Effective management of the elderly hearing impaired--a review.

In the United Kingdom, two and a half million people over 70 are thought to have hearing impairment that would benefit from an aid. Only one-third of these will possess one, and as many as 10 per cent probably never use their aid. Although it is important to examine the relative merits of different aids, there is also a need to look at how audiological services may reduce the unmet need that results from underuse of aids.

NHS reforms in the United Kingdom and learning from developing country experience.

The NHS has been the object of much international interest from its inception and through its periodic reforms. However, UK policy-makers have expressed only limited and selective concern for health sector reforms in other countries. This paper seeks to identify key elements of the present process and content of reforms to the UK NHS and examine the extent to which international learning would be important in developing these reforms.

Home care and the reshaping of acute hospitals in England. An overview of problems and possibilities.

A changing boundary between hospital and home-care services over two decades has taken place enabling people to live in their own homes wherever possible, enabling "choice of independence". Against this background, five principal issues are raised regarding how hospital services have been reshaped over that time and how the pattern of service developments outside the hospital has altered over the same period.

Assessing payback from NHS reactive research programmes.

Aims to assess retrospectively the payback from NHS reactive research programmes in the Northern and Yorkshire region. A questionnaire was sent to all recipients of regional reactive research programme funding (biomedical, health services research (HSR), and primary and community care programmes) between 1 April 1991 and 31 March 1996. The sample available for analysis involved 174 respondents covering 119 projects, with a total financial value of 2.

Primary care organisation and management. Evidence from a total purchasing pilot.

This paper reports the experience of a single pilot in total primary care purchasing (TPP) between 1995 and 1997. The article's structure is based on a framework created from the seven original objectives of the pilot and 12 themes emerging from qualitative data analysis. Data are mainly drawn from interviews with participants.

Selecting a mental health needs assessment scale: guidance on the critical appraisal of standardized measures.

The assessment of need has become a central element of the NHS policy on mental health care. Despite the importance placed on a needs-led mental health service, little guidance has been provided as to the most appropriate means of assessing need. The use of standardized instruments can facilitate a systematic approach to the needs assessment process.

The effect of the full moon on general practice consultation rates.

Background: The effect of the full moon on human behaviour, the so-called 'Transylvania hypothesis', has fascinated the public and occupied the mind of researchers for centuries.

Objective: The aim of the present study was to determine whether or not there was any change in general practice consultation patterns around the time of the full moon.

Method: We analysed data from the fourth national morbidity study of general practice.

UK measles outbreak in non-immune anthroposophic communities: the implications for the elimination of measles from Europe.

We describe the epidemiology of the first nationwide outbreak of measles infection in the UK since the implementation of a mass vaccination campaign. Notifications of infectious diseases, interview and postal questionnaire identified 293 clinical cases, 138 of which were confirmed by salivary IgM, measles virus isolation and PCR. Twelve were epidemiologically linked to confirmed cases.

Promoting effective practice in secondary care.

Background: This qualitative study aimed to explore the views of key stakeholders regarding the role that public health professionals have or should have in the provision of effective health care within the National Health Service.

Methods: A national (England) questionnaire survey generated a sample for qualitative telephone interviews and two site case studies. The interviews were conducted in three stages: first, 27 interviews were based on assessed reported levels of organizational activity, including non-respondents; next, views in six areas were consolidated by extra interviews; finally, two extra areas were visited for individual and group interviews.

Tuberculosis in Swaziland: a health needs assessment in preparation for a community-based programme.

This study was undertaken to assess the healthcare needs of people with tuberculosis (TB) in the rural district of Lubombo in Swaziland, with a view to improving the delivery of healthcare services. Qualitative and quantitative methodologies were used to describe the knowledge, attitudes and behaviour of TB patients, the epidemiology of TB, and the strengths and weaknesses of the current TB control programme. The incidence of TB is rising rapidly in this rural region of Swaziland.

'I always seem to be there'--a qualitative study of frequent attenders.

Background: Much is still unknown about the consultation behaviour of frequent attenders, including why they consult as often as they do and why they consult in the patterns that they do.

Aim: To determine why frequent attenders to general practice consult in the patterns that they do.

Method: A qualitative study based on semi-structured interviews.

Palliative care provided by GPs: the carer's viewpoint.

As most terminal and palliative care is in the community, general practitioners (GPs) have an important role to play. This study presents bereaved carers' views of the palliative care provided by GPs. It suggests that symptom control may not be optimal.

Resource allocation and budgetary mechanisms for decentralized health systems: experiences from Balochistan, Pakistan.

