Current Healthcare Situation Research Articles

Maximizing the public health impact of eating disorder services: A simulation study.

Although effective interventions for eating disorders (ED) are available, the impact of health care services on a population level is far from satisfactory. A mathematical model of how health care for ED affects the population's disease burden can stimulate discussions and provide guidance about promising strategies to reduce ED-related suffering on the population level. The current health care situation for ED is modeled taking into account the reach and effectiveness of prevention, treatment, and aftercare, as well as incidence rates, relapse rates, and rates for spontaneous remissions. A first-order Markov model is applied and the effect of changes in single service parameters on the populations overall disease burden are simulated. Improvements of treatment utilization and the reach of prevention programs would have the largest effects on the population's disease burden. Improving the efficacy of treatment, prevention, and aftercare show only limited effects. In order to maximize the public health impact of health care for ED new models of treatment delivery as well as public health approaches to the prevention of ED are critical.

Co-occurring Mental Disorders in Substance Abuse Treatment: the Current Health Care Situation in Germany

Aim of this study was to investigate the current health care situation for patients with co-occurring mental disorders in addiction treatment. Therefore, data from the German Substance Abuse Treatment System (N = 194,406) was analysed with regard to the prevalence of comorbid mental disorders, treatment characteristics and outcomes of patients with comorbid psychiatric diagnosis. In outpatient setting, the prevalence of comorbid diagnoses was considerably lower (4.6%) than in inpatient setting (50.7%), but mood and anxiety disorders were the most prevalent additional diagnoses in both settings. In the treatment of patients with these comorbid disorders, we found higher rates of complementary internal and external (psychiatric) treatment, more co-operations and referrals after treatment, and positive treatment process outcomes. Findings indicate that the knowledge of an additional diagnosis influences the health care provision of affected patients and can therefore be seen as the essential precondition for providing adequate and comprehensive treatment. This highlights the importance of a sufficient consideration and diagnostic assessment of mental disorders in addiction treatment to further improve the health care situation of comorbid patients.

Normalizing Bribes as a Solution to Romania’s Deteriorating Health System

Normalizing Bribes as a Solution to Romania’s Deteriorating Health System

Understanding the Importance of Gene and Environment in the Etiology and Prevention of Type 2 Diabetes Mellitus in High-Risk Populations

Current literature focuses on the complications and treatment of Type 2 Diabetes Mellitus (T2DM) while clustering environmental and genetic factors to explain the disease. Interventions proposed to reduce diabetes prevalence should focus predominantly on initiating active rapports of family members and promoting a more communication-oriented preventative approach between diabetics and non-diabetics. Due to varying risks in T2DM by race and ethnicity, these populations should follow race-appropriate guidelines to prevent further T2DM occurrence and complications. The review consists of information related to the genetic component of T2DM to help identify high-risk groups and focuses on the environmental aspect of the disease to help consider appropriate techniques to reduce disease burden. Genetic factors play important roles in the pathogenesis of diabetes and thus are an essential element of understanding the cause of the disease and possible methods of prevention. Focusing on high-risk groups with T2DM could have profound effects on the current health care situation. In this review, we discuss the epidemiology of diabetes in the United States and propose methods of preventing and delaying the development of T2DM in high-risk individuals.

Unterschiede in der Häufigkeit von Gesundheitsleistungen – ist alles unethisch?

Regional differences in the use of health services have been known for several decades. This variability is often overall regarded as undesirable in discussions and ethical-moral argumentation takes place. The description and analysis of this variability and the underlying causes are the subject of numerous investigations in various health care systems. The purpose of this research was to determine which causes can the current health care situation be attributed to and which approaches exist to counteract undesirable variability. On the basis of a selective literature search, an overview on the identification of variations in surgical care as well as a presentation of possible causes and solution approaches were created. Numerous factors influencing the decision-making process regarding surgical interventions could be identified. These can be patient-related, disease-/intervention-related, physician-related, or system-related and are partially linked with each other. The optimal strategies to minimize variability in health care are still unclear. Scientific evidence to assess the benefit and risk of an intervention, physician's attitudes and preferences as well as the involvement of patients in the decision-making process, however, seem to be important starting points. The description of regional differences is an important step toward provision of evidence-based and tailored health care. Differences in health care provision and especially regionally varying high intervention rates are not per se problematic. Whether a patient receives an intervention or not should, however, not depend any more on where he or she lives and which physician is being consulted, but on his or her individual medical condition or preferences. Target group-oriented evidence-based information can help to minimize undesirable variability.

