[Implementation of the Madrid International Plan of Action on Aging in the CIS countries: the first 10 years]

In this article the information on policy action on aging in the CIS countries and Georgia (CIS+) are presented and discussed. The process of implementation of the Madrid International Plan of Action on Aging (MIPAA) from 2002 through 2012 is chosen as a framework for analyzing the government policy on ageing. The article begins with a concise overview of the demographic situation in the CIS+ countries, which belong to various stages of demographic transition. In its concluding part, the article presents the policy goals for implementing MIPAA during its third implementation cycle (2013-2017).

[Approaches to optimization of the work of forensic medical specialists (as exemplified by the experience gained in the Republic of Tatarstan)]

Analysis of day-to-day activity of the forensic medical service and results of a questionnaire study involving forensic medical examiners, health care providers, and law enforcement officers carried out in the Republic of Tatarstan were used to develop recommendations for the improvement of the efficiency of work of these employee groups. It is concluded that its optimization will require further enhancement of material, technical, and methodological support of this service, its better organization, financial incentive for the personnel, and mobilization of social factors.

The short-term effect on technical and scale efficiency of establishing regional health systems and general management in Greek NHS hospitals

OBJECTIVES

The Greek National Health System has been subjected to a reform initiative in 2001. The new legislation required hospitals to operate as administrative and economic decentralized units, under the control of newly established Regional Health Systems. In addition, Professional Managers have been appointed and signed "efficiency contracts", which supposedly committed them to run the hospitals effectively and efficiently. The present study aims at estimating the efficiency impact of this reform.

METHODS

Data Envelopment Analysis was employed with included inputs being the number of medical staff employees, other hospital employees and staffed beds, whereas outputs were the case-mix adjusted inpatient cases, outpatient visits and surgical operations performed. The technical and scale efficiencies of a sample of 51 general acute National Health System hospitals have been comparatively examined before and after the reform.

RESULTS

The analysis surprisingly indicates that technical and scale efficiency has been reduced following the policy changes.

CONCLUSIONS

It appears that the expected benefits from the reform have not in general been achieved, at least in the short-run. This result is examined in light of coexisting administrative and organizational factors, which are impeding the reform process.

The long‐term effect of local policies to restrict retail sale of tobacco to youth

Many adolescent smokers rely significantly on retail tobacco sources to initiate or maintain their smoking behavior. Though promising, the results from various interventions aimed at curtailing retail tobacco access have been mixed. In the present study, 14 communities were randomly assigned to intervention and control groups in an attempt to determine the long-term effect of local youth access laws and policies on adolescent smoking. The intervention continued for 32 months. Assessments were conducted at baseline (1991) and at years 3, 5, and 7. The intervention was based on a community-organizing approach that mobilized community members to support adoption and enforcement of local ordinances to restrict minors' access to commercial sources of tobacco. The major outcome measure for the study was cross-sectional prevalence of daily tobacco use among all students in grades 8, 9, and 10 in each community, measured by a self-administered student survey. A short-term significant intervention effect was observed and reported previously. That difference between intervention and control communities was maintained through the year 5 assessment but had dissipated by the year 7 assessment, very likely related to adoption of ordinances by control communities. Restricting commercial access to tobacco through local ordinances is effective in reducing adolescent smoking both immediately after the intervention (year 3) and 2 years later (year 5). Longer-term results are still inconclusive, because control communities adopted ordinances similar to those in the intervention communities.

Tennessee trauma care system plan, Part II

Tennessee implemented a statewide trauma care system in 1988. This system serves the state of Tennessee and supports eight neighboring states. The demographics and geography of Tennessee have ensured that nearly all residents have rapid access to the trauma care system. However, since 1988, many changes have occurred in healthcare in general, and trauma care in particular, that point out problems and issues with the Tennessee trauma care system. Therefore, the Tennessee Trauma Care Advisory Council has developed this Trauma Care System Plan to look at needs and opportunities for the future of trauma care in Tennessee. This plan will be presented in four segments: History, Administrative Components, Operational Components, and Clinical Components.

