Effects of distal cement voids on cement stress in total hip arthroplasty

Studies done by Médecins du Monde indicate that sanitary exclusion is a growing phenomenon in France, children included. Paediatricians must be concerned by this phenomenon, which is related to the social precarity of many families who do not use the standard health care structure. They must understand the reasoning behind the choices of these families, and be involved in the care of their children in places that they accept to visit. Paediatricians should also be present in institutions, conferences and debates where public health policy is discussed in order to defend the place of paediatrics in the sanitary organisation.     

How Stigma Interferes With Mental Health Care.

Many people who would benefit from mental health services opt not to pursue them or fail to fully participate once they have begun. One of the reasons for this disconnect is stigma; namely, to avoid the label of mental illness and the harm it brings, people decide not to seek or fully participate in care. Stigma yields 2 kinds of harm that may impede treatment participation: It diminishes self-esteem and robs people of social opportunities. Given the existing literature in this area, recommendations are reviewed for ongoing research that will more comprehensively expand understanding of the stigma-care seeking link. Implications for the development of antistigma programs that might promote care seeking and participation are also reviewed (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women with little or no prenatal care during pregnancy. Results of a study of twenty departments

OBJECTIVES: To estimate the frequency of women who have little or no health care during pregnancy, to assess associated perinatal risk, and to identify the corresponding risk factors. METHODS: Women who consulted less than 4 times or who began consultation during the third trimester were identified in public and private maternity units in 20 French departments. These women were compared with a sample of women from the same institutions who consulted regularly. RESULTS: The percentage of pregnant women with little or no care was 1.1%. Risk of premature birth was increased 4-fold compared with women who consulted regularly. Women who consulted little were very young, multiparous or living alone with no health care insurance. These women stated that the reason for not consulting was that their pregnancy was not accepted, financial difficulties and administrative problems. CONCLUSION: The lack of regular medical care results from social obstacles, especially in foreign born women but is also related to personal problems which are difficult to identify and manage.     

The health and welfare system for elderly in France

Dichotomy is the main characteristic of the Health and Welfare system in France. This system lies on two distinct fields, the medical field which is managed by the National Government, and the social field managed by the Local Government. The French home care policy for the elderly has developed a large number of services to assist in activities of daily living, to provide nursing and medical care at home, to improve living conditions, to maintain social relationships, and to postpone institutionalization and hospitalization, respectively. The main home care service is represented by "home helpers" who provide maid Notiniralics services. The second widely used service is the "home care service" performed by a team of nurses, assistant-nurses, psychologists, physiotherapists. This team provides nursing care and assistance in activities of daily living. As for institutions for the elderly, they are divided into welfare and medical institutions. The welfare institutions include social establishments like shelter homes and nursing homes. The medical institutions are mostly represented by long-term care hospitals. One of the main goals of the aging policy is to create medical wards in welfare institutions in response to the increased dependency of the institutionalized elderly. Recent experimental and innovative concepts have been established, such as "shelter homes for dependent elderly" for physically or cognitively impaired elderly.     

The sexual health needs of people with learning disabilities

The sexual health of people with learning disabilities raises important management and practice issues for health services, and should be examined in the context of the current policy emphasis on advocacy, person-centred services and social inclusion (Department of Health, 2001). People with learning disabilities may have limited access to mainstream health services, and sexual health and genitourinary medicine (GUM) services are no exception (DoH, 2001; 1998). They are often excluded from society, either because they are 'segregated' within specialist support services in the community or because they live in isolation with carers, and health and social care models do not always join up locally to meet their needs.     

Why do we need more information about the risk factors of the musculoskeletal pain disorders in childhood and adolescence?

Musculoskeletal pain disorders such as low back pain, neck pain and shoulder pain are a major and ever increasing public health problem among the working population in industrialized countries with social insurance. Especially the economic impact of these diseases on society has been rising, but the disorders do also produce a lot of pain and suffering to the people. It is an important challenge to the health care systems to prevent and treat these disorders, but at the moment poor understanding of the risk factors of these diseases has failed in giving any effective tools to control the musculoskeletal pain disorder epidemic. Most of the epidemiological studies made are cross-sectional and they do not extend to childhood and adolescence, when the organs are developing, achieving their loading strength and possibly being traumatized and starting their degenerative process. The longitudinal Northern Finland 1966 birth cohort study offers a unique opportunity to find early risk factors for musculoskeletal pain syndromes.     