JUSTIFICATION OF A SYSTEMIC APPROACH IN THE SUDDEN CARDIAC DEATH PREVENTION: A POSSIBLE SOLUTION TO THE PROBLEM OF EXCESSIVE MORTALITY IN RUSSIA (LITERATURE REVIEW) PART I. CARDIOVASCULAR ASPECTS OF EXCESSIVE MORALITY IN RUSSIA: THE STATE OF THE PROBLEM AND POTENTIAL FOR PREVENTION

The review of the existing evidence on the problem of excessive mortality in Russia has demonstrated that the country is at the initial stage of the irreversible depopulation process. The current healthcare situation, in regard to cardiovascular disease (CVD), does not provide much hope for the effectiveness of existing measures for fatal CVD prevention. It is clear that a large-scale focussed analysis of the clinical and organisational limitations of the existing prevention systems is urgently needed. This discussion should be started in the nearest future.

Ageing Prisoners' Health Care: Analysing the Legal Settings in Europe and the United States

Background: Relatively little is known about the current health care situation and the legal rights of ageing prisoners worldwide. To date, only a few studies have investigated their rights to health care. However, elderly prisoners need special attention. Objective: The aim of this article is to critically review the health care situation of older prisoners by analysing the relevant national and international legal frameworks with a particular focus on Switzerland, England and Wales, and the United States (US). Methods: Publications on legal frameworks were searched using Web of Science, PubMed, MEDLINE, HeinOnline, and the National Criminal Justice Reference Service. Searches utilizing combinations of keywords relating to ageing prisoners were performed. Relevant reports and policy documents were obtained in order to understand the legal settings in Switzerland, England and Wales, and the US. All articles, reports, and policy documents published in English and German between 1774 to June 2012 were included for analysis. Using a comparative approach, an outline was completed to distinguish positive policies in this area. Regulatory approaches were investigated through evaluations of soft laws applicable in Europe and US Supreme Court judgements. Results: Even though several documents could be interpreted as guaranteeing adequate health care for ageing prisoners, there is no specific regulation that addresses this issue completely. The Vienna International Plan of Action on Ageing contributes the most by providing an in-depth analysis of the health care needs of older persons. Still, critical analysis of retrieved documents reveals the lack of specific legislation regarding the health care for ageing prisoners. Conclusion: No consistent regulation delineates the provision of health care for ageing prisoners. Neither national nor international institutions have enforceable laws that secure the precarious situation of older adults in prisons. To initiate a change, this work presents critical issues that must be addressed to protect the right to health care and well-being of ageing prisoners. Additionally, it is important to design legal structures and guidelines which acknowledge and accommodate the needs of ageing prisoners.

Organización de la asistencia a la transexualidad en el sistema sanitario público español

