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The article examines abstracts of papers submitted but not included in the program of the annual meeting of the American Public Health Association, Medical Care Section, 1962. Some of these are "Experiences and Activities at a Medical Computing Center," by L.D. Cady, M.A. Woodbury, and L.J. Tich and "An Internist's Experiences With Medical Care of Welfare Patients in Proprietary Nursing Homes," by Sidney M. Greenberg. The first abstract focuses on the center that is cooperating with investigators in the area of mathematical and theoretical analysis and statistical data handling and analysis, information coding, keypunching and storage of medical data for further study and retrieval. The second abstract contains observations of the medical, nursing, and administrative practices in four nursing homes as made by an internist responsible for the medical Scare of welfare patients in these homes. In evaluating these activities the recognition and meeting of the patient's total needs was utilized as the criterion of quality of performance.

The article focuses on the relation between epidemiology and experimental toxicology. The two disciplines look interlinked but they are different. In epidemiology, species investigated is the definitive species and the conditions of exposure to the chemicals are real. In experimental toxicology, test and control groups are defined and routes of treatment and doses are well established. Yet there are situations where both disciplines complement each other to help mankind.

The article discusses the cost and effectiveness of in vitro fertilization (IVF) technique in Great Britain. The development of IVF presents the providers of health care with several problems. Inequality of distribution will become a problem if the new technique would be taken up by the private sector. In the present financial climate of the country it appears that National Health Service funding will be available to meet the demand for IVF.

In today's online data-driven world, people constantly shed data and deposit digital footprints. When individuals access health services, governments and health providers collect and store large volumes of health information about people that can later be retrieved, linked and analysed for research purposes. This can lead to new discoveries in medicine and healthcare. In addition, when securely stored and de-identified, the privacy risks are minimal and manageable. In many jurisdictions, ethics committees routinely waive the requirement for researchers to obtain consent from data subjects before using and linking these datasets in an effort to balance respect for individuals with research efficiency. In this paper, I explore the ethical justification for using routinely collected health data for research without consent. I conclude that, not only is this morally justified but also that data subjects have a moral obligation to contribute their data to such research, which would obviate the need for ethics committees to consider consent waivers. In justifying this argument, I look to the duty of easy rescue, distributive justice and draw analogies with vaccination ethics. [ABSTRACT FROM AUTHOR]

This brief paper contextualises the reform of health care in the UK National Health Service, before introducing the papers in this special edition. [ABSTRACT FROM AUTHOR]

This paper reviews the author's experience in becoming a medical sociologist before the field had become formalized. The contributions to medical sociology of sociologist Selden D. Bacon and physician and medical educator William R. Willard are described. The relationship of medical sociology to medical behavioral science, as experienced at the University of Kentucky, is discussed. Finally, the thesis of the author's 1957 paper on the nature and status of medical sociology is re-examined. [ABSTRACT FROM AUTHOR]

The ideal future state of health for the world's populations requires a cohesive model that considers the synergistic roles of communities, public health and healthcare. This future state reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing. This is the definition of Integrative Medicine. We are far from this idealistic future. Healthcare costs continue to escalate while life expectancy declines. We train our future healthcare professionals in our current disease-based model that prioritizes siloed pharmaceutical and interventional approaches over whole person prevention focused care. As healthcare professionals, we disregard our capacity to influence the leading risk factors for disease-related death and disability which include health behaviors, social, economic and environmental drivers. Burnout is high and rising. Rapid shifts are expected in the coming years as the current system's cost becomes untenable. We need a sustainable future for healthcare. That means we must figure out how to re-center on the patient, on a full spectrum of prevention and treatment, and how to influence public and community health. The future model must focus on health behaviors at its foundation, use systems thinking, be environmentally sustainable, and approach health from a population lens. The future will require an ability to consider complex systems approaches to health and wellbeing that include a focus on both the patient and the healthcare team. Research strategies must not only consider effectiveness but also reach, implementation and institutionalization in a multi-dimensional capacity that looks at whole person health as an outcome while looking at individuals in the context of where they live and work. The Integrative Medicine community has an opportunity to help lead the way to a sustainable and health focused future. [ABSTRACT FROM AUTHOR]