Gene-expression screens in vertebrate embryos: more than meets the eye

The health control of the travellers and medical assistance for them and their families is one of the oldest and most fundamental missions of the "Office des migrations internationales" (OMI) as defined by the reglementary treaties of November 1945 and June 1946. More recent reglementations have broadened the competence of the OMI to include certain categories of foreigners who had been exempt from all controls. Finally, the ministerial order of November the 7th 1994 specifies means of the health screening. Medical examinations are carried in various French and foreign institutions. It nowadays has become a consultation aiming at prevention and orientation. The medical examination has three principal objectives: the detection of little known abnormalities; the contact between the medical service of the OMI and regional services in charge of the first check-up; the health education of the examined persons. The clinical and paraclinical results are communicated to the patient who is also informed of the most serious health questions, as well as ways of gaining access to medical care in France; this is done by taking into account all medical parameters and health conditions prevailing in the patient's native country. All detected abnormalities are brought to the attention of the head physician of the OMI who in turn informs the medical inspector of the "Direction départementale des affires sanitaires et sociales" (DDASS) in charge of making sure that the migrant benefits from health and social assistance and receives medical treatment. All pathological results are given to the examined persons in form of a written and confidential report, enabling them to visit a doctor of their choice. A network has thus been built up throughout the various departments involved in the first medical examination and the DDASS has made available for the OMI medical staff listings of public institutions likely to welcome the migrants.     

Dental health attitudes among dentate black and white adults

OBJECTIVES: Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use. METHODS: As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried. RESULTS: Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account. CONCLUSIONS: Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.     

Helping disabled people--the user's view

The main needs for most people with physical disabilities are housing and help with daily living. Thus, many of them will find the new emphasis on social aspects of community care particularly relevant. Peter Swain is a disabled man who leads a project in east Devon which ensures that disabled people have a voice in helping to shape the services they need. In this article he explains how the project, Living Options East Devon, works and how the new legislation for community care might affect disabled people.     

Epidemiology and economic impact of heart failure in France

There are little epidemiological data available about heart failure in France, despite its considerable impact on the system of health care and the fact that this problem will become even more acute in the future. Here are some important statistics: in France, there are about 500,000 people suffering from heart failure with about 120,000 new cases every year. The incidence increases from 4% in men and 3% in women of 55 to 64 years of age to 50% in men and 85% in women of 85 to 94 years of age. The average age of diagnosis is 73.5 years: two thirds of patients are over 70 years of age. There are about 3.5 million consultations and 150,000 hospital admissions for heart failure per year. The average length of hospital stay is 11 days. There are more than 32,000 deaths per year from heart failure. The cost of treating heart failure represents more than 1% of total medical expenses. Heart failure is a major problem of public health which is on the increase. This should incite physicians to provide optimal treatment for those affected and to place greater emphasis on preventive measures.     

Access to health care for destitute persons at Public Assistance Hospitals in Paris

All legal French residents are entitled to health care. The 1992 regulatory measures, which create a contractual agreement between the government and public medical institutions, aim at facilitating access to health care by resolving the financial obstacles to accessing health care. The Assistance Publique-H?pitaux de Paris (AP-HP) has set up a medical reception center in several hospitals since 1993. This system is integrated in the general structure of each hospital: in some cases, there is a single and centralized unit; in other cases, all departments of the hospital, including the emergency room, are involved in caring for destitute patients. Whatever the type of the structure may be, social workers are a key element to helping the patients recover their social rights. Thirty to seventy-percent of patients visiting these centers regain access to social and health care coverage. The epidemiological survey of the active file of patients revealed that 70% are male, more than 50% are non-French nationals, half of which do not have legal immigration status in France. Homeless people represent 40 to 80% of the population. The average age is around 35. The number of medical visits varies greatly from one hospital to another and range from 20 to 60 per month. The reasons for visiting the center and the identified medical disorders are strongly related to the patients' life conditions and vary significantly with the risk factors related to the social and economic situation. The frequency of some diseases (psychiatric disorders, tuberculosis, infections by the HIV and HCV) is higher in this population than in general population. Delayed visits to the medical center represents a severity factor. The hospitals' mission statement is not only to ensure that patients facing a precarious social and professional situation have equal access to health care, but also to help such patients recover their social rights, facilitate their integration in the society and fight against social exclusion.     

