State intervention in medical care: types, trends and variables.
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This article attempts to develop some of the basic elements for a theory of state intervention in medical care. First, a typology of state intervention is proposed based on two dimensions: the form of state control over the production of medical services and the basis for eligibility of the population. The resulting twelve types provide a means of describing national patterns of state intervention at a given point in time. Next, in order to analyse the changing patterns of state intervention in medical care over time, changes in state control and population coverage are used to construct three hypothetical 'paths' of state intervention, which may serve to depict broad historical trends in major groups of countries. In the final section, several variables are analysed according to their expected effect on the patterns of convergence and divergence in the form and degree of state intervention between countries. This cross-national comparative perspective is offered as a strategy for building a theory capable of explaining state intervention, a process that, to a large extent, informs the medical experience of today. (+info)
The impact of smoke-free workplaces on declining cigarette consumption in Australia and the United States.
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OBJECTIVES: This study estimates the contribution of smoke-free workplaces to the recent national declines in cigarette consumption in Australia and the United States. METHODS: Nineteen studies of the impact of smoke-free workplaces on workday cigarette consumption were reviewed. The number and cost of cigarettes forgone were calculated and extrapolated to a scenario in which all indoor work areas were smoke-free. RESULTS: Of the 19 studies, 18 reported declines in daily smoking rates, and 17 reported declines in smoking prevalence. Smoke-free workplaces are currently responsible for an annual reduction of some 602 million cigarettes, or 1.8% of all cigarettes that might otherwise be consumed, in Australia, and an annual reduction of 9.7 billion cigarettes (2%) in the United States. Approximately 22.3% of the 2.7 billion decrease in cigarette consumption in Australia between 1988 and 1995 can be attributed to smoke-free workplaces, as can 12.7% of the 76.5 billion decrease in the United States between 1988 and 1994. CONCLUSIONS: If workplaces were universally smoke-free, the number of cigarettes forgone annually would increase to 1.14 billion (3.4%) in Australia and 20.9 billion (4.1%) in the United States. (+info)
Effect of closed circuit television on urban violence.
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OBJECTIVE: To evaluate the effect of city and town centre closed circuit television (CCTV) surveillance on violence in terms of accident and emergency (A&E) department and police assault data. METHODS: A&E department and local police assault data in three centres in Wales (Cardiff, Swansea, and Rhyl) two years before and two years after the installation of CCTV were studied. British Crime Survey and police crime statistics were used as control data. RESULTS: A&E records of 24,442 assault patients and 3228 violent offences recorded by the police were studied. Data from two A&E departments (Swansea (+3%) and Rhyl (+45%)) showed increases in recorded assaults after CCTV installation but a decrease (12%) in the largest centre, Cardiff. There was an overall reduction in town/city centre violence from the A&E department perspective of 1% in the two years after CCTV installation. In contrast, police data demonstrated changes in the opposite direction (-44%, -24%, and +20% respectively) contributing to an overall decrease of 9%. British Crime Survey and police statistics for England and Wales demonstrated no overall change and a 16% increase respectively. CONCLUSIONS: City centre CCTV installation had no obvious influence on levels of assaults recorded in A&E departments. There was a negative relationship between police and A&E recording in all three centres. A&E departments are important and unique sources of information about community violence. (+info)
Fraud, misconduct or normal science in medical research--an empirical study of demarcation.
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OBJECTIVES: To study and describe how a group of senior researchers and a group of postgraduate students perceived the so-called "grey zone" between normal scientific practice and obvious misconduct. DESIGN: A questionnaire concerning various practices including dishonesty and obvious misconduct. The answers were obtained by means of a visual analogue scale (VAS). The central (two quarters) of the VAS were designated as a grey zone. SETTING: A Swedish medical faculty. SURVEY SAMPLE: 30 senior researchers and 30 postgraduate students. RESULTS: Twenty of the senior researchers and 25 of the postgraduate students answered the questionnaire. In five cases out of 14 the senior researchers' median was found to be clearly within the interval of the grey zone, compared with three cases for the postgraduate students. Three examples of experienced misconduct were provided. Compared with postgraduate students, established researchers do not call for more research ethical guidelines and restrictions. CONCLUSION: Although the results indicate that consensus exists regarding certain obvious types of misconduct the response pattern also indicates that there is no general consensus on several procedures. (+info)
Teenage suicides in northern Sweden: an interview study of investigating police officers.
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OBJECTIVE: To disclose recurrent, dynamic, and static factors in teenage suicide involving the suicidee, his/her family, and the community; and to investigate the feasibility of using police as informants for suicide studies. SUBJECTS: All deaths categorised as suicide 1993 through 1995 among teenagers in Northern Sweden (n=15). METHOD: Semiqualitative interviews with police officers, and, when applicable, general practitioners. Police reports, necropsy protocols, medical records, and conscription data were also analysed. RESULTS: Most suicides occurred in rural and depopulated areas. In contrast to males, females often had a history of overt psychiatric problems with suicide attempts. At least two thirds of the suicides were planned. CONCLUSION: Cultural and sociopolitical aspects are important in teenage suicide as well as gender differences. Police officers can provide essential information. Identifying teenagers at risk remains difficult, however, due to low baseline rates. (+info)
A multifaceted approach to improving motor vehicle restraint complicance.
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OBJECTIVES: To increase proper use of seat belts and car seats, thereby reducing morbidity and mortality from motor vehicle collisions. SETTING: The Vehicle Injury Prevention program community intervention was implemented in Houston, Texas. Effectiveness data are limited to "target area one", an impoverished neighborhood in northeast Harris County. METHODS: This multifaceted public health education campaign brought together six segments of the community: education, health, government, law enforcement, private industry, and the media, to improve restraint use. It was evaluated by observation of proper restraint use before and nine months after implementation. Trained, independent observers made observations of occupants in the target area and at two comparison sites. Pre-post differences in restraint compliance were calculated by a standard binomial proportion test. RESULTS: Motorists in target area one significantly improved their restraint use by 15% (p<0.05) from 39% pre-intervention to 54% post-intervention, whereas use in the comparison neighborhoods remained unchanged. CONCLUSIONS: Implementation of a public health education program, combined with economic incentives to increase vehicle restraint use, can be successful with multifaceted community support. (+info)
Starting clinical trials of xenotransplantation--reflections on the ethics of the early phase.
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What kind of patients may be recruited to early clinical trials of xenotransplantation? This is discussed under the assumption that the risk of viral infection to the public is non-negligible. Furthermore, the conditions imposed by the Helsinki declaration are analysed. The conclusion is that only patients at risk of dying and with no alternative treatment available should be recruited to xenotransplantation trials in the early phase. For some of the less dangerous cell or islet cell xenotransplantation other categories might be recruited. The risk of cell and islet cell xenotransplantation should, however, be weighted against the development of other technologies. In order to safeguard the public, the opt-out clause in the Helsinki declaration should not be fully applied. Legally binding rules on obligatory monitoring and restrictions should be imposed--before clinical trials start. (+info)
Commercial predictive testing: the desirability of one overseeing body.
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In Europe a process of harmonisation of standards and regulations on genetic testing has started. Public discussion and consultation are recommended, but it is not clear in every European country how the decision making process as regards the further introduction of genetic testing services should be formed. In this paper the usefulness and importance of an overseeing body for genetic screening and testing is founded on four lines of reasoning: (1) analysis of the role of value judgments in the use of the concept of (genetic) abnormality; (2) a balancing of potential benefits for all parties involved; (3) a balancing of potential disadvantages, and (4) the greater availability of commercial genetic tests in the future. It is further argued that such an overseeing body has advantages for all the interested parties. (+info)