The impact of the quality of family planning services on contraceptive use in Peru

Through linkage of a Demographic and Health Survey to a situation analysis, this article explores whether current contraceptive use in Peru is affected by the service environment in which a woman resides. The investigation focuses explicitly on the impact of the quality of family planning services and finds that, net of personal and household characteristics, a significant, albeit small, effect exists for one specification of quality in the total sample and for the other specification a nearly significant (p = .053) effect exists. The analysis reveals that contraceptive prevalence would be 16 to 23 percent greater if all women lived in a cluster with the highest quality of care compared with the lowest. Methodological problems that arise in measuring quality of care at the cluster level and in linking quality to individual contraceptive use are also addressed.     

Private practitioners in the slums of Karachi: what quality of care do they offer?

Private health services have expanded in many developing countries over the last 10 yr. Qualified private practitioners provide basic health care for poorer groups in urban areas, although health care planners frequently criticize them for providing poor quality of care, charging high fees and failing to provide preventive health advice. In Karachi, a large city with more than 400 slums, private practitioners are important providers of care to the poor. This study assessed the nature and quality of care provided by 201 practitioners selected from four districts of the city. Vignettes of specific medical problems were used to assess their knowledge and their practice was measured by observing 658 doctor-patient contacts. The results show that knowledge was closer to accepted medical management than was their actual prescribing practice. On the other hand, their manners and interpersonal behaviour were good. Thus poor prescribing practice, which might equally stem from market influences as lack of knowledge, is the cause of low standards of care. In these circumstances, didactic in-service training to improve prescribing practice is unlikely to be successful.     

Considering the role of the amygdala in psychotic illness: a clinicopathological correlation

Today a "just" health policy is balanced between the problem of the allocation of scarce resources and the priority setting of services, care and cures. Despite technologies and molecular medicine, with their tendency to reach absolute prediction of disease or absence of disease and to cure with predicted efficacy, a large portion of the public refuse the results of experimental procedures and prefer to place trust in so-called alternative medicine or in drugs which are not in the official guide-lines following the principles of evidence-based medicine according to DL Sackett. Juridical problems arise between the rights of free choice of cure and social dimension of Governmental care programs, which include the maximum of benefits (i.e. effective therapies) for a pre-fixed total budget. An explicit rationing only on budgetary bases without rationalisation of medical procedures reduces the rights to care of citizens-patients. Thus, an explicit rationing-rationalisation seems to be the only procedure compatible with the interest of patients in a social security system allocating "scarce" resources.     

用秘鲁磁铁矿粉生产球团矿工艺技术研究

秘鲁磁铁矿粉具有粒度细、品位高、脉石含量低等优点,但其碱金属含量相对较高,且SiO2含量过低,容易引起球团矿还原膨胀率高等问题,而且放置时间较长的秘鲁矿粉成球性能下降,影响造球和生球质量.通过试验,研究了秘鲁矿粉的造球性能,以及地方矿粉和含镁熔剂对秘鲁矿粉球团造球、焙烧及成品球质量的影响.试验结果显示,采取高压辊磨、配...     

Mammalian class IV alcohol dehydrogenase (stomach alcohol dehydrogenase): structure, origin, and correlation with enzymology

The structure of a mammalian class IV alcohol dehydrogenase has been determined by peptide analysis of the protein isolated from rat stomach. The structure indicates that the enzyme constitutes a separate alcohol dehydrogenase class, in agreement with the distinct enzymatic properties; the class IV enzyme is somewhat closer to class I (the "classical" liver alcohol dehydrogenase; approximately 68% residue identities) than to the other classes (II, III, and V; approximately 60% residue identities), suggesting that class IV might have originated through duplication of an early vertebrate class I gene. The activity of the class IV protein toward ethanol is even higher than that of the classical liver enzyme. Both Km and kcat values are high, the latter being the highest of any class characterized so far. Structurally, these properties are correlated with replacements at the active site, affecting both substrate and coenzyme binding. In particular, Ala-294 (instead of valine) results in increased space in the middle section of the substrate cleft, Gly-47 (instead of a basic residue) results in decreased charge interactions with the coenzyme pyrophosphate, and Tyr-363 (instead of a basic residue) may also affect coenzyme binding. In combination, these exchanges are compatible with a promotion of the off dissociation and an increased turnover rate. In contrast, residues at the inner part of the substrate cleft are bulky, accounting for low activity toward secondary alcohols and cyclohexanol. Exchanges at positions 259-261 involve minor shifts in glycine residues at a reverse turn in the coenzyme-binding fold. Clearly, class IV is distinct in structure, ethanol turnover, stomach expression, and possible emergence from class I.     

