An evaluation of consumer participation in hospital breast services

Community expectations and research demonstrate that consumers play an important role in shaping services for women with breast cancer. Consumer contribution has been mandated recently in Victoria, Australia, to ensure the inclusion of consumer involvement in the planning and decision‐making processes within health organizations. As part of the redevelopment of breast services in Victoria, Southern Health has been funded to plan local improvements to care co‐ordination for women diagnosed with breast cancer in the southern metropolitan area of Melbourne. The establishment of effective consumer participation in breast services is an integral aspect of this project and a range of initiatives has been undertaken to achieve meaningful consumer involvement including the appointment of a consumer advisor; appointment of staff with extensive knowledge in women's health and community development to the project; establishment of a consumer reference group; and plans made to improve the receptivity of health service systems to consumer input. A preliminary evaluation of this ongoing project has indicated that a productive role for consumers in service practice review and policy and planning activities has been established and some change and engagement of staff has occurred. There is still work to be done to promote the involvement of a wider range of health professionals and to increase the level of trust between consumers and staff.     

Consumer use of the internet for health information: a survey of primary care patients

An increasing number of patients use the internet to obtain information about health. Although some information is available about how health professionals use the internet, little is known about how patients utilize this information. Some patients may actively seek information to assume more responsibility for their health. However, others may feel obliged to do so because of failing confidence in health care provision. Health professionals have the potential to assist patients to make sense of health information from the internet; however, they may not necessarily welcome this role. This study aims to evaluate patients’ use of such information in a primary care setting. The sample consisted of adult patients (n = 851) from two general practice populations at different levels of the socio‐economic spectrum in South Wales (UK). Patients were surveyed by questionnaire about the health information they use, including the internet. The majority of patients preferred to use their general practitioner as the main source of health information. The internet was jointly the second preferred source for information about an illness (6%). Just over half (51%) of patients in this study had access to the internet, of which about half use it to access health information. Just under a quarter (24%, n = 55) of health internet users had discussed information accessed from the internet during a subsequent consultation with a health professional. Of these, three‐quarters felt more prepared and able to participate in decision‐making about treatments. This study provides a greater understanding of how patients are making use of health‐related information from the internet. These findings can be used to help prepare health care professionals for dealing appropriately with internet‐informed patients.     

Statistical considerations for the design,conduct and analysis of the efficacy of safe community interventions

In injury research, the use of community-level intervention trials is quite common. Often, it is the only practical method for assessing the efficacy of countermeasures or preventive interventions. ‘Safe Community’ is an intervention concept aimed at establishing community-level programs and policies to ensure the safety of inhabitants in a community. The methodological considerations in evaluating the efficacy of such interventions need to be well understood by injury researchers and policy makers. This paper presents various statistical issues that need to be considered in the design, conduct and analyses of community-level intervention trials. Only with an understanding of the statistical issues will such studies have the appropriate design, conduct and analysis, and thus be appropriately well-received, with the implication that they will indeed help to build safer communities.     

Consumer education in the UK: new developments in policy,strategy and implementation

Consumer education is an integral part of the European Community's consumer policy. It plays a key role in consumer empowerment, helping consumers gain the skills, attitudes and knowledge they need to be able to gear the choices they make as consumers to their economic interests and to protect their health and safety. In its policy statement, the Directorate General for Health and Consumer Protection states that the European Community is aware that joint measures at national and Community levels should be more structured, in order to achieve maximum effectiveness. This paper aims to set out the current policy and strategic context for consumer education and empowerment in the UK; review the role of UK government bodies and other agencies concerned with developments; review recent literature; present the results of interviews with an extensive range of key stakeholders and the results of a survey of service heads for trading standards throughout the UK. It will consider implementation, partnership, resources, ideas and opportunities. The research found that the agenda for consumer education in the UK is at an interesting stage of development. The Enterprise Act 2002 gives the Office of Fair Trading (OFT) a statutory power to carry out educational activities. Consumer education is also moving up the agenda in the trading standards service. In addition, the teaching of citizenship in English schools is already stimulating new developments in consumer education. The paper will consider the need for organizations like these to work together to build on these policy developments and ensure that consumer education gains the profile it needs to influence consumer attitudes and behaviour.     