ObjectiveRecognition of transexuality as a clinical entity for which medical attention should be available is currently a well-established reality, but institutional care has not been uniformly instituted throughout Spain. The aim of the present study was to determine the current situation of healthcare for transexualism in the publicly-funded health service in Spain. Materials and methodsA descriptive study based on data provided by the Spanish Society of Endocrinology Group on Identity and Sexual Differentiation was performed. The resources in the regions that have created specific gender units for these disorders are described. ResultsNine autonomous regions (55%) have started to provide various procedures, although only four provide genitoplastic procedures. The first region to include all sex reassignment surgeries was Andalusia (year 1999). At the same time, Madrid and Catalonia also began to provide specialized mental health care and endocrinology but did not include surgical procedures until 2007 and institutional recognition until 2008. Since 2007 other regions have incorporated healthcare for transsexual patients. Overall, 3,303 patients (a male-to female/female-to-male transsexual ratio of 1.9/1) and 864 surgical procedures have been registered in this study. The composition and proportion of working hours of specialists, as well as the kinds of treatments provided, differ widely in each region. ConclusionsThe geographical distribution of healthcare to transsexual persons and the services provided vary. Few regions offer genitoplastic procedures. The number of applicants exceeds the number estimated by the national health system.

Versorgungsforschung zur angemessenen Gesundheitsversorgung im Alter

This article addresses the contribution that health care research can make to facilitating appropriate health care provision for older adults. First, the major risks in this age group are described. These include multiple illnesses, the increasing need for nursing care with age, but also the growing numbers of older adults with psychological disorders, primarily dementia. The second section of the article presents a critical assessment of the current health care situation in light of the risks identified. On this basis, the third section specifies the areas of health care research that can contribute to improving the quality of the health care provision for this population. The article is based on a presentation made by the author at the 2010 Berlin Talks on Social Medicine: "The New Old--Health Care Research for a Changed Society."

Sleep Apnoea in Patients of Elderly: Care Activity in Spain (2002–2008)

Introduction and objective There is a significant lack of scientific evidence on the role of SAHS in the elderly despite the increasing ageing of the population. The objective of the present study is to analyse the current healthcare situation in Spain on the diagnosis and treatment of sleep apnoea in the elderly population (≥65 years) and its progress over the last few years. Material and method Cross-sectional study. Healthcare information was collected on the diagnosis and treatment of patients of both sexes, ≥65 years old suspected of having SAHS and referred to sleep units (SU) between 2002 and 2008. Results There were 51,229 sleep studies performed in 16 SU. Of these, 24.3% were performed on subjects ≥65 years old (64.9% men), of which 71.5% had an apnoea-hypopnoea index (AHI) > 10 (68.6% treated with CPAP). There were no differences over time as regards mean age, mean AHI or percentage of studies done. A significant decrease was observed in the number of CPAP prescribed to men ≥65 years from 2002 to 2005 ( P=.01) which subsequently increased up to 2008 ( P=.01). This phenomenon was not observed in women ≥65 years. Conclusion Despite the lack of evidence on the subject, healthcare activity due to suspected SAHS in the elderly population is intense; therefore it should be a priority to start clinical studies that may be able to answer key questions on the diagnosis and treatment of SAHS in this age group

Resources for and barriers to effective diabetes care management—experiences and perspectives of people with type 2 diabetes

AimsTo identify barriers and resources of effective diabetes care management from the perspectives of patients with diabetes.BackgroundThe current health care situation of patients with diabetes indicates that the German health care system is not sufficiently prepared for the increasing incidence rate.MethodsQualitative design reflecting symbolic interactionism as a methodological background. Problem-centered interviews were used for data collection. A qualitative content analysis was applied for data analysis.ResultsFindings suggest a need for individual- and resource-oriented concepts of care in home settings. Participants rate exercise, professional and social support as well as self-efficacy as important resources in diabetes management. Barriers such as lacking acceptance of the disease, problems in adjustment to a new diet as well as utilization of diabetes education in the daily routine, cognitive impairment and impaired perception of physical changes, such as neuropathy, were identified.ConclusionsPrevention-orientated counseling and education concepts in diabetes management should systematically integrate the resources of patients with diabetes and tackle the barriers they perceive in order to support them in their specific care needs.