There is consensus that physicians, health professionals and health care organizations should discuss harm that results from health care delivery (adverse events), including the reasons for harm, with patients and their families. Thought leaders and policy makers in the USA and Canada support this goal. However, there are gaps in both countries between patients and physicians in their attitudes about how errors should be handled, and between disclosure policies and their implementation in practice. This paper reviews the state of disclosure policy and practice in the two countries, and the barriers to full disclosure. Important barriers include fear of consequences, attitudes about disclosure, lack of skill and role models, and lack of peer and institutional support. The paper also describes the problem of the second victim, a corollary of disclosure whereby health care workers are also traumatized by the same events that harm patients. The presence of multiple practical and personal barriers to disclosure suggests the need for a comprehensive solution directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support. At the local level, implementation could be based on a translating-evidence-into-practice framework. Applying this framework would involve the formation of teams, training, measurement and identification of local barriers to achieving universal disclosure of adverse events. [ABSTRACT FROM AUTHOR]

This paper considers how changes in urban governance in Delhi over the last two decades have influenced the provision of health care services. It begins by describing the introduction of, or return to, elected governments for the National Capital Territory of Delhi and for the Municipal Corporation of Delhi. It then discusses public health care, which in effect serves low-income groups as most higher-income groups now use private services, and how this has changed, drawing on interviews and direct observations of elected representatives and officials at state and municipal levels, political cadres, NGOs, members of residential welfare associations and public health care users. The research focused on four municipal wards that included a middle-class area, a mixed-income area, a ward where many slum communities had been relocated and an “urban village”. The research also included an analysis of the priority given to health care issues (and what those issues are) in the Legislative Assembly and in the Municipal Health Department and Municipal Health Committee. The paper suggests that the opening by state government of new invited spaces for resident welfare associations meant that the elected members of the Legislative Assembly and of the municipal government were by-passed. It increased the influence of resident welfare associations, but these are a feature of middle-class areas whose inhabitants use private health care. It avoided contestation, as the state could decide who was invited. The role of NGOs as advocates for the urban poor also diminished, as many were drawn into becoming implementers of government programmes. In effect, this increase in participation can be seen as a new form of centralization, strengthening the position of senior bureaucrats and by-passing the elected politicians. [ABSTRACT FROM PUBLISHER]

Over the last 25 years, national Health Maintenance Organization (HMO) and hospital firms attempted to enter local markets, either by acquiring formerly independent, locally based HMOs and hospitals or by directly entering local markets. While national HMOs have been relatively successful, national hospital firms have had much less success. This paper explores the reasons for this difference. It reviews changes in presence of national HMO and hospital firms in markets, discusses common conceptual lenses through which national entry into local markets typically has been viewed, and shows how social network theory can be used to develop a better understanding of why the entry experience of national HMO and hospital firms varies across markets. The paper concludes with a research agenda that addresses issues raised by social network theory and its application to national firm entry into local markets. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to situate the predominant medical model of Evidence Based Health Care (EBHC) in a processual framework by construing the organization of health care knowledge as non-linear, rhizomic communication. The paper is based on a theoretically driven, empirically based account of specific micro-processes of health care research and the particular settings in which those processes take place. We show how the production and appropriation of health care knowledge breaks out, cuts across and complicates simple lines of information transfer and dissemination. The boundary between research and practice is not seen simply as a frontier between two totally different realms, but rather as an interconnection between different patterns of relationality. It is this point that EBHC commentaries often miss. They typically see 'research' and 'practice' as pre-established forms, because both appear to enjoy what amounts to an independent existence, before any philosophical questions about their inherent relatedness have been asked. [ABSTRACT FROM AUTHOR]

