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Uncontrolled access to information on the Internet has many advantages, but it also leads to the phenomenon of fake news. Fake news is dangerous in many spheres, including that of health. For example, we are facing an increase in the amount of vaccine hesitancy. This has been w considered by the World Health Organization in 2019 as one of the greatest threats to public health. This specific phenomenon is linked with the spread of information on the Internet around that issue. In this paper, I discuss a proposition of new crime, which has the aim of fighting medical fake news by stopping its spread. This proposition should be considered only if other non-criminal measures are inefficient. The proposal is "Whoever publicly disseminates information evidently discrepant with medical knowledge is subject to a penalty." [ABSTRACT FROM AUTHOR]

Background: Translation science entails application of information gained through scientific research to practices intended to improve prevention and public health. The outreach arm of Land-Grant Universities—the Cooperative Extension System—is uniquely poised to facilitate this translation process and contribute to resolution of current substance misuse and other behavioral health issues. Objective: This paper summarizes selected literatures that guided the conceptualization of a framework for building Extension's capacity to enhance the translation process, in order to better address substance misuse and other behavioral health issues. Method: Peer-reviewed literature was obtained from journals representing varied disciplines including medicine, public health, education, and psychology. Journals for Extension professionals were a prominent source of relevant literature. The literature review informed the identification of relevant practice gaps, barriers in addressing those gaps, and the development of a capacity-building framework. Results: The framework described highlights opportunities for building Cooperative Extension's capacity to address goals in four key domains. These goals include (1) catalyzing Extension's organizational development to support science-driven practices, (2) bolstering prevention and behavioral health-oriented professional development for Extension faculty and staff, (3) creating a stronger culture of behavioral health in Extension, and (4) strengthening Extension's financing of prevention-oriented behavioral health efforts. Conclusion: Addressing the capacity-related goals identified in this paper could be a major catalyst for enhancing the power of proven, prevention-oriented behavioral health and, thereby, the well-being of our families, communities and nation. [ABSTRACT FROM AUTHOR]

In this paper, we describe the planning, development, and overall impact of Electronic Medical Records (EMRs) on Dryden Family Medicine (DFM), a rural family practice in Dryden, New York. The EMR system was installed in July, 2003, and the full conversion to the new system was accomplished in three phases. Significant efficiency gains were achieved in billing, prescription ordering, and other routine processes. Protocols were developed to enhance quality management, preventive medicine, and disease management. Job responsibilities changed and expanded for all members of the practice and coding issues became paramount. Practice revenue increased by about 20 percent and average “case-mix” increased by 10 percent in the second year following the implementation of EMRs due to improved billing documentation. We focus on the implementation process, the lessons learned, the obstacles encountered, and the successes achieved by one rural family practice. [ABSTRACT FROM AUTHOR]

Twenty years ago, the "Panel on Cost-effectiveness in Health and Medicine" published a landmark text setting out appropriate methods for conducting cost-effectiveness analyses of health technologies. In the two decades since, the methods used for economic evaluations have advanced substantially. Recently, a "second panel" (hereafter "the panel") was convened to update the text and its recommendations were published in November 2016. The purpose of this paper is to critique the panel's updated guidance regarding the discounting of costs and health effects. The advances in discounting methodology since the first panel include greater theoretical clarity regarding the specification of discount rates, how these rates vary with the analytical perspective chosen, and whether the healthcare budget is constrained. More specifically, there has been an important resolution of the debate regarding the conditions under which differential discounting of costs and health effects is appropriate. We show that the panel's recommendations are inconsistent with this recent literature. Importantly, the panel's departures from previously published findings do not arise from an alternative interpretation of theory; rather, we demonstrate that this is due to fundamental errors in methodology and logic. The panel also failed to conduct a formal review of relevant empirical evidence. We provide a number of suggestions for how the panel's recommendations could be improved in future. [ABSTRACT FROM AUTHOR]

