Health sector reform in the Republic of Macedonia. (49/10025)

AIM: To evaluate the results of current reforms in Macedonian health sector. METHOD: Description and situation analysis, covering the period 1991-1997, are focused on demographic and vital indicators, morbidity and mortality data, elements of health care system, legislation, health insurance, health care financing, and elements of health care reforms. RESULTS: The Republic of Macedonia experienced changes in the social and economic situation, similar to those in other countries in transition. The growing number of dependents (young and old persons) impact high health expenditures. High priority health problems were infant and premature adult mortality. As an inheritance of the former political system, the development of different parts of health care services was unbalanced and insurance and local network of health facilities were highly decentralized. The reforms addressed health financing and reimbursement, organization and management of health services, and pharmaceutical policies and supply. The legislation was revised, but new revision is needed. CONCLUSIONS: Health care reforms were needed in Republic of Macedonia in order to overcome the problems associated with early phase of transition. The disadvantages of the current reforms are: lack of proper political will for the implementation of activities according to the planned schedule, initial over-utilization of hospital care, and no significant changes in financing of the public sector facilities. The advantages are that the health system did not disintegrate, universal access to health services was maintained, free choice of physician was promoted, and public/private mix of services was established and financed by the Health Insurance Fund.  (+info)

Quality of life in patients with cystic fibrosis and their parents: what is important besides disease severity? (50/10025)

BACKGROUND: Cystic fibrosis is the most common inherited disease with a fatal outcome in industrialised nations. With the improvement in life expectancy, supporting patients and their families in adapting to life with this chronic progressive disease has become increasingly important. The aim of the present study was to investigate the relationship between health related quality of life (HRQOL) in this population, severity of disease, and cognitive/behavioural factors such as subjective health perception and ways of coping. METHODS: A sample of 89 adolescent and adult patients with cystic fibrosis and 125 parents of younger patients with cystic fibrosis completed questionnaires on health related quality of life and on ways of coping with the illness. Parents were asked to fill out the questionnaires regarding their own quality of life and coping. Multiple regression analyses were performed to examine the relationship between different predictor variables and quality of life. RESULTS: After accounting for the impact of disease severity and hours of treatment per day, the subjective health perception of patients significantly explained variance in their quality of life. Ways of coping were also significantly correlated with HRQOL. In parents the most important factor in explaining variance of HRQOL seems to be the coping style, whereas disease severity of the child and subjective health perception did not show any influence. CONCLUSIONS: The findings support the important role of cognitive and behavioural factors in specific subjective health perception and ways of coping in the adaptation to this severe chronic disease, both in patients themselves and in parents. The results call for a careful assessment of issues of coping and professional support for families of patients with cystic fibrosis in the early course of disease.  (+info)

Epidemiology of job stress and health in Japan: review of current evidence and future direction. (51/10025)

With the increasing concern about job stress, there is a growing body of literature addressing psychosocial job stress and its adverse effects on health in Japan. This paper reviews research findings over the past 15 years concerning the assessment of job stress, the relationship of job stress to mental and physical health, and the effects of worksite stress reduction activities in Japan. Although studies were conducted in the past using ad-hoc job stress questionnaires, well-established job stressor scales have since been translated into Japanese, their psychometric properties tested and these scales extensively used in recent epidemiologic studies. While the impact of overtime and quantitative job overload on mental health seems moderate, job control, skill use and worksite support, as well as qualitative job demands, had greater effects on psychological distress and drinking problems in cross-sectional and prospective studies. These job stressors also indicated a strong association with psychiatric disorders, including major depression, even with a prospective study design. Long working hours were associated with a higher risk of myocardial infarction, diabetes mellitus and hypertension. There is evidence that the job demands-control model, as well as the use of new technology at work, is associated with higher levels of blood pressure and serum lipids among Japanese working populations. Fibrinolytic activity, blood glucose levels, immune functions and medical consultation rates were also affected by job stressors. It is further suggested that Japanese workers tend to suppress expression of positive feelings, which results in apparently higher psychological distress and lower job satisfaction among Japanese workers compared with workers in the U.S. Future epidemiologic studies in Japan should focus more on a prospective study design, theoretical models of job stress, job stress among women, and cultural difference and well-designed intervention studies of various types of worksite stress reduction.  (+info)