The National Health Service in Britain has recently undergone a major reorganization. It has moved away from being a planned system of health care delivery to a demand driven system organized on the principles of (quasi-) market competition and quality assurance. These changes are intended by government to `empower' the consumer (patient) with real choice and to incorporate the health professionals within a more effective and efficient system of hospital management. It is in this context that the paper examines the usefulness of `postmodernity' as an explanation for the emergence of new `flexible' organizational forms within the hospital service. The paper will concentrate on the ideological and organizational contradictions between state policy and local practice, especially in relation to issues of managerial vs professional autonomy and control. [ABSTRACT FROM AUTHOR]

Emphasis on rural health problems has led to a relative neglect of urban health issues in developing societies. Yet the fact that a large proportion of the limited financial and human resources is allocated to urban health care makes it imperative for researchers and health planners to evaluate the effectiveness of the urban health care system. This paper examines data on health care utilization from a sample survey of 1500 households conducted in three areas of Accra, Ghana in 1982. The factors that influence the use of three types of health care services (clinics, drug vendors, and traditional healers) are examined. Suggestions are made for increasing the effectiveness of the health care system in Accra, with the aim of making medical care more accessible to all families. [ABSTRACT FROM AUTHOR]

This paper evaluates and describes methods for making psychiatric distinctions. It is by means of psychiatric distinctions that individuals are labeled mentally ill or mentally well. Within the mentally ill category, patients are differentially placed according to the severity and type of their mental illness. The placement of individuals into psychiatric categories is an essential prerequisite not only to the clinical treatment of patients but also to any research where the objective is to determine empirical regularities associated with mental illness. Until the patient is categorized, the practitioner has no logical guide for how to perform treatment or even whether he should treat the patient—i.e, the patient may not be a patient. Similarly, unless the psychiatric researcher has categorized his subjects according to some notion of mental illness he has no way of making comparisons or of assessing change, the two essential processes in research. Thus, the logical first step for arty discovery of new knowledge in the field of mental illness is to appraise the reliability and validity of methods for making psychiatric distinctions. No research findings can be more reliable or valid than the psychiatric distinctions used in carrying oat the research. [ABSTRACT FROM AUTHOR]

The authors reflect on the performance of health in England, as published in the November 2004 White Paper of Great Britain's government. They stressed that most of the consumers wish to make their own health choices though they still need help in coping with harmful factors. They assessed that this paper differs from any previous document in proposing public health back to the public. They pointed out that the current emphasis on preventive targets boosts strong emotions among clinicians.

Rationing of National Health Service expenditure is inevitable, difficult, controversial, and it is unusual for the public to have a direct say in setting healthcare spending priorities at the local level. This paper presents a case study of public involvement in the allocation of some £60 million by a Primary Care Trust in North West London. Market research based techniques were used to demonstrate that the public are indeed capable of making these rationing decisions, given the right support. The results of a collective decision making process are reported, as are the effects on healthcare spending in this locality. [ABSTRACT FROM AUTHOR]

The influence of artificial intelligence (AI) has drastically risen in recent years, especially in the field of medicine. Its influence has spread so greatly that it is determined to become a pillar in the future medical world. A comprehensive literature search related to AI in healthcare was performed in the PubMed database and retrieved the relevant information from suitable ones. AI excels in aspects such as rapid adaptation, high diagnostic accuracy, and data management that can help improve workforce productivity. With this potential in sight, the FDA has continuously approved more machine learning (ML) software to be used by medical workers and scientists. However, there are few controversies such as increased chances of data breaches, concern for clinical implementation, and potential healthcare dilemmas. In this article, the positive and negative aspects of AI implementation in healthcare are discussed, as well as recommended some potential solutions to the potential issues at hand. [ABSTRACT FROM AUTHOR]

The paper summarises previous theories of accident causation, human error, foresight, resilience and system migration. Five lessons from these theories are used as the foundation for a new model which describes how patient safety emerges in complex systems like healthcare: the System Evolution Erosion and Enhancement model. It is concluded that to improve patient safety, healthcare organisations need to understand how system evolution both enhances and erodes patient safety. [ABSTRACT FROM AUTHOR]

The chronic medical conditions in the paediatric population pose a range of potential psychosocial challenges not only to the child, but also to the family members and health care providers. This paper comprehensively reviews the psychosocial issues of children infected with HIV and AIDS and offer some of the strategies to address the issues comprehensively by multidisciplinary team. [ABSTRACT FROM AUTHOR]

