Deinstitutionalization reconsidered: geographic and demographic changes in mental health care in British Columbia and Alberta, 1950-1980.

Using demographics on admission to, and discharge from, mental hospitals in Alberta and British Columbia, this paper analyzes the social process commonly framed as deinstitutionalization between 1950 and 1980. A focus on the two most western Canadian provinces permits an exploration of these changes in these regional contexts. Pressured by new funding arrangements, a shift towards community care, and growing criticism of the alleged oppressive nature of large institutions, the three main mental hospitals scaled down as of the 1950s. This trend did not mean, however, that the overall number of hospitalized patients decreased during this time period. The total number of hospitalizations, particularly short-term admissions, actually expanded, while trans-institutionalization also occurred. This case study mirrors larger trends of postwar mental health care, illustrating the social, political, and cultural challenges experienced in the reconstruction of institutional care.

[An evaluation of the pediatric medico-legal admissions to a tertiary hospital emergency department]. / Bir üçüncü basamak hastane acil servisine basvuran adli nitelikli çocuk hastalarin degerlendirilmesi.

BACKGROUND: This study aimed to determine the demographic and epidemiological characteristics and to investigate the outcomes of pediatric medico-legal cases who admitted to the emergency department. It was also aimed to contribute to the national survey. METHODS: Medico-legal charts of the pediatric cases were reviewed retrospectively. Patients were allocated into two groups as traumatic (Group 1) and non-traumatic (Group 2). Age, sex, presenting complaint and frequencies, local or multiple trauma frequencies, and localizations (based on the Abbreviated Injury Scale) and also admission, discharge and mortality rates were ascertained. Data were evaluated by descriptive methods, Kolmogorov-Smirnov and chi-square tests. Values of p<0.05 were accepted as significant. RESULTS: There were a total of 486 eligible patients. The mean age was 8.91+/-5.08 years (95% confidence interval [CI]). The majority (66.3%) were male. The group aged 5-9 years was larger (33.3%) than the others (in Kolmogorov-Smirnov test, p=0.000). Summer was the most common season for admissions. There were 153 patients in Group 1, and the most common complaint was accidental drug intake (13.8%). In Group 2, the most common reason for admission was motor vehicle accident (32.5%). CONCLUSION: Motor vehicle and home accidents in childhood are preventable health problems. To ensure a safe environment, continuous health education programs on injury and prevention for parents and children and legal controls will be effective in injury control.

On the coding and reporting of race and ethnicity in New Hampshire for purposes of cancer reporting.

BACKGROUND: The objective was to investigate how data on race and ethnicity are collected by hospitals reporting to the New Hampshire State Cancer Registry (NHSCR). METHOD: NHSCR surveyed hospitals asking how information on race and ethnicity were collected. A review of relevant legal mandates and national guidelines was undertaken. RESULTS: Many hospitals lack policies on collection, computer systems fail to support national guidelines, and staff rely on visual inspection. CONCLUSIONS: Hospital staffs are not now culturally equipped to collect race and ethnicity in a meaningful way. The numerator in cancer incidence rates is most likely not accurate and for some smaller populations very biased. A new framework is needed that takes into account the needs of the democracy.

Whose info is it, anyway? As HIPAA provisions take effect, patients may be surprised by the level confidentiality, intent on exercising new rights.

As the long-awaited HIPAA privacy regulations finally take effect this week, the question remains as to just how warmly consumers will respond to the raft of new federal rules governing control of medical information. The adjustment period may be lengthy for these complex regulations, but the new rules certainly will educate patients about their rights as consumers, says consultant Jill Callahan Dennis, left.

The Medicare secondary payor provisions: possible rewards and pitfalls.

A 1990 report prepared by the Office of Inspector General estimated that as much as $1 billion is lost to the Medicare program annually because (i) secondary payor situations are not detected and (ii) insurance companies often do not pay when they are required to be the primary payors. Office of Inspector General, No. A-09-98-00151, April 1990, Medicare and Medicaid Guide (CCH) [symbol: see text] 39,112, at 25,649. In order to better enforce the MSP provisions, suggestions have been made at the Congressional level to impose sanctions against providers who demonstrate a pattern of inappropriate billing practices such as double billing, repeated failures to screen beneficiaries for other insurance coverage, and the repeated submission to Medicare of bills that should be submitted to another payor. (See the Subcommittee Report on erroneous payments under the MSP program, supra.) Although authority for such sanctions has yet to be adopted, given the fiscal problems currently plaguing the federal government, providers can expect increased enforcement of the MSP provisions as a means of reducing Medicare costs, and should review their screening and billing practices accordingly.

Advance directives: development, opposition, and criticism.

Since the PSDA became law on December 1, all Medicare and Medicaid health care providers are required to develop policies and procedures to comply with the law. The principles of autonomy and distributive justice are basic to the Act, and the social worker's vital role will continue to develop as the law is implemented.