DNA testing for fragile X syndrome: implications for parents and family

The current discussion focuses on criticism as a positive force for improving epidemiologic practice through periodic reexamination of the basic approach to the discipline and the strategy for meeting the future educational needs of students and practicing epidemiologists. The types of epidemiologic research conducted and the settings within which the research will be conducted are also discussed. Epidemiology can be expected to play a major role in new areas of research that are created by changes in the medical care system and the development of large data systems associated with these approaches to health care delivery. This paper also discusses the growing threat to data access, the problems of communicating epidemiologic research findings to the public through the media, and the expanding interface between epidemiologic research and the legal system. The role of epidemiologic organizations in helping to shape the discipline's response to these issues and the opportunities these issues or problems present for improving epidemiologic research are also discussed.     

Painful justice: an ethical perspective on the allocation of trauma services in Australia

Australia faces general and particular problems in the just distribution of trauma services, such as a proliferation of expensive technologies, economic and geographic limitations on their provision, and inequities in allocation. The ethics of shalom in which people live in harmonious relationships with each other, the world and God provide a moral framework for the discussion of the allocation of health care. Ethics deal with people and their relationships, which entails examining the nature and consequences of an action or policy and the character of the persons and institutions involved. The goal of health care, including trauma services, is not to 'fight disease' or to improve the health of the community, but to return people to proper functioning as people-in-relationships, as far as this is practicable. In applying this to the equitable provision of trauma services in Australia, we should distinguish between sustenance rights and community-provided mercies. The former are basic services that we need in order to function meaningfully in the community, and to which we are entitled (eg., basic health care). The latter are other benefits that we as members of the community choose to provide for each other, but to which we are not entitled per se (eg., ICU, Tertiary Trauma Centres). We should do all we reasonably can to ensure that all people receive their healthcare sustenance rights, that healthcare mercies are equitably distributed, and that the person-orientation of health care is maintained in the face of 'technological imperatives'.     

Genetic markers and duodenal ulcer

In the second stage of the reform it is essential to proceed from problems of financing and rewards to health services and their ethic attributes. The dilemma produced by the increasing demands on availability and standard of services on the one hand and efforts to reduce costs on the other leads to the metaphorical "iron triangle of health care", exposed to intense internal tension. The only possibility how to straighten it, which would weaken the danger of crisis, are strict regulatory measures enforced by the State. The foremost task is to define and specify basic (standard) care. As a possible approach the author mentions the Oregon experiment. He draws attention to the phenomenon of "concentration of costs" in the practice of health insurance companies, calling for a major measure of solidarity.     

Population-based needs assessment. Bringing public health to midwifery practice

Midwives are accustomed to individualizing their care of women on the basis of an assessment of each client's health status. By expanding their focus of care to encompass treatment of a population group, midwives and other providers can adopt a public health perspective through use of a community needs assessment. The first steps in diagnosing and treating the health problems of a group require the same rigorous and systematic examination of health indicators as does treatment of an individual. This article outlines the needs assessment process, identifies basic sources of information, and describes ways in which results can be presented.     

Role of clinical trials in memory clinics

The main points of a workshop on the place of clinical trials in the memory clinics in France are reproduced schematically. The efficiency of these centres has been tested at the time of the numerous clinical trials performed in France on Alzheimer's disease. In parallel, several difficulties have been pointed out: inhomogeneity of the technical approaches, official role of psychologists in the hospital teams, integration of clinical research to individual care. A particular effort should be oriented towards specific research on the different types of dementia, on early stages, on information for both media and authorities as well as on specific technical and methodological problems.     

Liver tumor ablation techniques

Decubitus ulcers are an important problem which must be known by health professionals in general and by nurses in particular. Its prevention is one of the basic care in Nursing. This care becomes especially relevant in patients who are admitted into Intensive Care Units. The objectives of the study are to know the incidence rate of patients who develop decubitus ulcers during their stay in the Unit and the proposal to introduce measures aiming to decrease its incidence. In general, the study proves that 17% of patients develop decubitus ulcers during their hospitalization and that 31.8% of patients who are catalogued as risk patients develop ulcers. The preventive measures introduced are the reassessment and application of prevention and treatment of decubitus ulcers protocols, the creation of improvement groups where these problems are approached, perfecting courses about decubitus ulcers, clinical sessions where strategies are unified, graphic divulging measures (notices, etc.) and antiscaric materials such as heelers, small cushions for head support, pillows, etc.     