Relationship management can be applied in a variety of fields, but there is perhaps no other field that could benefit more from the application of relationship management than public health. The achievements of public health in the United States over the last century are many, but its challenges are daunting. This paper begins with a review of the mission of public health and the status of public health in this nation, including an examination of the most significant public health challenges. I then describe the complex nature of the public health system and summarize the latest positive development in public health planning. Finally, I outline how relationship management can be implemented in order to help improve public health outcomes. [ABSTRACT FROM AUTHOR]

Personal care services are often provided to clients in community settings through highly discretionary processes. Such processes provide little guidance for caseworkers concerning how public resources should be allocated. The results of such processes almost guarantee that individuals with very similar needs will receive very different levels of care resources. Such disparities in treatment open the door to inequity and ineffectiveness. One way to address this problem is through case-mix classification systems that allocate hours of care according to client needs. This paper outlines the preliminary steps taken by one state in its movement toward such a system. [ABSTRACT FROM AUTHOR]

Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM) in many countries without the health care infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative health care teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary health care agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a) professional and research development, b) health human resource planning, c) regulation and legislation and d) practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in health care; a culturally sensitive health care system and a broader spectrum of services for achieving public health goals. [ABSTRACT FROM AUTHOR]

This paper shows that regulatory actions can work as an instrument to correct the shortcomings of the private health insurance market. However, despite rules that defend both competition and consumer rights, these actions can, paradoxically, bring about a more marked concentration of the market if the power of the oligopolies is not challenged. To critique this sort of management, we first discuss the political context in which the Agência Nacional de Saúde Suplementar -- ANS (National Supplementary Health Agency) arose, and describe the nature of the economic crisis facing the market. Considering these issues, we suggest an alternative proposal, in which the Agency would play a key role in overcoming the crisis, particularly by supporting public health principles and reducing the price of health insurance. We finally argue for the institutional reform of the market, restoring the meaning of the Agency's rules and preventing the ANS from falling under the power of the oligopolies. [ABSTRACT FROM AUTHOR]

Evaluating health care quality is important for consumers, health care providers, and society. Developing a measure of health care service quality is an important precursor to systems and organizations that value health care quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to health care settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to health care settings. [ABSTRACT FROM AUTHOR]

This paper uses an institutional perspective (Scott, 1994; 2001; DiMaggio and Powell, 1991) to analyze the history and current state of the American health care field in terms of the alignment of its normative, cognitive, and regulatory elements. I depict the relation between institutional elements in each of three historical eras of the health care field (Scott et al 2000): the era of professional dominance (1945-1965), the era of federal involvement (1966-1982), and the era of managerial control and market mechanisms (after 1983 to the present). I argue that a weakening of alignment between these elements, beginning in the 1970s and increasing in the 1980s, led to consumer and provider dissatisfaction with managed care, and that the state of the field in the beginning of the 21st century suggests that a new era is emerging with renewed alignment between normative beliefs and values, cognitive models, and regulation. Implications for the future of health care and institutional theory are discussed. [ABSTRACT FROM AUTHOR]

Over the past decade, different parties in the health care field have developed and disseminated clinical practice guidelines as part of evidence-based medicine. These formal tools based on a scientific evaluation of the research literature purport to tell health care professionals how to practice medicine. Because clinical practice guidelines shift the knowledge base in the health care field through standardization, they remain con troversial within and outside medicine. In this paper, we evaluate the predictive accuracy of four medical professionalization theories-functionalism, Freidson's theory of professional dominance, deprofessionalization theory, and the theory of countervailing powers- to account for (1) the shift from pathophysiology to epidemiology with guidelines, (2) the creation of practice guidelines, and (3) the effects of clinical practice guidelines on the autonomy of health professionals. In light of the mixed predictive record of professionalization theories, we conclude with a need for "evidence-based sociology" and a recalibration of basic premises underlying professionalization theories. [ABSTRACT FROM AUTHOR]