Do health and use of services differ in residents of sheltered accommodation? A pilot study

OBJECTIVE: To compare the rates of mental health problems, disability and use of health and social services of older people living in sheltered accommodation with those of the rest of the community in the same age group. DESIGN: Door-to-door survey in randomly selected enumeration districts. The districts contained three sheltered accommodation complexes. Residents from these addresses were compared with the others. SETTING: London Borough of Islington. SUBJECTS: 700 men and women aged 65 or over. MAIN OUTCOME MEASURES: Short-CARE depression, dementia and activity scales; the Guy's/Age Concern anxiety scale; individual items detailing problems with mobility, vision and hearing; use of a number of health and social services. RESULTS: The only difference in mental health variables on univariate analysis was a greater severity of cognitive impairment and dementia symptoms in sheltered accommodation. When demographic differences were taken into account, the association with cognitive impairment became statistically insignificant. There were significant associations between residence in sheltered accommodation and several of the disability variables. Increased use of health and social services by sheltered residents remained significant after disability and living alone were taken into account. CONCLUSIONS: The residents of sheltered accommodation were more disabled than the general elderly population but, in contrast to those in residential care, did not have a great excess of mental health problems. Indeed, the possibility was raised that sheltered accommodation may protect against depression in people who live alone.     

Care for Canada's frail elderly population: fragmentation or integration?

Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. Demonstration projects are needed to evaluate its cost-effectiveness and address issues raised by its introduction.     

Reared in adversity: institutional care of children in the 18th century

The earliest public pediatric care of the 18th century in this country took the form of "outdoor relief." Institutional care followed, first almshouses were built; then orphanages, hospitals, and dispensaries. Almshouses not only included workhouses but provided comprehensive medical services. Throughout the 18th century, people often referred to the almshouses as hospitals. As general hospitals, they rendered a variety of pediatric services to sick children, including the idiotic and hopelessly crippled, and the newborns delivered in the maternity wards; and they tendered services for well children, such as foundlings, abandoned children, and the children of destitute parents, placing infants in foster homes and indenturing older children for training in various trades and crafts. The voluntary hospitals, on the other hand, were for the "worthy" poor and limited their services to the insane and the curable sick. There were only two opened during the 18th century-the Pennsylvania Hospital in 1752 and the New York Hospital in 1791. The former excluded young children during the 18th century. Orphanages preceded the voluntary hospitals in point of time, offering many pediatric services to children, well and sick. Finally, at the end of the century, the independent dispensaries appeared, the first in Philadelphia in 1786. By the middle of this 20th century, practically all of them had been absorbed by hospitals. In these institutions, pediatric knowledge advanced and medical manpower developed even during the 18th century. By the end of that century, social movements began from which evolved the 19th-century concern for the welfare of children.     

Health care rationing: the public's debate

OBJECTIVE: To elicit the views of a large nationally representative sample of adults on priorities for health services. DESIGN: An interview survey based on a random sample of people aged 16 and over in Great Britain taken by the Office of Population Censuses and Surveys. SUBJECTS: The response rate to the survey was 75%, and the total number of adults interviewed was 2005. MAIN OUTCOME MEASURES: A priority ranking exercise of health services supplemented with attitude questions about priorities, who should set priorities, and budget allocation. RESULTS: The results of the main priority ranking exercise of 12 health services showed that the highest priority (rank 1) was accorded to "treatments for children with life threatening illness," the next highest priority (rank 2) was accorded to "special care and pain relief for people who are dying." The lowest priorities (11 and 12) were given to "treatment for infertility" and "treatment for people aged 75 and over with life threatening illness." Most respondents thought that surveys like this one should be used in the planning of health services. CONCLUSIONS: The public prioritise treatments specifically for younger rather than older people. There is some public support for people with self inflicted conditions (for example, through tobacco smoking) receiving lower priority for care, which raises ethical issues.     

Utilization of mental health services by women in a male-dominated environment: the VA experience

OBJECTIVE: The study examined whether women in the Veterans Affairs system use mental health services at a lower rate than men because the system is geared to treat a mostly male population. METHODS: Data were obtained on a national cohort of patients utilizing specialty mental health services in the VA during a two-week period in fiscal year 1991 (N = 70,979). Analyses included comparison of the proportion of women among treated veterans with the age-adjusted proportion of women among all veterans, comparison across gender of the likelihood of use of any general psychiatric services or substance abuse care in 1991, comparison of the intensity of services used (inpatient days and outpatient contacts) by service users in 1991, and comparison of the likelihood of receiving care and the intensity of mental health services received two years later. RESULTS: Overall, 3.95 percent of veterans who used VA mental health specialty services were women; 4.02 percent of all veterans were women. No significant differences between genders were found in use of general psychiatric services, either in the likelihood of any use or the intensity of services used. However, women were significantly less likely to receive substance abuse care (16.3 percent of women versus 71.2 percent of men); once receiving care, they used a similar intensity of substance abuse services. CONCLUSIONS: Being a woman does not appear to have a substantial effect on overall access to VA mental health services or use of general psychiatric services; however, women use VA substance abuse treatment services at a lower rate than men.     

