Institutional contexts and mortality: the case of Peru

Increasingly, attention is being given to institutional contexts to explain differential demographic and health outcomes. Regional inequality in terms of economic development, social institutions, and health services leads to regional disparities in health outcomes, especially infant mortality. The author uses linked data from population and economic censuses, government agencies, and health surveys on 24 Peruvian provinces to explore how differential economic development and institutional contexts influence health outcomes. Regional inequities based on rural population, subsistence activity, women's illiteracy, monthly income, gross domestic product, medical care, and health facilities are compared, with a cluster analysis identifying institutional contexts which have internal similarities. These contexts are able to discriminate differences in infant mortality. The analysis demonstrates that infant mortality in Peru varies systematically with social, economic, and medical contexts. Economic development, income and subsistence levels, women's literacy, and the amount of medical care and public health services influence health outcomes. It is clear that understanding such regional inequities can help explain disparities in health outcomes.     

Socioeconomic status and infant mortality: evidence from a rural agricultural state

The extent to which the traditional inverse relationship between infant mortality and socioeconomic status holds true in Kansas is examined for the years around 1950, 1960, and 1970. A social-ranking approach and correlation and regression analysis fail to confirm this inverse relationship. The authors suggest that the social organization characteristics of a rural U.S. state may provide a quality of life that transcends socioeconomic differentials.     

Quality of medical care by central government health scheme--a study

This study reports findings on the time spent by CGHS medical officers per patient in different medical care activities for 2,115 patients, as obtained by time study technique. This study was conducted during the year 1976-77. The average observed time spent by the medical officer per patient was found to be 117.15 seconds per patient. The medical officers elicited only main complaints without asking past and family history in 84.44 per cent of patients and the average time spent on history taking was 42 seconds per patient which also included examination of identify card, recording of name, age and sex of the patients. Physical examinations were conducted in only 23.88 per cent of patients and the time spent per patient was 45.93 seconds. The advice for investigations was imparted in 2.60 per cent of patients, though the facilities for routine laboratory examinations were available in the dispensaries. Advice to the patient regarding dietary instructions and general advice was exclusively given in only 5.20 per cent of cases whereas the family planning/health education advice to the patients was given only in 0.76 per cent of patients. The medical officers are aware of the inadequate quality of medical care provided to the beneficiaries and they felt they should at least spend 6.83 minutes for an old patient and 12.42 minutes for the new patient. Probably they are not able to do so because of long queues in the dispensaries during peak hours. Hence, to improve the overall medical care and provide comprehensive care to the beneficiaries it is suggested that the medical officers can be given certain beneficiary population and made responsible to them.     

Socioeconomic status, smoking, and health: a test of competing theories of cumulative advantage

Although both low socioeconomic status and cigarette smoking increase health problems and mortality, their possible combined or interactive influence is less clear On one hand, the health of low status groups may be harmed least by unhealthy behavior such as smoking because, given the substantial health risks produced by limited resources, they have less to lose from damaging lifestyles. On the other hand, the health of low status groups may be harmed most by smoking because lifestyle choices exacerbate the health problems created by deprived material conditions. Alternatively, the harm of low status and smoking may accumulate additively rather than multiplicatively. We test these arguments with data from the 1990 U.S. National Health Interview Survey, and with measures of morbidity and mortality. For ascribed statuses such as gender, race, and ethnicity, and for the outcome measure of mortality, the results favor the additive argument, whereas for achieved status and morbidity, the results support the vulnerability hypothesis--that smoking inflicts greater harm among disadvantaged groups.     

Changes in health, mortality, and disability and their impact on long-term care needs

The need for long-term care is driven both by the growth of the elderly population and changes in the age relations of morbidity, disability, and mortality. Data show these relations changed in the U.S. elderly population from 1982 to 1989. Chronic disability prevalence declined between the 1982 and 1989 U.S. National Long Term Care Surveys. Among those impaired, many persons using personal assistance to meet their needs shifted to the use of assisted housing and special equipment. The relation of these trends to other changes--such as the increasing educational level of the elderly population--is examined to estimate how future changes in disability and morbidity may affect the demand for long-term care. Disabilities at specific times as well as their transition rates were examined to determine how long individuals need long-term care. The analyses suggest that, while the amount of long-term care services needed will increase rapidly, the types and amounts of services used by the U.S. elderly population will undergo significant change.     