This paper identifies key political and technical issues involved in the development of an appropriate resource allocation and budgetary system for the public health sector, using experience gained in the Province of Balochistan, Pakistan. The resource allocation and budgetary system is a critical, yet often neglected, component of any decentralization policy. Current systems are often based on historical incrementalism that is neither efficient nor equitable.

Hypoglycaemia induced by exogenous insulin--'human' and animal insulin compared.

Aims: A systematic review of the literature was carried out to examine whether published evidence suggests a difference in the frequency and awareness of hypoglycaemia induced by 'human' and animal insulin.

Methods: The review identified randomized controlled trials and studies of other designs including observational comparisons, case series and case reports in which the use of 'human' insulin was compared to animal insulin in people with diabetes. These were identified from bibliographic databases and hand-searches of key journals.

Adjusting stroke patients' poor position: an observational study.

Although nurses' role in rehabilitation has been generally ill-defined and consistently undervalued, of all professional groups, nurses working with stroke patients have potentially the greatest contribution to make. Stroke patients are believed to benefit from good posture yet they can spend long periods in inappropriate positions. This study examined the positioning, handling and mobilizing of stroke patients in hospital.

Can general practitioners influence the nation's health through a population approach to provision of lifestyle advice?

Background: Lifestyle advice from general practitioners (GPs) has been shown to have a positive effect on population health. In practice, GPs provide lifestyle advice to a minority of their patients only, those who are high risk or already have symptoms.

Aim: To look in depth at GPs' attitudes towards adopting a population approach to lifestyle advice and to use these results to identify ways of maximising the potential of GPs to affect population health.

Reforming the health sector in Thailand: the role of policy actors on the policy stage.

This paper reports on exploratory research carried out into the processes of policy-making, and in particular health sector reform, in the health sector of Thailand. It is one of a set of studies examining health sector reform processes in a number of countries. Though in the period under study (1970-1996) there had been no single health sector reform package in Thailand, there was interest in a number of quarters in the development of such an initiative.

Socio-economic characteristics of adult frequent attenders in general practice: secondary analysis of data.

Objective: This study was carried out to determine the effect of a range of socio-economic features on frequent attendance in general practice from a large database of general practice consultations using two definitions of frequent attendance.

Methods: Secondary analyses were carried out of data from the Fourth National Survey of Morbidity in General Practice covering 60 general practices in England and Wales. A total of 283 842 adult patients and their consultations between September 1991 and August 1992 were examined.

Investigation of the association between excess winter mortality and socio-economic deprivation.

Background: Excess winter mortality is higher in England and Wales than in other European countries with similar or lower average winter temperatures. It might be expected that excess winter mortality would be higher in areas with greater socio-economic deprivation, and if this were so preventive interventions could be directed at populations in these areas. The association between deprivation and excess winter mortality has not been adequately investigated in the past.

Implementing the integration of component services for reproductive health.

In the wake of the 1994 International Conference on Population and Development in Cairo, considerable activity has occurred both in national policymaking for reproductive health and in research on the implementation of the Cairo Program of Action. This report considers how effectively a key component of the Cairo agenda--integration of the management of sexually transmitted infections, including human immunodeficiency virus, with maternal and child health-family planning services--has been implemented. Quantitative and qualitative data are used to illuminate the difficulties faced by implementers of reproductive health programs in Ghana, Kenya, South Africa, and Zambia.

The development of a collaborative stroke training programme for nurses.

The effectiveness of multidisciplinary stroke rehabilitation may be enhanced by nurses and therapists adopting a single consistent approach to the positioning and mobilizing of patients. As patients can spend as little as 4% of the waking day receiving 'therapy' there is considerable potential for a more dynamic nursing intervention, which may contribute to improving patient care. We aimed to investigate whether physiotherapists could step back from direct patient treatment in order to participate in a structured training programme for nurses involved with patients recovering from stroke on an established elderly care rehabilitation ward in a district general hospital.

Aldose reductase inhibitors for the prevention and treatment of diabetic peripheral neuropathy.

Objectives: To assess the efficacy of aldose reductase inhibitors in the prevention, reversal or delay in the progression of diabetic peripheral neuropathy.

Search Strategy: The Cochrane Diabetes Group's database was searched and the citation lists of identified trials and previous reviews checked. Investigators identified as active in the field were approached for overlooked studies.

Decentralising the health sector: issues in Brazil.

The health sector in Brazil has undergone important changes, particularly with the development of the Unified Health System (SUS). Decentralisation is an important principle of SUS and advances have been made in transferring responsibilities and resources to the local government units, known as municipios. This article describes the changes introduced, focusing on the system of municipio classification and the funding mechanisms introduced through the basic operating rule (BOR) of 1996.