Standards in school toilets--a questionnaire survey.
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BACKGROUND: Children often say they have problems with their toilets in school. Educationalists and health workers need to be aware of potential difficulties, to try and improve these facilities for school children. The objective of this study was to assess the perception children have of the toilet facilities in their schools and whether or not this influences their use of them. METHODS: An interviewer-administered questionnaire was given to children attending community audiology clinics and their parents. RESULTS: Eighty-seven children from 65 schools were surveyed. Poorly maintained and unhygienic facilities were described to which access was restricted. A significant proportion of children were bullied or teased. Forty per cent would never open their bowels using the toilets in school. CONCLUSION: The same standards for toilet facilities in the workplace should apply to schools. Substandard facilities may contribute to the suppression of the 'call to stool', leading to chronic constipation. Infectious illnesses may be more easily spread. (+info)
Undignifying institutions.
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Declarations of the importance of dignity in health care are commonplace in codes of practice and other mission statements, yet these documents never clarify dignity's meaning. Their vague aspirations are compared to comments from staff and patients about opportunities for and barriers against the promotion of dignity in elderly care institutions. These suggest that while nurses and health care assistants have an intuitive understanding of dignity, they either do not or cannot always bring it about in practice. Thus, despite stated intentions to promote dignity, it appears that the circumstances of at least some elderly care institutions cause patients to experience avoidable indignities. Such institutions are "undignifying institutions" because they fail to acknowledge dignity's basic components, focus excessively on quantifiable priorities, and have insufficient resources available to assure consistently dignifying care. As a partial solution, we argue that health workers should be taught to understand and specify the components of dignity, which will better prepare them to challenge undignifying practices and to recognise opportunities for dignity promotion. (+info)
Expanding the Andersen model: the role of psychosocial factors in long-term care use.
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OBJECTIVE: To examine a prevailing conceptual model of health services use (Andersen 1995) and to suggest modifications that may enhance its explanatory power when applied to empirical studies of race/ethnicity and long-term care. STUDY SETTING: Twelve focus groups of African-American (five groups) and white (seven groups) individuals, aged 65 and older, residing in Connecticut during 2000. STUDY DESIGN: Using qualitative analysis, data were coded and analyzed in NUD-IST 4 software to facilitate the reporting of recurrent themes, supporting quotations, and links among the themes for developing the conceptual framework. Specific analysis was conducted to assess distinctions in common themes between African-American and white focus groups. DATA COLLECTION: Data were collected using a standardized discussion guide, augmented by prompts for clarification. Audio taped sessions were transcribed and independently coded by investigators and crosschecked to enhance coding validity. An audit trail was maintained to document analytic decisions during data analysis and interpretation. PRINCIPAL FINDINGS: Psychosocial factors (e.g., attitudes and knowledge, social norms, and perceived control) are identified as determinants of service use, thereby expanding the Andersen model (1995). African-American and white focus group members differed in their reported accessibility of information about long-term care, social norms concerning caregiving expectations and burden, and concerns of privacy and self-determination. CONCLUSIONS: More comprehensive identification of psychosocial factors may enhance our understanding of the complex role of race/ethnicity in long-term care use as well as the effectiveness of policies and programs designed to address disparities in long-term care service use among minority and nonminority groups. (+info)
A proposed architecture and method of operation for improving the protection of privacy and confidentiality in disease registers.
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BACKGROUND: Disease registers aim to collect information about all instances of a disease or condition in a defined population of individuals. Traditionally methods of operating disease registers have required that notifications of cases be identified by unique identifiers such as social security number or national identification number, or by ensembles of non-unique identifying data items, such as name, sex and date of birth. However, growing concern over the privacy and confidentiality aspects of disease registers may hinder their future operation. Technical solutions to these legitimate concerns are needed. DISCUSSION: An alternative method of operation is proposed which involves splitting the personal identifiers from the medical details at the source of notification, and separately encrypting each part using asymmetrical (public key) cryptographic methods. The identifying information is sent to a single Population Register, and the medical details to the relevant disease register. The Population Register uses probabilistic record linkage to assign a unique personal identification (UPI) number to each person notified to it, although not necessarily everyone in the entire population. This UPI is shared only with a single trusted third party whose sole function is to translate between this UPI and separate series of personal identification numbers which are specific to each disease register. SUMMARY: The system proposed would significantly improve the protection of privacy and confidentiality, while still allowing the efficient linkage of records between disease registers, under the control and supervision of the trusted third party and independent ethics committees. The proposed architecture could accommodate genetic databases and tissue banks as well as a wide range of other health and social data collections. It is important that proposals such as this are subject to widespread scrutiny by information security experts, researchers and interested members of the general public, alike. (+info)
Building the national health information infrastructure for personal health, health care services, public health, and research.
