essential experience is forgotten. METHODS This paper describes the analysis of the worldwide experience of disasters through a health systems approach. A systematic search of the core literature from January 2000 to November 2011 was conducted. Components drawn from the WHO’s Global assessment of national health sector emergency preparedness and response baseline survey were combined with WHO’s six health system building blocks (or levers) to act as the initial analysis anchors, with a further grounded theory qualitative analysis of the literature allowing the identification of emerging themes and insights. The priority areas identified by this literature review were then compared with the topics covered by the new expert-consensus-derived Toolkit for assessing health-system capacity for crisis management developed by the WHO Regional Office for Europe. FINDINGS 143 publications identified from a literature search were analysed and appraised. Themes and examples from the literature demonstrate how health system strengthening should contribute to disaster management. Priority areas under-represented in the WHO Toolkit and identified by the qualitative analysis are discussed. INTERPRETATION Collation and analysis of the disaster management literature identifies how health system strengthening can promote resilience and efficient recovery in the face of disasters. These findings support and complement the WHO Toolkit. Countries can use the literature evidence with the

  1. Cumulative Adversity Sensitizes Neural Response to Acute Stress: Association with Health Symptoms

    PubMed Central

    Seo, Dongju; Tsou, Kristen A; Ansell, Emily B; Potenza, Marc N; Sinha, Rajita

    2014-01-01

    Cumulative adversity (CA) increases stress sensitivity and risk of adverse health outcomes. However, neural mechanisms underlying these associations in humans remain unclear. To understand neural responses underlying the link between CA and adverse health symptoms, the current study assessed brain activity during stress and neutral-relaxing states in 75 demographically matched, healthy individuals with high, mid, and low CA (25 in each group), and their health symptoms using the Cornell Medical Index. CA was significantly associated with greater adverse health symptoms (P=0.01) in all participants. Functional magnetic resonance imaging results indicated significant associations between CA scores and increased stress-induced activity in the lateral prefrontal cortex, insula, striatum, right amygdala, hippocampus, and temporal regions in all 75 participants (p<0.05, whole-brain corrected). In addition to these regions, the high vs low CA group comparison revealed decreased stress-induced activity in the medial orbitofrontal cortex (OFC) in the high CA group (p<0.01, whole-brain corrected). Specifically, hypoactive medial OFC and hyperactive right hippocampus responses to stress were each significantly associated with greater adverse health symptoms (p<0.01). Furthermore, an inverse correlation was found between activity in the medial OFC and right hippocampus (p=0.01). These results indicate that high CA sensitizes limbic–striatal responses to acute stress and also identifies an important role for stress-related medial OFC and hippocampus responses in the effects of CA on increasing vulnerability to adverse health consequences. PMID:24051900

  2. Serum and salivary cardiac analytes in acute myocardial infarction related to oral health status

    NASA Astrophysics Data System (ADS)

    Ebersole, Jeffrey L.; Kryscio, Richard J.; Campbell, Charles; Kinane, Denis F.; McDevitt, John T.; Christodoulides, Nicolaos; Floriano, Pierre N.; Miller, Craig S.

    2014-06-01

    With the advent of an increased emphasis on the potential to utilize biomarkers in saliva for systemic diseases, the issue of existing oral disease is an important consideration that could adversely affect the interpretation of diagnostic results obtained from saliva. We addressed the question does a patient's oral inflammation status confound biomarker levels used in diagnosis of acute myocardial infarction (AMI). The results demonstrated that multiple serum biomarkers and a few salivary biomarkers reflected the cardiac event. Importantly, oral health of the individual had minimal impact on the validity of the serum or salivary biomarker effectiveness.

  3. Exploring the Relationships between the Electronic Health Record System Components and Patient Outcomes in an Acute Hospital Setting

    ERIC Educational Resources Information Center

    Wiggley, Shirley L.

    2011-01-01

    Purpose: The purpose of this study was to examine the relationship between the electronic health record system components and patient outcomes in an acute hospital setting, given that the current presidential administration has earmarked nearly $50 billion to the implementation of the electronic health record. The relationship between the…

  4. A service user-initiated project investigating the attitudes of mental health staff towards clients and services in an acute mental health unit.

    PubMed

    Tyson, P J

    2013-04-01

    Mental Health Service Users (MHSU) are becoming increasingly recognized as very valuable contributors to the research process. The current study originated from the idea of a group of MHSU within a service user and carer research group. They wanted to investigate the attitudes of mental health staff towards clients in an acute mental health setting, as well as their attitudes towards certain aspects of service. An amended version of the 'Attitudes Towards Acute Mental Health Scale' was sent to nursing and allied staff at an acute psychiatric unit within the Gloucestershire 2gether NHS Foundation Trust. Fifty-seven of the 200 anonymous questionnaires were returned. Generally positive opinions of MHSU were obtained, but there were divided opinions on questions regarding the aetiology of mental health problems (e.g. social vs. genetic determinants). Opinions on aspects of the admissions process, therapeutic aspects of care, the use of medication and the use of control and restraint techniques were also obtained. Demographic variables of staff age, status and years of experience in mental health were found to be associated with attitudes and opinions. This MHSU-initiated study has extended the literature on mental health staff attitudes towards clients and services in an acute mental health setting. This study is split into two parts, Part A is focused on the process of involving MHSU in this project, Part B is concerned with the empirical investigation.

  5. School Crisis Aftermath: Care for the Caregivers

    ERIC Educational Resources Information Center

    Paine, Cathy Kennedy

    2009-01-01

    "Professional" crisis caregivers (e.g., emergency responders, mental health providers, medical professionals, victim assistance counselors, and faith leaders) are trained to handle exposure to images of destruction and loss and to help victims or survivors cope with the impact of a crisis. They try to help individuals, schools, and communities…

  6. Assessing strategic behaviour within the acute sector of the National Health Service.

    PubMed

    Chaston, I

    1994-01-01

    The creation of the internal market has merely been the latest progression in the change processes confronting the NHS over recent years as the UK Government searches for new ways of expanding patient output while concurrently restricting provision of additional financial resources. To assist in the implementation of change, acute sector providers have introduced managerial concepts from the private sector such as strategic planning. It is not clear, however, whether these techniques are appropriate or effective in the management of health-care services. A survey was undertaken to gain the perspectives of middle managers in acute units on the degree to which senior management involves them in determining performance goals and strategic plans. Results indicate that in most units, the orientation of senior management is to retain control over key issues associated with strategic planning and to minimize the degree to which the workforce is involved in any decision-making processes. Reviewing these results relative to the service-sector management theories concerning the options of industrializing or employee empowerment strategies indicates that senior management in the acute sector is operating a production-line service output philosophy. Although this orientation may meet the immediate needs of the UK Government, a review of how this strategic philosophy has severely weakened Western firms' position in world markets provides a basis for examining whether greater economic advantages might accrue to Britain by redirecting the management of change in the NHS towards a strategic philosophy based on employee empowerment.

  7. Acute effects of summer air pollution on respiratory health of asthmatic children.

    PubMed

    Gielen, M H; van der Zee, S C; van Wijnen, J H; van Steen, C J; Brunekreef, B

    1997-06-01

    In the early summer of 1995, the acute respiratory effects of ambient air pollution were studied in a panel of 61 children, ages 7 to 13 yr, of whom 77% were taking asthma medication. Peak flow was measured twice daily with MiniWright meters at home and the occurrence of acute respiratory symptoms and medication use was registered daily by the parents in a diary. Exposure to air pollution was characterized by the ambient concentrations of ozone, PM10, and black smoke. During the study period, maximal 1-h ozone concentrations never exceeded 130 microg/m3, and 24-h black smoke and PM10 concentrations were never higher than 41 and 60 microg/m3 respectively. Associations of air pollution and health outcomes were evaluated using time series analysis. After adjusting for pollen, time trend, and day of the week, black smoke in particular was associated with acute respiratory symptoms and with medication use. Less strong associations were found for PM10 and ozone. These results suggest that in this panel of children, most of whom had asthma, relatively low levels of particulate matter and ozone in ambient air are able to increase symptoms and medication use.

  8. RESPONSE OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES IN PROTECTING CIVILIAN AMERICANS IN JAPAN DURING THE FUKUSHIMA NUCLEAR CRISIS

    PubMed Central

    Simon, Steven L.; Coleman, C. Norman; Noska, Michael A.; Bowman, Thomas

    2012-01-01

    Following the earthquake and tsunami in northern Japan on 11 March 2011, and the ensuing damage to the Fukushima Daiichi nuclear power plant complex, a request by the U.S. Ambassador to Japan to the U.S. Department of Health and Human Services (DHHS) Assistant Secretary for Preparedness and Response (ASPR) resulted in deployment of a five-person team of subject matter experts to the U.S. Embassy. The primary purpose of the deployment was to provide the U.S. Embassy in Tokyo with guidance on health and medical issues related to potential radiation exposure of U.S. citizens in Japan, including employees of the U.S. Department of State at consulates in Japan and American citizens living in or visiting Japan. At the request of the Government of Japan, the deployed health team also assisted Japanese experts in their public health response to the radiation incident. Over a three-week period in Japan and continuing for weeks after their return to the U.S., the team provided expertise in the areas of medical and radiation oncology, health physics, assessment of radiation dose and cancer risk, particularly to U.S. citizens living in Tokyo and the surrounding areas, food and water contamination and the acceptable limits, countermeasures to exposure such as potassium iodide (KI), the use of KI and an offered donation from the United States, evacuation and re-entry issues, and health/emergency-related communication strategies. This paper describes the various strategies used and observations made by the DHHS team during the first two months after the Fukushima crisis began. PMID:24198437

  9. Not Safe at Home: How America's Housing Crisis Threatens the Health of Its Children. A Research Report.

    ERIC Educational Resources Information Center

    Sharfstein, Joshua; Sandel, Megan

    Through an Internet campaign, the Doc4Kids Project gathered stories from pediatric caregivers about children whose health has been compromised by poor housing and whose health has been improved by housing assistance. The medical literature was also reviewed to estimate the total impact of inadequate housing on child health in the United States.…

  10. Modeling Acute Health Effects of Astronauts from Exposure to Large Solar Particle Events

    NASA Technical Reports Server (NTRS)

    Hu, Shaowen; Kim, Myung-Hee Y.; Cucinotta, Francis A.

    2011-01-01

    In space exploration outside the Earth s geomagnetic field, radiation exposure from solar particle events (SPE) presents a health concern for astronauts, that could impair their performance and result in possible failure of the mission. Acute risks are of special concern during extra-vehicular activities because of the rapid onset of SPE. However, most SPEs will not lead to acute risks but can lead to mission disruption if accurate projection methods are not available. Acute Radiation Sickness (ARS) is a group of clinical syndromes developing acutely (within several seconds to 3 days) after high dose whole-body or significant partial-body ionizing radiation exposures. The manifestation of these syndromes reflects the disturbance of physiological processes of various cellular groups damaged by radiation. Hematopoietic cells, skin, epithelium, intestine, and vascular endothelium are among the most sensitive tissues of human body to ionizing radiation. Most ARS symptoms are directly related to these tissues and other systems (nervous, endocrine, and cardiovascular, etc.) with coupled regulations. Here we report the progress in bio-mathematical models to describe the dose and time-dependent early human responses to ionizing radiation. The responses include lymphocyte depression, granulocyte modulation, fatigue and weakness syndrome, and upper gastrointestinal distress. The modest dose and dose-rates of SPEs are predicted to lead to large sparing of ARS, however detailed experimental data on a range of proton dose-rates for organ doses from 0.5 to 2 Gy is needed to validate the models. We also report on the ARRBOD code that integrates the BRYNTRN and SUMDOSE codes, which are used to estimate the SPE organ doses for astronauts under various space travel scenarios, with our models of ARS. The more recent effort is to provide easy web access to space radiation risk assessment using the ARRBOD code.