Education programs in US medical schools, 1995-1996

We present herein data on US medical education programs and describe how medical schools are adapting to a changing health care environment. The data mainly derive from the 1995-1996 Liaison Committee on Medical Education Medical School Questionnaire, which had a 100% response rate. The data indicate that in the 1995-1996 academic year there were 91 451 full-time faculty members in basic science and clinical departments, a 1.6% increase from 1994-1995. In clinical departments, major increases occurred in emergency medicine (a 10.6% increase in full-time faculty) and family medicine (a 13.5% increase). Applicants for the class entering in 1995 numbered 46 591, an increase of 2.7% from 1994; however, the number of first-time applicants decreased slightly (0.6%). Of the 17 357 applicants accepted, 2179 (12.6%) were members of underrepresented minority groups. Health system changes are affecting medical school clinical affiliations. During the past 2 years, 42 schools saw a merger, acquisition, or closure involving medical school-owned or medical school-affiliated hospitals used for core clinical clerkships. At 15 sites, this change affected the distribution of students across clinical sites. In 1995-1996, 40 medical schools or their universities owned a health maintenance organization or other managed care organization, 93 schools contracted with a managed care organization to provide primary care services, and 96 schools contracted with managed care to provide specialty services. During the past year, 57 schools acquired primary care physician practices, and 70 started primary care clinics in the community.     

Patterns of emergency department visits for disorders of the eye and ocular adnexa

OBJECTIVE: To characterize the magnitude and patterns of visits to the emergency department (ED) for problems related to the eye and ocular adnexa. METHODS: The National Hospital Ambulatory Medical Care Survey was used to obtain information on ED visits in the United States for conditions of the eye and ocular adnexa in 1993. Patients were identified by International Classification of Diseases, Ninth Revision, Clinical Modification, codes. National projections were based on a staged probability design. RESULTS: There were 2.32 million projected ED visits for problems of the eye and ocular adnexa in 1993. Forty-nine percent of visits were for injuries, two thirds of which occurred in males. Thirty-five percent of injuries occurred in the home and 18% occurred in the workplace. Only 3% of patients required hospitalization. Most patients had private insurance, but substantial variations in coverage existed for patients who used the ED for injury- vs non-injury-related care. CONCLUSIONS: Emergency departments in the United States provide a large amount of eye care, much of which is for conditions other than trauma. Differences in insurance coverage for injury- and non-injury-related eye care indicate that factors other than medical urgency are involved in the decision to use ED services. Further studies are needed to determine the cost-effectiveness and quality of ocular-related ED visits.     

Head Start and urban children's school readiness: A birth cohort study in 18 cities.

We used longitudinal data from a birth cohort study, the Fragile Families and Child Wellbeing Study, to investigate the links between Head Start and school readiness in a large and diverse sample of urban children at age 5 (N = 2,803; 18 cities). We found that Head Start attendance was associated with enhanced cognitive ability and social competence and reduced attention problems but not reduced internalizing or externalizing behavior problems. These findings were robust to model specifications (including models with city-fixed effects and propensity-scoring matching). Furthermore, the effects of Head Start varied by the reference group. Head Start was associated with improved cognitive development when compared with parental care or other nonparental care, as well as improved social competence (compared with parental care) and reduced attention problems (compared with other nonparental care). In contrast, compared with attendance at pre-kindergarten or other center-based care, Head Start attendance was not associated with cognitive gains but with improved social competence and reduced attention and externalizing behavior problems (compared with attendance at other center-based care). These associations were not moderated by child gender or race/ethnicity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A tale of two New Jersey cities

Judging from the social and health measures considered in this article, Newark and Jersey City face similar challenges as other large cities. For Newark, the challenges are more extreme. The high rates of poverty and violence, coupled with a low rate of high school graduation and a large number of single parent households bode ill for the city. The hospitals in Newark and Jersey City have undergone major changes in meeting the needs of their communities. They have adjusted their size, shortened their lengths of stay, and provided more intensive care services and outpatient services. Of special concern for New Jersey's hospitals is the reliance on Medicaid financing. If dramatic changes are made to the Medicaid program, Newark hospitals should be on high alert. Legislatures need to tread carefully in designing policies that address the needs of New Jersey's large cities. The state is undergoing major changes in its health care system. The demise of the all-payer rate setting system, the establishment of the Health Care Subsidy Fund to finance uncompensated care and subsidize insurance for low and middle-income families, modifications to the community rating system for private insurance, and changes to the welfare system that affect eligibility for Medicaid all require legislators to consider the context in which these programs operate.     

