Malnutrition in a UK children's hospital

A survey of the nutritional status of a multi-racial group of children in a UK regional referral centre revealed a high prevalence of both acute and chronic protein-energy malnutrition; 16% were severely stunted and 14% severely wasted, with a further 20% at risk of severe malnutrition if nutritionally stressed. Severe stunting was particularly common in patients with chronic cardiac or gastrointestinal disorders. No racial differences in stunting were found. These findings indicate that formal nutritional surveillance of children in hospital is important, and will identify a large reservoir of patients with secondary malnutrition requiring nutritional support.     

Social trust and self-rated health in US communities: a multilevel analysis

This study assessed the contextual and individual effects of social trust on health. Methods consisted of a multilevel regression analysis of self-rated poor health among 21,456 individuals nested within 40 US communities included in the 2000 Social Capital Community Benchmark Survey. Controlling for demographic covariates, a strong income and education gradient was observed for self-rated health. Higher levels of cominunity social trust were associated with a lover probability of reporting poor health. Individual demographic and socioeconomic preditors did not explain the association of community social trust with self-rated health. Controlling for individual trust perception, however, rendered the main effect of community social trust statistically insignificant, but a complex interaction effect was observed, such that the health-promoting effect of community social trust was significantly greater for high-trust individuals. For low-trust individuals, the effect of community social trust on self-rated health was the opposite. Using the latest data available on community social trust, we conclude that the role of community social trust in explaining average population health achievements and health inequalities is complex and is contingent on individual perceptions of social trust. Future multilevel investigations of social capital and population health should routinely consider the cross-level nature of community or neighborbood effects.     

发挥质控网络在医院全面质量管理中的作用

目的探讨提高医院全面质量管理的有效方法。方法通过强化医院三级质量控制网络体系建设，开展质控网络小组的活动，渗透医院全面质量管理过程。结果提升了全民质控意识，提高了事前控制和事中控制的执行力。结论三级质量控制网络体系的建设，对医院质量进行动态的实时控制，可有力保障医院全面质量管理落实。     

Social capital and trust in providers

Trust in providers has been in decline in recent decades. This study attempts to identify sources of trust in characteristics of health care systems and the wider community. The design is cross-sectional. Data are from (1) the 1996 Household Survey of the Community Tracking Study, drawn from 24 Metropolitan Statistical Areas; (2) a 1996 multi-city broadcast media marketing database including key social capital indicators; (3) Interstudy; (4) the American Hospital Association; and (5) the American Medical Association. Independent variables include individual socio-demographic variables, HMO enrollment, community-level health sector variables, and social capital. The dependent variable is self-reported trust in physicians. Data are merged from the various sources and analyzed using SUDAAN. Subjects include adults in the Household Survey who responded to the items on trust in physicians (N=17,653). Trust in physicians is independently predicted by community social capital (p<0.001). Trust is also negatively related to HMO enrollment and to many individual characteristics. The effect of HMOs is not uniform across all communities. Social capital plays a role in how health care is perceived by citizens, and how health care is delivered by providers. Efforts to build trust and collaboration in a community may improve trust in physicians, health care quality, access, and preserve local health care control.     

Securing our genetic health: engendering trust in UK Biobank

The recent development of genetic databases, or 'biobanks', in a number of countries reflects scientists' and policy makers' beliefs in the future health benefits to be derived from genetics research. In Britain, however, a proposal for a genetic database, UK Biobank, has been the focus of a number of concerns. Establishing consent and legitimacy for any controversial biomedical research involving the participation of human subjects is difficult; it is however, acute for UK Biobank given the scale of the project and the criticisms levelled at it. Analysing recently published documents pertaining to UK Biobank, this article examines how consent for the project has been discursively framed and how this is reflected in its governance. It is argued that the problem of organising consent has been framed narrowly in terms of adherence to a well-established repertoire of institutional mechanisms which serves to limit debate on the substantive issues at stake. There is little evidence of reflection on the adequacy of such mechanisms for dealing with the unique challenges posed by UK Biobank, including achieving the confidence and participation of a population with diverse perspectives on genetic research. It is concluded that a restricted public discourse about UK Biobank may contribute to a decline in confidence in regulatory systems governing biotechnology and science more generally.     