Premature infant behavior: an ethological study in a special care nursery.

The Social and Sensory Environment Studies of very low birthweight infants have quantified the amount and quality of social interaction with staff and parents and described the sound environment in an incubator. The present study concerns preterm infant behavior and reactions to these stimuli with particular reference to approach and withdrawal and vocalization. Among the findings are that while intermittent vocalization increases, infant cry decreases over the first three weeks in the incubator. Approach activities take place with some consistency whereas withdrawal differs from child to child. The ethnographic focus on interactive components of the intensive care experience documents the process of intersubjective development for the purpose of locating and isolating points of vulnerability in language and cognitive skills of infants born at very low birthweight.     

Care of older people in migration contexts: local and transnational arrangements between Peru and Spain

Care arrangements for the elderly are becoming a main social process in contemporary societies due to socio-political and lifestyle changes over the last few decades. The family and the State play a basic role in the construction of care systems and in the establishment of strategies to access care resources. In the present context of migration, these resources interact at a transnational level, challenging family and State migratory regimes. These new realities need the recognition of basic international social rights, as the experiences of Peruvians living in a migration context in Spain show.     

Dissociation in medical practice: Social distress and the health care system

The average physician has developed several different heads, each representing another self on the same body. One is that of the conventional, ethical professional who wants nothing more than to improve mankind's health and well-being, the standard model. Another is the scientist who intends to be perceived as calculating, cold, and factual in determining what will or will not assist the ailing patient (Uexkull & Hannes, 1986). His tools are drugs, surgery, and hospitalization for presumed physical and mental ills. The third, and the one that concerns us the most, is what I will call the neo-capitalist professional hero (Lifion, 1971). This persona is an evolution of our American dominated international culture which the medical profession as a group has honored by honing and polishing with extraordinary skill, second only to politicians and bankers, maximizing it to the further detriment of the entire society. Though the body needs all three to function, none of these heads willingly acknowledges or supports the importance of the others. In what follows, a variety of media, journals, professional books, and a survey are referred to in documenting data about ethical laxity and fraud in the medical profession. Institutional, social concepts are developed that explain the data, and revealing how social distress is the embodiment of the neo-capitalist professional hero. There are also suggestions for remedies in what follows, which are presented without realistic hope for implementation very soon, unfortunately, since they involve deep changes in established social institutions. However, the country at large has developed some awareness of a problem which has reached epidemic proportions in the medical profession. Further increments in awareness promise to tip the balance into positive government action.     

Developing a public health policy-research nexus: An evaluation of Nurse Practitioner models in aged care

A frustration often expressed by researchers and policy-makers in public health is an apparent mismatch between respective priorities and expectations for research. Academics bemoan an oversimplification of their work, a reticence for independent critique and the constant pressure to pursue evaluation funding. Meanwhile, policy-makers look for research reports written in plain language with clear application, which are attuned to current policy settings and produced quickly. In a context where there are calls in western nations for evidence based policy with stronger links to academic research, such a mismatch can present significant challenges to policy program evaluation. The purpose of this paper is to present one attempt to overcome these challenges. Specifically, the paper describes the development of a conceptual framework for a large-scale, multifaceted evaluation of an Australian Government health initiative to expand Nurse Practitioner models of practice in aged care service delivery. In doing so, the paper provides a brief review of key points for the facilitation of a strong research-policy nexus in public health evaluations, as well as describes how this particular evaluation embodies these key points. As such, the paper presents an evaluation approach which may be adopted and adapted by others undertaking public health policy program evaluations.     