The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies. These arrangements leave one-sixth of the population uninsured at any given time, and they leave others at risk of losing insurance as a result of normal lVe course events. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development, but they ignore the distinctive character of the health care financing arrangements that do exist Medical sociologists emphasize the way that physicians parlayed their professional expertise into legal, institutional, and economic power but not the way this power was asserted in the political arena. This paper proposes a theory of stakeholder mobilization as the primary obstacle to national health insurance. The evidence supports the argument that powerful stakeholder groups, first the American Medical Association, then organizations of insurance companies and employer groups, have been able to defeat every effort to enact national health insurance across an entire century because they had superior resources and an organizational structure that closely mirrored the federated arrangements of the American state. The exception occurred when the AFL-CIO, with its national leadership, state federations and union locals, mobilized on behalf of Medicare. [ABSTRACT FROM AUTHOR]

The context for contemporary research and policy is set through a theoretically informed history of the modern American health care system that draws on the concept of countervailing powers and Fligstein's theory of control In this context, the papers of this special issue are then introduced. [ABSTRACT FROM AUTHOR]

The prevalence of fluctuating demand is increasingly seen as a serious and ongoing issue facing the health services industry. Volume flexibility in a health care setting represents a means to improve service delivery and it allows organizations to leverage their scarce resources for optimal utilization in response to fluctuations in patient demand. This paper develops a research framework that describes four volume flexible strategies based on literature reviews and structured field interviews of health care administrators at a Carnegie I research and teaching hospital. This prescriptive framework and the propositions that are developed create a foundation to help guide future research on the important relationships between demand uncertainty, volume flexible strategies, and organizational performance. [ABSTRACT FROM AUTHOR]

The study described in this paper was designed to measure the effects of variations in (1) the amount of information provided to respondents about the content of a survey ahead of time, (2) the assurance of confidentiality given to respondents, and (3) the request for and timing of a signature to document consent on three aspects of social surveys: (a) overall response rate, (b) response rates to individual questions, and (c) response quality. That is, the study was designed to measure the impact of informed consent procedures on response rates and response quality in social survey research. For this purpose, a fully crossed 2 × 3 × 3 factorial design was imposed on a national probability sample of 2,084 potential respondents. The questionnaire consisted of a large number of items in such presumably sensitive areas as drinking, marijuana use, sexual behavior, and mental health, in addition to more conventional questions about leisure activities. Major findings can be summarized as follows: 1. The overall response rate to the survey was 67%; of the three variables investigated, only the request for a signature had a significant effect on the probability of responding. Seventy-one percent of those not asked for a signature were interviewed, compared with 64% and 65% of those asked to sign before and those asked to sign afterwards. 2. Only the assurance of confidentiality had a significant effect on item nonresponse. Despite the sensitive nature of the interview, nonresponse to individual questions was very low. On those questions to which the nonresponse rate totaled more than 3%-all of them questions about behavior rather than attitudes -respondents given an assurance of absolute confidentiality had a lower nonresponse rate than those in two other experimental groups, in some cases by a statistically significant margin. 3. None of the three independent variables had either consistent or large effects on the quality of response. How- ever, there are suggestions in the data that asking for a signature before the interview has a sensitization effect, so that better data are obtained if the respondent is asked to sign a consent form afterwards. [ABSTRACT FROM AUTHOR]

This paper examines the causal model which recent research suggests as a framework for research in health service utilization. Data from the 1971, 1972 and 1973 Health Interview Surveys are used to determine the effects of the predisposing, enabling, and illness-morbidity characteristics on several measures of health service utilization. Standardized regression coefficients show these characteristics to be substantively unrelated to health service utilization. The implications of these findings for existing theories of health service utilization are discussed. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between attributes of thirty-two innovative health services and their level of implementation in a national sample of hospitals and health departments. It was found that services implemented in hospitals are primarily characterized by high payoff, a low rate of cost recovery, and low social approval. For health department services perceived primarily as having high divisibility, a high association with the preventive orientation of the department, and a relatively low payoff had a high level of implementation. The respective attribute patterns accounted for 58 per cent of the variance in the implementation of health services in hospitals and 50 per cent of the variance in health departments. [ABSTRACT FROM AUTHOR]