It has been proposed that equity may be included in the economic evaluation of health services using the 'proportional shortfall' (PS)-the proportion of a person's QALY expectation that they would lose because of an illness. The present paper reports the results of a population survey designed to test whether PS helped to explain people's preferences for health services and whether it did this better than the absolute shortfall or the equity related variables that PS seeks to replace. Survey respondents were asked to allocate 100 votes between 13 scenarios and a standard scenario. Variation in the allocation of votes was explained by health gain and different combinations of the equity variables. Differences in votes for the comparisons were significantly related to differences in PS but the relationship was weaker than between votes and the age related variables. Cases were identified where PS suggested a priority ordering of services which was strongly rejected by respondents. It is concluded that the use of PS is unlikely to improve the alignment of priorities with public preferences. [ABSTRACT FROM AUTHOR]

OASIS is a non-for-profit consortium that drives the development convergence and adoption of open standards for the global information society. It involves more than 600 organizations and individuals as well as IT leaders Sun, Microsoft, IBM and Oracle. One of its standards is XACML which appeared a few years ago and now there are about 150,000 hits on Google. XACML (eXtensible Access Control Markup Language) is not technology related. Sun published in 2004 open source Sun XACML which is in compliance with XACML 1.0. specification and now works to make it comply with XACML 2.0. The heart of XACML are attributes values of defined type and name that is to be attached to a subject, a resource, an action and an environment in which a subject request action on resource. In that way XACML is to replace Role Based Access Control which dominated for years. The paper examines performances in CEN 13 606 and ISO 22 600 based healthcare system which uses XACML for access control. [ABSTRACT FROM AUTHOR]

This paper addresses a pharmacy delivery design problem with two types of human resources: pharmacy assistants and transporters within a hospital. Each medical unit of the hospital has a mobile medicine closet which is conveyed each week by transporters to the central pharmacy for inventory assessment and refill by assistants. Transportation is carried out by foot, by tractor or by truck depending on the location. The problem consists in creating a transportation and supply planning for each day of the week in order to balance workloads for both transporters and assistants while ensuring the availability of medicine to each medical service. A two-step approach using mixed-integer linear programming formulation is proposed to determine a near optimal schedule. Numerical results are given to assess its efficiency. The proposed approach is then combined with a simulation model to redesign the delivery process of the pharmacy department of a French university teaching hospital. Methodology of this real-life reengineering study is presented and discussed. [ABSTRACT FROM AUTHOR]

This purpose of this paper is to review the literature on racial/ethnic disparities in the utilization and quality of care and the proposed explanations for these differences. First, the literature on racial/ethnic disparities in medical treatment is reviewed briefly with the goal of providing a sense of the range of procedures and conditions on which these disparities occur. Then, the possible role of physician/provider, patient, and health care system factors in contributing to these disparities is reviewed. Finally, suggestions for new or expanded directions for research in each of these three areas are given. The goal of the paper is to identify factors that might be particularly amenable to the type of research done by health psychologists. [ABSTRACT FROM AUTHOR]

An increasing variety of professional educational and training disciplines are now problem based (eg, medicine, nursing, engineering, community health), and they may have a corresponding variety of educational objectives. However, they all have in common the use of problems in the instructional sequence. The problems may be as diverse as a mechanical predicament, an unexplained phenomena, or patient symptoms. Technology education in secondary schools is undergoing a period of significant change in many countries. It is therefore imperative that technology teacher education adopt not only the technologies that have been identified as being important, but also incorporate appropriate methodologies for the instruction of these technologies. PBL offers a number of relevant features to technology education and it is because of these that the project outlined in this paper has been developed. [ABSTRACT FROM AUTHOR]

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The objective of this paper was to determine predictors of complementary and alternative medicine (CAM) use among individuals with specific health problems. Data were derived from the 1998 Medical Expenditure Panel Survey (MEPS). After adjustment for potential confounders, individuals with perceived barriers to obatining care were more likely to useanyCAM treatment (OR 2.16), herbal therapy (OR 2.70) and spiritual care (OR 3.99) for a specific health problem. Individuals dissatisfied with their family’s access to care were more likely to use acupuncture (OR 3.43). Dissatisfaction with quality of care was associated with increased use of spiritual therapy (OR 4.74). Perceptions of inadequate access to health care may contribute to utilization of CAM therapies; such therapies in this instance appear to be used as analternativeto mainstream medicine. [ABSTRACT FROM AUTHOR]