Socioeconomic status,psychosocial factors and health in urban Guyana

Individuals of higher socioeconomic status live longer and enjoy better physical and mental health relative to individuals of lower social status. Socioeconomic status differences in health status persist over time. This paper examines the association between socioeconomic status, psychosocial factors, and health in Georgetown, Guyana. The major causes of death are cardiovascular and cerebrovascular disease; life expectancy at birth is 67.3 years for males and 72.3 years for females; and the infant mortality rate is 44 per 1000 live births. Data for the study were drawn from a probability sample of 654 adult residents of Georgetown. A significant inverse association was found between formal education and morbidity for four of the six measures of health status. The authors investigated the extent to which self-concept, health behaviors, stress, and social ties are linked to health status and socioeconomic status, and can explain socioeconomic status differences in health status. Psychosocial factors, especially the self-concept measures of self-esteem and mastery, were found to play a moderate role in accounting for educational differences in health status.     

Tools of innovative public procurement in health care in Poland

This paper sets out to map the issues of innovation in public procurement in Poland with specific reference to health care and presents case studies of Polish hospitals using an innovative approach to public procurement. It is based on the analysis of secondary data collected using Internet search engines, introductory research conducted in hospitals which have recently used innovative procurement tools (e.g. technical dialogue and competitive dialogue) and the experience of two Polish hospitals involved in projects aimed at increasing the efficiency of procurement through innovations, described in a case study form. Although innovative procurement in Poland is at an early stage of development, it is also a topic of growing interest to both public authorities and hospitals and some hospitals are adopting new procurement methods such technical and competitive dialogue. However, barriers to the adoption of new procurement approaches are evident and these delay this process of adoption. Barriers encountered include the conservative organizational culture of hospitals, lack of awareness and know-how and a lack of trust and understanding of new procurement approaches.     

Modern health services and health care behavior: a survey in Kathmandu, Nepal

The most important problem regarding health service utilization in Third World countries is that established indigenous forms of health care are readily available and compete with modern health care. Thus, in addition to understanding the components of the decision to seek medical help, we must understand the conditions that affect the choice of a specific health care system. This study examines the impact of medical pluralism on the use of modern forms of health care in Nepal. The findings show that the presence of medical pluralism is a significant factor which delays use of modern health services. Policy implications are discussed, and the need for more research in this area is stressed.     

Racial differences in infant mortality rates: United States, 1969

Using multiple regression analyses, we measured the effects of demographic, health, and socioeconomic variables on race-specific neonatal and postneonatal infant mortality rates. The racial difference in rates in 1969 is due to (1) effects of mean differences in black and white population characteristics, (2) differences in the impact of independent variables, and (3) differences from other causes. Higher black than white infant mortality is the result of unfavorable black means on birthweight, age of mothers at birth, education, and marital stability. Black mortality is also higher because mothers' age at birth, marital stability, and education have more favorable impact on mortality for whites than blacks.     

Networks of social capital: Extending a public relations model of civil society in Peru

Scholars have argued that public relations can and indeed must be used to improve society. This article builds on the work of Taylor and Doerfel (2005), who advocated for the continued study of civil society through the lens of public relations theory. This study contributes to a normative public relations model of civil society by examining how interorganizational relationships, which may initially be established for purposes of resource exchange, benefit civil society through the creation and maintenance of social capital. The study examined a segment of Peruvian civil society dedicated to media development, as media is a key partner in building civil society (Taylor, 2009). The results of the study help to explain how interorganizational relationships contribute to the creation of social capital in a civil society network, and how certain network positions are integral to maintaining the social capital of a community of actors. Implications for the role of public relations in building and maintaining networks of interorganizational communities are discussed.     

Sexuality and health challenges: responding to a public health imperative

Sexuality is associated with a number of public health imperatives to prevent disease or disability or, if prevention is not possible, to treat and reduce the burden of disease as expeditiously as possible. With the advent of modern testing technology and better sampling of populations, the burden of sexually transmissible infections, sexual assault, and sexual disability have become more apparent. Presented here are U.S. data on the public health dimensions of human sexuality and the evidence for the urgent need to address the magnitude of sexually related public health problems.