Safe community in different settings

This paper describes the Safe Community concept and how communities aspired to safety through a structured, collaborative approach rather than a community that is already perfectly safe. The Safe Community movement started in Sweden at the end of the 1980s and was based on community-based injury prevention activities. Safe Communities are the communities that meet a set of 12 criteria (later changed to six indicators) set out by the WHO Collaborating Centre (WHO CC) on Community Safety Promotion at Karolinska Institutet in Stockholm. The communities may apply to the WHO CC to be designated as an official member of the WHO International Safe Community Network. To date, 83 communities around the world have been designated as members of the Safe Community Network, ranging in population from 1000 to nearly 2 million. Lidkj?ping in Sweden was the first designated safe community in 1989 and Rapla in Estonia was the last, designated in October 2004. The movement recognizes that it is the people who not only live, learn, work and play in a community but also best understand their community's specific problems, needs, assets and capacities. Their involvement and commitment are critical factors in identifying and mobilizing resources so as to create an effective, comprehensive and coordinated community-based action on unintentional and intentional injuries.     

Road safety perspectives among employees of a multinational corporation in urban India: local context for global injury prevention

In rapidly developing economies, like urban India, where road traffic injury rates are among the world's highest, the corporate workplace offers a non-traditional venue for road safety interventions. In partnership with a major multinational corporation (MNC) with a large Indian workforce, this study aimed to elicit local employee perspectives on road safety to inform a global corporate health platform. The safety attitudes and behaviours of 75 employees were collected through self-report survey and focus groups in the MNC offices in Bangalore and Pune. Analysis of these data uncovered incongruity between employee knowledge of safety strategies and their enacted safety behaviours and identified local preference for interventions and policy-level actions. The methods modelled by this study offer a straightforward approach for eliciting employee perspective for local road safety interventions that fit within a global strategy to improve employee health. Study findings suggest that MNCs can employ a range of strategies to improve the road traffic safety of their employees in settings like urban India including: implementing corporate traffic safety policy, making local infrastructure changes to improve road and traffic conditions, advocating for road safety with government partners and providing employees with education and access to safety equipment and safe transportation options.     

An epidemiological study of injury in mines: implications for safety promotion

This paper is intended to raise risk management as a topic for discussion among product safety professionals and discuss one particular key element of understanding risk. Risk management is an essential part of good product safety management, whether at the policy level or the implementation stage, and is relevant to all those involved in the development and use of standards, including regulators and suppliers. The risk management process involves measuring the risks at the initial stage, by looking at consequence (possible injury) and likelihood (of that injury occurring) which then gives us the ‘inherent risk.’ We then seek ways to treat the risks. A second assessment of the risks is subsequently done to establish the extent to which the treatment will address the problem (‘assessed risk’). In product safety, this means how dangerous is the product as it is and how effective will a measure be in reducing the risk. Communication is vital in this process. When standards are developed and policy adopted, the factors that are taken into consideration need to be properly documented. The rationales for decisions, i.e., what the hazard is and how it is treated by the product specification, should be recorded within the standard itself. In the absence of recorded reasons, assumptions are made and these may well be incorrect. This paper discusses this topic in some detail and provides illustrative examples.     

Road traffic accidents and policy interventions in Korea

The high rate of road traffic crashes, in conjunction with the absence of order on the road, has long been considered a critical social problem in Korea. The Korean public seems to agree that high priority ought to be placed on policies for improving road safety. Using data from government sources, this study describes what has happened in the area of road traffic crashes since 1970, the causes of traffic crashes, and the relative importance of traffic injuries as a cause of death in Korea. Road traffic crashes in Korea increased nearly eightfold, from 37,000 in 1970 to 290,481 in 2000. The fatalities increased three-fold and injuries ten-fold over the same period. Road traffic injuries were the leading cause of death for people under 29. However, through multiple policy interventions, partly in response to the 2002 FIFA World Cup, about two thousand road traffic deaths and nine thousand traffic-related disabilities were averted in 2001 alone. The policy interventions included enforcement of penalties for seven risky driving behaviours, including drunk driving and speeding, installation of traffic-monitoring cameras, financial rewards for citizens who reported traffic violations, introduction of a road safety evaluation system, correction of accident black spots in existing roads, and road safety education programs. Through multiple policy interventions, road traffic crashes in Korea were reduced in a relatively short time period, along with their associated injuries and fatalities. However, road traffic crashes still pose a major public health problem, threatening the quality of life of the Korean people.     