Apnea del sueño en individuos de edad avanzada. Actividad asistencial (2002–2008) en España

Introduction and objective There is a significant lack of scientific evidence on the role of SAHS in the elderly despite the increasing ageing of the population. The objective of the present study is to analyse the current healthcare situation in Spain on the diagnosis and treatment of sleep apnea in the population ≥65 years and its progress over the last few years. Material and method Cross-sectional study. Healthcare information was collected on the diagnosis and treatment of patients of both sexes and ≥65 years suspected with having SAHS and referred to sleep units (SU) between 2002 and 2008. Results There were 51,229 sleep studies performed in 16 SU. Of these, 24.3% were performed on subjects ≥ 65 years (64.9% males), of which 71.5% had an AHI (apnoea-hypopnoea index) >10 (68.6% treated with CPAP). There were no differences over time as regards mean age, mean AHI or percentage of studies done. A significant decrease was observed in the number of CPAP prescribed to males ≥65 years from 2002 to 2005 ( p=0.01) which subsequently increased up to 2008 ( p=0.01). This phenomenon was not observed in women ≥65 years. Conclusion Despite the lack of evidence on the subject, healthcare activity due to suspected SAHS in the elderly population is intense, therefore it should be a priority to start clinical studies that may be able to answer key questions on the diagnosis and treatment of SAHS in this age group.

Current situation of depression healthcare in Spain: results of a psychiatrists' survey

Objective: To analyze the current situation of healthcare for depression in Spain, according to psychiatrists opinion, and how it has evolved over the last 20 years, comparativily with the results reported in previous studies of our group. Methods: Throughout 2002, we recorded the opinions of 101 specialists in psychiatry after asking them to fill out structured questionnaires in which they rated care, clinical, therapeutic and care quality. ' Results: The presence of depressive disorders in healthcare is substantial, despite the high figures for concealed epidemiology, with an increase in these last 20 years of disorders comorbid with anxiety. Currently, most patients arrive at the psychiatrist having been referred by their general practitioners (GP), as there is now less reluctance in depressive patients to such referral. In the last years there has been an increase in pharmacological treatment, with adverse effects of the drugs representing the major obstacle to non-adherence to such treatment. Selective serotonin reuptake inhibitors (SSRIs) constitute the pharmacological group of choice, and are the drugs most commonly used in the treatment of depression, together with venlafaxine. Areas where there is a need for improvement are time devoted to consultation, coordination between GPs and psychiatrists, waiting lists, and resources available to Mental Health Units. Conclusions: Current situation of depression healthcare in Spain has substantially changed in recent years, improving in some aspects, thanks, in part, to the attitudes of GPs with this disorder and to evolution of pharmacological treatment.

Management of depression in primary care: a survey of general practitioners in Spain

Objective The objective of this study was to analyze the current situation of health care for depression in Spain according to general practitioners' (GPs') opinion and how it has evolved over the last 20 years on the basis of comparisons with the results of two previous social-health studies (published in 1997 and 1982). Method Throughout 2002, we recorded the opinions of 238 GPs after asking them to fill up structured questionnaires in which they rated care, clinical, therapeutic and care quality aspects. Results Only 40% of patients with depression visit a doctor, implying a very high level of “concealed epidemiology.” The diagnostic instruments most commonly used are assessment of symptoms and patient interview. Pharmacological treatment is the option GPs most commonly choose once a depression diagnosis is established (80% vs. 50% in 1997; P<.001). Selective serotonin reuptake inhibitors (SSRIs), together with anxiolytics, are the drugs most commonly used in the treatment of depression. SSRIs are the first choice drugs, being preferred to tricyclic antidepressants and anxiolytics, which were the most popular options for GPs in the 1997 survey. Areas where there is a need for improvement are time devoted to consultation, coordination between GPs and psychiatrists and waiting lists. Conclusions The quality of health care for depression has improved in recent years, thanks to changes in the attitudes of GPs and the evolution of pharmacological treatment.