  11. Outpatient mental health service use by older adults after acute psychiatric hospitalization.

    PubMed

    Li, Hong; Proctor, Enola; Morrow-Howell, Nancy

    2005-01-01

    This study described outpatient mental health service used by elderly patients discharged from acute inpatient psychiatric treatment for depression, assessed services barriers, and identified factors related to the use of outpatient mental health services. The sample consisted of 199 elderly patients discharged home from a geropsychiatric unit of an urban midwestern hospital. Multivariate logistic regression was used to identify factors associated with use of various mental health services. Almost three quarters of the elderly patients saw a psychiatrist within 6 weeks postdischarge, but few used other outpatient mental health services. The most frequently reported barriers to use included (1) cost of services, (2) personal belief that depression would improve on its own, and (3) lack of awareness of available services. The use of various outpatient services was differentially related to predisposing, need, and enabling factors. Female patients, those residing in rural areas, and those who wanted to solve their problems on their own were less likely to use outpatient mental health services. Patients who reported greater levels of functional impairment, resided in rural areas, and perceived that getting services required too much time were less likely to see a psychiatrist in the postacute period. African American patients were more likely than whites to use day treatment programs. This may be related to the fact that most day treatment centers were located in areas where the majority of residents were African Americans.

  12. [Access to medicines prescribed for acute health conditions in adults in South and Northeast Brazil].

    PubMed

    Paniz, Vera Maria Vieira; Cechin, Isabel Carolina Coelho Flores; Fassa, Anaclaudia Gastal; Piccini, Roberto Xavier; Tomasi, Elaine; Thumé, Elaine; Silveira, Denise Silva da; Facchini, Luiz Augusto

    2016-01-01

    This was a cross-sectional study within Brazil's Project for the Expansion and Consolidation of Family Health, 2005, with the objective of universal and free access to the medication prescribed in the last medical appointment for acute health problems and to estimate the degree to which access may have improved with inclusion of the medicines in prevailing policies and programs. The sample included 4,060 adults living in the area of primary health care units in 41 municipalities in South and Northeast Brazil. Access was greater in the South (83.2%) than in the Northeast (71%), and free access was similar (37%), with a greater share by the Family Health Program (FHP) when compared to the traditional model, especially in the Northeast. Some 60% of prescribed medicines and 50% of those on the National List of Essential Medicines (RENAME) were paid for. No variation was observed in the proportion of medicines present on the prevailing RENAME list and access. However, 40% of the medicines that were paid for can currently be obtained through the Popular Pharmacy Program. The latter program appears to emerge as a new way to guarantee access to medicines prescribed in the health system.

  13. Crisis Assessment: A Three-Dimensional Model for Triage.

    ERIC Educational Resources Information Center

    Myer, Rick A.; And Others

    1992-01-01

    Presents triage assessment model for crisis intervention that enables mental health counselors to initiate appropriate crisis interventions in variety of situations. Model guides assessment of clients in crisis on three domains: affective, cognitive, and behavioral. Describes assessment and rating of severity of impairment for each of the three…

  14. Responding to the Unthinkable: School Crisis Response and Recovery

    ERIC Educational Resources Information Center

    Cowan, Katherine C.; Rossen, Eric

    2014-01-01

    The mental health implications of crisis exposure have emerged as a critical and challenging facet of school safety and crisis response, expanding our focus to encompass both psychological and physical safety, as well as prevention and recovery. Best practice reflects this evolution in our understanding and encompasses the continuum of crisis and…

  15. Turning Crisis into Opportunity: Nature of Science and Scientific Inquiry as Illustrated in the Scientific Research on Severe Acute Respiratory Syndrome

    ERIC Educational Resources Information Center

    Wong, Siu Ling; Kwan, Jenny; Hodson, Derek; Yung, Benny Hin Wai

    2009-01-01

    Interviews with key scientists who had conducted research on Severe Acute Respiratory Syndrome (SARS), together with analysis of media reports, documentaries and other literature published during and after the SARS epidemic, revealed many interesting aspects of the nature of science (NOS) and scientific inquiry in contemporary scientific research…

  16. The current crisis in human resources for health in Africa: the time to adjust our focus is now.

    PubMed

    Dalton, Simon C

    2014-09-01

    The challenges as we strive towards universal health coverage are many, but the need for an improved health workforce is chief among them. Unfortunately the global deficit in skilled professionals continues to increase. Nevertheless, there are potential solutions, and success stories are well documented when the approach is on system building and sustainability. As we approach 2015 and the Millennium Development Goals, we must shift our focus to a more distant time point in order to achieve the dramatic gains in global health that are possible. However, we must understand that there can be no health without a workforce. PMID:25059526

  17. The current crisis in human resources for health in Africa: the time to adjust our focus is now.

    PubMed

    Dalton, Simon C

    2014-09-01

    The challenges as we strive towards universal health coverage are many, but the need for an improved health workforce is chief among them. Unfortunately the global deficit in skilled professionals continues to increase. Nevertheless, there are potential solutions, and success stories are well documented when the approach is on system building and sustainability. As we approach 2015 and the Millennium Development Goals, we must shift our focus to a more distant time point in order to achieve the dramatic gains in global health that are possible. However, we must understand that there can be no health without a workforce.

  18. Reengineering acute episodic and chronic care delivery: the Geisinger Health System experience.

    PubMed

    Slotkin, Jonathan R; Casale, Alfred S; Steele, Glenn D; Toms, Steven A

    2012-07-01

    Comparative effectiveness research (CER) represents an evolution in clinical decision-making research that allows for the study of heterogeneous groups of patients with complex diseases processes. It has foundations in decision science, reliability science, and health care policy research. Health care finance will increasingly rely on CER for guidance in the coming years. There is increasing awareness of the importance of decreasing unwarranted variation in health care delivery. In the past 7 years, Geisinger Health System has performed broad reengineering of its acute episodic and chronic care delivery models utilizing macrosystem-level application of CER principles. These provider-driven process initiatives have resulted in significant improvement across all segments of care delivery, improved patient outcomes, and notable cost containment. These programs have led to the creation of novel pricing models, and when "hardwired" throughout a care delivery system, they can lead to correct medical decision making by 100% of providers in all patient encounters. Neurosurgery as a specialty faces unique challenges and opportunities with respect to broad adoption and application of CER techniques. PMID:22746233

  19. Reengineering acute episodic and chronic care delivery: the Geisinger Health System experience.

    PubMed

    Slotkin, Jonathan R; Casale, Alfred S; Steele, Glenn D; Toms, Steven A

    2012-07-01

    Comparative effectiveness research (CER) represents an evolution in clinical decision-making research that allows for the study of heterogeneous groups of patients with complex diseases processes. It has foundations in decision science, reliability science, and health care policy research. Health care finance will increasingly rely on CER for guidance in the coming years. There is increasing awareness of the importance of decreasing unwarranted variation in health care delivery. In the past 7 years, Geisinger Health System has performed broad reengineering of its acute episodic and chronic care delivery models utilizing macrosystem-level application of CER principles. These provider-driven process initiatives have resulted in significant improvement across all segments of care delivery, improved patient outcomes, and notable cost containment. These programs have led to the creation of novel pricing models, and when "hardwired" throughout a care delivery system, they can lead to correct medical decision making by 100% of providers in all patient encounters. Neurosurgery as a specialty faces unique challenges and opportunities with respect to broad adoption and application of CER techniques.

  20. Acute health impacts of airborne particles estimated from satellite remote sensing.

    PubMed

    Wang, Zhaoxi; Liu, Yang; Hu, Mu; Pan, Xiaochuan; Shi, Jing; Chen, Feng; He, Kebin; Koutrakis, Petros; Christiani, David C

    2013-01-01

    Satellite-based remote sensing provides a unique opportunity to monitor air quality from space at global, continental, national and regional scales. Most current research focused on developing empirical models using ground measurements of the ambient particulate. However, the application of satellite-based exposure assessment in environmental health is still limited, especially for acute effects, because the development of satellite PM(2.5) model depends on the availability of ground measurements. We tested the hypothesis that MODIS AOD (aerosol optical depth) exposure estimates, obtained from NASA satellites, are directly associated with daily health outcomes. Three independent healthcare databases were used: unscheduled outpatient visits, hospital admissions, and mortality collected in Beijing metropolitan area, China during 2006. We use generalized linear models to compare the short-term effects of air pollution assessed by ground monitoring (PM(10)) with adjustment of absolute humidity (AH) and AH-calibrated AOD. Across all databases we found that both AH-calibrated AOD and PM(10) (adjusted by AH) were consistently associated with elevated daily events on the current day and/or lag days for cardiovascular diseases, ischemic heart diseases, and COPD. The relative risks estimated by AH-calibrated AOD and PM(10) (adjusted by AH) were similar. Additionally, compared to ground PM(10), we found that AH-calibrated AOD had narrower confidence intervals for all models and was more robust in estimating the current day and lag day effects. Our preliminary findings suggested that, with proper adjustment of meteorological factors, satellite AOD can be used directly to estimate the acute health impacts of ambient particles without prior calibrating to the sparse ground monitoring networks. PMID:23220016

  1. Acute health impacts of airborne particles estimated from satellite remote sensing✩

    PubMed Central

    Wang, Zhaoxi; Liu, Yang; Hu, Mu; Pan, Xiaochuan; Shi, Jing; Chen, Feng; He, Kebin; Koutrakis, Petros; Christiani, David C.

    2013-01-01

    Satellite-based remote sensing provides a unique opportunity to monitor air quality from space at global, continental, national and regional scales. Most current research focused on developing empirical models using ground measurements of the ambient particulate. However, the application of satellite-based exposure assessment in environmental health is still limited, especially for acute effects, because the development of satellite PM2.5 model depends on the availability of ground measurements. We tested the hypothesis that MODIS AOD (aerosol optical depth) exposure estimates, obtained from NASA satellites, are directly associated with daily health outcomes. Three independent healthcare databases were used: unscheduled outpatient visits, hospital admissions, and mortality collected in Beijing metropolitan area, China during 2006. We use generalized linear models to compare the short-term effects of air pollution assessed by ground monitoring (PM10) with adjustment of absolute humidity (AH) and AH-calibrated AOD. Across all databases we found that both AH-calibrated AOD and PM10 (adjusted by AH) were consistently associated with elevated daily events on the current day and/or lag days for cardiovascular diseases, ischemic heart diseases, and COPD. The relative risks estimated by AH-calibrated AOD and PM10 (adjusted by AH) were similar. Additionally, compared to ground PM10, we found that AH-calibrated AOD had narrower confidence intervals for all models and was more robust in estimating the current day and lag day effects. Our preliminary findings suggested that, with proper adjustment of meteorological factors, satellite AOD can be used directly to estimate the acute health impacts of ambient particles without prior calibrating to the sparse ground monitoring networks. PMID:23220016

  2. Acute health impacts of airborne particles estimated from satellite remote sensing.

    PubMed

    Wang, Zhaoxi; Liu, Yang; Hu, Mu; Pan, Xiaochuan; Shi, Jing; Chen, Feng; He, Kebin; Koutrakis, Petros; Christiani, David C

    2013-01-01

    Satellite-based remote sensing provides a unique opportunity to monitor air quality from space at global, continental, national and regional scales. Most current research focused on developing empirical models using ground measurements of the ambient particulate. However, the application of satellite-based exposure assessment in environmental health is still limited, especially for acute effects, because the development of satellite PM(2.5) model depends on the availability of ground measurements. We tested the hypothesis that MODIS AOD (aerosol optical depth) exposure estimates, obtained from NASA satellites, are directly associated with daily health outcomes. Three independent healthcare databases were used: unscheduled outpatient visits, hospital admissions, and mortality collected in Beijing metropolitan area, China during 2006. We use generalized linear models to compare the short-term effects of air pollution assessed by ground monitoring (PM(10)) with adjustment of absolute humidity (AH) and AH-calibrated AOD. Across all databases we found that both AH-calibrated AOD and PM(10) (adjusted by AH) were consistently associated with elevated daily events on the current day and/or lag days for cardiovascular diseases, ischemic heart diseases, and COPD. The relative risks estimated by AH-calibrated AOD and PM(10) (adjusted by AH) were similar. Additionally, compared to ground PM(10), we found that AH-calibrated AOD had narrower confidence intervals for all models and was more robust in estimating the current day and lag day effects. Our preliminary findings suggested that, with proper adjustment of meteorological factors, satellite AOD can be used directly to estimate the acute health impacts of ambient particles without prior calibrating to the sparse ground monitoring networks.