The 20th century produced overwhelming advances in biomedicine with the 1990s introducing 148,000 patents as part of the mapping and sequencing of the human genome. Bioethical realities and debates of prenatal genetic testing, new reproductive technologies, stem cell research, human cloning and DNA data banks have obscured the less provocative public and social issues of gun control, immunization, employee leave programs to assist care for dying relatives, emergency room use as primary care sites by the uninsured, and medical care provision to the homeless. With the events of September 11, the focus has shifted to bioterrorism: an international and global concern that portends broad environmental consequences while requiring a local, community response of which the business enterprise is a part. The tension that results from a required local and global response to bioterrorism and biotechnology by the business community forms a dialectic and provides a venue for addressing business ethics in an international forum. This paper explores the relationship of events and its meaning for business. Part I provides the background of biotechnology and bioterrorism and how the two form a dialectic reality that shapes ethical debate. Part II presents provocations and questions for an emerging ethic based on the integrative response from the public health, medical, business and religious communities. Four areas for business contribution in shaping emerging ethics in the age of biotechnology-bioterrorism are suggested. [ABSTRACT FROM AUTHOR]

There is ample evidence regarding medical-psychological comorbidity to consider clinical psychology as a viable component of health care services in medical settings. Psychologists can become valuable assets to primary care physicians who treat a high number of primary psychiatric cases as well as medical cases with secondary psychological symptoms. Psychologists who function in hospital-based clinics as well as affiliates with primary care (PC) offices can provide empirically supported assessment services that can make treatment more effective and efficient. Multiple studies indicate high prevalence rates of psychiatric patients in PC settings using various instruments. This paper reviews selected assessment tools that have established diagnostic validity and reliability that can be both strategic for patient care and useful to reinforce psychologist collaboration with primary care physicians (PCP). [ABSTRACT FROM AUTHOR]

The paper looks at potential uses of health care modelling techniques in day-to-day clinical practice, adopting the viewpoint of a specialist in geriatric medicine. After a brief review of the recent literature on the practical applications of bed modelling techniques, the potential of such techniques in the future is discussed. Possible barriers to the adoption of these techniques by clinicians are presented together with suggestions about ways of overcoming these barriers. [ABSTRACT FROM AUTHOR]

Should medicine be defined as the enterprise in charge of the health problems of society? If so, then any problem (individual, public, social or political) that can be reformulated as a "health problem" could serve as a goal of medicine. If, on the other hand, medicine--or medicine proper--is defined in terms of some limited goal and limited means, then some medical professionals would find themselves working in other fields than medicine. It could be of some importance to the patient to know whether the medical professional he meets is engaged in medical practice (aiming at the patient's health), research, public health or some other project which involves medical competence. Obviously, some of these enterprises may have conflicting goals. This paper will analyse various candidates for being a model of medicine, discuss some of the consequences, and argue for a limited view of medical practice. [ABSTRACT FROM AUTHOR]

The article discusses the role of the Society of Environmental Toxicology and Chemistry (SETAC) in the initial stages of development of the Life Cycle Assessment (LCA). The role of SETAC in the development and establishment of LCA is a valuable technique that was vital and formative for without this role, chances are the progress would have been slower and difficult. Information about the meetings and workshops held from 1991 up to 1997 and important activities that happened in the said events is also presented.

Promoting translational research as a means to overcoming chasms in the translation of knowledge through successive fields of research from basic science to public health impacts and back is a central challenge for research managers and policymakers. Organizational leaders need to assess baseline conditions, identify areas needing improvement, and to judge the impact of specific initiatives to sustain or improve translational research practices at their institutions. Currently, there is a lack of such an assessment tool addressing the specific context of translational biomedical research. To close this gap, we have developed a new survey for assessing the organizational climate for translational research. This self-assessment tool measures employees' perceptions of translational research climate and underlying research practices in organizational environments and builds on the established Survey of Organizational Research Climate, assessing research integrity. Using this tool, we show that scientists at a large university hospital (Charité Berlin) perceive translation as a central and important component of their work. Importantly, local resources and direct support are main contributing factors for the practical implementation of translation into their own research practice. We identify and discuss potential leverage points for an improvement of research climate to foster successful translational research. [ABSTRACT FROM AUTHOR]

