Investment In Health Services Research Articles

Geographical clustering of anal cancer incidence in Australia

Homosexual men are at an increased risk of anal cancer. We aimed to establish the burden of anal squamous cell carcinoma (SCC) in those parts of Australia where homosexual men are most likely to live. Data on the proportion of homosexual male residents were obtained from published estimates. Men were categorised into three postcode groups by prevalence of men reporting homosexual identity. Male population data in age groups were extracted for each postcode group and analyses of cancer incidence were performed by postcode group. The analyses were restricted to 2000-2005. Eight postcodes had populations where more than 10% of males reported homosexual identity (high prevalence) and 4-10% of men reported homosexual activity in a further 19 postcodes (medium prevalence). From 2000 to 2005, the average annual age-standardised incidence rates of anal SCC in males was 7.61 per 100000 (95% confidence interval (CI): 4.68-10.55) and 2.21 per 100000 (95% CI: 1.05-3.37) in high and medium prevalence postcodes, respectively. The corresponding incidence rate ratios compared with low prevalence postcodes (less than 4% of males reported homosexual identity) were 9.6 (95% CI: 6.6-14.1) for the high prevalence and 2.4 (95% CI: 1.4-4.1) for the medium prevalence postcodes. A substantial concentration of the burden of anal cancer occurred among areas where large proportions of homosexual men reside. These results should guide the prioritisation of health service investment in anal cancer treatment and prevention to appropriate geographical areas.

The challenge of building rural health services

The challenge of building rural health services

News

Young children are in a worse state of health now than a decade ago, despite more than £10 billion of government investment in health services, a new report has found.

An unhealthy bunch

Young children are in a worse state of health now than a decade ago, despite more than £10 billion of government investment in health services, a new report has found.

Complexity and health – yesterday's traditions, tomorrow's future

‘If it is complex it means we don’t really understand it,and the way forward is to break the problem down into its partsto make sense of it’. This thought reflects the way we havebeen taught, and the way we largely practise in clinical care everyday.But are we really functioning on this basis? Or is it the only waywe know how to live? We all experience situations every daywhere the evidence does not really fit our understanding of aproblem – the familiar reductionist approach limits our ability tofully explore new problems and to gain new insight. An increas-ingly persistent question has emerged in relation to what consti-tutes the knowledge we need for effective and efficient clinicalcare, an issue taken up by this new

Improved sanitation and income are associated with decreased rates of hospitalization for diarrhoea in Brazilian infants

Diarrhoeal diseases remain a major cause of morbidity and mortality in Brazilian children. However, from 1992 to 2001 there was a significant decline in hospitalizations for acute diarrhoea in children below 1 year of age in Brazil. A significant improvement in child health was also observed in the state of Rio Grande do Norte (RN), with a decrease in child mortality from 70 to 40 deaths per 1000. Using distributed lag analysis we analysed a number of factors possibly connected with decreased hospitalization in RN and found that hospitalization was correlated up to lag 3 with poverty (P<0.001) and inflation (P<0.001). Improvements in public health infrastructure such as better waste collection, presence of city water supply and increased sanitation, socio-economic variables such as education and literacy, and increased investment in health services were all important in reducing severe early childhood diarrhoeas and thus directly associated with the decrease in hospitalization. We also observed a positive seasonal correlation between rainfall and hospitalizations with an increased in rainfall impacting positively on hospitalization in all lags. The data suggests that increased buying power and reductions in poverty played a crucial role in reducing hospitalizations for acute diarrhoea in infants in RN.

MORTALIDADE NEONATAL: UM DESAFIO PARA OS SERVIÇOS DE SAÚDE

SUMMARY: In Brazil, the children health promotion actions develop a decline in the infant mortality rate in the several areas of the country. It is preoccupying the fact that 90% of the neonatal mortality of the world still happens at countries in development, where there are few resources, and the technological readiness of the health has different priorities. The reduction of the neonatal mortality is still more difficult because this associated as to biological factor as to the prenatal, to the childbirth and the newly born attendance; and its prevention involves mainly investments in health services of more complex technology as well as in educational and public health actions. Considering the fact that Goiânia (capital of the State of Goiás) has great demand to the health services, it is necessary a larger quality of the rendered services as much in the basic units of health services as in the hospital, looking for to implement programs of improvement of services to guarantee the quality of attendance. We considered that the education actions and health are important factors of intervention for the reduction and control of the infant mortality rates, mainly your component neonatal and that all professional relationship of health and patient is a pedagogic relationship. Key words: infant mortality, neonatal, prenatal, newly born

Will new matrons boost ‘grey’ health care?

With a general election approaching, all political parties will be acutely aware of the increasing importance of the ‘grey’ vote. Older people represent a growing proportion of the electorate, and as major users of public health services, they will expect parties to develop strategies to overcome the current shortcomings in health care provision. Much will be made of investment in health services and meeting targets, however, most older people will be more concerned about the quality of health care outside hospitals.Shorter hospital stays mean that those who are admitted have only a relatively fleeting glimpse before discharge home or to intermediate care. What matters is the quality of primary care.

Re-Engineering the Los Angeles County Public Health Care Safety Net: Recommendations from a Blue Ribbon Health Task Force

Public hospitals throughout the United States are under increasing fiscal and political pressure to survive because of dynamic changes in healthcare delivery, an increasing uninsured population of patients and rapidly declining reimbursement. These safety net health care programs are also saddled with outdated and bureaucratic governmental policies and procedures which make it even more difficult to improve the quality of care and efficiency of the organization. As these pressures mount, some public hospital systems have attempted to be reinvented through the re-engineering process. Los Angeles County, the second largest health system in the United States, has done relatively little to adjust to changing times. Los Angeles County Department of Health Services has been attempting to re-engineer for the past three years, but this has not averted the need for a second billion-dollar waiver in 2000 from the state and federal governments. A Blue Ribbon Health Task Force was appointed to examine the failure of re-engineering to restructure the Los Angeles public health delivery system. In this article, the group's findings and recommendations are reported. They cover three general areas: eliminating bureaucratic hurdles, improving healthcare planning and management of operations and setting priorities on critical investments in health services.

Something to be done: treating HIV/AIDS. River Path Associates.

Largely because of disparities in access to drug treatment and care, AIDS morbidity and mortality have fallen in the developed world but continue to rise among developing countries. Achieving more equitable access to AIDS drugs is hindered by high drug prices, technical complexities related to the provision of health care, and conflict among stakeholders. Recognition that health is vital to the prospects of the emerging global society must be combined with new mechanisms to help all stakeholders work together cooperatively. Tiered drugs pricing should be coupled with investment in health services. An independent "Global Task Force," able to act as an "active think tank," could build consensus about the way forward.