  3. The health effects of the global financial crisis: can we reconcile the differing views? A network analysis of literature across disciplines.

    PubMed

    Stuckler, David; Reeves, Aaron; Karanikolos, Marina; McKee, Martin

    2015-01-01

    Why are researchers studying the health effects of economic change reaching markedly varying conclusions? To understand these differences, we first systematically searched Web of Science for the literature on recessions and health yielding 461 articles and 14,401 cited documents. We then undertook a network analysis of co-citation pattern by disciplines, journals and backgrounds of the authors, followed by a chronological review of the literature, to trace the evolution of ideas. We then examined the extent to which earlier literature predicted what has happened in the 2007-2012 crisis. Our analysis finds the literature is dominated by disciplinary silos, with economics studies predominantly citing each other and relative isolation of psychiatry and substance abuse journals. Different philosophical approaches to assessing causality appear to contribute to varying interpretations, a tendency that is unlikely to be resolved without a shift in research norms. We conclude by calling for more inter-disciplinary research that combines empirical findings with a search for plausible mechanisms. This approach would evaluate not only the effects of economic shocks but also the mechanisms that offer protection against them. PMID:25662198

  4. Ideologies of Black churches in New York City and the public health crisis of HIV among Black men who have sex with men

    PubMed Central

    Wilson, Patrick A.; Wittlin, Natalie M.; Muñoz-Laboy, Miguel; Parker, Richard G.

    2011-01-01

    Black men who have sex with men (MSM) are disproportionately affected by the HIV and AIDS in New York City (NYC). Black churches in NYC have a history of engaging in community mobilisation; however, research suggests that churches play a role in promoting stigma against Black MSM, which impedes prevention efforts. The goal of this study was to explore church ideologies surrounding sexuality and health, and the relationship of these ideologies to church mobilisation in response to HIV/AIDS among Black MSM. We conducted interviews and focus groups with pastors and parishioners at Black churches in NYC. Three prominent themes were identified: (1) `Love the sinner, hate the sin' – distinguishing behaviour and identity; (2) `Don't ask, don't tell' – keeping same-sex behaviour private; and (3) `Your body is a temple' – connecting physical and spiritual health. We discuss the implications of these ideologies for church mobilisation and HIV prevention efforts. In doing so, we pay close attention to how ideologies may both impede and facilitate church dialogue around sexuality and heightened responses to the HIV crisis affecting Black MSM. PMID:21892894

  5. The health effects of the global financial crisis: can we reconcile the differing views? A network analysis of literature across disciplines.

    PubMed

    Stuckler, David; Reeves, Aaron; Karanikolos, Marina; McKee, Martin

    2015-01-01

    Why are researchers studying the health effects of economic change reaching markedly varying conclusions? To understand these differences, we first systematically searched Web of Science for the literature on recessions and health yielding 461 articles and 14,401 cited documents. We then undertook a network analysis of co-citation pattern by disciplines, journals and backgrounds of the authors, followed by a chronological review of the literature, to trace the evolution of ideas. We then examined the extent to which earlier literature predicted what has happened in the 2007-2012 crisis. Our analysis finds the literature is dominated by disciplinary silos, with economics studies predominantly citing each other and relative isolation of psychiatry and substance abuse journals. Different philosophical approaches to assessing causality appear to contribute to varying interpretations, a tendency that is unlikely to be resolved without a shift in research norms. We conclude by calling for more inter-disciplinary research that combines empirical findings with a search for plausible mechanisms. This approach would evaluate not only the effects of economic shocks but also the mechanisms that offer protection against them.

  6. Is it a policy crisis or it is a health crisis? The Egyptian context--analysis of the Egyptian health policy for the H1N1 flu pandemic control.

    PubMed

    Seef, Sameh; Jeppsson, Anders

    2013-01-01

    A new influenza virus that was first detected in people in April 2009, was initially referred to colloquially as "swine flu", since it contained genes from swine, avian and human influenza viruses. It can, however, not be transmitted by eating pork or dealing with pigs. In Egypt, several hundred thousand pigs were killed in May, in spite of advice from global health authorities that such an action was unnecessary. Pigs are raised and consumed mainly by the Christian minority, which constitute some 10% of the population. Health Ministry estimated there were between 300,000-350,000 pigs in Egypt. This paper will analyze the Egyptian health policy for controlling the pandemic H1N1 flu, exploring its context, content, process, and actors. The analysis is based on the Leichter Context, which refers to systemic factors-political, economic and social, both national and international-that may have an effect on health policy, and is based on data collected from literature review and policy documents. The International health officials said the swine flu virus that has caused worldwide fear is not transmitted by pigs, and that pig slaughters do nothing to stop its spread. The WHO stopped using the term "swine flu" to avoid confusion. In Egypt, even the editor of a pro-government newspaper criticized the order to slaughter: "Killing (pigs) is not a solution, otherwise, we should kill the people, because the virus spreads through them," wrote Abdullah Kamal of the daily Rose El-Youssef. The World Health organization also criticized the decision. The extinction of the Egyptian pigs is an example of how a health issue can be used to persecute a minority within a country. Although the current influenza has nothing whatsoever to do with pigs, the previous name of the epidemic was used as an argument to violate the rights of the Christian minority in Egypt.

  7. Is it a policy crisis or it is a health crisis? The Egyptian context--analysis of the Egyptian health policy for the H1N1 flu pandemic control.

    PubMed

    Seef, Sameh; Jeppsson, Anders

    2013-01-01

    A new influenza virus that was first detected in people in April 2009, was initially referred to colloquially as "swine flu", since it contained genes from swine, avian and human influenza viruses. It can, however, not be transmitted by eating pork or dealing with pigs. In Egypt, several hundred thousand pigs were killed in May, in spite of advice from global health authorities that such an action was unnecessary. Pigs are raised and consumed mainly by the Christian minority, which constitute some 10% of the population. Health Ministry estimated there were between 300,000-350,000 pigs in Egypt. This paper will analyze the Egyptian health policy for controlling the pandemic H1N1 flu, exploring its context, content, process, and actors. The analysis is based on the Leichter Context, which refers to systemic factors-political, economic and social, both national and international-that may have an effect on health policy, and is based on data collected from literature review and policy documents. The International health officials said the swine flu virus that has caused worldwide fear is not transmitted by pigs, and that pig slaughters do nothing to stop its spread. The WHO stopped using the term "swine flu" to avoid confusion. In Egypt, even the editor of a pro-government newspaper criticized the order to slaughter: "Killing (pigs) is not a solution, otherwise, we should kill the people, because the virus spreads through them," wrote Abdullah Kamal of the daily Rose El-Youssef. The World Health organization also criticized the decision. The extinction of the Egyptian pigs is an example of how a health issue can be used to persecute a minority within a country. Although the current influenza has nothing whatsoever to do with pigs, the previous name of the epidemic was used as an argument to violate the rights of the Christian minority in Egypt. PMID:23565306

  8. The Efficacy of Crisis Intervention Training for Educators: A Preliminary Study from the United States

    ERIC Educational Resources Information Center

    Forthun, Larry F.; McCombie, Jeffrey W.

    2011-01-01

    Professional development in crisis intervention skills can help address the growing needs of schools to train faculty to respond to students in acute crisis. Unlike traditional methods of classroom management, crisis intervention training teaches specific strategies to de-escalate conflict while at the same time addressing the underlying…

  9. Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis

    PubMed Central

    Cohen, Odeya; Feder-Bubis, Paula; Bar-Dayan, Yaron; Adini, Bruria

    2015-01-01

    Background Public health legal preparedness (PHLP) for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC) and developed countries. Objective This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak. Design A rigorous literature review was conducted using eight electronic databases as well as Google Scholar. The results encompassed peer-reviewed English articles, reports, theses, and position papers dating from 2011 to 2014. Earlier articles concerning regulatory actions were also examined. Results The importance of PHLP has grown during the past decade and focuses mainly on infection–disease scenarios. Amid LMICs, it mostly refers to application of international regulations, whereas in developed states, it focuses on independent legislation and creation of conditions optimal to promoting an effective emergency management. Among developed countries, the United States’ utilisation of health legal preparedness is the most advanced, including the creation of a model comprising four elements: law, competencies, information, and coordination. Only limited research has been conducted in this field to date. Nevertheless, in both developed and developing states, studies that focused on regulations and laws activated in health systems during emergencies, identified inconsistency and incoherence. The Ebola outbreak plaguing West Africa since 2014 has global implications, challenges and paralleling results, that were identified in this review. Conclusions The review has shown the need to broaden international regulations, to deepen reciprocity between countries, and to consider LMICs health capacities, in order to strengthen the national health security. Adopting elements of the health legal preparedness model is recommended. PMID:26449204

  10. A comparison of Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation III scoring system in predicting mortality and length of stay at surgical intensive care unit

    PubMed Central

    Gilani, Mahryar Taghavi; Razavi, Majid; Azad, Azadeh Mokhtari

    2014-01-01

    Background: In critically ill patients, several scoring systems have been developed over the last three decades. The Acute Physiology and Chronic Health Evaluation (APACHE) and the Simplified Acute Physiology Score (SAPS) are the most widely used scoring systems in the intensive care unit (ICU). The aim of this study was to assess the prognostic accuracy of SAPS II and APACHE II and APACHE III scoring systems in predicting short-term hospital mortality of surgical ICU patients. Materials and Methods: Prospectively collected data from 202 patients admitted to Mashhad University Hospital postoperative ICU were analyzed. Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Discrimination was evaluated by using the receiver operating characteristic (ROC) curves and area under a ROC curve (AUC). Result: Two hundred and two patients admitted on post-surgical ICU were evaluated. The mean SAPS II, APACHE II, and APACHE III scores for survivors were found to be significantly lower than of non-survivors. The calibration was best for APACHE II score. Discrimination was excellent for APACHE II (AUC: 0.828) score and acceptable for APACHE III (AUC: 0.782) and SAPS II (AUC: 0.778) scores. Conclusion: APACHE II provided better discrimination than APACHE III and SAPS II calibration was good at APACHE II and poor at APACHE III and SAPS II. Use of APACHE II was excellent in this post-surgical ICU. PMID:24791049

  11. Acute health effects associated with exposure to volcanic air pollution (vog) from increased activity at Kilauea Volcano in 2008.