Five teams of FACTS researchers conducted a series of rigorous scoping reviews of the existing published scientific literature from the fields of medicine, public health, psychology, behavioral health, and criminology from January of 1985 through April of 2018 utilizing the Preferred Reporting Items for Scoping Reviews (Tricco et al., Ann Intern Med 169:467–473, 2018) framework to guide the search strategy, study selection, data abstraction, and analysis process. These scoping reviews characterize the existing scientific literature in five key areas related to Firearm Injury Prevention among children and adolescents (age 0–17): (1) Adolescent Firearm Carriage; (2) Risk and Protective Factors for Firearm Injury; (3) Primary Prevention Initiatives; (4) Long-term consequences and secondary prevention of negative outcomes after a firearm injury; and, (5) Effects of existing law and policy interventions on pediatric firearm outcomes. In this special issue of the Journal of Behavioral Medicine, we present these five scoping review articles. [ABSTRACT FROM AUTHOR]

This research aims to present a bibliometric analysis of the published documents on spirituality, religion and health. Despite the increasing number of publications spirituality, religion and health research in recent years, there is still little information about the effects of these publications in the literature. "Religion," "spirituality," "spiritual," "health" and "medicine" keywords were used to search the Web of Science (WoS) database. Bibliometric analysis was conducted on the articles published between 1975 and 2017. The analysis was presented with network and density maps. The analysis also included the regression analysis to predict a number of publications in 2018. A total number of 1674 publications were found: 818 of these publications were articles. Of the 818 articles, 210 were religion, 198 were Public Environmental Occupational Health, 139 were Psychology, and 77 were performed in the field of Psychiatry. The most productive journal with 107 articles and 1129 citations was the Journal of Religion and Health. The USA (495; 60.5%) was the most productive country on spirituality, religion and health publications. The author who had the highest number of publications and citations was Koenig HG (33 publications; 4.03% and 1617 citations), the document who had the highest number of citations was Ellison CG and Levin JS (633 citations), and the author who had the highest number of citations in the references was Koenig HG, 2001, (126 citations). Duke Univ was the top institution in the number of publication (50 Article). This study will lead the researchers especially in terms of the important journals, active countries, authors, top-cited articles and current topics in spirituality, religion and health research. [ABSTRACT FROM AUTHOR]

Thromboangiitis obliterans (TAO) or Buerger's disease is a rare form of vasculitis with distinctive clinical and pathological features that carries significant morbidity, often leading to amputation, and is strongly associated with tobacco smoking. Despite its distinctive clinicopathological characteristics, the existence of TAO as an entity sui generis was challenged for many years as it languished in relative obscurity. Then, as societal attitudes towards smoking changed, TAO not only became accepted as a disease entity, it quite literally became a poster child to illustrate the ills of smoking. Herein, we examine the history of TAO to illustrate the power of societal attitudes and politics in shaping medicine. [ABSTRACT FROM AUTHOR]

The KNOWLEDGE-CARE vision is to enable new e-health services that are personalized, preventive, predictive, pre-emptive, participatory, pervasive and precise. This vision aims to make a move from reactive medicine to predictive medicine, developing dynamic and responsive models through knowledge extraction and using such models for personalized clinical healthcare. The proposed healthcare ecosystem can learn over time and can adapt to the variation seen in the actual real-world population. [ABSTRACT FROM AUTHOR]

Presents an opinion on how the editorial process can safeguard the reading public against hasty and inappropriate publication. Problems in reporting science to the public; Criteria for publication of scientific papers; Importance of striking a balance between encouraging new ideas and theories and avoiding confusion and potential harm.