Background: COVID-19 vaccine hesitancy in the United States is high, with at least 63 million unvaccinated individuals to date. Socioeconomically disadvantaged populations experience lower COVID-19 vaccination rates despite facing a disproportionate COVID-19 burden. Objective: To assess the factors associated with COVID-19 vaccine acceptance among under-resourced, adult patients. Methods: Participants were patients receiving care at a Federally Qualified Health Center (FQHC) in St. Paul, Minnesota. Data were collected via multiple modes over 2 phases in 2020 (self-administered electronic survey) and 2021 (study team-administered survey by telephone, self-administered written survey) to promote diversity and inclusion for study participation. The primary outcome was COVID-19 vaccine acceptance. Using logistic regression analysis, associations between vaccine acceptance and factors including risk perception, concerns about the COVID-19 vaccine, social determinants of health (SDOH), co-morbidities, pandemic-induced hardships, and stress were assessed by adjusted odds ratios (AORs) and 95% confidence intervals (CI). Results: One hundred sixty-eight patients (62.5% female; mean age [SD]: 49.9 [17.4] years; 32% <$20 000 annual household income; 69%

Background: It is known that QRS duration is related to prognosis in acute myocardial infarction. The relation between QRS duration and coronary collateral circulation is uncertain. In the present study, we aimed to determine the relation between QRS duration and coronary collateral circulation in patients admitted with acute myocardial infarction. Methods: The present study was composed of 109 consecutive patients with acute myocardial infarction. All patients had total occlusion in the left anterior descending coronary artery. Electrocardiographic recordings on admission were obtained for the assessment of QRS duration. The Rentrop classification was used to define coronary collateral circulation on coronary angiography. Patients were divided into two groups as follows: Group 1 with poor coronary collateral circulation (Rentrop 0–1) and Group 2 with good coronary collateral circulation (Rentrop 2–3). Results: Of all patients, 62 patients were included in group 1 and 47 patients in group 2, respectively. In the present study, patients in the group 1 had longer QRS duration than patients in the group 2 (p<0.005). Additionally, we found that Rentrop grading had negative correlation with both QRS duration and white blood cell count (r: -0.28; p<0.005 and r: -0.35; p<0.001). Conclusion: Our study showed that there was an inverse relationship between QRS duration on admission and presence of coronary collateral circulation in patients with acute myocardial infarction. [ABSTRACT FROM AUTHOR]

The time is NOW for Lifestyle Medicine. In this review based on a presentation at the American College of Lifestyle Medicine (ACLM) 2021 annual conference, ACLM Current President Cate Collings, MD, Immediate Past-President Dexter Shurney, MD, and President Elect Beth Frates, MD, share insights on the current state of lifestyle medicine (LM). Interest in LM has greatly advanced in the face of disruptions from the COVID-19 pandemic, expanded educational opportunities in the field, and a rapidly changing healthcare landscape. With growing access to virtual care, advancing technologies, growing emphasis on home-based chronic care, continuing corporate healthcare mergers and acquisitions, and widening adoption of personalized, patient-empowered treatments, the time is ripe for LM interventions to move to the mainstream. As health investments and costs skyrocket, and new players enter the scene, traditional models of payments, reimbursements, and incentives are slowly being upended. Companies and healthcare systems are finally recognizing the scientific evidence and powerful but undervalued potential of LM to accelerate healthy outcomes while controlling costs. Taken together, the lessons from the COVID-19 pandemic, the growth in LM educational opportunities, and the evolving "business of medicine landscape" signal that the time for lifestyle medicine is NOW. [ABSTRACT FROM AUTHOR]