A higher prevalence of health problems in low income groups: does it reflect relative deprivation? (52/10025)

STUDY OBJECTIVE: Although it has frequently been suggested that income affects health, there is hardly any research in which this issue has been explored directly. The aim of this study was, firstly, to examine whether income is independently associated with health, secondly, to assess the extent to which this association reflects high levels of deprivation in low income groups, and thirdly, to examine which specific components of deprivation contribute most to the link between income and health. Health indicators used were the prevalence of chronic conditions, health complaints and less than "good" perceived general health. SETTING: Region in the south east of the Netherlands. PARTICIPANTS: A population of 2567 men and women who participated in an oral interview, aged 15-74. DESIGN: Data were obtained from the baseline of a prospective cohort study aimed at the explanation of socioeconomic inequalities in health. RESULTS: Large inequalities in health by (equivalent) income after differences in other socioeconomic indicators had been controlled for were observed. For example, among those in the lowest income group the risk of bad perceived health was three times as high as among people in the highest income group. The prevalence of deprivation (basic, housing, social) increased with decreasing income to approximately 50-60% in the lowest income group. A substantial part of the increased health risks of the lowest income groups could statistically be accounted for by the higher prevalence of deprivation in these groups. The components that are likely to influence health indirectly, through a psychological or behavioural mechanism, accounted for most of the effect. CONCLUSIONS: These analyses provide evidence to suggest that a low income has detrimental health effects through relative deprivation. Moreover, the results indicate an indirect link between deprivation and health problems involving psychological or behavioural factors.  (+info)

Generational continuity and change in British Asian health and health behaviour. (53/10025)

OBJECTIVES: To trace patterns of health and health behaviour in those with ancestry in the Indian subcontinent (British Asians) compared with the general population of their age (1) in the younger generation age 14-15 mainly born in the UK and (2) in the older mainly migrant generation. DESIGN: Cross sectional random sample surveys of two age groups in Glasgow. SAMPLES: 334 British Asians (86% born in the UK) and 490 non-Asians, all aged 14-15; 173 British Asians aged 30-40 (mean age 35, 93% born abroad), and 344 general population aged 35. MEASURES: Health: self assessed health/fitness, longstanding/limiting illness, chronic phlegm, accidents, symptoms, tooth loss. Health behaviour: smoking, alcohol, drugs, exercise. RESULTS: At age 14-15, compared with non-Asian counterparts: fewer British Asian girls reported limiting illness (p < 0.05) or chronic phlegm (p < 0.01), fewer boys reported accidents (p < 0.01), and fewer of both sexes had lost second teeth (p < 0.05); more of both sexes reported not smoking, drinking alcohol, or using drugs (p < 0.01 or below), fewer reported frequent exercise (p < 0.05 or below). Smoking patterns were consistently related to ethnic differences in chronic phlegm, and patterns of alcohol consumption to those in accidents. In health, British Asian girls aged 14-15 generally compared more favourably with non-Asian counterparts than did those aged 30-40. The reverse was true for British Asian male subjects. In health behaviour, British Asians of both sexes aged 14-15 showed strong continuities with those aged 30-40. CONCLUSIONS: Favourable health behaviour has brought a health advantage to young British born Asians, even though this was not the case in the migrant generation. Female health disadvantage is also much less marked than in migrants aged 30-40, but may re-emerge between ages 15-30. Migrant Asian male subjects may have had misleadingly high respiratory health levels because of positive selection.  (+info)

Do postal questionnaires change GPs' workload and referral patterns? (54/10025)

