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Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced?  [PDF]
Cynthia LeRouge,Monica J. Garfield
International Journal of Environmental Research and Public Health , 2013, DOI: 10.3390/ijerph10126472
Abstract: Barriers have challenged widespread telemedicine adoption by health care organizations for 40 years. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. The article canvasses recent trends—events and activities in each of these areas as well as US health reform activities that might help to break down these barriers. The key to telemedicine success in the future is to view it as an integral part of health care services and not as a stand-alone project. Telemedicine must move from experimental and separate to integrated and equivalent to other health services within health care organizations. Furthermore, telemedicine serves as vital connective tissue for expanding health care organization networks.
Understanding health systems, health economies and globalization: the need for social science perspectives
Susan F Murray, Ramila Bisht, Rama Baru, Emma Pitchforth
Globalization and Health , 2012, DOI: 10.1186/1744-8603-8-30
Abstract: The peer-reviewed, online open-access journal Globalization and Health was established in [2005] with the aim of providing an international forum for high quality original research, knowledge sharing and debate on the topic of globalization and its effects on health, both positive and negative. Within its stated scope the journal recognises the complexity and breadth of topics and the range of disciplinary perspectives required to understand the relationship between globalization and health. In this editorial and special issue we pay attention to the particular contribution of social science. Social scientists, including economists, political scientists and sociologists, have undoubtedly been key contributors to the discussions and theorising about globalization processes since they began to use the term in the [1960]s, long its current widespread use. That theoretical armoury is combined with research approaches that lend themselves well to exploration of the micro, meso and macro forces that confront health systems in the globalizing world, and one would expect to see prominent participation of these disciplines in current published research in this field. The review paper by Bisht et al. [] published in this special issue examines the broader ‘state of the art’ in this regard using the case of research on India, and gives suggestions for future ways forward. [1] We also undertook a mapping of this journal’s own content in order to track trends, emphases, commonalities and differences in the work published over the first six full years of its operation ( [2005,2010]) and to locate the place of social science within its content so far. Ninety four papers were reviewed for topic, author’s institution, disciplinary perspective, geographical focus, methodology and funding. Topics were then grouped into more general themes.The topic areas of HIV/AIDS and globalization and food, diet and obesity have been consistent themes throughout the early years of the journal, as h
Economic Inequalities in Maternal Health Care: Prenatal Care and Skilled Birth Attendance in India, 1992–2006  [PDF]
Praveen Kumar Pathak,Abhishek Singh,S. V. Subramanian
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0013593
Abstract: The use of maternal health care is limited in India despite several programmatic efforts for its improvement since the late 1980's. The use of maternal health care is typically patterned on socioeconomic and cultural contours. However, there is no clear perspective about how socioeconomic differences over time have contributed towards the use of maternal health care in India.
Christiane Diehl-Taylor,George Green
Essays in Economic & Business History , 1999,
Abstract: This paper examines the health insurance industry’s response to the welliness movement between 1960 and 1990. Based primarily on insurance and personnel management trade publications, it argues that the health insurance industry cautiously joined the weliness campaigns of the 70s and 80s despite its on-going reservations regarding the actuarial basis for rate differentials. The industry’s business-like conservatism was overcome by its recognition of wellness promotion as a cost-control measure, public relations tool, and means to stave off the threat of further governmental oversight and regulation.
Improvements in the Status of Women and Increased Use of Maternal Health Services in Rural Egypt  [PDF]
Nagoya Journal of Medical Science , 2012,
Abstract: This research investigated the association between the household status of women and their use of maternal health services in rural Egypt. Face-to-face interviews with a structured questionnaire to 201 married women were carried out in a village, posing questions about their health service utilization and their household socio-economic status. The association between service utilization and other variables was statistically analysed. Older ages at first marriage and higher education levels showed significant positive associations with the three outcome variables—regular antenatal care (ANC), deliveries attended by skilled health professionals, and deliveries at heath facilities—of the use of maternal health services. Women who had not experienced physical assaults by husbands and had knowledge of community activities were more likely to receive ANC regularly; however, there were no significant association with the other two outcome variables. Participation in household decision-making and availability of assistance with household chores had no significant linkage to the use of maternal health services. Marriages to husbands with secondary or higher levels of education and residence in extended families were significantly associated with greater maternal health service usage. Our results suggest that the improved status of women in the household and moral support from family members contributes to an increase in the use of maternal health services.
Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery
Carol S Burckhardt, Kim D Jones
Health and Quality of Life Outcomes , 2005, DOI: 10.1186/1477-7525-3-30
Abstract: A cross-sectional, descriptive design compared two groups of women with chronic pain that began after surgery: regional pain (n = 11) and widespread pain (n = 12). Demographics, characteristics of the surgery, as well as standardized questionnaires that measured pain (Brief Pain Inventory (BPI), Short Form McGill Pain Questionnaire (MPQ-SF)), disease impact (Fibromyalgia Impact Questionnaire (FIQ), Functional Assessment of Cancer Therapy-Breast (FACT-B)), health status (Medical Outcomes Short Form (SF-36)) and quality of life (Quality of Life Scale (QOLS)) were gathered.There were no significant differences between the groups on any demographic or type of surgery variable. A majority of both groups described their pain as aching, tender, and sharp on the MPQ-SF. On the BPI, intensity of pain and pain interference were significantly higher in the widespread pain group. Differences between the two groups reached statistical significance on the FIQ total score as well as the FACT-B physical well-being, emotional well-being and breast concerns subscales. The SF-36 physical function, physical role, and body pain subscales were significantly lower in the widespread pain group. QOLS scores were lower in the widespread pain group, but did not reach statistical significance.This preliminary work suggests that the women in this study who experienced widespread pain after breast cancer surgery had significantly more severity of pain, pain impact and lower physical health status than those with regional pain.Breast cancer is the most common form of cancer among women in the United States, Canada and Europe [1,2]. A sharp increase in incidence has been seen over the past two decades due in large part to use of mammography and subsequent earlier detection of disease. Earlier detection and treatment has led to increased survival rates approaching 90% for noninvasive cancers [3,4] Thus, a large majority of women with breast cancer will survive for many years after the initial diagn
The Fall and Rise of US Inequities in Premature Mortality: 1960–2002  [PDF]
Nancy Krieger ,David H Rehkopf,Jarvis T Chen,Pamela D Waterman,Enrico Marcelli,Malinda Kennedy
PLOS Medicine , 2008, DOI: 10.1371/journal.pmed.0050046
Abstract: Background Debates exist as to whether, as overall population health improves, the absolute and relative magnitude of income- and race/ethnicity-related health disparities necessarily increase—or derease. We accordingly decided to test the hypothesis that health inequities widen—or shrink—in a context of declining mortality rates, by examining annual US mortality data over a 42 year period. Methods and Findings Using US county mortality data from 1960–2002 and county median family income data from the 1960–2000 decennial censuses, we analyzed the rates of premature mortality (deaths among persons under age 65) and infant death (deaths among persons under age 1) by quintiles of county median family income weighted by county population size. Between 1960 and 2002, as US premature mortality and infant death rates declined in all county income quintiles, socioeconomic and racial/ethnic inequities in premature mortality and infant death (both relative and absolute) shrank between 1966 and 1980, especially for US populations of color; thereafter, the relative health inequities widened and the absolute differences barely changed in magnitude. Had all persons experienced the same yearly age-specific premature mortality rates as the white population living in the highest income quintile, between 1960 and 2002, 14% of the white premature deaths and 30% of the premature deaths among populations of color would not have occurred. Conclusions The observed trends refute arguments that health inequities inevitably widen—or shrink—as population health improves. Instead, the magnitude of health inequalities can fall or rise; it is our job to understand why.
Yes, research can inform health policy; but can we bridge the 'Do-Knowing It's Been Done' gap?