    PubMed

    Longo, Bernadette M; Yang, Wei; Green, Joshua B; Crosby, Frederick L; Crosby, Vickie L

    2010-01-01

    In 2008, the Kilauea Volcano on the island of Hawai'i increased eruption activity and emissions of sulfurous volcanic air pollution called vog. The purpose of this study was to promptly assess for a relative increase in cases of medically diagnosed acute illnesses in an exposed Hawaiian community. Using a within-clinic retrospective cohort design, comparisons were made for visits of acute illnesses during the 14 wk prior to the increased volcanic emissions (low exposure) to 14 wk of high vog exposure when ambient sulfur dioxide was threefold higher and averaged 75 parts per billion volume per day. Logistic regression analysis estimated effect measures between the low- and high-exposure cohorts for age, gender, race, and smoking status. There were statistically significant positive associations between high vog exposure and visits for medically diagnosed cough, headache, acute pharyngitis, and acute airway problems. More than a sixfold increase in odds was estimated for visits with acute airway problems, primarily experienced by young Pacific Islanders. These findings suggest that the elevated volcanic emissions in 2008 were associated with increased morbidity of acute illnesses in age and racial subgroups of the general Hawaiian population. Continued investigation is crucial to fully assess the health impact of this natural source of sulfurous air pollution. Culturally appropriate primary- and secondary-level health prevention initiatives are recommended for populations in Hawai'i and volcanically active areas worldwide. PMID:20818536

  12. Comparative effectiveness research as choice architecture: the behavioral law and economics solution to the health care cost crisis.

    PubMed

    Korobkin, Russell

    2014-02-01

    With the Patient Protection and Affordable Care Act ("ACA") set to dramatically increase access to medical care, the problem of rising costs will move center stage in health law and policy discussions. "Consumer directed health care" proposals, which provide patients with financial incentives to equate marginal costs and benefits of care at the point of treatment, demand more decisionmaking ability from consumers than is plausible due to bounded rationality. Proposals that seek to change the incentives of health care providers threaten to create conflicts of interest between doctors and patients. New approaches are desperately needed. This Article proposes a government-facilitated but market-based approach to improving efficiency in the private market for medical care that I call "relative value health insurance." This approach focuses on the "choice architecture" necessary to enable even boundedly rational patients to contract for an efficient level of health care services through their health insurance purchase decisions. It uses comparative effectiveness research, which the ACA funds at a significant level for the first time, to rate medical treatments on a scale of one to ten based on their relative value, taking into account expected costs and benefits. These relative value ratings would enable consumers to contract with insurers for different levels of medical care at different prices, reflecting different cost-quality trade-offs. The Article describes both the benefits of relative value health insurance and the impediments to its implementation. It concludes with a brief discussion of how relative value ratings could also help to rationalize expenditures on public health insurance programs.

  13. Comparative effectiveness research as choice architecture: the behavioral law and economics solution to the health care cost crisis.

    PubMed

    Korobkin, Russell

    2014-02-01

    With the Patient Protection and Affordable Care Act ("ACA") set to dramatically increase access to medical care, the problem of rising costs will move center stage in health law and policy discussions. "Consumer directed health care" proposals, which provide patients with financial incentives to equate marginal costs and benefits of care at the point of treatment, demand more decisionmaking ability from consumers than is plausible due to bounded rationality. Proposals that seek to change the incentives of health care providers threaten to create conflicts of interest between doctors and patients. New approaches are desperately needed. This Article proposes a government-facilitated but market-based approach to improving efficiency in the private market for medical care that I call "relative value health insurance." This approach focuses on the "choice architecture" necessary to enable even boundedly rational patients to contract for an efficient level of health care services through their health insurance purchase decisions. It uses comparative effectiveness research, which the ACA funds at a significant level for the first time, to rate medical treatments on a scale of one to ten based on their relative value, taking into account expected costs and benefits. These relative value ratings would enable consumers to contract with insurers for different levels of medical care at different prices, reflecting different cost-quality trade-offs. The Article describes both the benefits of relative value health insurance and the impediments to its implementation. It concludes with a brief discussion of how relative value ratings could also help to rationalize expenditures on public health insurance programs. PMID:24446572

  14. Forward and inverse electroencephalographic modeling in health and in acute traumatic brain injury

    PubMed Central

    Irimia, Andrei; Goh, S.Y. Matthew; Torgerson, Carinna M.; Chambers, Micah C.; Kikinis, Ron; Van Horn, John D.

    2013-01-01

    Objective EEG source localization is demonstrated in three cases of acute traumatic brain injury (TBI) with progressive lesion loads using anatomically faithful models of the head which account for pathology. Methods Multimodal magnetic resonance imaging (MRI) volumes were used to generate head models via the finite element method (FEM). A total of 25 tissue types—including 6 types accounting for pathology— were included. To determine the effects of TBI upon source localization accuracy, a minimum-norm operator was used to perform inverse localization and to determine the accuracy of the latter. Results The importance of using a more comprehensive number of tissue types is confirmed in both health and in TBI. Pathology omission is found to cause substantial inaccuracies in EEG forward matrix calculations, with lead field sensitivity being underestimated by as much as ~200% in (peri-) contusional regions when TBI-related changes are ignored. Failing to account for such conductivity changes is found to misestimate substantial localization error by up to 35 mm. Conclusions Changes in head conductivity profiles should be accounted for when performing EEG modeling in acute TBI. Significance Given the challenges of inverse localization in TBI, this framework can benefit neurotrauma patients by providing useful insights on pathophysiology. PMID:23746499

  15. Effects of acute and chronic hypohydration on kidney health and function.

    PubMed

    Feehally, John; Khosravi, Maryam

    2015-09-01

    The kidneys play a critical role in the homeostasis of body fluid tonicity and effective circulating volume. Renal homeostatic mechanisms are frequently challenged in acutely ill people. Fluid depletion causing hypovolemia may result in renal hypoperfusion that, if left untreated, may lead to acute kidney failure. Some populations, notably older people and neonates, are less tolerant of extremes in fluid loading and deprivation, similar to those with established chronic kidney disease. Risk of kidney injury during fluid depletion is increased by medications including diuretics, nonsteroidal antiinflammatory drugs, and renin-angiotensin system blockers. There is no consistent evidence indicating that lower-than-average fluid intake can cause chronic kidney disease, nor accelerate progression of established kidney disease. Increasing consumption of sugar-containing beverages is, however, a major concern for kidney health as a precursor of obesity and diabetes. There is no evidence that high dietary protein intake can cause chronic kidney disease, nor accelerate progression of established kidney disease. Idiosyncratic, adverse renal responses have been described with creatine supplements. There are only a few clinical conditions for which high fluid intake should be considered. These include recurrent kidney stones or urinary tract infections and, possibly, polycystic kidney disease. PMID:26290296

  16. Effects of acute and chronic hypohydration on kidney health and function.

    PubMed

    Feehally, John; Khosravi, Maryam

    2015-09-01

    The kidneys play a critical role in the homeostasis of body fluid tonicity and effective circulating volume. Renal homeostatic mechanisms are frequently challenged in acutely ill people. Fluid depletion causing hypovolemia may result in renal hypoperfusion that, if left untreated, may lead to acute kidney failure. Some populations, notably older people and neonates, are less tolerant of extremes in fluid loading and deprivation, similar to those with established chronic kidney disease. Risk of kidney injury during fluid depletion is increased by medications including diuretics, nonsteroidal antiinflammatory drugs, and renin-angiotensin system blockers. There is no consistent evidence indicating that lower-than-average fluid intake can cause chronic kidney disease, nor accelerate progression of established kidney disease. Increasing consumption of sugar-containing beverages is, however, a major concern for kidney health as a precursor of obesity and diabetes. There is no evidence that high dietary protein intake can cause chronic kidney disease, nor accelerate progression of established kidney disease. Idiosyncratic, adverse renal responses have been described with creatine supplements. There are only a few clinical conditions for which high fluid intake should be considered. These include recurrent kidney stones or urinary tract infections and, possibly, polycystic kidney disease.

  17. Life in acute mental health settings: experiences and perceptions of service users and nurses.

    PubMed

    Rose, D; Evans, J; Laker, C; Wykes, T

    2015-02-01

    Background. Acute psychiatric provision in the UK today as well as globally has many critics including service users and nurses. Method. Four focus groups, each meeting twice, were held separately for service users and nurses. The analysis was not purely inductive but driven by concerns with the social position of marginalised groups - both patients and staff. Results. The main themes were nurse/patient interaction and coercion. Service users and nurses conceptualised these differently. Service users found nurses inaccessible and uncaring, whereas nurses also felt powerless because their working life was dominated by administration. Nurses saw coercive situations as a reasonable response to factors 'internal' to the patient whereas for service users they were driven to extreme behaviour by the environment of the ward and coercive interventions were unnecessary and heavy handed. Conclusion. This study sheds new light on living and working in acute mental health settings today by comparing the perceptions of service users and nurses and deploying service user and nurse researchers. The intention is to promote better practice by providing a window on the perceptions of both groups. PMID:24330951

  18. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia.

    PubMed

    Arber, Daniel A; Orazi, Attilio; Hasserjian, Robert; Thiele, Jürgen; Borowitz, Michael J; Le Beau, Michelle M; Bloomfield, Clara D; Cazzola, Mario; Vardiman, James W

    2016-05-19

    The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues was last updated in 2008. Since then, there have been numerous advances in the identification of unique biomarkers associated with some myeloid neoplasms and acute leukemias, largely derived from gene expression analysis and next-generation sequencing that can significantly improve the diagnostic criteria as well as the prognostic relevance of entities currently included in the WHO classification and that also suggest new entities that should be added. Therefore, there is a clear need for a revision to the current classification. The revisions to the categories of myeloid neoplasms and acute leukemia will be published in a monograph in 2016 and reflect a consensus of opinion of hematopathologists, hematologists, oncologists, and geneticists. The 2016 edition represents a revision of the prior classification rather than an entirely new classification and attempts to incorporate new clinical, prognostic, morphologic, immunophenotypic, and genetic data that have emerged since the last edition. The major changes in the classification and their rationale are presented here.

  19. Comparison of acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation IV to predict intensive care unit mortality

    PubMed Central

    Parajuli, Bashu Dev; Shrestha, Gentle S.; Pradhan, Bishwas; Amatya, Roshana

    2015-01-01

    Context: Clinical assessment of severity of illness is an essential component of medical practice to predict the outcome of critically ill-patient. Acute Physiology and Chronic Health Evaluation (APACHE) model is one of the widely used scoring systems. Aims: This study was designed to evaluate the Performance of APACHE II and IV scoring systems in our Intensive Care Unit (ICU). Settings and Design: A prospective study in 6 bedded ICU, including 76 patients all above 15 years. Subjects and Methods: APACHE II and APACHE IV scores were calculated based on the worst values in the first 24 h of admission. All enrolled patients were followed, and outcome was recorded as survivors or nonsurvivors. Statistical Analysis Used: SPSS version 17. Results: The mean APACHE score was significantly higher among nonsurvivors than survivors (P < 0.005). Discrimination for APACHE II and APACHE IV was fair with area under receiver operating characteristic curve of 0.73 and 0.79 respectively. The cut-off point with best Youden index for APACHE II was 17 and for APACHE IV was 85. Above cut-off point, mortality was higher for both models (P < 0.005). Hosmer–Lemeshow Chi-square coefficient test showed better calibration for APACHE II than APACHE IV. A positive correlation was seen between the models with Spearman's correlation coefficient of 0.748 (P < 0.01). Conclusions: Discrimination was better for APACHE IV than APACHE II model however Calibration was better for APACHE II than APACHE IV model in our study. There was good correlation between the two models observed in our study. PMID:25722550

  20. Knowledge, attitude and practice factors in childhood acute respiratory infections in a peninsular Malaysia health district.

