Avoidable mortality. Changes in the new century?

OBJECTIVES: To analyze time trends and the geographical distribution of avoidable mortality in the autonomous community of Valencia and its health departments by sex in the periods 1990-1994, 1995-1999, and 2000-2004. MATERIAL AND METHOD: Twenty-one causes of avoidable mortality were analyzed. The deaths analyzed corresponded to residents in the autonomous community of Valencia between 1990 and 2004. Age-standardized mortality rates were calculated using the direct method. To study time trends in the geographical area of interest for each period and sex, comparative mortality ratios were calculated. To analyze geographical distribution, standardized mortality rates were calculated by the indirect method. RESULTS: The total number of avoidable deaths was 38,061 (7.1% of overall deaths). Men accounted for 76.2% and women for 23.8%. By groups, 82.4% were preventable and 17.6% were treatable. Preventable deaths represented 86.5% of deaths in men and 69.4% of those in women. Avoidable mortality in Valencia significantly decreased in both sexes, this decrease being more marked in the group of treatable deaths and in men. Mortality from lung cancer in women significantly increased. Between 2000 and 2004, none of the health departments showed a significant excess of treatable mortality. CONCLUSIONS: In the autonomous community of Valencia, there was a greater decrease in avoidable mortality than in general mortality. The increase in lung cancer in women was notable.     

The myths of motivation: Time for a fresh look at some received wisdom in the eating disorders?

The eating disorders typically involve poor motivation to change. This article reviews the evidence behind many of our beliefs about motivation and whether we need a different conceptual framework for understanding why patients commonly get "stuck." The outcome literature is reviewed, and demonstrates that there is little evidence that we are effective in enhancing motivation to induce changes in symptoms. Indeed, there are suggestions that commonly used models are unhelpful. Verbal expressions of motivation are not the best indicator of likely treatment response, and can best be understood as providing a "manifesto," which has functions that can obstruct recovery from the eating disorder. A behavioral analysis of motivation is likely to be more effective. Cognitive, emotional, and behavioral methods for enhancing motivation are outlined, with the aim of bypassing the motivational manifesto and encouraging positive therapeutic change.     

The abortion pill: a solution for unsafe abortions in developing countries?

The abortion pill is a new abortion technique which does not require technically skilled health personnel. Several clinical researchers have stated that the ease of administration of the abortion pill gives it the potential to save lives in countries where thousands of women die annually from complications of failed abortions due to poor health services. This article discusses medical and users' aspects of the abortion pill, with particular emphasis on its use in developing countries, and questions the usefulness of the abortion pill in areas where health care facilities are in short supply. It stresses the need to consider the social, cultural and health care context in which the abortion pill will be used before it is sold on the world market. The safety and efficacy of the abortion pill could be adversely affected by the way women perceive its effectiveness, women's beliefs about conception and pregnancy, and their health status. In the present two-phase administration form the abortion pill is not likely to be appropriate for use in developing countries with a shortage of health care facilities.     

Will our health system fall apart? The need for a new paradigm

It is a truism that medicine is in a crisis but the truism is right. This paper sets out the symptoms of the crisis. The effectiveness of modern medicine has been questioned by many. Doctors use too many tests and do not always understand the results. This is the practice of 'decerebrate medicine'. The alleged triumphs of modern medicine have made only a modest impact on mortality rates and death from iatrogenic causes is real. Modern medicine is allied to the industrial society with its hierarchies and division of work. This leads to tensions between doctors and between doctors and their patients. Administrators fear the progressive rise in health costs and ask whether more really means better. Economists demand evaluation of medical procedures and there is a growing demand for real preventive medicine. Health is a problem for the whole of society. This paper then sets out the epistemological aspects of the crisis in medicine. It suggests that a new paradigm must be constructed in the light of the scientific revolution. The concept of medicine based on analytical science with its reductionism and disjunctivism is not enough to cover the complexity of man. The new paradigm needs to embrace all the sciences, both of nature and of man. A view is given of how this process of comprehending an exceedingly complex problem should be tackled and the role to be played by information sciences.     

From consumerism to partnership? Britain's National Health Service at the turn of the century.

It has been argued that "consumerism" has been one of the main influences on health policy in many countries over the last decade or so. This article focuses on the role of consumerism in U.K. health policy during this period through the introduction of changes in National Health Service provision such as introduction of the quasi-market, creation of the new managerialism, and new organizational structures set up under the recent Labour government. It considers the consequences of these changes for the users of health care and for citizenship rights, in particular the extent to which the changes have empowered these users and citizens.