Targets--are they sensible?

Targets are becoming increasingly important in the new NHS for both purchasers and providers. Targets must be meaningful and carefully considered before it becomes sensible or realistic to attempt to achieve them. Choosing an unworkable target no matter how well-intentioned, will not achieve the desired result. This paper discusses the role of targets, comments on targets that are in use and proposes a set of 'Golden Rules' for the selection of targets.     

Reconceptualizing adolescent sexual behavior: beyond did they or didn't they?

CONTEXT: Adolescent sexual behavior is typically studied as a dichotomy: Adolescents have had sex or they have not. Broadening this view would lead to a greater understanding of teenagers' sexual behavior. METHODS: Interview data from 907 high school students in Alabama, New York and Puerto Rico were used to examine the relationships between sexual experience and a variety of social, psychological and behavioral variables. Four groups of teenagers are compared: those who did not anticipate initiating sex in the next year (delayers), those who anticipated initiating sex in the next year (anticipators), those who had had one sexual partner (singles) and those who had had two or more partners (multiples). RESULTS: Compared with delayers, anticipators reported more alcohol use and marijuana use; poorer psychological health; riskier peer behaviors; and looser ties to family school and church. Similarly, multiples reported more alcohol and marijuana use, riskier peer behaviors and looser ties to family and school than singles. Risk behaviors, peer behaviors, family variables, and school and church involvement showed a linear trend across the four categories of sexual behavior. CONCLUSIONS: The traditional sex-no sex dichotomy obscures differences among sexually inexperienced teenagers and among adolescents who have had sex. Prevention efforts must be tailored to the specific needs of teenagers with differing sexual experiences and expectations, and must address the social and psychological context in which sexual experiences occur.     

Medicare beneficiary counseling programs: what are they and do they work?

Medicare beneficiaries face myriad rules, conditions, and exceptions under the Medicare program. As a result, State Information, Counseling, and Assistance (ICA) programs were established or enhanced with Federal funding as part of the Omnibus Budget Reconciliation Act (OBRA) of 1990. ICA programs utilize a volunteer-based and locally-sponsored support system to deliver free and unbiased counseling on the Medicare program and related health insurance issues. This article discusses the effectiveness of the ICA model. Because the ICA programs serve as a vital link between HCFA and its beneficiaries, information about the programs' success may be useful to HCFA and other policymakers during this era of consumer information.     

Insurance expansions: do they hurt those they are designed to help?

Seeking to redress health disparities across income and race, many policy-makers mandate health insurance benefits, presuming that equalized benefits will help equalize use of beneficial health services. This paper tests that presumption by measuring health care use by a diverse population with comprehensive health insurance. Focusing on use of mental health care and pharmaceuticals, it finds that even when insurance benefits and access are constant, whites and those with high incomes consume more of these benefits than other people do. This suggests that privileged classes extract more health care services even when everyone pays equal premiums for equal insurance coverage.     

Monoamine oxidase inhibitors: have they a place, have they a future?

The legacy of the hepatotoxic effect and the "cheese reaction" of monoamine oxidase inhibitors still overshadows these useful drugs, despite near-resolution of many of the problems. This short article reviews the indications, adverse effects and progress and future of these agents in psychopharmacology.     

On-line journals--are they the future?

The significant growth of the online literature usage, and the conspicuously differing interest of publishers, procurers and users raise the question whether the electronic or the paper journals will be the primary information sources in the future. The price of the scientific literature has gotten out of control in the last two decades. At the same time websites showed up providing open access, and this may make all participants of the market to change their marketing policy. Instead of the extra-profit accumulation strategy, publishers should take individual users' interests into consideration. Although the technical conditions of value-added option-enriched online services to surpass the paper journals are given already, there is still a demand for the latter, due to ingrained user habits. At the same time, the electronic version is attracting the users with e-versions, three-dimensional images, video records, sound, hypertext, content and relation analysis, which are limited only by the imagination. According to the authors, the development of information media is unstoppable, and the main challenge in the future will be still to find the most effective way of processing information, make it available for professional research and preserve it for the scientific heritage.     

Realist methods in medical education research: what are they and what can they contribute?

Medical Education 2012: 46: 89–96 Context Education is a complex intervention which produces different outcomes in different circumstances. Education researchers have long recognised the need to supplement experimental studies of efficacy with a broader range of study designs that will help to unpack the ‘how’ and ‘why’ questions and illuminate the many, varied and interdependent mechanisms by which interventions may work (or fail to work) in different contexts. Methods One promising approach is realist evaluation, which seeks to establish what works, for whom, in what circumstances, in what respects, to what extent, and why. This paper introduces the realist approach and explains why it is particularly suited to education research. It gives a brief introduction to the philosophical assumptions underlying realist methods and outlines key principles of realist evaluation (designed for empirical studies) and realist review (the application of realist methods to secondary research). Discussion The paper warns that realist approaches are not a panacea and lists the circumstances in which they are likely to be particularly useful.     

Adolescent clients of primary health care services. How do they live? Why do they seek help, and how do they express themselves?

The objective of this study was to characterize adolescent clients of community-based primary health care services in order to understand: 1) how they express themselves when they seek medical help; 2) the health care they receive; and 3) key social and family factors. Among 35 urban primary care services belonging to the municipal public health department in Pelotas, Rio Grande do Sul State, Brazil, 10 were randomly selected, and all individuals between 13 and 19 years of age who had previously had an appointment with a non-psychiatric physician were interviewed during a three-month period (n = 463). Use of the services has more of a more curative than preventive focus. Males seek medical help less frequently and mainly due to physical complaints. Females tend to express themselves on the basis of sexual problems. Few adolescents expressed their emotional problems, although some mentioned family and school problems as well as stressful situations.