    PubMed

    Vasanthamala, A; Arokiasamy, J T

    1989-01-01

    This study compares the knowledge, attitudes and practice of mothers in two ethnic groups with regard to acute respiratory infections (ARI) in their child. Most had traditional beliefs as to the cause of ARI with only a minority knowing the causes. Most mothers were aware of the effect of frequent attacks of ARI on the health status of their child and of the importance of early treatment. Reasons for their becoming worried during an episode of ARI in their child indicated that problems of distance, transportation and arrangements for care of their other children predominate. A large proportion of the respondents felt that their present knowledge of ARI was inadequate and were thus interested in obtaining more information. PMID:2620023

  1. Knowledge, attitude and practice factors in childhood acute respiratory infections in a peninsular Malaysia health district.

    PubMed

    Vasanthamala, A; Arokiasamy, J T

    1989-01-01

    This study compares the knowledge, attitudes and practice of mothers in two ethnic groups with regard to acute respiratory infections (ARI) in their child. Most had traditional beliefs as to the cause of ARI with only a minority knowing the causes. Most mothers were aware of the effect of frequent attacks of ARI on the health status of their child and of the importance of early treatment. Reasons for their becoming worried during an episode of ARI in their child indicated that problems of distance, transportation and arrangements for care of their other children predominate. A large proportion of the respondents felt that their present knowledge of ARI was inadequate and were thus interested in obtaining more information.

  2. Expanding the Crisis Planning Function: Introducing Elements of Risk Communication to Crisis Communication Practice.

    ERIC Educational Resources Information Center

    Williams, David E.; Olaniran, Bolanle A.

    1998-01-01

    Suggests use of elements of risk communication by crisis communication practitioners facing increasing industrial reliance on new technologies which might be associated with potential health/environment harm. Studies a small company crisis which reveals that elements of anticipation, public involvement/trust, technological comparison, and media…

  3. Three day crisis resolution unit.

    PubMed

    Dubin, S E; Ananth, J; Bajwa-Goldsmith, B; Stuller, S; Lewis, C; Miller, M; Noel, N; Fernandez, L

    1990-01-01

    This paper describes a three day crisis resolution unit within the confines of the psychiatric emergency service of a general hospital. It utilizes a crisis model of acute intervention, time limited psychotherapeutic approach combined with family therapy, and psychotropic meditation when indicated. One hundred thirty six consecutive admissions were rev ie.wed. 19% were discharged within 72 hours, and 51% required further hospitalization. Seventy seven percent of the patients discharged had involved families (significant others) in the treatment process, in comparison with only 28% family involvement with those patients who needed further hospitalization. This may be even more significant for psychotic patients who were discharged (14/18 family involvement) versus those who needed long hospitalization (13/50 family involvement).

  4. A Crisis of Lost Opportunity--Conclusions from a Symposium on Challenges for Animal Population Health Education.

    ERIC Educational Resources Information Center

    Hird, David; King, Lonnie; Salman, Mo; Werge, Rob

    2002-01-01

    Describes a symposium on "Population Health Education" held at the University of California Davis on May 9-11, 2002. Its objectives were to assess the market needs and opportunities presented by the users of population medicine veterinarians, determine the degree to which veterinary colleges are producing professionals who meet these needs,…

  5. Will the Disadvantaged Ride the Information Superhighway?: Hopeful Answers from a Computer-Based Health Crisis System.

    ERIC Educational Resources Information Center

    Pingree, Suzanna; And Others

    1996-01-01

    This study monitored use of an interactive computer system called CHESS (Comprehensive Health Enhancement Support System), placed in homes of HIV-infected persons. Usage differences among demographic subgroups were small, but typically the system was used more by groups expected to use it less (women, minorities, the less educated). Results…

  6. A Crisis Mental Health Intervention Service: An Innovative Model for Working Intensively with Young People on the Edge of Care

    ERIC Educational Resources Information Center

    Witkon, Yael

    2012-01-01

    This paper describes the setting up and the first year of running of an innovative outreach service for adolescents on the edge of care that aimed at redressing family breakdown and preventing placements in the care system. It was a collaborative endeavour between social services and a child and adolescent mental health provision to facilitate the…

  7. Health Care Insurance, Financial Concerns, and Delays to Hospital Presentation in Acute Myocardial Infarction

    PubMed Central

    Smolderen, Kim G.; Spertus, John A.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.; Tang, Fengming; Ross, Joseph S.; Ting, Henry H.; Alexander, Karen P.; Rathore, Saif S.; Chan, Paul S.

    2011-01-01

    Context Little is known about how health insurance status affects decisions to seek care during emergency medical conditions like acute myocardial infarction (AMI). Objective To examine the association between lack of health insurance and financial concerns about accessing care among those with health insurance, and the time from symptom onset to hospital presentation (prehospital delays) during AMI. Design, Setting and Patients Multicenter, prospective registry of 3721 AMI patients enrolled between April, 2005 and December, 2008 from 24 U.S. hospitals. Health insurance status was categorized as uninsured, insured with financial concerns about accessing care, and insured without financial concerns. Insurance information was determined from medical records while financial concerns among those with health insurance were determined from structured interviews. Main Outcome Measure Prehospital delay times (≤2 hours, >2 to 6 hours, >6 hours), adjusted for demographic, clinical, social and psychological factors using hierarchical ordinal regression models. Results Of 3,721 patients, 738 (19.8%) were uninsured, and 689 (18.5%) were insured with financial concerns, and 2294 (61.7%) were insured without financial concerns. Uninsured and insured patients with financial concerns were more likely to delay seeking care during AMI, with prehospital delays >6 hours among 48.6% of uninsured patients, 44.6% of insured patients with financial concerns, and 39.3% of insured patients without financial concerns, as compared with prehospital delays of <2 hours among 27.5%, 33.5%, and 36.6% of those who were uninsured, insured with financial concerns, and insured without financial concerns, respectively (P <.001). After adjusting for potential confounders, both insurance with financial concerns and lack of insurance were associated with prehospital delays: insurance without financial concerns (reference); insurance with financial concerns, adjusted odds ratio [OR)], 1.21; 95% confidence

  8. Acute health effects in a community after a release of hydrofluoric acid

    SciTech Connect

    Wing, J.S.; Brender, J.D.; Sanderson, L.M.; Perrotta, D.M.; Beauchamp, R.A. )

    1991-05-01

    {approximately} 3,000 persons were evacuated from a Texas community after 24,036 kg (53,000 lb) of caustic hydrofluoric acid (HF) were released from a nearby petrochemical plant. Emergency room and hospital records of 939 persons who were seen at two area hospitals were reviewed. Most persons who presented at the emergency rooms were female (56%) or black (60%), and their mean age was 33.9 y. The most frequently reported symptoms were eye irritation (41.5%), burning throat (21%), headache (20.6%), and shortness of breath (19.4%). Physical examination results were normal for 49% of the cases; however, irritation of the eyes, nose, throat, skin, and lungs were noted on other exams. Decreased pulmonary function was demonstrated by pulmonary function tests (forced expiratory volume in the first second, less than 80% of predicted value, 42.3%); hypoxemia (pO2 less than 80 mm Hg, 17.4%) and hypocalcemia (less than 8.5 mg/dl, 16.3%) were also noted. Ninety-four (10%) of the cases were hospitalized, and more than 83% of all cases were discharged with a primary diagnosis of HF exposure. There are several reports of individuals who are acutely and chronically exposed to HF; however, we are unaware of other published reports that describe exposure of a community to HF. This incident represented a unique opportunity to study the immediate health impact on a community of residents who were exposed to a hazardous materials release. Results of this analysis suggest that (a) initial health problems should be followed up, (b) any long-term health effects of HF exposure must be assessed, and (c) the health impact on the population at risk should be determined.

  9. Building on a national health information technology strategic plan for long-term and post-acute care: comments by the Long Term Post Acute Care Health Information Technology Collaborative.

    PubMed

    Alexander, Gregory L; Alwan, Majd; Batshon, Lynne; Bloom, Shawn M; Brennan, Richard D; Derr, John F; Dougherty, Michelle; Gruhn, Peter; Kirby, Annessa; Manard, Barbara; Raiford, Robin; Serio, Ingrid Johnson

    2011-07-01

    The LTPAC (Long Term Post Acute Care) Health Information Technology (HIT) Collaborative consists of an alliance of long-term services and post-acute care stakeholders. Members of the collaborative are actively promoting HIT innovations in long-term care settings because IT adoption for health care institutions in the United States has become a high priority. One method used to actively promote HIT is providing expert comments on important documents addressing HIT adoption. Recently, the Office of the National Coordinator for HIT released a draft of the Federal Health Information Technology Strategic Plan 2011-2015 for public comment. The following brief is intended to inform about recommendations and comments made by the Collaborative on the strategic plan. PMID:21667892

  10. Building on a national health information technology strategic plan for long-term and post-acute care: comments by the Long Term Post Acute Care Health Information Technology Collaborative.

    PubMed

    Alexander, Gregory L; Alwan, Majd; Batshon, Lynne; Bloom, Shawn M; Brennan, Richard D; Derr, John F; Dougherty, Michelle; Gruhn, Peter; Kirby, Annessa; Manard, Barbara; Raiford, Robin; Serio, Ingrid Johnson

    2011-07-01

    The LTPAC (Long Term Post Acute Care) Health Information Technology (HIT) Collaborative consists of an alliance of long-term services and post-acute care stakeholders. Members of the collaborative are actively promoting HIT innovations in long-term care settings because IT adoption for health care institutions in the United States has become a high priority. One method used to actively promote HIT is providing expert comments on important documents addressing HIT adoption. Recently, the Office of the National Coordinator for HIT released a draft of the Federal Health Information Technology Strategic Plan 2011-2015 for public comment. The following brief is intended to inform about recommendations and comments made by the Collaborative on the strategic plan.

  11. Health-related QOL in acute exacerbations of chronic bronchitis and chronic obstructive pulmonary disease: a review of the literature.

    PubMed

    Doll, Helen; Miravitlles, Marc

    2005-01-01

    There is a lack of emphasis on health-related QOL (HR-QOL) changes associated with acute exacerbation of chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD). The aim of this review is to examine the use of HR-QOL instruments to evaluate acute exacerbation of CB or COPD, so as to form recommendations for future research.A literature search of papers published between 1966 and July 2003 identified more than 300 articles that used acute exacerbation of CB or COPD as the search term. However, only 21 of these studies employed HR-QOL measures as predictors of outcome or in the assessment of the impact, evolution or treatment of acute exacerbations of COPD or CB. A variety of HR-QOL measures were used, both generic and disease specific. The disease-specific St George's Respiratory Questionnaire (SGRQ), devised for patients with stable CB and with a recall period of 1-12 months, was the most widely used measure, with the Chronic Respiratory disease Questionnaire (CRQ) and the Baseline and Transitional Dyspnoea Index (BDI, TDI) being the only other disease-specific measures used. Most measures, both generic and disease specific, performed adequately when used during acute exacerbation of CB or COPD and indicated poor HR-QOL during acute exacerbation, which improved on resolution of the exacerbation. Relationships were evident between HR-QOL during an acute exacerbation and various outcomes, including post-exacerbation functional status, hospital re- admission for acute exacerbation or COPD, and mortality. There is a need for studies of treatments for acute exacerbation of CB or COPD to include an appropriate HR-QOL instrument to aid in the stratification of patients so as to target the right treatment to the right patient group. While a new instrument could be developed to measure HR-QOL during acute exacerbation of CB or COPD, currently available disease-specific measures such as the CRQ and the SGRQ appear to be acceptable to patients during acute

  12. Exposure to multiple metals from groundwater-a global crisis: geology, climate change, health effects, testing, and mitigation.