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Previous research has indicated that Indigenous Sami families in Norway use public home-based care services less often than their non-Sami peers. Based on qualitative interviews with Sami family caregivers, we explore what they experience as barriers to accessing public care services for older adults living with dementia, and how they experience collaborating with care services providers. Through a reflexive thematic approach, we identified that rather than a cultural norm of "taking care of one's own," the underuse of public care services among Sami families were related to several intertwined circumstances. The Sami family caregivers reported barriers to accessing public care, such as lack of familiarity with the services and cultural and language concerns and the legacy of history, and drivers for continuing family care, such as blurred distribution of responsibility, lack of continuity of care, and culturally unsafe caring environments and marginalizing practices. [ABSTRACT FROM AUTHOR]

Introduction: From the onset of the COVID-19 pandemic, public health officials have sought to develop evidence-based messages to reduce COVID-19 transmission by communicating key information to media outlets and the public. We describe the development of an interdisciplinary rapid message testing model to quickly create, test, and share messages with public health officials for use in health campaigns and policy briefings. Methods: An interdisciplinary research team from the University of North Carolina at Chapel Hill assembled in March 2020 to assist the state health department in developing evidence-based messages to influence social distancing behaviors in the state. We developed and iteratively executed a rapid message testing model; the components of the 4-step model were message creation, survey development, survey administration, and analysis and presentation to health department officials. The model was executed 4 times, each during a 7-day period in April and May, and each subsequent survey included new phrasing and/or messaging informed by the previous week's survey. A total of 917 adults from North Carolina participated in the 4 surveys. Results: Survey participants rated messages focused on protecting oneself and others higher than messages focused on norms and fear-based approaches. Pairing behaviors with motivations increased participants' desire to social distance across all themes and subgroups. For example, adding "Protect your grandmother, your neighbor with cancer, and your best friend with asthma," to messaging received a 0.9-point higher score than the base message, "Stay 6 feet apart from others when out in public." Practice Implications: Our model to promote social distancing in North Carolina during the COVID-19 pandemic can be used for rapid, iterative message testing during public health emergencies. [ABSTRACT FROM AUTHOR]

The article presents an update on the periodical "Public Health Reports" (PHR) as of 2020. Topics discussed include the total number of articles published by PHR such as original research articles, public health methodology articles and case studies, the most common topics of the submitted articles, namely, chronic health conditions, infectious diseases and health disparities, and editorial changes at PHR including the appointment of Hazel D. Dean as editor in chief.

The article presents information on the issues related to the government policy for public health and the efficient production of hospital services. The promotion of consumer choice and the provision of information to the public are the main principles of the current government policy in Great Britain. The performance of hospital is manifested in the National Health Service.

The article presents a critique to Geoffrey Rose's population strategy for preventive medicine. Rose's book "The Strategy of Preventive Medicine," outlined a population programme of lifestyle changes that suggested massive gains in the field of public health. This book stirred many opinions and ideas which are discussed here.

The persistent underuse of family planning services by inner-city, low-income, sexually active youth underscores the importance of testing innovative programs that maximize participation. Presented in this paper is an analysis of a Chicago public health clinic's special program for adolescents that originated from the staff's observations of the scheduling, educational, and support needs of teens seeking family planning services from a traditionally managed public health facility. Between December 1982, when the special program—the Teen Clinic—was implemented, and March 1985, more than 600 adolescents sought social support and contraceptive services—an 82 percent increase in new-patient registration compared with the enrollment before the program began. In contrast, two neighboring public health department facilities without special family planning programs for teens experienced either a small increase, 4 percent, or a modest decrease, 17 percent, in utilization by teenagers during the same period. The increased use of the study facility by teens, coupled with patients' self-reported nonuse of alternative sources of care and referral patterns, suggests that the new program was successful in recruiting sexually active teens who had previously been inadequately protected against pregnancy. The perceived institutional and interpersonal factors influencing 153 teens' initial and repeated use of the Teen Clinic, as measured by a structured survey, echo the findings of previous research. Strategies suggested by the study's findings for improving outreach and service delivery are described. [ABSTRACT FROM AUTHOR]

