The growing elderly population and the rising number of people with chronic diseases indicate an increasing need for rehabilitation. Norwegian municipalities are required by law to offer rehabilitation. The aim of this study was to investigate how rehabilitation work is perceived and carried out by first-line service providers compared with the guidelines issued by Norway's health authorities.
In this action research project, qualitative data were collected through 24 individual interviews and seven group interviews with employees--service providers and managers--in the home-based service of two boroughs in Oslo, Norway. The data were analysed using a systematic text-condensation method.
The results show that rehabilitation receives little attention in the boroughs and that patients are seldom rehabilitated at home. There is disagreement among professional staff as to what rehabilitation is and should be. The purchaser-provider organization, high speed of service delivery, and scarcity of resources are reported to hamper rehabilitation work.
A discrepancy exists between the high level of ambitious goals of Norwegian health authorities and the possibilities that practitioners have to achieve them. This situation results in healthcare staff being squeezed by the increasing expectations and demands of the population and the promises and statutory rights coming from politicians and administrators. For the employees in the municipalities to place rehabilitation on the agenda, it is a requirement that authorities understand the clinical aspect of rehabilitation and provide the municipalities with adequate framework conditions for successful rehabilitation work.
Home-based rehabilitation is documented to be effective, and access to rehabilitation has been established in Norwegian law. The purchaser-provider organization, high rate of speed, and a scarcity of resources in home-based services hamper rehabilitation work. Healthcare providers find themselves squeezed between the health authorities' overarching guidelines and requirements and the possibilities of achieving them. Rehabilitation must be placed on the agenda on the condition that authorities understand the clinical aspect of rehabilitation.
The paper presents data on planned measures to modernize our cancer service, one of the key areas of public health modernization, the main goal of which is to maximally ensure the citizens' right to have accessible and qualitative medical care. To adequately finance the field and to set up a current legislative base will give rise to the reorientation of the cancer service to priorities for primary prevention and active detection of malignancies, to an improvement of quality of life in cancer patients; to the formation of the populations' positive and integral awareness of health and healthy society, to the rational use of available manpower resources and inventory of all health facilities, which is extremely important under current conditions.
Some persons at risk for Huntington disease (HD) seek predictive testing under the protection of anonymity to reduce the risk of insurance discrimination for themselves and their families. While Canadian and European health care systems seem to limit insurance discrimination to life and disability insurance, U.S. residents do not have national health insurance and are concerned about health insurance discrimination. Two persons residing outside Canada requested predictive testing anonymously. Their primary reason for doing so was to avoid the risks of medical insurance discrimination. After a detailed preparatory session and agreement to counselling and to receipt of results in person, we agreed to provide anonymous testing to these persons. One participant, whose psychological assessment was unremarkable, coped well with the predictive testing process and did not have the CAG expansion. The other participant had considerable emotional problems prior to testing, which necesitated postponement of discussion of results and referral for psychiatric assessment and support. Both participants had difficulty maintaining anonymity. The provision of anonymous predictive testing raises several problems. With anonymous testing, clinicians cooperate with participants to exclude insurance companies from information. This may invalidate the contract with insurance companies. A policy response by insurance companies or a universal health care system to protect individuals is preferable. Individuals who request anonymous testing may be precisely those most vulnerable and in need of additional support and counselling. However, the preservation of anonymity is a burden to participants and may frustrate the clinicians' ability to establish rapport in counselling and to provide appropriate follow-up typically available through genetic counselling in predictive testing programs.
The authors show the necessity of elaboration and practical application of normative documents (standards) and forensic-medical criterions of assessment of defects in obstetric-gynecological medical aid. The examples of the above assessment are given in the article.
We studied the trend in the number of forensic-medical examinations in trials against obstetricians and gynecologists conducted in Primorsky Region in 1997-2005. Most typical defects in obstetric-gynecological care are characterized. These cases are analysed in terms of forensic-medical practice. Detection and forensic-medical analysis of the above defects contribute to optimization of the diagnosis and treatment both in obstetric-gynecological practice and in wide medical practice.
The article presents the analysis of primary gynecologic pathology in female soldiers for the last years. The basic disease groups are marked out. The information about the very medical help standard in different hospitals is given. This paper presents the perspective directions of development of the delivery of obstetrical and gynecological care for women due to level of military medical establishments of the Russian Federation Ministry of Defense.
Medical information systems composed of many specialized modules help in synchronous solving of diagnostic, therapeutic, administrative, financial, statistical, and other tasks. According to the authors, the creation of a single information space of the medical service, integrating it into a single information space of the Defense Ministry of the Russian Fedaration, development and widespread use of telemedicine technology will significantly accelerate the integration in the daily activities of military hospitals of the latest achievements in medical science and practices consistent with the objectives of improving the military health care and improvement of the quality and accessibility of health care.