Private obstetric practice in a public hospital: mythical trust in obstetric care

There is evidence to suggest the decline of trusting relationships in modern healthcare systems. The primary aim of this study was to investigate the role of trust in medical transactions in Thailand, using obstetric care as a tracer service. The paper proposes an explanatory framework of trust for further investigation in other healthcare settings. The study site was a 1300-bed tertiary public hospital in Bangkok which it provides two forms of obstetric care: regular obstetric practice (RP) and private obstetric practice (PP). Forty pregnant women were selected and interviewed using a set of guiding questions. A thematic analysis of the interviews was undertaken to generate understanding and develop an explanatory framework. It was found that patients' trust in obstetric services was influenced by their perceptions of risk and uncertainty in pregnancy and childbirth, and that these perceptions were linked to their social class. Social class also influenced the accessibility and affordability of care to patients. Middle class pregnant women with relatively high-level concerns about risk and uncertainty preferred using PP service as a means to achieve interpersonal trust. These women thought that an informal payment would provide the basis for interpersonal trust between themselves and the chosen obstetricians. In practice, however, obstetricians involved in PP rarely acknowledged this reciprocal relationship and hardly expressed the additional courtesy expected by patients. As a result, PP service only created an expensive impersonal trust that was mistaken as interpersonal trust by patients. Negative outcomes from PP often caused disappointment that could eventually lead to medical litigation. The study suggests that there are some negative impacts of PP within the health system. Negative experiences among PP users may undermine trust not only in the specific doctor but also trust in health professionals and hospitals more generally. Steps need to be undertaken to protect and strengthen existing impersonal trust, which combine institutional trust based on good governance and service quality with trust in the professional standard of practice. The explanatory framework developed through this study provides a foundation for further studies of trust in different specialties and care settings.     

我院病历全面质量管理的构想与实践

从全面质量管理理念出发,对实施病历全面质量管理进行了初步构想,进一步明确了病历质量控制的功能定位及拓展,贯彻全程、全员、全面质控的理念,重视病历质量控制中的反馈和交流环节,强化质量文化的建设和传承.同时在病历质量控制实践中,从组织体系的完善、评价指标体系的调整、质控关键点的确定、环节质控与终末质控的结合、质控培训体系的建设等方面,加强了病历质量控制的综合管理力度.     

Social capital, political trust and self rated-health: a population-based study in southern Sweden

AIM: To investigate the association between political trust (an aspect of institutional trust) and self-rated health, taking generalized (horizontal) trust in other people into account. METHODS: The 2004 public health survey in Sk?ne is a cross-sectional postal questionnaire study answered by 27,963 respondents aged 18-80 years, yielding a 59% response rate. A logistic regression model was used to investigate the associations between political trust in the Riksdag (national parliament) and self-rated health. Multivariate analyses of political trust and self-rated health were performed in order to investigate the importance of possible confounders. RESULTS: Poor health was reported by 28.7% of the men and 33.2% of the women. In total, 17.3% and 11.6% of the male and female respondents, respectively, reported that they had no trust at all in the Riksdag. The addition of generalized (horizontal) trust in the multivariate models reduced the odds ratios of poor self-rated health in the "no political trust at all' category as compared to the "very high political trust' category from 2.4 (1.8-3.1) to 2.1 (1.6-2.7) among men and from 1.9 (1.4-2.4) to 1.6 (1.3-2.1) among women. CONCLUSIONS: Low political trust in the Riksdag seems to be significantly associated with poor self-rated health, even after adjustments for plausible confounders, including generalized (horizontal) trust.     

北京市某三级甲等综合性教学医院医疗质量评价——住院死亡率

目的探讨使用住院死亡类指标评价北京市某三级甲等综合性教学医院医疗质量。方法基准比较,包括以年度为基准的医院自身纵向比较和以领先者为基准的医院间横向比较。结果该医院住院患者总死亡率,特别是手术患者住院死亡率呈逐年下降趋势;围手术期死亡率与重返手术室患者住院死亡率呈波动状态。在5所同地区、同类、同级别医院中,该医院2006年手术患者住院死亡率和重返手术室患者住院死亡率处于第二位;住院患者总死亡率处于第三位,围手术期死亡率处于第四位。结论该医院医疗质量相对稳定并有所改善,但在5所同地区、同类、同级别的医院中尚未达到领先水平。     

Privatization of a public hospital: a quality improvement strategy

Public hospitals face mounting challenges posed by the rise of managed care, increasing hospital competition, growing responsibilities in indigent care, and stagnant public sector revenues. Privatization exists as a viable strategy for reengineering the structure and operation of public hospitals to meet the new demands of quality and efficiency imposed by a rapidly changing health care environment.     