    PubMed

    Mitchell, Erika; Frisbie, Seth; Sarkar, Bibudhendra

    2011-09-01

    This paper presents an overview of the global extent of naturally occurring toxic metals in groundwater. Adverse health effects attributed to the toxic metals most commonly found in groundwater are reviewed, as well as chemical, biochemical, and physiological interactions between these metals. Synergistic and antagonistic effects that have been reported between the toxic metals found in groundwater and the dietary trace elements are highlighted, and common behavioural, cultural, and dietary practices that are likely to significantly modify health risks due to use of metal-contaminated groundwater are reviewed. Methods for analytical testing of samples containing multiple metals are discussed, with special attention to analytical interferences between metals and reagents. An overview is presented of approaches to providing safe water when groundwater contains multiple metallic toxins.

  13. Developing a market orientation in the Health Service: a survey of acute NHS Trusts in Scotland.

    PubMed

    Laing, A W; Galbraith, A

    1996-01-01

    Argues that the introduction of the quasi market mechanism into the Health Service has required that managers within NHS trusts acquire new managerial skills relating to market operations and, more importantly, reorientate their organizations towards the marketplace. Examines the pattern of development which has occurred within acute trusts across Scotland in the past three years, and argues that managers in the majority of trusts have developed a remarkably robust and relevant conceptualization of the nature and application of marketing within the NHS, reflecting the difficulties managers have faced in selling the concept of marketing to a generally sceptical body of clinicians. Notes, in part owing to such professional scepticism, that the development of marketing as an implementable approach to operations has lagged significantly behind the managerial conceptualization, although this cannot be attributed solely to resistance from clinicians and other health care professionals. Rather, suggests that such limited progress in implementing a market orientation reflects a range of "structural" barriers, both within individual trusts and the specific market environment faced by trusts.

  14. Untargeted LC-MS Metabolomics of Bronchoalveolar Lavage Fluid Differentiates Acute Respiratory Distress Syndrome from Health

    PubMed Central

    Evans, Charles R.; Karnovsky, Alla; Kovach, Melissa A.; Standiford, Theodore J.; Burant, Charles F.; Stringer, Kathleen A.

    2014-01-01

    Acute respiratory distress syndrome (ARDS) remains a significant hazard to human health and is clinically challenging because there are no prognostic biomarkers and no effective pharmacotherapy. The lung compartment metabolome may detail the status of the local environment that could be useful in ARDS biomarker discovery and the identification of drug target opportunities. However, neither the utility of bronchoalveolar lavage fluid (BALF) as a biofluid for metabolomics nor the optimal analytical platform for metabolite identification are established. To address this, we undertook a study to compare metabolites in BALF samples from patients with ARDS and healthy controls using a newly developed liquid chromatography (LC)-mass spectroscopy (MS) platform for untargeted metabolomics. Following initial testing of three different high performance liquid chromatography (HPLC) columns, we determined that reversed phase (RP)-LC and hydrophilic interaction chromatography (HILIC), were the most informative chromatographic methods because they yielded the most and highest quality data. Following confirmation of metabolite identification, statistical analysis resulted in 37 differentiating metabolites in the BALF of ARDS compared with health across both analytical platforms. Pathway analysis revealed networks associated with amino acid metabolism, glycolysis and gluconeogenesis, fatty acid biosynthesis, phospholipids and purine metabolism in the ARDS BALF. The complementary analytical platforms of RPLC and HILIC-LC generated informative, insightful metabolomics data of the ARDS lung environment. PMID:24289193

  15. Community health, media, and policy in sub-Saharan Africa: a primary prevention approach to the AIDS crisis.

    PubMed

    Ndiwane, A N

    2000-01-01

    Availability, access and utilization of essential health services present challenges to community health services in Sub-Saharan Africa. HIV/AIDS infection has added yet another dimension to a continent already experiencing economic crises. A primary prevention approach is emphasized as a means of addressing sexual behaviors that decrease risk of transmission. Educating the sexually active to use condom and also HIV/AIDS testing and counseling can be effective in curbing transmission of the virus. Community forums such as the local schools and churches, together with the political leadership need to coordinate primary prevention efforts against HIV/AIDS transmission. The media can be powerful in raising awareness, community activism, and mobilization of the masses at grass-roots level by advocating behaviors that promote health. African leaders must indicate a strong political will by shaping policies that address HIV/AIDS. These leaders need resources (both internally and externally) to fund primary prevention programs that are community-based and outcome-oriented. PMID:11760309

  16. Crowdsourcing, citizen sensing and sensor web technologies for public and environmental health surveillance and crisis management: trends, OGC standards and application examples.

    PubMed

    Kamel Boulos, Maged N; Resch, Bernd; Crowley, David N; Breslin, John G; Sohn, Gunho; Burtner, Russ; Pike, William A; Jezierski, Eduardo; Chuang, Kuo-Yu Slayer

    2011-01-01

    'Wikification of GIS by the masses' is a phrase-term first coined by Kamel Boulos in 2005, two years earlier than Goodchild's term 'Volunteered Geographic Information'. Six years later (2005-2011), OpenStreetMap and Google Earth (GE) are now full-fledged, crowdsourced 'Wikipedias of the Earth' par excellence, with millions of users contributing their own layers to GE, attaching photos, videos, notes and even 3-D (three dimensional) models to locations in GE. From using Twitter in participatory sensing and bicycle-mounted sensors in pervasive environmental sensing, to creating a 100,000-sensor geo-mashup using Semantic Web technology, to the 3-D visualisation of indoor and outdoor surveillance data in real-time and the development of next-generation, collaborative natural user interfaces that will power the spatially-enabled public health and emergency situation rooms of the future, where sensor data and citizen reports can be triaged and acted upon in real-time by distributed teams of professionals, this paper offers a comprehensive state-of-the-art review of the overlapping domains of the Sensor Web, citizen sensing and 'human-in-the-loop sensing' in the era of the Mobile and Social Web, and the roles these domains can play in environmental and public health surveillance and crisis/disaster informatics. We provide an in-depth review of the key issues and trends in these areas, the challenges faced when reasoning and making decisions with real-time crowdsourced data (such as issues of information overload, "noise", misinformation, bias and trust), the core technologies and Open Geospatial Consortium (OGC) standards involved (Sensor Web Enablement and Open GeoSMS), as well as a few outstanding project implementation examples from around the world. PMID:22188675

  17. Crowdsourcing, citizen sensing and sensor web technologies for public and environmental health surveillance and crisis management: trends, OGC standards and application examples

    PubMed Central

    2011-01-01

    'Wikification of GIS by the masses' is a phrase-term first coined by Kamel Boulos in 2005, two years earlier than Goodchild's term 'Volunteered Geographic Information'. Six years later (2005-2011), OpenStreetMap and Google Earth (GE) are now full-fledged, crowdsourced 'Wikipedias of the Earth' par excellence, with millions of users contributing their own layers to GE, attaching photos, videos, notes and even 3-D (three dimensional) models to locations in GE. From using Twitter in participatory sensing and bicycle-mounted sensors in pervasive environmental sensing, to creating a 100,000-sensor geo-mashup using Semantic Web technology, to the 3-D visualisation of indoor and outdoor surveillance data in real-time and the development of next-generation, collaborative natural user interfaces that will power the spatially-enabled public health and emergency situation rooms of the future, where sensor data and citizen reports can be triaged and acted upon in real-time by distributed teams of professionals, this paper offers a comprehensive state-of-the-art review of the overlapping domains of the Sensor Web, citizen sensing and 'human-in-the-loop sensing' in the era of the Mobile and Social Web, and the roles these domains can play in environmental and public health surveillance and crisis/disaster informatics. We provide an in-depth review of the key issues and trends in these areas, the challenges faced when reasoning and making decisions with real-time crowdsourced data (such as issues of information overload, "noise", misinformation, bias and trust), the core technologies and Open Geospatial Consortium (OGC) standards involved (Sensor Web Enablement and Open GeoSMS), as well as a few outstanding project implementation examples from around the world. PMID:22188675

  18. Social deprivation and the outcomes of crisis resolution and home treatment for people with mental health problems: a historical cohort study.

    PubMed

    Kingsford, Richard; Webber, Martin

    2010-09-01

    The development of crisis resolution and home treatment (CRHT) teams has been central to the UK Government's objective of reducing reliance on hospital-based care and is supported by a growing body of evidence. However, there has been no research specifically exploring the relationship between social deprivation and CRHT teams, in spite of evidence of an association between social deprivation and increased pressure on inpatient services. This article reports a study which tested the hypothesis that social deprivation is associated with the outcome of CRHT interventions. Using a historical cohort study design, we examined a total of 260 accepted referrals to a CRHT. Social deprivation was measured by the Index of Multiple Deprivation (Office of the Deputy Prime Minister 2004) as a predictor of CRHT interventions outcomes. CRHT outcomes were dichotomised into successful and unsuccessful and were defined with reference to the CRHT operational policy. Univariate analysis found that people who lived in more socially deprived areas had a poorer outcome, as did older people and those referred from the enhanced community mental health team (CMHT). Logistic regression analysis found that age and referral source were independently associated with outcome. Analysis of the demographic data also suggested a non-significant trend towards men having less successful outcomes. Further analysis exploring the characteristics of the different referral sources to the CRHT found that those referred from the enhanced CMHT were significantly more likely to be from the most deprived area. This suggested a relationship between an enhanced level of mental health need, social deprivation and poor outcome of CRHT intervention.

  19. 'HTA for Crisis': sharing experiences during the 7th EBHC Symposium.

    PubMed

    Wladysiuk, Magdalena; Tabor, Anna; Godman, Brian

    2013-02-01

    The Central and Eastern European Society of Technology Assessment in Health Care was founded in Krakow, Poland in 2003. On October 8th and 9th, the 7th symposium took place titled 'HTA for Crisis'. This meeting was attended by over 250 decision makers, evidence-based specialists, healthcare managers, commercial company personnel and experts. The symposium was principally divided into four main themes: insurance in times of crisis; importance of pricing of health services in times of crisis; managing welfare benefits in times of crisis and Health Technology Assessment in crisis-laden countries. The symposium finished by debating potential ways forward for healthcare systems in times of crisis.

  20. Non-conventional humanitarian interventions on Ebola outbreak crisis in West Africa: health, ethics and legal implications.

    PubMed

    Tambo, Ernest

    2014-01-01

    Due to the lack of Ebola outbreak early warning alert, preparedness, surveillance and response systems, the most deadly, complex and largest ever seen Ebola war has been devastating West African communities. The unparalleled Ebola tsunami has prompted interrogations into, and uncertainties about, the effectiveness and efficiency of national, regional and international community's illed- responses using conventional humanitarian control and containment approaches and methods. The late humanitarian and local non-government organisations emergency responses and challenges to curb transmission dynamics and stop the ongoing spread in the Ebola outbreak in West Africa have led to an unprecedented toll of 14,413 reported Ebola cases in eight countries since the outbreak began, with 5,177 reported deaths including 571 health-care workers and 325 died as 14 November 2014. These indications the need of further evaluation of monitoring as substantial proportion of infections outside the context of Ebola epicentres, Ebola health centres treatment and care, infection prevention and control quality assurance checks in these countries. At the same time, exhaustive efforts should target ensuring an sufficient supply of optimal personal protective equipment (PPE) to all Ebola treatment facilities, along with the provision of training and relevant guidelines to limit to the minimum possible level of risk. The continent hosts a big proportion of the world's wealth, yet its people live in abject poverty, with governments unable to feed and govern them effectively, and who are condemned to endure even darker moments with the Ebola outbreak in West Africa. Institutionalisation of practical and operational non-conventional emergency response models efficient health systems, and tailored programmes can clearly support to prevent, control and eventually stamp out Ebola geo-distribution in addition to population mental health services that are requisite to address the massive range of the

  1. Non-conventional humanitarian interventions on Ebola outbreak crisis in West Africa: health, ethics and legal implications.

