Poor Financial Situation Research Articles

Forstliche Planung – heute und morgen | Forestry planning: today and tomorrow

Changing demands upon the forest and the poor financial situation of forest enterprises in Switzerland led to the development of a new forestry planning concept around fifteen years ago. This concept introduced a clear distinction between planning at the level of the authorities and planning at the level of the owners. At the level of the authorities, and in agreement with land use planning and with the participation of the population,the regional forest development plan defines objectives, priorities and controlling mechanisms with which to ensure both public interests and the management of the forest. At the level of owners elements of strategic management are instrumental and should no longer require permission from the authorities. The interconnection between the two levels of planning is regulated by agreements pertaining to goods and services, projects, contracts and, if need be, also to the authorization for harvesting. The introduction of the regional forest development plan was a success. Such plans have either been implemented or are being elaborated or prepared for over 80% of Switzerland's forested areas. The use of management techniques for planning purposes at the enterprise level has only just started, but has a promising future. In order to deepen and enhance the effect of these new forestry-planning tools on the landscape as a whole, appropriate research and teaching is required in the future, which is not presently ensured at the ETH.

What Are the Facilitators and Barriers in Physician Organizations’ Use of Care Management Processes?

Care management processes (CMPs) such as disease registries, reminder systems, performance feedback, case management, and self-management education can improve chronic illness care, yet 50% of physician organizations have instituted few if any CMPs. Site-visit interviews were conducted with 158 leaders at 15 physician organizations, with 3 organizations (1 large medical group, 1 small medical group, and 1 independent practice association [IPA]) chosen randomly in most cases in each of five communities. Seven of the 15 organizations had implemented CMPs minimally or not at all. CMPs were most common for diabetes and least common for depression; no IPAs had achieved significant CMP implementation for any of the conditions. The two most commonly mentioned facilitators were strong leadership and organizational culture valuing quality. The top five barriers were poor financial situation, reimbursement that does not reward high quality, inadequate information technology, physician resistance, and physicians being too busy. Strong leadership and a quality-valuing culture are important facilitators of improved chronic care, but if insurers do not reward chronic care improvement, it is unlikely that CMPs will become permanently institutionalized in physician organizations.

Violent victimization in schizophrenia.

We investigated the 3-year prevalence, and the sociodemographic and clinical correlates of violent victimization in a large and unselected nationwide sample of deinstitutionalized patients with schizophrenia. The sample comprised 670 schizophrenic patients aged 15-64 years, who had been discharged from psychiatric hospitals in Finland in 1994. Comprehensive data were collected from psychiatric case records on the patients' sociodemographic factors and psychiatric history, as well as the patients' overall level of functioning. The patients were interviewed 3 years after discharge by each district's psychiatric professionals using a structured interview schedule specifically designed for the purposes of the present study project. The prevalence of self-reported violent victimization during the 3-year follow-up was 5.6%. In the multivariate analysis, a poor financial situation, alcohol abuse and being a perpetrator of a violent or some other crime were associated with violent victimization. The prevalence of violent victimization among schizophrenic patients in Finland was markedly lower than that reported on patients in the United States or Great Britain, but correlates were similar. Patients with a poor financial situation and a history of alcohol misuse, as well as of violent behaviour, seem to have an increased risk for violent victimization, and constitute a vulnerable subgroup in this respect. This subgroup of deinstitutionalized patients with schizophrenia may need additional care and protection from the danger posed to them from other members of the society.

Do stressful life-events or sociodemographic variables associate with depression and alexithymia among a general population?—a 3-year follow-up study

This 3-year follow-up study examined background factors, stressful life-events, and changes in alexithymia and depression scores in four groups of subjects from a general population (N = 1,339): alexithymic (A), depressed (D), simultaneously alexithymic/depressed (AD), and non-alexithymic/non-depressed (O). Alexithymia was assessed using the 20-item version of the Toronto Alexithymia Scale (TAS) and depression using the 21-item Beck Depression Inventory (BDI). A questionnaire screening sociodemography and stressful life-events was also used. The results showed that alexithymia was associated with male gender and blue-collar working, whereas depressive symptoms associated with female gender, older age, poor subjective health, poor financial situation, and low life satisfaction. During the follow-up the sum of stressful life-events was higher among groups AD and D than in groups A and O. The most common stressful life-events were the death of a close relative or friend, a negative change in the health of a family member, and financial problems. The TAS scores decreased only in groups A and AD. The BDI scores decreased in group AD but remained relatively unchanged in group D. Interestingly, if only those without depressive symptoms are considered, alexithymia appears to be a rarer phenomenon than has been reported previously. Furthermore, it seems that depressive symptoms were chronic and long-lasting among the general population.