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BACKGROUND: Improving health in our nation requires strengthening four major domains of the health care system: personal health management, health care delivery, public health, and health-related research. Many avoidable shortcomings in the health sector that result in poor quality are due to inaccessible data, information, and knowledge. A national health information infrastructure (NHII) offers the connectivity and knowledge management essential to correct these shortcomings. Better health and a better health system are within our reach. DISCUSSION: A national health information infrastructure for the United States should address the needs of personal health management, health care delivery, public health, and research. It should also address relevant global dimensions (e.g., standards for sharing data and knowledge across national boundaries). The public and private sectors will need to collaborate to build a robust national health information infrastructure, essentially a 'paperless' health care system, for the United States. The federal government should assume leadership for assuring a national health information infrastructure as recommended by the National Committee on Vital and Health Statistics and the President's Information Technology Advisory Committee. Progress is needed in the areas of funding, incentives, standards, and continued refinement of a privacy (i.e., confidentiality and security) framework to facilitate personal identification for health purposes. Particular attention should be paid to NHII leadership and change management challenges. SUMMARY: A national health information infrastructure is a necessary step for improved health in the U.S. It will require a concerted, collaborative effort by both public and private sectors. (+info)
eEurope 2002: Quality Criteria for Health Related Websites.
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BACKGROUND: A number of organisations have begun to provide specific tools for searching, rating, and grading this information, while others have set up codes of conduct by which site providers can attest to their high quality services. The aim of such tools is to assist individuals to sift through the mountains of information available so as to be better able to discern valid and reliable messages from those which are misleading or inaccurate. OBJECTIVE: Recognising that European citizens are avid consumers of health related information on the internet and recognising that they are already using the types of rating system described above, the European Council at Feira on June 19-20 2000 supported an initiative within eEurope 2002 to develop a core set of Quality Criteria for Health Related Websites. The specific aim was to draw up a commonly agreed set of simple quality criteria on which Member States, as well as public and private bodies, may draw in the development of quality initiatives for health related websites. These criteria should be applied in addition to relevant Community law. METHODS: A meeting was held during 2001 which drew together key players from Government departments, International Organisations, non-governmental organisations and industry, to explore current practices and experiments in this field. Some sixty invited participants from all the Member States, Norway, Switzerland, and the United States of America took part in the meeting of June 7-8, 2001: they included delegates from industrial, medical, and patient interest groups, delegates from Member States' governments, and key invited speakers from the field of health information ethics. These individuals, and many others, also took part in the web-based consultation which was open from august to November 2001. RESULTS: The broad headings for quality criteria identified include Transparency and Honesty, Authority, Privacy and data protection, Updating of information, Accountability, Responsible partnering, Editorial policy, Accessibility, the latter includes attention to guidelines on physical accessibility as well as general findability, searchability, readability, usability, etc. A metadata labelling system may be used to make health data more findable. Such a system may also be used in conjunction with quality criteria to give higher ranking by search engines to those sites or pages labelled as complying with defined quality criteria. CONCLUSIONS: The set of quality criteria is based upon a broad consensus among specialists in this field, health authorities, and prospective users. It is now to be expected that national and regional health authorities, relevant professional associations, and private medical website owners will 1) implement the Quality Criteria for Health Related Websites in a manner appropriate to their website and consumers; 2) develop information campaigns to educate site developers and citizens about minimum quality standards for health related websites; 3) draw on the wide range of health information offered across the European Union and localise such information for the benefit of citizens (translation and cultural adaptation); 4) exchange information and experience at European level about how quality standards are being implemented. (+info)
Security, privacy, and confidentiality issues on the Internet.
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We introduce the issues around protecting information about patients and related data sent via the Internet. We begin by reviewing three concepts necessary to any discussion about data security in a healthcare environment: privacy, confidentiality, and consent. We are giving some advice on how to protect local data. Authentication and privacy of e-mail via encryption is offered by Pretty Good Privacy (PGP) and Secure Multipurpose Internet Mail Extensions (S/MIME). The de facto Internet standard for encrypting Web-based information interchanges is Secure Sockets Layer (SSL), more recently known as Transport Layer Security or TLS. There is a public key infrastructure process to 'sign' a message whereby the private key of an individual can be used to 'hash' the message. This can then be verified against the sender's public key. This ensures the data's authenticity and origin without conferring privacy, and is called a 'digital signature'. The best protection against viruses is not opening e-mails from unknown sources or those containing unusual message headers. (+info)
Health insurance reform: security standards. Final rule.
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This final rule adopts standards for the security of electronic protected health information to be implemented by health plans, health care clearinghouses, and certain health care providers. The use of the security standards will improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general by establishing a level of protection for certain electronic health information. This final rule implements some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). (+info)