« Soigner un enfant : la pensée dans le corps, le corps dans la pensée »

This communication opened the national annual meeting of the French Society for Child and Adolescent Psychiatry and Allied Professions (SFPEADA) in Toulouse, France, on May 16, 2003. First, the author presented three testimonies: the first, written by a journalist, the second by a parent who is also a writer, and the third by a professional of healthcare. Then, he proposes, in a subjective and necessarily uncompleted way, an analysis of the current situation of healthcare, of the links between body and thought in child psychiatry and the allied professions. Of what will be made the future, between biology and psychology, acting and thinking, care and “no care”? What must remain of our theories and practices? How do we need to change and open our ways of working and thinking our work? Which is the real influence of our society, our communities, our medias on minds, bodies, individuals?

The debate over the U.S. government's role in health care financing:"deja vu, all over again"

Yogi Berra's famous quote captures the continuing debate over the legitimate role of the U.S. government in health care financing. The issues of individual choice, equity of access, and concern about income security are just as unresolved today as they were in the early twentieth century. Until we engage in an explicit national debate on these issues and come to a national consensus on the human and political values underlying our current health care situation, a “solution” to the health care financing problems will never be found. This article discusses the history of the issue of government's involvement in health care financing, American ambivalence about government regulation, and the role of American business as a major health care insurer.

Protecting the Therapeutic Alliance in this Time of Changing Health-Care Delivery Systems

ABSTRACTThis Presidential Address examines the current health-care situation, focusing on group therapists and patients. Psychodynamically inclined practitioners emphasize that group treatment effectiveness is related to the quality and strength of the “therapeutic alliance.” But the empowerment of provider-administrators to determine treatment availability can undermine the treatment bond, so vitally needed for effective and efficient therapy! Although health-care costs have increased rapidly and need realistic containment, the importance of the group-therapist bond must be enhanced rather than minimized since it contributes to favorable therapeutic results. The final section addresses some possible approaches to protecting treatment.

Chronic childhood illness: a nursing health-promotion model for rehabilitation in the community.

In this article, the authors present a cultural model for community practice, which can be used by an interdisciplinary healthcare team caring for children in the community. Its focus is on rehabilitation issues related to the patient and the family members who are coping with a child who has a disability related to chronic illness. The need for culturally sensitive care that empowers the patient and the family and that brings the healthcare team and the community together is stressed. The current healthcare situation of many poor Americans in urban areas also is discussed, along with creative strategies for nurse-managed, advanced practice interventions.

Cardiology patient simulator and computer-assisted instruction technologies in bedside teaching

The design and uses of an innovative technology-based approach which addresses critical problems with bedside teaching during ward rounds in the current health care situation are described. A cardiology patient simulator (HARVEY) and an accompanying computer-based interactive laserdisk system provide medical students, house officers and other health professionals with the opportunity to encounter a wide variety of clinical problems for learning and assessment. A group of cardiologists and medical educators from a consortium of US medical schools has guided the development and formal assessment of the entire system over the past 10 years. The system and simulator can be configured and programmed to provide appropriate heart sounds, laboratory data, and test results upon request; hands-on experience to practise examination skills is also available. The system, whole or in part, can be used in a variety of instructional modes from self-instruction to demonstration teaching, and from self-assessment to the final clinical examination. The system's effectiveness for teaching medical clerks is summarized, as is its use in providing continuing education for primary care doctors in rural practice.

Future perspectives and nursing issues in gastrointestinal cancer

Greater public understanding, preventionoriented health behaviors, participation in screening programs, and more effective methods of screening are needed to achieve the overall goal of reducing cancer incidence in the United States. Each of these areas requires further study to allow us as health professionals to know how to improve current approaches and measure effectiveness. Human and financial resources are becoming more limited, so that creative approaches to these problems will truly be the challenge of the future. Gastrointestinal cancers are being treated with more extensive procedures to achieve greater therapeutic results. The nursing care of patients with GI cancer is complex and requires considerable skill, sensitivity, and time. Nurses need to develop new strategies to care for and teach GI cancer patients in an era of economic constraint and nursing shortages. While some may view the current health care situation as a threat, individuals who see the challenge and accept it will offer us new directions in cancer care.