Factors associated with hopelessness: a population study.

Hopelessness is associated with depression and suicidality in clinical as well as in non-clinical populations. However, data on the prevalence of hopelessness and the associated factors in general population are exiguous. To assess the prevalence and the associated factors of hopelessness in a general population sample. The random population sample consisted of 1722 subjects. The study questionnaires included the Beck Hopelessness Scale (HS), Beck Depression Inventory (BDI), Toronto Alexithymia Scale (TAS-20) and Life Satisfaction Scale (LS). Eleven percent of the subjects reported at least moderate hopelessness. A poor financial situation (OR 3.64), poor subjective health (OR 2.87) and reduced working ability (OR 2.67) independently associated with hopelessness. Moreover, the likelihood of moderate or severe hopelessness was significantly increased in subjects dissatisfied with life (OR 5.99), with depression (OR 4.86), with alexithymia (OR 2.37) and with suicidal ideation (OR 1.85). This study demonstrated a moderately high prevalence of hopelessness at the population level. Hopelessness appears to be an important indicator of low subjective well-being in the general population that health care personnel should pay attention to.

Somatoform Dissociation and Adverse Childhood Experiences in the General Population

Childhood trauma has been associated with psychological dissociation, but there is evidence that trauma may also result in somatoform dissociation. We performed a general population study with 1739 subjects, using the Somatoform Dissociation Questionnaire, measures of adverse childhood experiences, and sociodemographic background. The prevalence of high somatoform dissociation (Somatoform Dissociation Questionnaire >or=30) was 9.4% in the Finnish general population. Unemployment, a reduced working ability, and a poor financial situation were associated with high somatoform dissociation. Of the adverse childhood experiences, high somatoform dissociation was strongly linked to physical punishment but not associated with domestic violence, including sexual and physical abuse. The odds of high somatoform dissociation were also increased among men by a poor relationship between their parents, and among women by alcohol abuse in their childhood home. We found a strong, graded relationship between an increasing number of adverse childhood experiences and high somatoform dissociation.

Stable Hopelessness and its Predictors in a General Population: A 2‐Year Follow‐Up Study

Information on hopelessness at the population level is limited, and no previous studies have focused on its stability in a general population. We examined the stability and associated factors of hopelessness in a general population sample of 1,389 adults. More than half of those who were hopeless at baseline remained hopeless on follow-up. When those with a mental disorder were excluded, the relative risk for stable hopelessness in unemployed men was 7.2 (95% CI 2.6-19.9), in men with a poor financial situation it was 3.5 (95% CI 1.3-9.3), and in women with a poor financial situation it was 3.8 (95% CI 1.5-9.4). Awareness of the stability of hopelessness offers us newpossibilities in preventative and mental health work.

An analysis of the role of health care in reducing socioeconomic inequalities in health: the case of the Netherlands.

The aim of this article is to analyze the role of the health care system in reducing socioeconomic inequalities in health in countries with good access to health services, using the Dutch example. In the past, health care has contributed substantially to reducing a number of health problems in the population, paticularly health problems leading to mortality. Data on trends in mortality from selected conditions by socioeconomic group show that both higher and lower socioeconomic groups have profited from these mortality reductions, probably because of largely equal access to essential health car services, and that absolute inequalities in mortality from these conditions have declined notably. The current situation is still one of largely equal financial access to health care services, with relatively small differences between socioeconomic groups in health care utilization, after adjustment for differences in prevalence of health problems. There is no evidence that inequalities in health care utilization contribute to a widening of socioeconomic inequalities in health. Financing of the health care system, however, is slightly regressive, and out-of-pocket payments contribute to the poor financial situation of the chronically ill. For the future, three possible contributions of the health care system to reducing socioeconomic inequalities in health are described: preservation of equal access to high-quality health care; development of specific care packages for lower socioeconomic groups; promotion and support of intersectoral activities.

Childhood adversities in patients with fibromyalgia and somatoform pain disorder

Primary fibromyalgia is regarded as disorder with a complex symptomatology, and no morphological alterations. Findings increasingly point to a dysfunction of the central nervous pain processing. The study aims to discuss vulnerability for fibromyalgia from a developmental psychopathological perspective. We investigated the presence of psychosocial adversities affecting the childhood of adult fibromyalgia patients (FM) and compared them to those of patients with somatoform pain disorders (SOM) and a control group (CG) with medically explained chronic pain. Using the structured biographical interview for pain patients (SBI-P), 38 FM patients, 71 SOM patients, and 44 CG patients were compared on the basis of 14 childhood adversities verified as relevant regarding longterm effects for adult health by prospective studies. The FM patients show the highest score of childhood adversities. In addition to sexual and physical maltreatment, the FM patients more frequently reported a poor emotional relationship with both parents, a lack of physical affection, experiences of the parents’ physical quarrels, as well as alcohol or other problems of addiction in the mother, separation, and a poor financial situation before the age of 7. These experiences were found to a similar extent in the SOM patients, but distinctly less frequently in the CG. The results point to early psychosocial adversities as holding a similar etiological meaning in fibromyalgia as well as in somatoform pain disorders. The potential role of these factors as increasing the vulnerability for fibromyalgia is discussed.

