The article takes as its subject Gaute Heivoll's latest novel Over det kinesiske hav [Across the Chinese Ocean], which describes the establishment of a private nursing home at Finsland in Vest-Agder county immediately before the liberation. The novel's protagonist describes retrospectively how his parents adopted a number of mentally disabled persons, among them a group of siblings from Stavanger. When their adoptive family is exposed to a tragedy, views on who are the providers and receivers of care are challenged, as are concepts such as madness and normality. The article shows how a fictional exposée of conditions for the mentally disabled in recent Norwegian history can provide new perspectives on historic health and care practices. Reading Gaute Heivoll's Over det kinesiske hav highlights the practice of placing patients in private care, as well as the 1934 Act that authorised the sterilisation of mentally disabled persons.
The proportion of older persons is increasing in developed and developing countries: this aging trend can be viewed as a two-edged sword. On the one hand, it represents remarkable successes regarding advances in health care; and on the other hand, it represents a considerable challenge for health systems to meet growing demand. A growing disequilibrium between supply and demand may be particularly challenging within publicly funding health systems that 'guarantee' services to eligible populations. Rehabilitation, including physical therapy, is a service that if provided in a timely manner, can maximize function and mobility for older persons, which may in turn optimize efficiency and effectiveness of overall health care systems. However, physical therapy services are not considered an insured service under the legislative framework of the Canadian health system, and as such, a complex public/private mix of funding and delivery has emerged. In this article, we explore the consequences of a public/private mix of physical therapy on timely access to services, and use the World Health Organization (WHO) health system performance framework to assess the extent to which the emerging system influences the goal of aggregated and equitable health. Overall, we argue that a shift to a public/private mix may not have positive influences at the population level, and that innovative approaches to deliver services would be desirable to strengthening rather than weaken the publicly funded system. We signal that strategies aimed at scaling up rehabilitation interventions are required in order to improve health outcomes in an evolving global aging society.
To study people's views on the accessibility and continuity of primary medical care provided by different providers: a public primary healthcare centre (PPHC), occupational healthcare (OHC), and a private practice (PP).
A nationwide population-based questionnaire study.
A total of 6437 (from a sample of 10,000) Finns aged 15-74 years.
Period of time (in days) to get an appointment with any physician was assessed via a single structured question. Accessibility and continuity were evaluated with a five-category Likert scale. Values 4-5 were regarded as good.
Altogether 72% had found that they could obtain an appointment with a physician within three days, while 6% had to wait more than two weeks. Older subjects and subjects with chronic diseases perceived waiting times as longer more often than younger subjects and those without chronic diseases. The proportion of subjects who perceived access to care to be good was 35% in a PPHC, 68% in OHC, and 78% in a PP. The proportion of subjects who were able to get successive appointments with the same doctor was 45% in a PPHC, 68% in OHC, and 81% in a PP. A personal doctor system was related to good continuity and access in a PPHC.
Access to and continuity of care in Finland are suboptimal for people suffering from chronic diseases. The core features of good primary healthcare are still not available within the medical care provided by public health centres.
Cites: Fam Pract. 2000 Jun;17(3):236-4210846142
Cites: Br J Gen Pract. 2000 Nov;50(460):882-711141874
Cites: Scand J Prim Health Care. 2001 Jun;19(2):131-4411482415
Cites: Br J Gen Pract. 2002 Jun;52(479):459-6212051209
Cites: Health Serv Res. 2002 Oct;37(5):1403-1712479503
Cites: Scand J Prim Health Care. 2006 Sep;24(3):140-416923622
Cites: Scand J Prim Health Care. 1992 Dec;10(4):290-41480869
Half of all Swedish forests are owned by private individuals, and at least 215,000 people work in these privately owned forest holdings. However, only lethal accidents are systematically monitored among self-employed forest workers. Therefore, data from the registries of the Swedish Work Environment Authority, the Labor Insurance Organization and the regional University Hospital in Umeå were gathered to allow us to perform a more in-depth assessment of the rate and types of accidents that occurred among private forest owners. We found large differences between the registries in the type and number of accidents that were reported. We encountered difficulties in defining "self-employed forest worker" and also in determining whether the accidents that did occur happened during work or leisure time. Consequently, the estimates for the accident rate that we obtained varied from 32 to > or = 4300 injured persons per year in Sweden, depending on the registry that was consulted, the definition of the sample population that was used, and the accident severity definition that was employed. Nevertheless, the different registries gave a consistent picture of the types of accidents that occur while individuals are participating in self-employed forestry work. Severe accidents were relatively common, as self-employed forestry work fatalities constituted 7% of the total number of fatalities in the work authority registry. Falling trees were associated with many of these fatal accidents as well as with accidents that resulted in severe non-fatal injuries. Thus, unsafe work methods appeared more related to the occurrence of an accident than the equipment that was being used at the time of the accident (e.g., a chainsaw). Improvement of the workers' skills should therefore be considered to be an important prevention measure that should be undertaken in this field. The challenges in improving the safety in these smallest of companies, which fall somewhere between the purview of occupational and consumer safety, are exemplified and discussed.
Social, ethical and policy analysis of the issues arising from gene patenting and commercial genetic testing is enhanced by the application of science and technology studies, and Actor-Network Theory (ANT) in particular. We suggest the potential for transferring ANT's flexible nature to an applied heuristic methodology for gathering empirical information and for analysing the complex networks involved in the development of genetic technologies. Three concepts are explored in this paper--actor-networks, translation, and drift--and applied to the case of Myriad Genetics and their commercial BRACAnalysis genetic susceptibility test for hereditary breast cancer. Treating this test as an active participant in socio-technical networks clarifies the extent to which it interacts with, shapes and is shaped by people, other technologies, and institutions. Such an understanding enables more sophisticated and nuanced technology assessment, academic analysis, as well as public debate about the social, ethical and policy implications of the commercialization of new genetic technologies.
Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children's access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them.
We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools.
The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers' nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY.
ANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for voluntary action are poor. Where ANGCY uptake does occur, changes to the food environment may be relatively minor. Stronger government measures may be needed to require recreational facilities to improve their food environments and to limit availability of unhealthy foods.
Cites: Can J Public Health. 2009 Jul-Aug;100(4):310-419722347
Cites: Milbank Q. 2004;82(4):581-62915595944
Cites: Int J Environ Res Public Health. 2010 May;7(5):2208-2120623020
Cites: Am J Public Health. 2010 Nov;100(11):2137-4520864696
Cites: Can J Diet Pract Res. 2010 Winter;71(4):180-521144134
Cites: Can J Diet Pract Res. 2010 Winter;71(4):186-9121144135
Cites: N Engl J Med. 2005 Mar 17;352(11):1138-4515784668
Cites: Qual Health Res. 2005 Nov;15(9):1277-8816204405
Cites: Health Policy Plan. 2007 Jan;22(1):28-3917237492
Cites: Health Educ Res. 2007 Apr;22(2):203-2616861362
Cites: Am J Prev Med. 2007 Apr;32(4):273-8117383558