Quality of life benefits of paid work activity in schizophrenia.
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In a study of work rehabilitation, 97 participants with schizophrenia or schizoaffective disorder were randomized into either a Pay or a No Pay condition to determine the impact of work activity and pay on rehabilitation outcomes. This report specifically investigates the relationship between work rehabilitation and quality of life (QOL) measures for people with schizophrenia. Previous reports have described improvements in symptoms and work outcomes for participants in the Pay condition. Results in this report reveal that randomization to the Pay condition improved ratings on the Heinrichs Quality of Life Scale (QLS). The improvements are found both in overall QLS and in the domain of Intrapsychic Foundations (motivation, sense of purpose, anhedonia, and empathy). For a larger sample (n = 114) we assessed the relationship between amount of participation and QLS improvement. Degree of participation was related to improvement on the QLS total and Intrapsychic Foundations domain. Finally, improvement in the Interpersonal Relations scale was associated with weeks of participation for the most consistent participants. How participation in work rehabilitation and its interaction with pay improves motivation, interpersonal relatedness, and overall quality of life is discussed. (+info)
Tracking health care costs: growth accelerates again in 2001.
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For the first time in more than a decade, health care spending per capita rose at a double-digit rate in 2001, growing 10 percent. Spending on hospital services (both inpatient and outpatient) surged by 12 percent in 2001, reflecting increases in both hospital payment rates and use of hospital services. Hospital spending was the key driver of overall cost growth, accounting for more than half of the total increase. Prescription drug spending growth declined for the second straight year and was overtaken by spending on outpatient hospital services as the fastest-growing component of total spending. Driven by these cost trends and other factors, premiums for employment-based health insurance increased 12.7 percent in 2002--the largest increase since 1990. But taking account of the sizable amount of "benefit buy-down" in 2002, the true increase in the cost of health insurance for employers and employees was about 15 percent. Early evidence from 2002 suggests that health care cost trends are now beginning to slow, possibly setting the stage for more moderate premium growth in the future. (+info)
Internationalization of the animal science undergraduate curriculum: a survey of its current status, barriers to its implementation and its value.
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The goal of this project was to identify the current level at which internationalization has been adopted as a theme in the North American animal science curriculum and to identify its value and the barriers to its implementation. We surveyed animal, dairy, and poultry science departments across Canada and the United States. One hundred twenty-four surveys were mailed and 60% were returned. Associations between aspects of internationalization and student outcomes (admission to veterinary and graduate schools and starting salaries) were examined. Although administrators strongly believed internationalization had value, implementation was limited. The most common practices included international content in core animal science classes, advising, international internships, and participation of faculty in international scholarly activities. Few departments have incorporated internationalization into their mission statements or developed a specific international-themed class, scholarships devoted to international activities, or roles for international students. Few departments reported participation of students in international programs. Barriers included finances and limited commitment from higher administration. Student outcomes were positively associated with faculty size, percentage of international faculty, the ratio of international students to the total student population, international content in core animal science classes, a specific international-themed class, availability of international internships, and exchange of class material internationally via the Internet. Departments that did not offer international opportunities had a negative association (r = -0.79) with starting salary, but these relationships may not be causal. Alternatively, progressive departments may attract and retain exceptional students. The analysis indicated an awareness of the value of international programs, positive impacts in student outcomes, and financial barriers to implementation. (+info)
Shifting the burden: the private sector's response to the AIDS epidemic in Africa.
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As the economic burden of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) increases in sub-Saharan Africa, allocation of the burden among levels and sectors of society is changing. The private sector has more scope to avoid the economic burden of AIDS than governments, households, or nongovernmental organizations, and the burden is being systematically shifted away from the private sector. Common practices that transfer the burden to households and government include pre-employment screening, reductions in employee benefits, restructured employment contracts, outsourcing of low skilled jobs, selective retrenchments, and changes in production technologies. Between 1997 and 1999 more than two-thirds of large South African employers reduced the level of health care benefits or increased employee contributions. Most firms also have replaced defined-benefit retirement funds, which expose the firm to large annual costs but provide long-term support for families, with defined-contribution funds, which eliminate risks to the firm but provide little for families of younger workers who die of AIDS. Contracting out previously permanent jobs is also shielding firms from benefit and turnover costs, effectively shifting the responsibility to care for affected workers and their families to households, nongovernmental organizations, and the government. Many of these changes are responses to globalization that would have occurred in the absence of AIDS, but they are devastating for the households of employees with HIV/AIDS. We argue that the shift in the economic burden of AIDS is a predictable response by business to which a deliberate public policy response is needed. Countries should make explicit decisions about each sector's responsibilities if a socially desirable allocation is to be achieved. (+info)
Lay workers in directly observed treatment (DOT) programmes for tuberculosis in high burden settings: Should they be paid? A review of behavioural perspectives.