Challenges to elderly safety in Safe Community movements in Japan

In Japan, with the longest life expectancy in the world over the last two decades, a great emphasis has been placed on the safety of the elderly, which has in turn influenced their well-being. Meantime, the concept of Safe Community (SC) has drawn more attention as one of the potential measures to sustain and improve the health conditions of the elderly. In hope of improving the effectiveness and efficiency of current efforts for elderly safety, the SC model is expected to provide features with which communities can make the better use of current limited resources. This article examines how the SC model makes a difference in these efforts by utilising existing programmes and how elderly safety can be promoted at the community level. Six communities working safety promotion based on the SC model were selected for the study. Although there are limitations to the information due to the insufficient experience in SC in Japan, it was found that two features make SC significant in promoting safety: (1) systematic evidence-based plan-do-check-action processes and (2) a framework of cross-sectoral collaboration. However, to examine and identify the effectiveness of SC on elderly health, further observation is required to develop strategies while accumulating longitudinal data.     

Information Management in Aged Care: Cases of Confidentiality and Elder Abuse

Typically seniors like others choose to avoid institutional care. However, when age-related infirmity requires it, they not only enter into the care of others, but they also do so as vulnerable members of society. As their frailty increases with age, so does their dependence on the professionals who care for them and on the enforcement of policies concerning their care. A qualitative case study involving seniors and their carers revealed that breaches of confidentiality, unprofessional behaviour and the non-enforcement of policy, continue to hide the physical and emotional abuse perpetrated by nursing and other staff on vulnerable consumers. Professional ethics, including at a corporate level, enforcing policy, protecting whistleblowers and creating reporting mechanisms for aged care researchers, are amongst the recommendations arising from this study.     

Embedding consumer culture in health and social care education – a university office's perspective

Health and social care services are changing – and this change is radical. Service user and carer involvement has been a key aspect of health and social care policy for a number of years. In terms of the National Health Service (NHS), this has been significantly strengthened by the report ‘High Quality Care for All’. The NHS will no longer be a monolith dictating what services it offers. It is beginning to take seriously the views of its consumers: the patients, service users and carers. The NHS is starting to put the patient experience at the centre of everything it does, and its regulators are asking for evidence of public and patient involvement. This process may yet prove to be one of the NHS' greatest challenges as it transforms to prioritize the consumer viewpoint. Social care, though further down the line in relation to involvement, is now responding to the relatively new personalization agenda. This paper will consider what the university sector can do to embed the consumer and service culture within the education of health and social care professionals. It looks at the challenges of involvement and required culture change, highlighting the key points to address in the early and middle stages of involvement from a university office's perspective. It includes examples of consumer involvement in teaching, assessment and the selection of students and how their input is starting to make a difference. Finally, the paper outlines what is needed in a development office to establish and support effective service user and carer involvement on health and social care courses in higher education. The article concludes by acknowledging that there is much more work that needs to be done in this field to embed the work of a development office, but that early steps have been promising.     