In recent years, in the UK and elsewhere, scientists and science policymakers have grappled with the question of how to reap the benefits of nanotechnologies while minimising the risks. Having recognised the importance of public support for future innovations, they have placed increasing emphasis on 'engaging' 'the public' during the early phase of technology development. Meaningful engagement suggests some common ground between experts and lay publics in relation to the definition of nanotechnologies and of their benefits and risks. However, views on nanotechnologies are likely to vary according to where actors stand in the technology production/consumption/assessment cycle. Drawing on data from a recent UK-based study, this article examines how scientists ('upstream' and 'downstream') and policymakers portray the benefits and risks of nanotechnologies, particularly as they relate to two major areas of predicted application, namely medicine/public health and environmental sustainability. The findings reveal that, in the main, scientists and science policymakers held a positive conception of nanotechnologies and see imminent applications, although they acknowledged particular risks, including adverse public reaction. While definitions of 'benefit' and 'risk' varied, most saw the benefits as outweighing the risks and believed that the risks could be adequately regulated once they were assessed. The difficulties of assessing risk, however, were acknowledged. The study raises a number of questions that will need to be addressed if regulations are to be developed that not only protect people's heath and wellbeing and the environment but also engender public trust in nanotechnologies. [ABSTRACT FROM AUTHOR]

The objective of study is to examine factors affecting the variation in technical and cost efficiency of community health centers (CHCs). A panel study design was formulated to examine the relationships among the contextual, organizational structural, and performance variables. Data Envelopment Analysis (DEA) of technical efficiency and latent growth curve modeling of multi-wave technical and cost efficiency were performed. Regardless of the efficiency measures, CHC efficiency was influenced more by contextual factors than organizational structural factors. The study confirms the independent and additive influences of contextual and organizational predictors on efficiency. The change in CHC technical efficiency positively affects the change in CHC cost efficiency. The practical implication of this finding is that healthcare managers can simultaneously optimize both technical and cost efficiency through appropriate use of inputs to generate optimal outputs. An innovative solution is to employ decision support software to prepare an expert system to assist poorly performing CHCs to achieve better cost efficiency through optimizing technical efficiency. [ABSTRACT FROM AUTHOR]

This article highlights and summarizes efforts that have been made primarily during the past 20 years to bring the significance of relational diagnosis to the attention of the entire mental health community, and either (1) to have dysfunctional relational interactive patterns classified and codified and accepted for inclusion in the Diagnostic and Statistical Manual of Mental Disorders, or (2) if this is not feasible, to have a nosology of relational diagnoses, which have been clearly defined with accompanying risks specified for mental illnesses that might develop, and criteria sets delineated and adequately field tested to warrant and lead to publication of a separate but equal Diagnostic Manual of Relational Disorders and Dysfunctional Interactional Patterns. [ABSTRACT FROM AUTHOR]

The article focuses on the changing concept of medicalization and its effect on medicine. Medicalization was once referred to the social process of expanding the medical profession which followed from the reformation of life processes and problems such as health. The current definition is much broader for it include a broad medical phenomena. Sociologists Eliot Freidson and Irving Zola commented that one of the problems of medicalization was the extended jurisdiction of medicine beyond its scope.

The article discusses various problems encountered by medical sociologists in dealing with medical sociology. The sociology practitioners were having difficulty on its branch of discipline and the confusing use of terms like medicalization and professional dominance. It also commented on the conflicting views of sociologists regarding medicine which include the belief that medicine is about social control, health and resources management by Talcott Parsons. It suggested that the new form of medicalization is a response to the shifts in the nature of social order.

In this article, we examine a set of 26 children’s books on HIV/AIDS published between 1989–1999 to identify the ways in which these texts construct HIV/AIDS and people living with HIV/AIDS. We explore how this marginalized group is depicted in these books, and how well-meaning teachers may in fact be reproducing dominant discourses about HIV/AIDS in their curricula. In this article we focus, in particular, on how the discourses connected to public health, medicine, and secrecy (as a discourse across many institutions) are filtered to children and take part in constructing their beliefs and assumptions about HIV/AIDS. We illustrate our argument with examples from the books and show why teachers need to know how to analyze texts they select for their curricula so as to read books about HIV/AIDS critically in the classroom. [ABSTRACT FROM AUTHOR]

