Health human resource development in rural China.
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China has made significant progress in increasing the quantity of health workers in rural areas. Attention is shifting to improving the quality of health workers. This article documents several features of health workers in rural China. Many have not received formal training to a level implied by their rank and title, and there is no clear relationship between the skills of health workers and the functions they perform. Many better-qualified personnel have left lower level health facilities for more attractive employment in higher level and urban facilities. A system of professional licensing is currently being considered that will link educational requirements to employment and promotion. This article outlines some of the issues that should be taken into consideration in formulating this system. In particular, licensing may have unequal impacts on rich and poorer areas. This article argues that other regulatory measures will be necessary if licensing is to be an effective mechanism for controlling the quality of health workers, and contribute to the provision of affordable health services in both rich and poor areas. (+info)
Pharmaceutical regulation in context: the case of Lao People's Democratic Republic.
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An explosive development of private pharmacies in the Lao People's Democratic Republic (Lao P.D.R.) has led to 80% of pharmaceuticals being provided by the private sector. In order to achieve the goal of access to good quality health care for all citizens, the Lao government is making an effort to regulate the private pharmaceutical sector using the emerging legal system of laws, decrees, and regulations. The aim of this paper is to describe and analyze the system of drug regulation in Lao P.D.R. in relation to the public social goals. Relevant official documents at the central, provincial and district levels have been reviewed, interviews were held with 30 key informants and 15 pharmacies were surveyed. The public social goals have been expressed in terms of equity and quality of care. However, total drug expenditure may be as low as US$1 per person per year which is far below any minimum standard and does not make it possible to achieve reasonable access to drugs for all. The regulatory system has so far been focused on entry into the pharmaceutical retail market and dealing with basic issues of product quality and conditions of sale. An enforcement system including sanctions is being developed; other policy instruments such as information and economic means are hardly being used at all. The government presently faces a trade-off between quality of pharmaceutical services and geographical equity of access. The study shows that regulation is strongly influenced by the general socioeconomic context. (+info)
Quality of care in unlicensed homes for the aged in the eastern townships of Quebec.
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BACKGROUND: The recent proliferation of unlicensed homes for the aged in Quebec, coupled with the increased needs of the population they serve, has raised concerns about the quality of case these homes provide. The authors compared the quality of care in unlicensed homes with that in licensed long-term care facilities in a region of Quebec. METHODS: The study involved 301 impaired people aged 65 and over in 88 residential care facilities (52 unlicensed, 36 licensed) in the Eastern Townships of Quebec. Study participants were chosen according to a 2-stage sampling scheme: stratified sampling of the primary units (facilities) and random sampling of the secondary units (residents). Quality of care was measured using the QUALCARE scale, a multidimensional instrument that uses a 5-point scale to assess 6 dimensions of care: environmental, physical, medical management, psychosocial, human rights and financial. A mean score of more than 2 was considered indicative of inadequate care. RESULTS: Overall, the quality of care was similar in the unlicensed and licensed facilities (mean global score 1.61 [standard error of the mean (SEM) 0.06] and 1.47 [SEM 0.09] respectively). Examination of dimension-specific quality-of-care scores revealed that the unlicensed homes performed worse than the licensed facilities in 2 areas of care: physical care (mean score 1.80 [SEM 0.08] v. 1.51 [SEM 0.09] respectively, p = 0.017) and medical management (1.37 [SEM 0.06] v. 1.14 [SEM 0.05], p = 0.004). The dimension-specific scores also revealed that both types of homes lacked appropriate attention to the psychosocial aspect of care. Overall, 25% of the facilities provided inadequate care to at least one resident. This situation was especially prevalent among homes with fewer than 40 residents, where up to 20% of the residents received inadequate care. INTERPRETATION: Most of the unlicensed homes for the aged that were studied delivered care of relatively good quality. However, some clearly provided inadequate care. (+info)
The clinical doctorate: a framework for analysis in physical therapist education.
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This article explores major considerations for analysis and discussion of the role of the clinical doctorate as the first professional degree in physical therapist education (DPT). A process for this analysis is posed based on a conceptual framework developed by Stark, Lowther, Hagerty, and Orczyk through grounded theory research on professional education. External influences from society and the profession, institutional and programmatic influences, and articulation of critical dimensions of professional competence and professional attitudes as major categories are discussed in relation to the DPT. A series of questions generated from the application of the model are put forth for continued discussion and deliberation concerning the DPT. We conclude that the DPT provides the best pathway to serve society, the patient, and the profession. (+info)
Graduated licensing comes to the United States.
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OBJECTIVE: To describe the young driver problem and the emergence of graduated licensing as a way to address it. METHODS: Literature review and commentary. RESULTS: Twenty-four states in the United States adopted versions of graduated licensing in 1996-98; initial results show positive effects. CONCLUSIONS: A major public health movement is under way that can be expected to produce significant reductions in crashes and injuries involving young drivers. (+info)
Store tobacco policies: a survey of store managers, California, 1996-1997.
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OBJECTIVE: To identify store tobacco policies and retailer perception and beliefs that may have contributed to changes in compliance with youth access laws in California. DESIGN: In the winter of 1996-7, a cross sectional, follow up telephone survey was conducted of California store managers whose stores were anonymously surveyed for illegal tobacco sales in the summer of 1996 (that is, 1996 Youth Tobacco Purchase Survey, YTPS). SETTING: A simple random sample of stores from a list of California stores likely to sell tobacco, used in the 1996 YTPS. PARTICIPANTS: 334 managers (77%) of the 434 stores surveyed in 1996 responded to the survey. After eliminating stores that stopped selling tobacco or were under new management or ownership, 320 responses of store managers were included in the analysis. The stores were analysed by type of ownership: chain, which included corporate managed (n = 61); franchise owned (n = 56); and independent (n = 203). MAIN OUTCOME MEASURES: Responses of store managers were linked with the 1996 YTPS outcomes. Manager responses were compared by chi2 tests. Logistic regression analyses were conducted to identify store factors associated with illegal tobacco sales. RESULTS: A lower likelihood of illegal sales rate was associated with the chain stores when compared with the independent stores (odds ratio (OR) = 0.4, 95% confidence interval (CI) 0.2 to 0.9). A lower likelihood of illegal tobacco sales was found in stores that implemented tobacco related activities in the previous year such as changing tobacco displays (OR = 0.5, 95% CI 0.2 to 0.9) or adding new warning signs (OR = 0.7, 95% CI 0.4 to 1.2). Store managers' beliefs that youth were sent to their stores to do compliance checks also resulted in a lower likelihood of illegal sales (OR = 0.7, 95% CI 0.4 to 1.1). CONCLUSIONS: Store tobacco youth access policies, and managers' beliefs about the extent of youth access enforcement in the community, are important in reducing illegal tobacco sales to minors. (+info)
Evaluating vaccine safety before and after licensure.(7/341)
Teenage drivers in the United States have greatly elevated crash rates, primarily a result of qualities associated with immaturity and lack of driving experience. State licensing systems vary substantially, but most have allowed quick and easy access to driving with full privileges at a young age, contributing to the crash problem. Formal driver education has not been an effective crash prevention measure. Following the introduction of graduated licensing in New Zealand, Australia, and Canada, this system has been considered in many states and has been implemented in some. Graduated systems phase in full privilege driving, requiring initial experience to be gained under conditions of lower risk. The author describes the first five multistage graduated systems enacted in the United States in 1996 and 1997. Factors that will influence the acceptability and effectiveness of these new licensing systems are discussed. (+info)