以制度创新解决中小企业融资“麦克米伦缺口”--基于韩国中小企业银行的研究

我国在政策性融资支持中小企业方面由较多部门掌握资源,各自为政,难以形成合力。政策性金融在中小企业融资领域长期缺位,企业过度依赖商业银行间接融资,是当前中小企业“融资难、融资贵”的一个重要原因。韩国政府从中小企业职能机构设置、机制完善、制度保障、金融支持、产业联动等方面大力扶持中小企业发展,尤其是韩国的政策性金融对中小企业的支持对我国具有借鉴作用。结合中小企业发展面临的融资困境,我国应当通过制度创新,建立两大政策性机构解决中小企业融资难、融资贵问题。     

A study of the effect of OHSAS 18001 on the occupational injury rate in Iran

The occupational health and safety management system (OHSMS) has been a widely used approach for managing occupational health and safety more effectively worldwide. Despite the interest of organizations in implementing OHSMS in recent decades, few studies have examined the effectiveness of these interventions. This study presents an empirical investigation of the effect of occupational health and safety assessment series (OHSAS) 18001 as a worldwide-accepted OHSMS on the occupational injury rate (OIR) in Iran. This study was carried out in six companies: three OHSAS 18001-certified, and three non-certified, including 998 occupational injuries for 15,842 person-months. A before–after analysis showed a positive safety performance change in one out of the three certified companies. For all 66 study years in the six companies, a negative binomial regression did not indicate a lower occupational injury during the certified years and a repeated measures analysis of variance (ANOVA) did not confirm the effect of certification. The results of this study indicated that the implementation of OHSAS 18001 is not a guarantee of improved safety.     

Government transparency: the citizen perspective and experience with food and health products policy

Citizen engagement (involvement of everyday citizens in policy decisions) is now seen as a major component of governance and policy making. Government transparency is a central tenet of citizen engagement. This study was sought by Health Canada in order to learn from citizen groups in other countries about the nature and degree of transparency related to food and health product review in their country. Health Canada anticipated learning from their experiences and perceptions so that it could increase the transparency of its own review and regulatory process. The opinions of a cross‐section of stakeholders in the United States, the European Union (especially the UK), Australia and New Zealand, solicited via an e‐mail survey, were analysed. The results clearly indicate that, in general, respondents do not feel that their food and health product review system is transparent. These opinions varied depending on which of the seven dimensions of transparency was being examined. Of the 64 recommendations tendered for increasing government transparency, the 32 suggestions for improving their own systems were quite different from the 32 made for Health Canada to consider. Collectively, they provide rich insights into the refinement and clarification of the food and health product review process.     

南宁市流动人口妇女卫生保健服务现状及对策研究概述

目的了解南宁市流动妇女的卫生服务需要、需求和利用现状。方法采用整群随机抽样的方法,随机抽取南宁市青秀区5个社区,每个社区调查200户共1000例流动妇女,采用问卷调查方法进行入户调查。结果调查的社区流动妇女有48.63%没有做过妇女病普查,181人自报在两周内患有各类疾病,共计201人次,两周患病率为201.9‰;136人自报半年内患有各类慢性病,共计209人次,慢性病患病率为20.9%。54.01%的妇女有病愿意去医院看病,72.7%的妇女就诊时首选社区卫生院,181名两周患病者就诊307人次,两周就诊率为30.7%;46.80%的妇女认为诊治费会对他们的生活有影响,有86.70%的妇女愿意了解和获取卫生科普知识。结论流动人口收入低,负担重,选择医疗服务最重视价格因素,服务便捷性,要优化社区卫生服务,改革社区卫生服务的收费制度,减轻流动人口的就医负担,同时加强对流动人口的健康教育,转变其传统的健康观,提高流动人口妇幼保健服务利用。     

中学体育课堂中运动损伤问题的探讨及对策研究

我国有两亿多名在校中小学学生,元论是走跑跳投还是一些别的活动在体育课堂中都要求学生具备过硬的身体和心理素质,然而安全问题在体育课堂上总是容易被学生们忽视,从而造成一些轻重不一的运动损伤。这不仅给学生本人及其家庭带来不幸和痛苦,也给教育行政部门、学校及教师的教学造成管理上的困惑和不安,文章就应对中学体育课堂中运动损伤的出现及避免于东损伤的出现提出相对应的建议与对策,希望能为中学生营造一个有较高安全保障的体育课堂。     

Reaching those at highest risk to fires and burns: Young children,older adults,and people in low-income communities