Stephen R Hanney, Miguel A González-Block
Health Research Policy and Systems , 2011, DOI: 10.1186/1478-4505-9-23
Abstract: The forthcoming World Health Report, to be entitled: 'No Health Without Research', reflects an ever-growing focus on the vital role of health research, and how best to bridge the 'Know-Do' gap. In 1990 the independent Commission on Health Research for Development published a landmark report, Health Research: Essential Link to Equity in Development [3]. The WHO has been playing an increasingly important part in promoting the role of health research. It organised the Mexico ministerial summit on health research [4] and the accompanying World Report on Knowledge for Better Health: Strengthening Health Systems [5]. That was followed by the second ministerial summit at Bamako [6] and the First Global Symposium on Health Systems Research organised by the WHO/Alliance for Health Policy and Systems Research at Montreux in November 2010.The specific role of health research in informing health policies has always been a major part of the analysis about the importance of health research [7]. In 2003 HARPS published a review and analysis of the topic [8] that had been undertaken as part of the lead-up to the Mexico summit. That paper made an early claim that, 'A full review of the many possible meanings of research impact reveals that there may be more utilisation in policymaking than is sometimes recognised.'[8]The various overlapping themes in the literature include:1. promoting the greater use of research and identifying the facilitators of and barriers to research making an impact on policy, which is sometimes framed as part of the debate about how best to bridge the 'Know-Do' gap;2. describing specific attempts to enhance the impact made by research on policy;3. one-off explorations of how far research has informed health policies in specific cases; and4. developing systematic methods to assess and monitor the impact made by health research on policies, which could seen as addressing what we are calling the 'Do-Knowing It's Been Done' gap.Various studies address these them
Indigenous Health and Socioeconomic Status in India  [PDF]
S. V Subramanian ,George Davey Smith,Malavika Subramanyam
PLOS Medicine , 2006, DOI: 10.1371/journal.pmed.0030421
Abstract: Background Systematic evidence on the patterns of health deprivation among indigenous peoples remains scant in developing countries. We investigate the inequalities in mortality and substance use between indigenous and non-indigenous, and within indigenous, groups in India, with an aim to establishing the relative contribution of socioeconomic status in generating health inequalities. Methods and Findings Cross-sectional population-based data were obtained from the 1998–1999 Indian National Family Health Survey. Mortality, smoking, chewing tobacco use, and alcohol use were four separate binary outcomes in our analysis. Indigenous status in the context of India was operationalized through the Indian government category of scheduled tribes, or Adivasis, which refers to people living in tribal communities characterized by distinctive social, cultural, historical, and geographical circumstances. Indigenous groups experience excess mortality compared to non-indigenous groups, even after adjusting for economic standard of living (odds ratio 1.22; 95% confidence interval 1.13–1.30). They are also more likely to smoke and (especially) drink alcohol, but the prevalence of chewing tobacco is not substantially different between indigenous and non-indigenous groups. There are substantial health variations within indigenous groups, such that indigenous peoples in the bottom quintile of the indigenous-peoples-specific standard of living index have an odds ratio for mortality of 1.61 (95% confidence interval 1.33–1.95) compared to indigenous peoples in the top fifth of the wealth distribution. Smoking, drinking alcohol, and chewing tobacco also show graded associations with socioeconomic status within indigenous groups. Conclusions Socioeconomic status differentials substantially account for the health inequalities between indigenous and non-indigenous groups in India. However, a strong socioeconomic gradient in health is also evident within indigenous populations, reiterating the overall importance of socioeconomic status for reducing population-level health disparities, regardless of indigeneity.
Inequalities in Advice Provided by Public Health Workers to Women during Antenatal Sessions in Rural India  [PDF]
Abhishek Singh, Saseendran Pallikadavath, Faujdar Ram, Reuben Ogollah
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0044931
Abstract: Objectives Studies have widely documented the socioeconomic inequalities in maternal and child health related outcomes in developing countries including India. However, there is limited research on the inequalities in advice provided by public health workers on maternal and child health during antenatal visits. This paper investigates the inequalities in advice provided by public health workers to women during antenatal visits in rural India. Methods and Findings The District Level Household Survey (2007–08) was used to compute rich-poor ratios and concentration indices. Binary logistic regressions were used to investigate inequalities in advice provided by public health workers. The dependent variables comprised the advice provided on seven essential components of maternal and child health care. A significant proportion of pregnant women who attended at least four ANC sessions were not advised on these components during their antenatal sessions. Only 51%–72% of the pregnant women were advised on at least one of the components. Moreover, socioeconomic inequalities in providing advice were significant and the provision of advice concentrated disproportionately among the rich. Inequalities were highest in the case of advice on family planning methods. Advice on breastfeeding was least unequal. Public health workers working in lower level health facilities were significantly less likely than their counterparts in the higher level health facilities to provide specific advice. Conclusion A significant proportion of women were not advised on recommended components of maternal and child health in rural India. Moreover, there were enormous socioeconomic inequalities. The findings of this study raise questions about the capacity of the public health care system in providing equitable services in India. The Government of India must focus on training and capacity building of the public health workers in communication skills so that they can deliver appropriate and recommended advice to all clients, irrespective of their socioeconomic status.
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