Social capital, political trust and experience of cannabis smoking: a population-based study in southern Sweden

OBJECTIVE: To investigate whether political mistrust in the Riksdag (the national parliament in Sweden) is an independent characteristic of cannabis smokers, or whether it reflects low confidence in people in general, and therefore low social capital. METHOD: The 2004 public health survey in Sk?ne is a cross-sectional postal questionnaire study answered by 27,757 respondents aged 18-80 with a 59% response rate providing data on political trust, cannabis smoking, and potential confounders. RESULTS: 13.9% of the men and 8.3% of the women had smoked cannabis; 17.3% of the male and 11.6% of the female respondents reported no trust at all in the Riksdag, and another 38.2% and 36.2%, respectively, reported a moderate political trust. Young age, high education, unemployment, low generalized trust in other people, and lower levels of political trust were associated with cannabis smoking, even after multiple adjustments. The groups men with no trust at all in the Riksdag, and women with high trust, not particularly high political trust and no political trust at all had significantly higher odds ratios of cannabis smoking than the very high trust reference category. The results thus somewhat differed between men and women. CONCLUSION: Low political trust is associated with cannabis smoking, independently of trust in people in general.     

Competing interests in healthcare: a conflict of quality. Part I: definition, background, and evidence

This policy paper investigates whether physician conflicts of interest have an effect on physicians' quality of care and whether implementation of conflict-of-interest policies will ameliorate any negative effects of divergent interests. Some government regulations are discussed in a policymaking perspective. We also suggest that healthcare organizations establish specific policies guarding against potential negative outcomes related to conflicts of interest. At the pinnacle of the conflict-of-interest debate resides the patient. One of the most important effects of disclosure is providing patients with the opportunity to make informed decisions regarding their healthcare. Research supports that conflicts of interest are inherent and oftentimes unavoidable in the healthcare setting.     

Recuperating from BSE: the shifting UK institutional basis for trust in food

How did the UK, the villain of Europe as the source of the greatest recent crisis in trust in food, become the country with the highest reported levels of trust in the safety of food? The nature of the BSE crisis is explored, particularly how it rapidly became primarily a question of trust in government and science. The responses to the crisis by the different institutional actors is examined, especially the provisioning system and retailers, but also consumers themselves. A major reform of governmental institutional architecture resulted in the Food Standards Agency, a model for European development. But, we argue that this reform conformed with growing retailer power and control over the supply chain to provide a new institutional basis for trust in food.     

Social capital, political trust and purchase of illegal liquor: a population-based study in southern Sweden

AimsTo investigate the association between political trust in the Riksdag (the national parliament in Sweden) and having purchased illegal liquor during the past 12 months.MethodsThe 2004 public health survey in Skåne is a cross-sectional postal questionnaire study answered by 27,757 respondents aged 18–80 with a 59% response rate. A logistic regression model was used to investigate the associations between political trust and having purchased illegal liquor during the past 12 months. Multivariate analyses of political trust and having purchased illegal liquor were performed in order to investigate the importance of possible confounders (including generalized/horizontal trust in other people).ResultsA 21.2% fraction of the men and 9.6% of the women had purchased illegal alcohol during the past 12 months. A total of 17.3% and 11.6% of the male and female respondents, respectively, reported that they had no trust at all in the national parliament, and another 38.2% and 36.2%, respectively, reported that their political trust was not particularly high. Respondents in younger age groups, with medium/low education, economic stress, low horizontal trust and not particularly high and no political trust at all and no opinion had significantly higher levels of having purchased illegal liquor. The significant odds ratios of having purchased illegal liquor in the not particularly high political trust and no political trust at all categories were somewhat reduced although still significant after multiple adjustments.ConclusionThe results suggest that political trust may have an independent effect on the propensity to purchase illegal liquor in Sweden.     

An audit of the use of isolation facilities in a UK National Health Service trust

To aid the ongoing battle against hospital-acquired infection in the UK, all acute National Health Service (NHS) trusts should have audit data about how dedicated isolation beds within the trust are being used. In a previously published audit, we demonstrated that one-third of patients admitted to a dedicated isolation room in Tayside were not thought to be an infection risk by experienced healthcare staff. Since this audit, Tayside's isolation facilities have moved from a small peripheral 'fever' hospital to a large central teaching hospital site. At the time of this move, and using the above audit data, we designed and implemented a guideline for general practitioners and hospital doctors regarding the admission of patients to an isolation bed. The aim of this study was to compare the use of isolation beds before and after the move to the new facilities, which we anticipated would increase the demand for isolation. The results show that by all three criteria used, the utilization of isolation beds has deteriorated following the move, mainly due to the increased admission of general medical 'boarders' and low-risk infection patients. At a time when hospital-acquired infections are increasing, NHS trusts should ensure that dedicated isolation beds are used appropriately.