Stomil-Olsztyn S.A.

In 1990 and 1991, the production of tires in Poland was about 30 percent lower than in 1989. The biggest drop occurred in the production of tractor tires and of tires for agricultural machinery and equipment. The recession in the tire industry was largely the result of the collapse in the production of motor vehicles, especially of trucks and tractors, which brought about a rapid decline in demand for new equipment. Also, demand for replacement tires among users of vehicles, particularly of trucks and agricultural machines, dropped considerably, in part because cuts in production in the entire economy led to a reduction in the road transport of goods. Also, the poor financial situation of Polish agriculture resulted in decreased demand for agricultural equipment. Polish tire producers also had to cope with substantial imports of used

Evolution of postpartum mental health

We investigated the postpartum mental health of 139 mothers, 4-8 weeks after delivery and 2 years later. The sample consisted of mothers who attended a maternity center for a routine health check-up 1-2 months after delivery. The occurrence of mental disorders was assessed using a 12-item General Health Questionnaire (GHQ). The occurrence of mental disorders (>2 on the GHQ) was 28.1% in the initial check-up and 19.4% 2 years later. Mental health improved in 21 mothers (19%) but remained impaired (i.e. cases) in 12 (9%). Mental health was normal in 85 mothers (61%) during both examinations. Factors predicting chronicity of mental disorder on univariate analysis were poor financial situation, poor social support, problems with a partner and life events perceived as stressful during follow-up. Those with continuing mental-health problems had had more psychiatric problems than the others before pregnancy. Most (92%) of these subjects had not become pregnant again. Using a logistic-regression analysis, independent factors predicting chronicity of mental-health problems were the high Zung score (Odds Ratio (OR) 1.4, 95% confidence interval (CI) 1.16-1.65) and a deterioration in relationship with a partner during pregnancy (OR 29, 95% C11.83-460). On the other hand, a low Zung score (OR 1.3, 95% CI 1.14-1.44) after delivery predicted recovery from mental disorder. A postpartum mental disorder usually resolves spontaneously. However, mental symptoms sometimes persist. The postpartum mental-health of mothers should be assessed, and treatment provided, if necessary.

Russian Policy in Africa: Disengagement or Cooperation?

After nearly a decade of retreat, Moscow has indicated its interest in establishing mutually beneficial economic ties with Africa. However, the poor financial situation of many African states, combined with Russia’s own political and economic problems, will likely impede these plans.

GENDER DIFFERENCES IN ORIENTATION TOWARD RETIREMENT FROM PAID LABOR

Recent studies have reported gender differences in older workers' orientations toward retirement, with women expressing less favorable views. This study of 557 women and 245 men in their 60s, not currently married, showed that previously married women, who often face a poor financial situation in retirement, were less likely than previously married men to agree that older workers should retire and also were less likely to define themselves as retirees. Never-married women and men did not differ on these measures of retirement orientation, but they did differ on a more general measure of well-being, with the women holding a more positive attitude toward life in retirement. This article concludes that differences in women's and men's occupational and economic circumstances are responsible in part for gender differences reported in the retirement literature, but in addition, marital circumstances also exert an important influence. Thus retirement policies based solely on gender seem unwarranted.

Retirement, aging, psychosocial adaptation and mental health. Findings of the TURVA project.

This article deals with certain preliminary findings obtained in a long-term prospective study begun in 1982 using the interview method; the first follow-up was carried out in 1986, the method consisting of a postal inquiry and the collection of recorded data. The sample consists of 200 randomly selected inhabitants of Turku born in 1920 and 189 individuals of the same age living in rural municipalities in the vicinity of Turku. During the 4-year follow-up period the subjects' biopsychosocial situation remained almost unchanged, showing that, for most people, retirement is not a stressor of crucial importance or a life crisis. Of the variables relating to the initial survey, poor subjective physical health, self-assessed work disability, poor financial situation, change into a taciturn and timid individual in adolescence, the spouse's poor mental equilibrium, an excess of leisure time and general dissatisfaction with life were associated with subsequent mental disturbance as measured by use of the General Health Questionnaire.