OBJECTIVE: We aimed to determine changes in workload in general practice associated with the postal administration of a health needs questionnaire. METHOD: We carried out controlled before-and-after intervention study of the effects of delivering a postal questionnaire to assess needs for care for patients with arthropathies of the hip and knee, groin hernia and varicose veins, and to assess health service utilization, general health status and risk factors for cardiovascular disease. The setting was a seven-partner, fundholding, group practice in Avon. The subjects were patients registered with an NHS group practice situated in Backwell and Nailsea, Avon. The outcome measures were the frequency of consultation, home visits and night visits, reasons for consultation, referral to specialist agencies and patterns of prescribing. RESULTS: There was no significant difference between the study and control group in the year before and the year after the postal administration of the questionnaire with respect to changes in overall frequency of consultation, frequency of referral (including type of referral) and frequency of prescribing of non-steroidal anti-inflammatory drugs. In the study group there was a significant (P<0.05) reduction in the number of daytime home visits and prescriptions written for analgesics. Analysis of the records of those who had received a medical examination, in addition to a postal questionnaire, showed that there was no significant difference between the study and control group with respect to frequency of consultation, referral to outside agencies or items prescribed. CONCLUSION: Administration of a health needs questionnaire to patients registered with this general practice was not associated with an increase in consultation frequency or referral, or a change in prescribing patterns. No plausible explanation could be identified for the significant reduction in the number of home visits and prescriptions written for analgesics. It was concluded that these results were a statistical artefact. On the basis of the evidence from this study, GPs can be reassured that the administration of health needs questionnaires of the type used in this study will not result in any increase in workload or costs of care incurred by increased referrals to outside agencies or increased prescribing.  (+info)

SF-36 scores vary by method of administration: implications for study design. (55/10025)

BACKGROUND: Previous research suggests that people respond differently to health status measures when data are collected by interview or self completion of a questionnaire. The objective of this study was to determine whether SF-36 health status scores differ systematically by method of administration. METHOD: A randomized cross-over study was carried out on 210 new attenders at general medicine, endocrinology, gastroenterology and urological out-patient departments. The outcome was the difference in SF-36 profiles comparing clinic based interviews with self completion at home by the same subjects. RESULTS: For seven of the eight variables of the SF-36 scores were lower in the self assessment, the differences being statistically significant in four of the eight comparisons. The largest differences were in role limitations due to emotional problems (difference 14.74, 95 per cent confidence interval (CI) 7.76-21.7) and social function (difference 7.21, 95 per cent CI 3.19-11.23). CONCLUSIONS: Clinic based interviews systematically exaggerate health status compared with self assessment. The difference is sufficiently large to underestimate the effectiveness of health service interventions when a clinic based pre-intervention and postal self completed follow-up design is used, unless adjustment is made for this systematic bias.  (+info)

Association of medical, physiological, behavioural and socio-economic factors with elevated mortality in men of Irish heritage in West Scotland. (56/10025)

BACKGROUND: Men with patrilineal Irish descent from the immigrations of the nineteenth and twentieth centuries have higher death rates from 'all-causes' and, specifically, cardiovascular disease (CVD) than the general population of the West of Scotland. METHODS: A total of 5766 male employees from 27 workplace settings were examined between 1970 and 1973. Surname analysis identified 15 per cent of these men as of patrilineal Irish heritage. For those who have since died, the date and cause of death was obtained. Cox's proportional hazards model was used to compare the mortality risk of those with Irish and non-Irish surnames, and to investigate established medical, physiological, behavioural and socio-economic risk factors (acting in early and later life) as possible explanations for this excess mortality. RESULTS: The relative risk of death from all causes for the Irish of 1.26 (95 per cent confidence interval (CI) (1.12, 1.43)) was reduced to 1.12 (95 per cent CI (0.99, 1.26)) by including established risk factors in the model. The relative risk of CVD mortality of 1.51 (95 per cent CI (1.29, 1.77)) for the Irish was reduced to 1.35 (95 per cent CI (1.14, 1.58)) by the same adjustments. The elevated all-cause mortality of the Irish was mainly attributable to cardiovascular deaths. CONCLUSIONS: Cigarette smoking was only able to 'explain' a small amount of the excess all-cause and CVD mortality of men with patrilineal Irish descent. Relative deprivation during childhood and adulthood contributed to the high Irish mortality. However, there remains a substantial excess of premature deaths among Irish men which is unaccounted for by established risk factors.  (+info)