Injury specialists have not successfully convinced policy makers and the public that injuries can be controlled. That failure may be due in part to the lack of a unified understanding of injury control. The two most important models utilized in injury control are Haddon's Matrix1 and the Public Health Approach (PHA). This paper argues that the PHA should be combined with the two axes of Haddon's Matrix to result in a model that is coherent and comprehensive. Thus it is better than either one of the original models on their own. Haddon's Matrix has two axes. The first includes elements of the epidemiological triad, host, vector, and environment and likens injury to disease. The second axis includes three time intervals, pre-event, event, and post-event. The importance of including time was that injury was conceptualized as predictable and preventable. The weakness of Haddon's matrix is that it lacks a systematic plan of action. The Public Health Approach is a methodology for addressing injury, which consists of a hierarchy of four levels; surveillance, risk factor identification, intervention evaluation and program implementation. The use of the PHA with no specific orientation or means of application is its weakness. The PHA lacks a systematic point of application. Haddon's Matrix lacks a systematic action plan. Therefore we propose the PHA as the systematic strategy for the more theoretical framework of Haddon's matrix. By combining these concepts a coherent and comprehensive three-dimensional framework is defined. The unified model closes the potential gaps in the two original models and includes a systematic approach not previously achieved. This unified model is practical in defining individual studies and groups of studies. It can be used as an inventory, for a complete understanding of a particular injury. Diagrams of the model are presented to help teach the concepts of injury described in this unitary model. In conclusion, we can say that the inclusion of three injury concepts in one framework provides a rigorous and coherent construct for the understanding of injury and implementation of control activities. It can therefore be used to design more comprehensive programs for injury control and promote policies and funding commensurate with the magnitude of the injury problem.     

Latino families report lower child injury rates than white families

Latino children have lower visit rates to emergency departments and primary care physicians than white children in the USA. Using a nationally representative household survey, this study asked whether parental report of injury was also lower for Latino children, after adjusting for demographic, socioeconomic, health status and health care access factors. Data were obtained on injuries for which medical advice or treatment was received from the National Health Interview Survey (NHIS) from 1997 to 2003. Using the multistage probability design of NHIS, annual rates and adjusted odds of childhood injury report by race and ethnicity were calculated. Respondents reported lower rates of injury for Latino children (6.0 (95% CI 5.3-6.8)/100 person-years) than white children (13.4 (12.7-14.2)/100 person-years). Lower injury rates were mainly due to lower rates of sports injuries and accidental falls. Latino children had lower odds of reported injury than white children, even after adjusting for multiple factors (odds ratio 0.7; 95% CI 0.6-0.8). Lower odds of injury report among Latino children are independent of direct measures of demographic, socioeconomic, health status and health care access factors and indirect measures of acculturation including respondent language and country of origin. Potential explanations include lower exposure to risk, greater child supervision, reporting bias, differences in cultural attitudes toward seeking of health care and reduced health care access that cannot be explored in NHIS due to the form of the current questions. Further research is needed to investigate cultural differences in risk exposure, child supervision and seeking of injury care.     

Value co‐creation in online healthcare communities: The impact of patients’ reference frames on cure and care

The gradual transition of health care toward businesses during the past 50 years has converted passive patients into active customers. In our digital society, patients increasingly use online health communities to satisfy complex needs that healthcare professionals leave unmet, including the creation of cure‐oriented (i.e., functional) and care‐oriented (i.e., emotion) value. This research investigates patients’ reference frames (self versus other) as an information processing mechanism and their impact on value creation in online communities. The analysis of 1,687 online postings of a leading healthcare platform shows that self‐referencing is typical for information obtained through an individualistic, patient–doctor encounter; other‐referencing emerges when patients focus on the needs of their peers. Information gathered through the patient–doctor encounter and processed with a self‐referencing frame accordingly enhances cure‐related value, but limits care‐oriented value co‐creation. Other‐referencing does exactly the opposite: it creates a barrier to cure‐related value, but stimulates care‐related value. A patient's experience with the community largely moderates the impact of both self‐ and other‐referencing on cure‐ and care‐related value. These findings show that online health communities can identify and address unmet patient needs, but healthcare professionals still play a critical role in terms of ensuring information quality in online health communities.