Background: The persistence of a large quality gap between what we know about how to produce high quality clinical care and what the public receives has prompted interest in developing more effective methods to get evidence into practice. Implementation research aims to supply such methods.Purpose: This article proposes a set of recommendations aimed at establishing a common understanding of what implementation research is, and how to foster its development.Methods: We developed the recommendations in the context of a translation research conference hosted by the VA for VA and non-VA health services researchers.Impacts: Health care organizations, journals, researchers and academic institutions can use these recommendations to advance the field of implementation science and thus increase the impact of clinical and health services research on the health and health care of the public. [ABSTRACT FROM AUTHOR]

PurposeThe aims of ideal preoperative informed consent include educating the patient adequately to enable an autonomous decision to be made without causing undue anxiety. We study how the paternalistic and nonpaternalistic approaches meet this ideal. The influence of the new patient consent forms is also assessed.MethodsTwo cycles of a prospective clinical audit are presented. An assessment of relevant patient knowledge was performed by patient interview. Visual analogue scales were used to quantify patient anxiety.ResultsThe first cycle, examining a paternalistic approach, demonstrated: 37% of patients understood what a cataract was and 48% understood what surgery involved. 48% misunderstood that cataract surgery was completely risk free. In total, 80% of patients undergoing second eye surgery believed that it was completely risk-free. Average anxiety visual analogue scores (VAS) for cataract surgery were low (2.89). The second cycle, examining the nonpaternalistic approach combined with the implementation of new consent forms showed that, despite more explicit repeated preoperative consent: 39% of patients understood correctly what a cataract was, 28% understood what surgery involved and 43% misunderstood that surgery was completely risk-free. All patients undergoing second eye surgery thought that it was risk-free. The average anxiety VAS for cataract surgery were moderate (5.00).ConclusionsBoth paternalistic and non-paternalistic approaches to informed consent are inadequate in meeting the demands of the ideal informed consent. The new patient consent forms appear to have little effect in influencing patient knowledge about their surgery. Patients undergoing second eye surgery often have an overoptimistic view of cataract surgery.Eye (2005) 19, 963–971. doi:10.1038/sj.eye.6701694; published online 15 April 2005 [ABSTRACT FROM AUTHOR]

Background. Training in the communication components of cancer care is necessary for the practice of oncology. We conducted a communication course for oncology fellows. Methods. Teaching methods included lectures, role playing and simulated patient interviews. We used self-reports, knowledge questionnaires and course/faculty evaluations. Results. A total of 17 fellows participated. Skills in dealing with bad news, denial and end-of-life issues improved. We obtained information on communication tasks commonly performed during patient interactions, various aspects of the course and faculty performance. Conclusions. Fellows' knowledge and self-efficacy improved postcourse. Information on challenges faced by trainees and their feedback may help focus the design of future courses. [ABSTRACT FROM AUTHOR]

This article examines socialized medicine in Great Britain. Doctors and nurses are, quite properly, highly regarded. Their work in healthcare is widely seen as immeasurably valuable. The hospitals and clinics in which they work are viewed by almost everyone as crucially important local and national institutions. The mission of healthcare--curing illness, relieving pain, repairing injury, preventing disease, and saving lives--justifiably ranks close to the top of national priorities. These positive popular sentiments have been unthinkingly and uncritically invested since 1948 in the British National Health Service (NHS). A particular, concrete social organization has thus been illegitimately endowed with high public reputation. This reputation properly belongs to the healthcare professions, to great hospitals and successful clinics, and to the medical scientists who advance the knowledge on which effective healthcare relies. This displacement of positive affect from healthcare institutions, and the long-established values and skills of medicine onto the recent, historically accidental and politically contingent organizational format of the NHS, is at once confusing and damaging. It inhibits radical criticism of the NHS. It provides a cloak of ideological defense for the most reactionary elements in the NHS workforce. It inoculates the popular mind against awareness of the grave and growing deficiencies of the NHS. It blinds political leaders to the fact that healthcare in Great Britain is as effective as it is, not because of the NHS, but despite it.