    PubMed

    Tambo, Ernest

    2014-01-01

    Due to the lack of Ebola outbreak early warning alert, preparedness, surveillance and response systems, the most deadly, complex and largest ever seen Ebola war has been devastating West African communities. The unparalleled Ebola tsunami has prompted interrogations into, and uncertainties about, the effectiveness and efficiency of national, regional and international community's illed- responses using conventional humanitarian control and containment approaches and methods. The late humanitarian and local non-government organisations emergency responses and challenges to curb transmission dynamics and stop the ongoing spread in the Ebola outbreak in West Africa have led to an unprecedented toll of 14,413 reported Ebola cases in eight countries since the outbreak began, with 5,177 reported deaths including 571 health-care workers and 325 died as 14 November 2014. These indications the need of further evaluation of monitoring as substantial proportion of infections outside the context of Ebola epicentres, Ebola health centres treatment and care, infection prevention and control quality assurance checks in these countries. At the same time, exhaustive efforts should target ensuring an sufficient supply of optimal personal protective equipment (PPE) to all Ebola treatment facilities, along with the provision of training and relevant guidelines to limit to the minimum possible level of risk. The continent hosts a big proportion of the world's wealth, yet its people live in abject poverty, with governments unable to feed and govern them effectively, and who are condemned to endure even darker moments with the Ebola outbreak in West Africa. Institutionalisation of practical and operational non-conventional emergency response models efficient health systems, and tailored programmes can clearly support to prevent, control and eventually stamp out Ebola geo-distribution in addition to population mental health services that are requisite to address the massive range of the

  2. Guidelines for Crisis Management.

    ERIC Educational Resources Information Center

    Wimberley, Lloyd

    1985-01-01

    The article offers guidelines for crisis prediction, preplanning, support team development, and post-crisis management that can handle aggressive behavior and convey to the child the existence of a legitimate system for enhancing positive self control. (CL)

  3. Facilitators and barriers to doing workplace mental health research: Case study of acute psychological trauma in a public transit system.

    PubMed

    Links, Paul S; Bender, Ash; Eynan, Rahel; O'Grady, John; Shah, Ravi

    2016-03-10

    The Acute Psychological Trauma (APT) Study was a collaboration between an acute care hospital, a specialized multidisciplinary program designed to meet the mental health needs of injured workers, and a large urban public transit system. The overall purpose was to evaluate a Best Practices Intervention (BPI) for employees affected by acute psychological trauma compared to a Treatment as Usual (TAU) group. The specific purpose is to discuss facilitators and barriers that were recognized in implementing and carrying out mental health research in a workplace setting. Over the course of the APT study, a joint implementation committee was responsible for day-to-day study operations and made regular observations on the facilitators and barriers that arose throughout the study. The facilitators to this study included the longstanding relationships among the partners, increased recognition for the need of mental health research in the workplace, and the existence of a community advisory committee. The significant barriers to doing this study of mental health research in the workplace included differences in organizational culture, inconsistent union support, co-interventions, and stigma. Researchers and funding agencies need to be flexible and provide additional resources in order to overcome the barriers that can exist doing workplace mental health research.

  4. Facilitators and barriers to doing workplace mental health research: Case study of acute psychological trauma in a public transit system.

    PubMed

    Links, Paul S; Bender, Ash; Eynan, Rahel; O'Grady, John; Shah, Ravi

    2016-03-10

    The Acute Psychological Trauma (APT) Study was a collaboration between an acute care hospital, a specialized multidisciplinary program designed to meet the mental health needs of injured workers, and a large urban public transit system. The overall purpose was to evaluate a Best Practices Intervention (BPI) for employees affected by acute psychological trauma compared to a Treatment as Usual (TAU) group. The specific purpose is to discuss facilitators and barriers that were recognized in implementing and carrying out mental health research in a workplace setting. Over the course of the APT study, a joint implementation committee was responsible for day-to-day study operations and made regular observations on the facilitators and barriers that arose throughout the study. The facilitators to this study included the longstanding relationships among the partners, increased recognition for the need of mental health research in the workplace, and the existence of a community advisory committee. The significant barriers to doing this study of mental health research in the workplace included differences in organizational culture, inconsistent union support, co-interventions, and stigma. Researchers and funding agencies need to be flexible and provide additional resources in order to overcome the barriers that can exist doing workplace mental health research. PMID:26967029

  5. A multinational health professional perspective of the prevalence of mood disorders in patients with acute and chronic wounds.

    PubMed

    Upton, Dominic; Solowiej, Kazia; Woo, Kevin Y

    2014-12-01

    Recent research has started to identify mood disorders and problems associated with acute and chronic wounds, which have been shown to contribute to delayed healing, poor patient well-being and a reduced quality of life. Furthermore, mood disorders have been shown to have a negative impact on financial costs for service providers and the wider society in terms of treatment and sickness absence. This study aimed to survey a multinational sample of health professionals to explore their perspective and awareness of mood disorders amongst acute and chronic wound patients. Responses were received from n = 908 health professionals working in Asia, Africa, Australia, Europe, North America and South America. A strong awareness of the prevalence of mood disorders appeared to be widespread among the health professionals across the world, in addition to a view on the potential factors contributing to these problems with mood. Despite this, it was thought that few patients were actually receiving treatment for their mood disorders. Implications for clinical practice include the need for health professionals to engage actively with their patients to enable them to learn from their experiences. Studies that explore the benefits of treatments and techniques appropriate for minimising mood disorders in patients with wounds would provide empirical evidence for health professionals to make recommendations for patients with acute and chronic wounds.

  6. AIDS/HIV crisis in developing countries: the need for greater understanding and innovative health promotion approaches.

    PubMed

    Livingston, I L

    1992-09-01

    Epidemiologic data on morbidity and mortality have shown that the acquired immunodeficiency syndrome/human immunodeficiency virus (AIDS/HIV) epidemic is relatively widespread in the developing countries of the world, especially in the already economically deprived regions of Sub-Saharan Africa. Africa is estimated to have approximately 5 million seropositive individuals, and by the year 2000, this number is expected to include 10 million HIV-infected children. Improved control over this epidemic can only come through a greater understanding of the specifics of the disease and, eventually, the introduction of more effective and innovative health promotion campaigns targeted at medical personnel, traditional healers, families, and persons with AIDS. Comprehensive health promotion campaigns, carefully using mass media strategies in addition to more community-based programs, all operating under "decentralized" AIDS control programs, are reasoned to be the most efficacious approach that African and other developing countries can use to successfully contain the AIDS/HIV epidemic. Given the reality of the following factors: Pattern II (ie, transmission of AIDS via heterosexual sexual activity) is the main mode of HIV transmission in Africa, the traditional dominant roles males have in sexual relations, and the positive relationship between sexually transmitted diseases and AIDS, health promotion campaigns must focus specifically on addressing at-risk culturally related sexual values and behaviors in African communities. Failure to address these and other related factors will certainly lead to an escalation of the AIDS/HIV epidemic in Africa and, therefore, concomitant devastation in the human and societal realms of the region. PMID:1404473

  7. Crisis Management: Research Summaries

    ERIC Educational Resources Information Center

    Brock, Stephen E., Ed.; Dorman, Sally; Anderson, Luke; McNair, Daniel

    2013-01-01

    This article presents summaries of three studies relevant to school crisis response. The first report, "A Framework for International Crisis Intervention" (Sally Dorman), is a review of how existing crisis intervention models (including the NASP PREPaRE model) have been adapted for international use. The second article, "Responding…

  8. Images for Crisis Management.

    ERIC Educational Resources Information Center

    Raffan, James

    1984-01-01

    Most take canoeing, leadership, first aid, CPR and other courses to help cope when something happens, but there is more to dealing with crisis than learning proper procedures and techniques. Three areas of concern interlock to form the Crisis Management Triangle: knowledge and skill, preventive awareness, and crisis management planning. (ERB)

  9. Electronic gaming and the obesity crisis.

    PubMed

    Calvert, Sandra L; Staiano, Amanda E; Bond, Bradley J

    2013-01-01

    Children and adolescents in the United States and in many countries are projected to have shorter life spans than their parents, partly because of the obesity crisis engulfing the developed world. Exposure to electronic media is often implicated in this crisis because media use, including electronic game play, may promote sedentary behavior and increase consumption of high-calorie foods and beverages that are low in nutritional value. Electronic games, however, may increase children's physical activity and expose them to healthier foods. We examine the role of electronic games in the pediatric obesity crisis and their contribution to more favorable health outcomes.

  10. Electronic gaming and the obesity crisis.

    PubMed

    Calvert, Sandra L; Staiano, Amanda E; Bond, Bradley J

    2013-01-01

    Children and adolescents in the United States and in many countries are projected to have shorter life spans than their parents, partly because of the obesity crisis engulfing the developed world. Exposure to electronic media is often implicated in this crisis because media use, including electronic game play, may promote sedentary behavior and increase consumption of high-calorie foods and beverages that are low in nutritional value. Electronic games, however, may increase children's physical activity and expose them to healthier foods. We examine the role of electronic games in the pediatric obesity crisis and their contribution to more favorable health outcomes. PMID:23483693

  11. Strengthening Health Systems While Responding to a Health Crisis: Lessons Learned by a Nongovernmental Organization During the Ebola Virus Disease Epidemic in Sierra Leone

    PubMed Central

    Cancedda, Corrado; Davis, Sheila M.; Dierberg, Kerry L.; Lascher, Jonathan; Kelly, J. Daniel; Barrie, Mohammed Bailor; Koroma, Alimamy Philip; George, Peter; Kamara, Adikali Alpha; Marsh, Ronald; Sumbuya, Manso S.; Nutt, Cameron T.; Scott, Kirstin W.; Thomas, Edgar; Bollbach, Katherine; Sesay, Andrew; Barrie, Ahmidu; Barrera, Elizabeth; Barron, Kathryn; Welch, John; Bhadelia, Nahid; Frankfurter, Raphael G.; Dahl, Ophelia M.; Das, Sarthak; Rollins, Rebecca E.; Eustis, Bryan; Schwartz, Amanda; Pertile, Piero; Pavlopoulos, Ilias; Mayfield, Allan; Marsh, Regan H.; Dibba, Yusupha; Kloepper, Danielle; Hall, Andrew; Huster, Karin; Grady, Michael; Spray, Kimberly; Walton, David A.; Daboh, Fodei; Nally, Cora; James, Sahr; Warren, Gabriel S.; Chang, Joyce; Drasher, Michael; Lamin, Gina; Bangura, Sherry; Miller, Ann C.; Michaelis, Annie P.; McBain, Ryan; Broadhurst, M. Jana; Murray, Megan; Richardson, Eugene T.; Philip, Ted; Gottlieb, Gary L.; Mukherjee, Joia S.; Farmer, Paul E.