The discovery of effective therapies for HIV requires a fundamental knowledge of retroviral infections. Research by the Public Health Service and collaborating organizations on oncogenic viruses, including retroviruses, has provided much of the basic understanding of retroviruses in general and anti-retroviral therapeutic strategies in particular. Early work by the Viral Cancer and Developmental Therapeutic Programs of the National Cancer Institute and the Intramural Research Program of the National Institute of Allergy and Infectious Diseases has contributed much of the current understanding of AIDS and its therapy. This paper describes the progress that has been made in the treatment of AIDS and the programs that have been created to develop future therapies. These programs include efforts to screen existing compounds for activity against HIV, to design new anti-HIV therapies, and to test potential agents in controlled clinical trials. As a result of these activities, researchers have identified one drug, AZT, that has proven effective in prolonging the lives of some patients with AIDS, and are developing several other promising compounds. The key question no longer is whether HIV infection can be treated, but what is the best and fastest way to develop new therapies and improve existing ones. [ABSTRACT FROM AUTHOR]

Mental health costs of economic change are measured in a cross-level analysis that combines aggregate economic conditions (unemployment rate or absolute change in employment levels) with individual self-reports of undesirable job and financial events, psychosomatic symptoms, and help-seeking for emotional problems. The data were collected in Los Angeles County during 1978-80 in 12 quarterly surveys. Data for 4,144 Anglo respondents are analyzed in seven-way contingency tables to test two competing classes of explanations of the reported association between economic change and the use of mental health facilities. One class assumes that economic contraction affects utilization by increasing the incidence of disorder. The other class assumes that economic change affects utilization without increasing the incidence of disorder, but by influencing the decision to seek help for chronic or anticipated disorder. The results support versions of both classes of explanations. The support, however, is qualified by several factors that suggest that the widely-cited association between the economy and mental health is more complex than usually portrayed. [ABSTRACT FROM AUTHOR]

The present study examines the relationship between stress and the utilization of health services. Utilizing a prospective diary method with a random sample of 96 female users of a neighborhood health center, bivariate analysis indicate that the presence of stress on a given day is associated with an approximate doubling of the probability of a health care contact on that day. When controls are introduced into these analyses for a variety of background characteristics of these families, the daily stress/utilization relationship persists, independently of reported symptoms. In addition, a measure of stressful life events reported prior to the diary period also predicts utilization independently of both the daily stresses and reported symptoms; the stressful life-events variable in fact is one of the best single predictors of utilization. The diary data are also aggregated to approximate a retrospective research design, and substantial evidence of aggregation bias is found. [ABSTRACT FROM AUTHOR]

This paper examines the internal and external stresses which accompany the gradual shift of responsibility from local boards of health to a possible eventual domination by the state health department. Fifty seven members of boards of health in 14 communities in one county in Eastern Pennsylvania were interviewed on the present functions of the local boards of health. Our finding suggests that the local board of health is not simply an organization. It is symbolic of a way of life in a community and it represents many things-a part of town, individualism, self-rule. [ABSTRACT FROM AUTHOR]

In the health insurance movement, the provision of drugs has been one of the medical needs least well met. One prepaid medical care plan has pioneered in an effort to meet this need, and its precise experience is reported in this paper. [ABSTRACT FROM AUTHOR]

The editor, in this article, presents his views on various issues related to health and social behavior. The editor argues that according to figures provided by the previous two editors of the "Journal of Health and Social Behavior," (JHSB) this journal has had and continues to have an impact just under the "American Sociological Review" and the "American Journal of Sociology. " In fact, JHSB's impact factor has been almost double that of "Social Forces" for a number of years. The editor promises to continue the outstanding work of prior JHSB editors in selecting and publishing high quality, theory-driven, empirical papers across a wide range of topics in health and illness, the sociology of medicine, and the organization of medical care. JHSB is the journal. In the editor's view , a good editor, with the help of the editorial board and a bevy of careful reviewers, publishes the very best papers that are submitted for consideration and trusts that these reflect the cutting edge of the field.

The authors discuss the challenges in translating national and state reopening plans into local reopening policies during the COVID-19 pandemic. Topics mentioned include the reason why linear plans are easy to communicate, a plan confirmed in Indiana on April 29, 2020 to hire 500 contact tracers, and the U.S. Centers for Disease Control and Prevention's Public Health Associates Program.