Objective: To estimate the relationship between size of intensive care unit and combined intensive care/high dependency units and average costs per patient day.Design: Retrospective data analysis. Multiple regression of average costs on critical care unit size, controlling for teaching status, type of unit, occupancy rate and average length of stay.Setting: Seventy-two United Kingdom adult intensive care and combined intensive care/high dependency units submitting expenditure data for the financial year 2000-2001 as part of the Critical Care National Cost Block Programme.Interventions: None.Measurements and Results: The main outcome measures were total cost per patient day and the following components: staffing cost, consumables cost and clinical support services costs. Nursing Whole Time Equivalents per patient day were recorded. The unit size variable has a negative and statistically significant ( p<0.05) coefficient in regressions for total, staffing and consumables cost. The predicted average cost for a seven-bed unit is about 96% of that predicted for a six-bed critical care unit.Conclusion: Policy makers should consider the possibility of economies of scale in planning intensive care and combined intensive care/high dependency units. [ABSTRACT FROM AUTHOR]

Comments on the role of clinical neuropsychology as one of the most robust and significant components of psychology’s presence within the health care arena. Growth shown in scientific, clinical, and personnel of this psychological specialty; Analysis of pertinent topics and relevant issues; Implications on studies of neuropsychology.

The aim of this article is to identify those factors which produce differences in the use of public health care services among individuals whose medical needs are similar. The empirical analysis employs Spanish data for three separate years and obtains results for four types of medical attention: visits to a GP, visits to a specialist, visits to the emergency services and hospital inpatient days. The results show that the influence of demand factors upon the probability of consuming more medical attention than expected depends on the type of health care considered.In addition, the minimal impact of supply factors is demonstrated. [ABSTRACT FROM AUTHOR]

Objectives: (a) to describe current practice in the monitoring and treatment of moderate and severe head injuries in Europe; (b) to report on intracranial pressure and cerebral perfusion pressure monitoring, occurrence of measured and reported intracranial hypertension, and complications related to this monitoring; (c) to investigate the relationship between the severity of injury, the frequency of monitoring and management, and outcome.Methods: A three-page questionnaire comprising 60 items of information has been compiled by 67 centres in 12 European countries. Information was collected prospectively regarding all severe and moderate head injuries in adults (> 16 years) admitted to neurosurgery within 24 h of injury. A total of 1005 adult head injury cases were enrolled in the study from 1 February 1995 to 30 April 1995. The Glasgow Outcome Scale was administered at 6 months.Results: Early surgery was performed in 346 cases (35%); arterial pressure was monitored invasively in 631 (68%), ICP in 346 (37%), and jugular bulb saturation in 173 (18%). Artificial ventilation was provided to 736 patients (78%). Intracranial hypertension was noted in 55% of patients in whom ICP was recorded, while it was suspected in only 12% of cases without ICP measurement. There were great differences in the use of ventilation and CPP monitoring among the centres. Mortality at 6 months was 31%. There was an association between an increased frequency of monitoring and intervention and an increased severity of injury; correspondingly, patients who more frequently underwent monitoring and ventilation had a less favourable outcome.Conclusions: In Europe there are great differences between centres in the frequency of CPP monitoring and ventilatory support applied to head-injured patients. ICP measurement disclosed a high rate of intracranial hypertension, which was not suspected in patients evaluated on a clinical basis alone. ICP monitoring was associated with a low rate of complications. Cases with severe neurological impairment, and with the worse outcome, were treated and monitored more intensively. [ABSTRACT FROM AUTHOR]

Since the terms of the health policy debate in the United States and Canada are largely supplied by biomedicine, the current “crisis” in health care is, in part, a product of biomedical rhetoric. In this essay, three metaphors widely identified as being associated with biomedicine— the body is a machine, medicine is war, and medicine is a business—are examined with a view to the ways in which they influence the health policy debate, not only with respect to outcomes, but also with respect to what can be argued at all. The essay proposes that biomedical language itself be foregrounded as the constitutive material of public discourse on health policy. [ABSTRACT FROM AUTHOR]

These pages offer you the chance to open topics for debate, discuss the latest issues, or even offer advice to fellow readers. One letter in this issue offers PCDs a way into a full dental degree programme. Send us your views on this or anything to do with working in the dental profession. We look forward to hearing from you. [ABSTRACT FROM AUTHOR]