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The current global tuberculosis (TB) epidemic has pressured health care managers, particularly in developing countries, to seek for alternative, innovative ways of delivering effective treatment to the large number of TB patients diagnosed annually. One strategy employed is direct observation of treatment (DOT) for all patients. In high-burden settings innovation with this strategy has resulted into the use of lay community members to supervise TB patients during the duration of anti-TB treatment. However, community involvement in health programmes is not a simple matter. There is often a need for continued motivation of community members in order to ensure sustainability of such projects. Lay workers may demand payment for work done particularly if this takes up a reasonable proportion of their time. TB treatment, by its very nature, lasts for a considerable period and this paper seeks to examine behavioural perspectives that attempt to address the issue of whether lay workers in such programmes should be paid for their services. The theories explored suggest intrinsic and extrinsic motivation as factors that lead people to volunteer for health programmes. Intrinsic motivation encompasses such feelings as empathy and altruism as well as other factors such as religious and cultural conviction. The authors argue however that in high-burden TB settings, these factors alone may be inadequate to provide continued motivation for lay worker involvement in health programmes. Extrinsic motivators, of which money is the strongest example, then also serve to keep sustained interest particularly in resource-limited settings where people expect payment for work done. The debate on whether lay workers in health programmes should be paid is thus compounded by issues such as what factors one believes are responsible for motivation in particular contextual settings; how long lay persons are expected to perform tasks at hand; the capacity that exists to pay them and the sustainability of the motivating option chosen. We recommend more qualitative research to be done on this issue in high TB burden settings. (+info)
Developing a neonatal workforce: role evolution and retention of advanced neonatal nurse practitioners.
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BACKGROUND: Over the past decade more than 120 advanced neonatal nurse practitioners (ANNPs) have graduated from the Southampton based ANNP programme. OBJECTIVES: To determine the scope of practice and evolving role of ANNPs and to identify factors that may affect future recruitment and retention. METHOD: An open ended structured questionnaire on clinical role, working arrangements, retention and attrition, continuing education, and professional development was sent to 95 ANNPs. RESULTS: A response rate of 83% was achieved. There was an attrition rate of 14%, with most ANNPs remaining in their original seconding unit. Factors considered to be important for role satisfaction included a well defined role, working within a team of ANNPs, appropriate remuneration, and evidence of unit support for both role definition and continuing professional development. CONCLUSIONS: Although ANNPs are expensive to both train and employ, this evidence suggests that there is a good return on the investment in terms of retention to the unit and the specialty. Their role incorporates many features of advanced nursing practice as well as providing "value added" neonatal care by merging traditional medical and nursing roles and crossing professional boundaries. In 2004 the manpower challenges for neonatal units will be even more acute; these data confirm that there are effective options available but they require long term strategic planning and investment. (+info)
Variations in the costs of child and adolescent psychiatric in-patient units.
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BACKGROUND: Child and adolescent in-patient care is a highly specialised service, ideally requiring planning at a national level, but there are no routine data collections specifically for these services. AIMS: To estimate unit costs for child and adolescent psychiatric in-patient units and to analyse the variations in costs between units. METHOD: Data collection alongside a national survey with cost estimations guided by principles drawn from economic theory. Bivariate and multivariate analyses are employed to identify cost influences. RESULTS: Fifty-eight units could provide sufficient data to allow calculation of the cost per in-patient day; mean= pound 197 (s.d.=71.6; 1999-2000 prices). The management sector, type of provision, number of rooms, capacity and location explained nearly half of the cost variation. CONCLUSIONS: Child and adolescent psychiatric in-patient units are an expensive resource, with personnel absorbing two-thirds of the total costs. Costs per in-patient day vary fourfold and the exploration of cost variations can inform commissioning strategies. (+info)
Nurse-physician collaboration: solving the nursing shortage crisis.
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The current severe nursing shortage in the United States has many causes and its solution requires new strategies. Collaboration among the American Association of Critical-Care Nurses (AACN), the Society of Critical Care Medicine (SCCM) and the American College of Cardiology (ACC) has provided a model for the multidisciplinary approach needed. Nurse-physician collaboration is an important strategy to address the ongoing shortage. (+info)