    2016-01-01

    An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives in West Africa. As the EVD epidemic subsides, it is important for all who participated in the emergency Ebola response to reflect on strengths and weaknesses of the response. Such reflections should take into account perspectives not usually included in peer-reviewed publications and after-action reports, including those from the public sector, nongovernmental organizations (NGOs), survivors of Ebola, and Ebola-affected households and communities. In this article, we first describe how the international NGO Partners In Health (PIH) partnered with the Government of Sierra Leone and Wellbody Alliance (a local NGO) to respond to the EVD epidemic in 4 of the country's most Ebola-affected districts. We then describe how, in the aftermath of the epidemic, PIH is partnering with the public sector to strengthen the health system and resume delivery of regular health services. PIH's experience in Sierra Leone is one of multiple partnerships with different stakeholders. It is also one of rapid deployment of expatriate clinicians and logistics personnel in health facilities largely deprived of health professionals, medical supplies, and physical infrastructure required to deliver health services effectively and safely. Lessons learned by PIH and its partners in Sierra Leone can contribute to the ongoing discussion within the international community on how to ensure emergency preparedness and build resilient health systems in settings without either. PMID:27688219

  12. Defining Crisis in Families of Individuals with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Weiss, Jonathan A.; Wingsiong, Aranda; Lunsky, Yona

    2014-01-01

    Parents of children diagnosed with autism spectrum disorder often report higher levels of depression, anxiety, and mental health-related issues. The combination of stressors and family adjustment difficulties can cause distress which may develop into a crisis. Understanding crisis in the family is important to mental health practice since it can…

  13. Mechanical Thrombectomy in Patients With Acute Ischemic Stroke: A Health Technology Assessment

    PubMed Central

    2016-01-01

    Background In Ontario, current treatment for eligible patients who have an acute ischemic stroke is intravenous thrombolysis (IVT). However, there are some limitations and contraindications to IVT, and outcomes may not be favourable for patients with stroke caused by a proximal intracranial occlusion. An alternative is mechanical thrombectomy with newer devices, and a number of recent studies have suggested that this treatment is more effective for improving functional independence and clinical outcomes. The objective of this health technology assessment was to evaluate the clinical effectiveness and cost-effectiveness of new-generation mechanical thrombectomy devices (with or without IVT) compared to IVT alone (if eligible) in patients with acute ischemic stroke. Methods We conducted a systematic review of the literature, limited to randomized controlled trials that examined the effectiveness of mechanical thrombectomy using stent retrievers and thromboaspiration devices for patients with acute ischemic stroke. We assessed the quality of the evidence using the GRADE approach. We developed a Markov decision-analytic model to assess the cost-effectiveness of mechanical thrombectomy (with or without IVT) versus IVT alone (if eligible), calculated incremental cost-effectiveness ratios using a 5-year time horizon, and conducted sensitivity analyses to examine the robustness of the estimates. Results There was a substantial, statistically significant difference in rate of functional independence (GRADE: high quality) between those who received mechanical thrombectomy (with or without IVT) and IVT alone (odds ratio [OR] 2.39, 95% confidence interval [CI] 1.88–3.04). We did not observe a difference in mortality (GRADE: moderate quality) (OR 0.80, 95% CI 0.60–1.07) or symptomatic intracerebral hemorrhage (GRADE: moderate quality) (OR 1.11, 95% CI 0.66–1.87). In the base-case cost-utility analysis, which had a 5 year time horizon, the costs and effectiveness for

  14. Arterial thromboembolism in cats: acute crisis in 127 cases (1992-2001) and long-term management with low-dose aspirin in 24 cases.

    PubMed

    Smith, Stephanie A; Tobias, Anthony H; Jacob, Kristin A; Fine, Deborah M; Grumbles, Pamela L

    2003-01-01

    Records of 127 cats with arterial thromboembolism (ATE) were reviewed. Abyssinian, Birman, Ragdoll, and male cats were overrepresented. Tachypnea (91%), hypothermia (66%), and absent limb motor function (66%) were common. Of 90 cats with diagnostics performed, underlying diseases were hyperthyroidism (12), cardiomyopathy (dilated [8], unclassified [33], hypertrophic obstructive [5], hypertrophic [19]), neoplasia (6), other (4), and none (3). Common abnormalities were left atrial enlargement (93%), congestive heart failure (CHF, 44%), and arrhythmias (44%). Of cats without CHF, 89% were tachypneic. Common biochemical abnormalities were hyperglycemia, azotemia, and abnormally high serum concentrations of muscle enzymes. Of 87 cats treated for acute limb ATE, 39 (45%) survived to be discharged. Significant differences were found between survivors and nonsurvivors for temperature (P < .00001), heart rate (P = .038), serum phosphorus concentration (P = .024), motor function (P = .008), and number of limbs affected (P = .001). No significant difference was found between survivors and nonsurvivors when compared by age, respiratory rate, other biochemical analytes, or concurrent CHE A logistic regression model based on rectal temperature predicted a 50% probability of survival at 98.9 degrees F (37.2 degrees C). Median survival time (MST) for discharged cats was 117 days. Eleven cats had ATE recurrences, and 5 cats developed limb problems. Cats with CHF (MST: 77 days) had significantly shorter survival than cats without CHF (MST: 223 days; P = .016). No significant difference was found in survival or recurrence rate between cats receiving high-dose aspirin (> or = 40 mg/cat q72h) and cats receiving low-dose aspirin (5 mg/cat q72h). Adverse effects were less frequent and milder for the lower dosage.

  15. [Cardiovascular complications of hypertensive crisis].

    PubMed

    Rosas-Peralta, Martín; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

    2016-01-01

    It is inexorable that a proportion of patients with systemic arterial hypertension will develop a hypertensive crisis at some point in their lives. The hypertensive crises can be divided in hypertensive patients with emergency or hypertensive emergency, according to the presence or absence of acute end-organ damage. In this review, we discuss the cardiovascular hypertensive emergencies, including acute coronary syndrome, congestive heart failure, aortic dissection and sympathomimetic hypertensive crises (those caused by cocaine use included). Each is presented in a unique way, although some patients with hypertensive emergency report non-specific symptoms. Treatment includes multiple medications for quick and effective action with security to reduce blood pressure, protect the function of organs remaining, relieve symptoms, minimize the risk of complications and improve patient outcomes.

  16. The Impending Crisis

    PubMed Central

    Kaplan, Raymond L.; Burgess, Thomas E.

    2010-01-01

    When you are ill and consult a physician for his or her expertise, many times laboratory testing is part of the clinical workup. This testing is critical to the physician’s ability to diagnose the patient’s condition. What if testing was not available … because there was no one to do the testing? Although seemingly far-fetched, this scenario could play itself out in the next ten years due to an impending manpower crisis in laboratory medicine. The profession of Medical Technology, also known as Clinical Laboratory Science, is experiencing a shortage of qualified individuals for a variety of reasons – not the least of which is the closure of almost 70% of the schools teaching this critical profession. Health care workers (HCW) rely on accurate and timely clinical laboratory results in order to make decisions for their patients. Because ∼ 70% of patient care decisions are based on clinical laboratory results, it is important to have a well-trained supply of laboratory professionals. This article will give an overview of the situation and the possible causes of this shortage, and pose challenges to our profession as to how this crisis can be averted. Visibility of this profession must be a prime focus of this effort in order for the population in general to be aware of the role Clinical Laboratory Scientists play in the health care consortium. This effort should begin early in the educational process, potentially as early as Middle School (junior high school), bringing awareness of the profession not only to students but to educators as well. PMID:23653714

  17. Modeling the acute health effects of astronauts from exposure to large solar particle events.

    PubMed

    Hu, Shaowen; Kim, Myung-Hee Y; McClellan, Gene E; Cucinotta, Francis A

    2009-04-01

    Radiation exposure from Solar Particle Events (SPE) presents a significant health concern for astronauts for exploration missions outside the protection of the Earth's magnetic field, which could impair their performance and result in the possibility of failure of the mission. Assessing the potential for early radiation effects under such adverse conditions is of prime importance. Here we apply a biologically based mathematical model that describes the dose- and time-dependent early human responses that constitute the prodromal syndromes to consider acute risks from SPEs. We examine the possible early effects on crews from exposure to some historically large solar events on lunar and/or Mars missions. The doses and dose rates of specific organs were calculated using the Baryon radiation transport (BRYNTRN) code and a computerized anatomical man model, while the hazard of the early radiation effects and performance reduction were calculated using the Radiation-Induced Performance Decrement (RIPD) code. Based on model assumptions we show that exposure to these historical events would cause moderate early health effects to crew members inside a typical spacecraft or during extra-vehicular activities, if effective shielding and medical countermeasure tactics were not provided. We also calculate possible even worse cases (double intensity, multiple occurrences in a short period of time, etc.) to estimate the severity, onset and duration of various types of early illness. Uncertainties in the calculation due to limited data on relative biological effectiveness and dose-rate modifying factors for protons and secondary radiation, and the identification of sensitive sites in critical organs are discussed.

  18. Modeling the acute health effects of astronauts from exposure to large solar particle events.

    PubMed

    Hu, Shaowen; Kim, Myung-Hee Y; McClellan, Gene E; Cucinotta, Francis A

    2009-04-01

    Radiation exposure from Solar Particle Events (SPE) presents a significant health concern for astronauts for exploration missions outside the protection of the Earth's magnetic field, which could impair their performance and result in the possibility of failure of the mission. Assessing the potential for early radiation effects under such adverse conditions is of prime importance. Here we apply a biologically based mathematical model that describes the dose- and time-dependent early human responses that constitute the prodromal syndromes to consider acute risks from SPEs. We examine the possible early effects on crews from exposure to some historically large solar events on lunar and/or Mars missions. The doses and dose rates of specific organs were calculated using the Baryon radiation transport (BRYNTRN) code and a computerized anatomical man model, while the hazard of the early radiation effects and performance reduction were calculated using the Radiation-Induced Performance Decrement (RIPD) code. Based on model assumptions we show that exposure to these historical events would cause moderate early health effects to crew members inside a typical spacecraft or during extra-vehicular activities, if effective shielding and medical countermeasure tactics were not provided. We also calculate possible even worse cases (double intensity, multiple occurrences in a short period of time, etc.) to estimate the severity, onset and duration of various types of early illness. Uncertainties in the calculation due to limited data on relative biological effectiveness and dose-rate modifying factors for protons and secondary radiation, and the identification of sensitive sites in critical organs are discussed. PMID:19276707

  19. Acute health impact of the gas release at Lake Nyos, Cameroon, 1986

    NASA Astrophysics Data System (ADS)

    Baxter, Peter J.; Kapila, Mukesh

    1989-11-01

    Available medical evidence on the acute health impact of the gas release at Lake Nyos is summarised, including the results of a survey of medical records of 845 survivors treated at Wum and Nkambe hospitals. The main clinical features were compatible with exposure to an asphyxiant gas such as CO 2 but confirmation of the identity of the gas or gases involved was not possible. Exposure to CO 2 over such a large inhabited area and reversible coma lasting for hours after CO 2 gassing do not appear to have been reported before. In some victims, blistering or ulceration of the skin was present which could not be readily explained by local injury from pressure, or burns from acid, or falling near fires. Further epidemiological studies on survivors are unlikely to be feasible, but the possibility of long-term anoxic brain damage among adults and children who had been rendered comatose by the gas should be considered, though overt evidence of major neurological or respiratory disability was not apparent in survivors in the weeks following the disaster. The inadequacy of the toxicological and forensic evidence obtained points to the need for the rapid mobilisation of medical scientists in future disasters of this kind.

  20. Leadership support for ward managers in acute mental health inpatient settings.

    PubMed

    Bonner, Gwen; McLaughlin, Sue

    2014-05-01

    This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused. PMID:24779763