Provision of drug treatment services in the juvenile justice system: a system reform

This article proposes a systemic reform of the organizational structure and delivery of substance abuse services for adolescents within the juvenile justice system. It first discusses the impact of substance use on the juvenile justice system and then reviews which drug treatment programs and services are currently available. Following an evaluation of the most effective drug treatment programs and modalities, recommendations for system reform are given. The recommendations are based on a graduated sanctions framework, supported by systems collaboration and comprehensive case management. Systems collaboration between service providers must exist for juveniles to receive appropriate and comprehensive services. Case managers (CMs) both assess juveniles and help them move through and between judicial, drug treatment, and social service systems. In this way, juveniles receive the most suitable and complete services a community can offer while remaining firmly under juvenile justice system supervision.

A historical perspective of trauma system development in the United States

The concept of a trauma system as public health policy has developed substantially during the 30 years since publication of Accidental Death and Disability: The Neglected Disease of Modern Society. The military experience with casualties established the public expectation that grievously injured citizens should be expected to survive if a system enables a team of experts to work smoothly together. The federal government has invested hundreds of millions of dollars in support of development of an infrastructure of emergency medical systems throughout the country, and trauma systems have benefited from timely prehospital care provided by trained professionals. State or regional metropolitan governments have initiated establishment of trauma systems as fusions of health care and the politics of health care policy. Trauma systems can be considered an experiment in health care policy because they have characteristics uncommon with other areas of medical practice. Hospitals have been categorized by means of outside review based on their capabilities to provide trauma care, which has led to designation, whereby individuals are transported to trauma centers after serious injury rather than the hospitals they might normally choose. The performance of hospitals and health providers in a trauma system is subjected to outside review and some form of public accountability. All of the effort, money, and work committed to trauma systems requires careful scrutiny to determine whether trauma systems are indeed beneficial. Have trauma systems reduced death, ameliorated disability, and successfully prevented the problems these public health policies intend to manage?

[The private hospital system before and after the 24 April 1996 regulations]

The hospital system has seen itself transformed by the regulations of April 24, 1996. The appearance of new structures and a new logic modified the links between actors: recourse to the contract became an instrument of regulation, the regionalization through the creation of ARH (regional hospitalisation agencies) defined in a new manner the responsibilities in matters of hospital management, the implementation of the ANAES is accompanied by the implementation of an accreditation procedure and pursues the missions of evaluations that, until now, were ensured by the ANDEM.

Progress in the development of trauma systems in the United States. Results of a national survey

OBJECTIVE

To examine the status of trauma system development and key structural and operational characteristics of these systems.

DESIGN AND SETTING

National survey of trauma systems with enabling state statute, regulation, or executive orders and for which designated trauma centers were present.

PARTICIPANTS

Trauma system administrators and directors of 37 state and regional organizations that had legal authority to administer trauma systems, which represented a response rate of 90.2%.

MAIN OUTCOME MEASURES

Trauma system components that had been implemented or were under development.

RESULTS

From 1988 to 1993, the number of states meeting one set of criteria for a complete trauma system criteria increased from two to five. The most common deficiency in establishing trauma systems was failure to limit the number of designated trauma centers based on community need. Although most existing trauma systems have developed formal processes for designating trauma centers, prehospital triage protocols to allow hospital bypass, and centralized trauma registries, several systems lack standardized policies for interhospital transfer and systemwide evaluation.

CONCLUSION

State and regional organizations have accomplished a great deal but still have substantial work ahead in developing comprehensive trauma systems. Research is needed to better understand the relationship between trauma volume and outcomes of care as well as the impact of trauma system structure and operational characteristics on care delivery. Improved measures of patient outcome are also needed so that effective system evaluation can take place.

Ten years of maternal-fetal transport

One maternal-fetal transport system and the public health policies that supported its development are presented. System development, the components necessary for successful two-way maternal-fetal transports, and growth between 1981 and 1991 are summarized.

That vision thing

The 1991 Janet Doe lecturer describes the vision held by the founders of the Medical Library Association of medical information being readily accessible to health professionals no matter how far they were located from major medical centers, and traces the pursuit of this vision to current outreach activities.

[Methadone maintenance of HIV-infected drug addicts with immune deficiency]

The Norwegian policy on methadone maintenance is restrictive. Support is given to needle dispensing programmes, HIV testing and drug rehabilitation programmes. In contrast, the central health authorities have opposed any methadone treatment except for methadone maintenance for HIV infected drug abusers with immune deficiency and in need of AZT treatment. "Akuttinstitusjonen" (The detoxification unit in Oslo) and the Infectious Diseases Unit at Ullevål Hospital have developed a model for treatment programme in cooperation with the local health and social services. We describe six cases, and discuss experiences in relation to the Norwegian policy on drugs. We conclude that the positive factors outweigh the negative. Basically, it should be possible to apply the model throughout Norway. In Oslo the case load creates a need for specialized therapeutic team.