Outcasts in a white-lie society: The enigmatic worlds of people with negative self-conceptions.

Although people with negative self-views want to be liked at some level, they repeatedly enact behaviors that alienate their relationship partners. Why? One possibility is that such persons reside in social environments that offer them little insight into what they are doing wrong. Although persons who had negative self-views elicited unfavorable reactions, they did not appreciate this fact because their interaction partners concealed their aversion behind a facade of kind words. To be sure, the interaction partners of people with negative self-views tended to leak their disdain nonverbally. These negative nonverbal messages proved to be uninformative, however, because people with negative self-views overlooked them. These data imply that people with negative self-views may live in social worlds in which they are deprived of corrective feedback that could allow them to improve themselves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reocclusion following successful thrombolysis. Emerging concepts

The behaviour of physicians is increasingly coming under scrutiny and attack, both from patients and from institutions that represent the public interest. This social process is partly a necessary and healthy quest for healing and partly a retaliatory response to inevitable failures on the part of physicians to live up to the standards expected of them. The process can assume such ruthless and pervasive forms that physicians are becoming exposed to impossible demands and even abuse at the hands of those they are trying to help. As a result, many physicians become defensive, withdrawing from patient care or reasserting their own needs in regressive ways that further offend or injure their patients. This increases public anxiety and outrage resulting in regressive and even violent "solutions", creating a vicious cycle in which mutual trust and respect is eroded and true health eludes our grasp. Physicians who practise psychotherapy are particularly aware of such regressive emotional pressures and therefore their experience can be taken as a bellwether of social change. Stirred by recent encounters with colleagues who have undergone public inquisition, humiliation and punishment, and drawing on personal clinical experience with patients whose regressive self-expression could at times be considered "borderline", the author attempts to understand the nature of the emotional forces being experienced by members of the profession at large. As in therapy, so in social change; the outcome depends on how well we understand, contain and channel the powerful feelings that underlie whatever actions are taken.(ABSTRACT TRUNCATED AT 250 WORDS)     

Toward a just society: Lessons from observations on the primary prevention of psychopathology.

Discusses an important distinction that should be maintained between preventive efforts to reduce psychopathology and those aimed at improving public health. It is argued that many mental conditions are not discrete diseases; they are often learned patterns of socially deviant behavior or idiosyncratic thought that result from stress, powerlessness, and exploitation. Prevention efforts aimed at reducing psychopathology will often require social change and a redistribution of power. Efforts to change the power structure and to reduce social class inequalities are opposed by persons who accept (1) the belief that class differences are natural and even desirable from a social Darwinian perspective and (2) the "just world" belief that says that people deserve whatever happens to them. Prevention workers are more likely to accept the fatalistic view that people, only through their own political efforts, can improve the quality of life for most of humankind if they accept the fact that there is no "divine plan" and that evolution has no goal. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Results from the 1995 survey of prevalent clinically diagnosed HIV infection in England, Wales, and Northern Ireland

Health districts in England, Wales, and Northern Ireland were surveyed in 1996 to collect summary information about people with diagnosed HIV infection who received care under the statutory services in 1995. The survey provided demographic and epidemiological information about the prevalent caseload by area of residence, and the extent to which patients with diagnosed HIV infection travelled to obtain care related to it. A total of 13362 people with diagnosed HIV infection were reported to be resident and treated in England, Wales, or Northern Ireland in 1995. Forty-four per cent of these were treated outside the health district where they lived, with regional specialist centres attracting patients from wider areas. At least 13% received care from more than one treatment centre. This national survey of prevalent diagnosed HIV infections provided public health specialists with information relevant to their own localities without compromising confidentiality. This information complements surveillance data from confidential AIDS case diagnosis reports, laboratory reports of HIV infections, and the unlinked anonymous HIV prevalence monitoring programme, all of which contribute to the assessment and projection of demands on health and social services, and provide evidence on which to develop and direct national and local health campaigns.