Potentials and limitations of the natural antioxidants RRR-alpha-tocopherol, L-ascorbic acid and beta-carotene in cutaneous photoprotection

In Germany the majority of people in need of nursing care are attended to at home. This is also promoted by the German nursing care insurance. Considering the increasing number of people in need of care more (people who care for them) are required. The article describes the readiness to care of a representative sample of 4806 people who are actually not involved in nursing care activities. The results show that the readiness to give nursing care is highly dependant on the care recipient. Independant from age, sex or social class, there is an strong readiness concerning care of the partner. Regarding other relatives (children, parents) or non-related persons like friends or neighbours, women show greater readiness than men to take over nursing care activities. Age and social class provoke differences, but not in such a homogenious way. All in all the readiness to provide nursing care is surprisingly high; it is to be hoped that it leads to realisation, in case of need.     

The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality

OBJECTIVE: To identify issues related to the quality of health care in the United States, including its measurement, assessment, and improvement, requiring action by health care professionals or other constituencies in the public or private sectors. PARTICIPANTS: The National Roundtable on Health Care Quality, convened by the Institute of Medicine, a component of the National Academy of Sciences, comprised 20 representatives of the private and public sectors, practicing medicine and nursing, representing academia, business, consumer advocacy, and the health media, and including the heads of federal health programs. The roundtable met 6 times between February 1996 and January 1998. It explored ongoing, rapid changes in health care and the implications of these changes for the quality of health and health care in the United States. EVIDENCE: Roundtable members held discussions with a wide variety of experts, convened conferences, commissioned papers, and drew on their individual professional experience. CONSENSUS PROCESS: At the end of its deliberations, roundtable members reached consensus on the conclusions described in this article by a series of discussions at committee meetings and reviews of successive draft documents, the first of which was created by the listed authors and the Institute of Medicine project director. The drafts were revised following these discussions, and the final document was approved according to the formal report review procedures of the National Research Council of the National Academy of Sciences. CONCLUSIONS: The quality of health care can be precisely defined and measured with a degree of scientific accuracy comparable with that of most measures used in clinical medicine. Serious and widespread quality problems exist throughout American medicine. These problems, which may be classified as underuse, overuse, or misuse, occur in small and large communities alike, in all parts of the country, and with approximately equal frequency in managed care and fee-for-service systems of care. Very large numbers of Americans are harmed as a direct result. Quality of care is the problem, not managed care. Current efforts to improve will not succeed unless we undertake a major, systematic effort to overhaul how we deliver health care services, educate and train clinicians, and assess and improve quality.     

招平断裂带中段金矿床控矿条件与成矿规律研究

招平断裂带中段为胶东地区重要的金成矿带,目前已查明的金矿床主要包括夏甸大型金矿床和大尹格庄特大型金矿床,姜家窑和曹家洼中型金矿床,以及焦格庄小型金矿床。研究人员对招平断裂带中段各类金矿床的构造控矿条件、分布规律和矿体赋存规律仍缺乏较系统的认识,亟待开展进一步研究。通过对金矿区地质特征、金矿床地质特征、构造控矿特征和金矿成矿规律进行分析和总结,得出大尹格庄特大型金矿主要受招平主干断裂控制;夏甸大型金矿床主要受控于主干控矿断裂下盘伴生、派生的低级和低序次断裂,夏甸北耩矿体主要受控于主断裂下盘岩体局部张性显微裂隙带;招平断裂带中段大尹格庄特大型金矿床、夏甸特大型金矿床和焦格庄中、小型金矿床大致呈等间距分布,近EW向断裂与招平断裂的交会部位是有利成矿部位;断裂的拐弯或交会部位为主要赋矿部位。     

Effects of hyperthyroidism and hypothyroidism on rat growth hormone release induced by thyrotropin-releasing hormone

The official final action method for sodium chloride in cereal foods, 14.129, was found to give erroneously low results because of loss of chloride during ashing. Comparison of the data with values obtained by the official first action potentiometric method, 32.A01-32.A06, which does not require ashing, showed that large and variable losses of chloride occurred. Official ashing methods for other foods specify addition of sodium carbonate to prevent conversion of chloride to volatile forms, but this was not specified in 14.129. In the present study it was found that sodium carbonate did not completely prevent loss of chloride. The official first action potentiometric method, 32.A01-32.A06, has been adopted as official first action for the determination of chloride in cereal foods to replace 14.129, which was repealed, official first action. A cross-reference to 32.A01-32.A06 has been added to 14.096.