[Financing regional health services. Problems and possible solutions]

The purpose of this paper is to highlight the fact that the present financial system of the Health Regional Services is constraining their management and development possibilities and thus, the System designed in the General Law of Health (Ley General de Salud); moreover, it is, hindering the development of the Autonomous Communities themselves, as the financing of these services is a hard weight to carry, within the own financing process of the Autonomous Communities. We just try to demonstrate there is no reason whatsoever that may justify the present financing procedure of the Health Services already Transferred to Government of the Autonomous Communities. We deem it is necessary to change such model, in order that principles of sufficiency, autonomy and interterritorial solidarity become effective. We are also of the opinion that we are now living the adequate moment to overcome these problems, as it is our must to renegotiate the application, for the five-year period 1992-1995, of the principles under the Organic Law for the financing of the Autonomous Communities. (Spanish, LOFCA).

Treating renal disease: a history

As dialysis technology advanced, physicians trained in the new specialty of nephrology set up dialysis programs in hospitals throughout New Jersey. Physicians, state legislators, organizations, and patients contributed to the growth of a life-saving technology.

National Library of Medicine programs--PHS. Final rule

These regulations govern the programs of the National Library of Medicine (NLM). The regulations permit the Regional Medical Libraries to recover part or all of the costs of providing photocopies of biomedical materials; improve readability of the regulations; and update references to statutory authorities and uniform administrative requirements.

Coordinating community and public-institutional mental health services: some unintended consequences

Where a target group such as the mentally ill tend to use multiple and varied services over a long period of time, service coordination is often seen as the key to continuity of care. This article argues that coordination also has its perverse effects. To demonstrate, two types of community organizations (COs) working in mental health in the Canadian province of Québec are examined: alternative COs, which have their roots in community action and maintain few formal links with each other or with institutional resources; and transitional structures, COs which are developed with the cooperation of psychiatric professionals, are closely linked to hospitals and are often part of a tightly coordinated system of community services. With respect to access, continuity, programs, internal structure and flexibility, each type of community resource has particular strengths and weaknesses. In the first part of the article, these are described and compared. In the second part of the article, we examine the possible effects of Québec's new mental health policy on COs working in mental health. The policy seeks to create comprehensive systems coordinating all services at the regional level-including alternative organizations, transitional structures and public institutions. The imperatives of the complex planning process risk diluting or even eradicating the differences between the two types of mental health COs described earlier. The process may thus rob certain service users of the particular advantages they found in alternative COs. For those mentally ill who, by choice or by chance, remain marginal to the coordinated system, there may ultimately be no resources available at all.

[The right to health]

No fim do século XX a simples declaração de direitos não satisfaz ao povo. Busca-se delimitá-los determinando seu conteúdo, para se construírem estruturas que possam garantir o direito declarado. Nessa linha analisou-se a conceituação de saúde e de direito à saúde para procurar na organização do Brasil, Estado federal e capitalista, meios para garantir o direito à saúde. A municipalização das ações de saúde somada à necessidade de aprovação legislativa do Plano de Saúde e à organização judiciária local foram considerados elementos importantes para a efetivação do direito à saúde.

[Integrated services in emergency medicine: the Regional Center for Emergency Medical Assistance]

According to the law of 8 July 1964, the Belgian State is responsible for the treatment of the emergencies in the public ways and places. Due to an important spontaneous private extension, among the 502.600 annual calls the 252.000 specifically medical cases are in practice selected, estimated and practically handled by the Responsible of the Call Center 900, that is to say a fire man, who also answers the 57.400 annual demands for medical advice. There is neither doctor on the scene of the emergency nor during transportation in 85% of the cases. Emergency Medical Support (EMS) may no longer be conceived without the presence of the doctor. The Regional Emergency Medical Support Centers (CRAMU) harmoniously and efficiently integrate, with everyone in his place, all the clinical institutions, their common medical regulating center, the SAMU (EMS Center) and the call center 900 where the specifically medical calls are selected and directed to the SAMU. The concrete results of the first experimental CRAMU in Charleroi are presented, after a three years experience.