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101.
Clark B 《Annals of health law / Loyola University Chicago, School of Law, Institute for Health Law》2011,20(2):253-327, 5p preceding i
The dominant rhetoric in the health care policy debate about cost has assumed an inherent tension between access and quality on the one hand, and cost effectiveness on the other; but an emerging discourse has challenged this narrative by presenting a more nuanced relationship between access, quality, and cost. This is reflected in the discourse surrounding health literacy, which is viewed as an important tool for achieving all three goals. Health literacy refers to one's ability to obtain, understand and use health information to make appropriate health decisions. Research shows that improving patients' health literacy can help overcome access barriers and empower patients to be better health care partners, which should lead to better health outcomes. Promoting health literacy can also reduce expenditures for unnecessary or inappropriate treatment. This explains why, as a policy matter, improving health literacy is an objective that has been embraced by almost every sector of the health care system. As a legal matter, however, the role of health literacy in ensuring quality and access is not as prominent. Although the health literacy movement is relatively young, it has roots in longstanding bioethical principles of patient autonomy, beneficence, and justice as well as the corresponding legal principles of informed consent, the right to quality care, and antidiscrimination. Assumptions and concerns about health literacy seem to do important, yet subtle work in these legal doctrines--influencing conclusions about patient understanding in informed consent cases, animating decisions about patient responsibility in malpractice cases, and underlying regulatory guidance concerning the quality of language assistance services that are necessary for meaningful access to care. Nonetheless, health literacy is not explicitly treated as a legally relevant factor in these doctrines. Moreover, there is no coherent legal framework for incorporating health literacy research that challenges traditional assumptions about patient comprehension and decision-making, and that emphasizes the need for providers to improve communication and take affirmative steps to assess patient understanding. The absence of a clear and robust consideration of health literacy in these doctrines undermines core access and quality aims, and it means that such laws are of limited efficacy in promoting health literacy. Returning to the theme that the health literacy problem reflects a complementary view of access, quality and cost, it is likely that the cost implications of this problem (and not concerns about quality and access) will motivate the kind of health literacy reform that may ultimately strengthen existing quality and access standards. One recent example of this can be seen in reforms linked to government, insurer and provider attempts to reduce costly medication errors. 相似文献
102.
In west-central Alberta, Canada, an ambitious collaborative conservation program for grizzly bears began in 1999, after extensive
controversy over the Cheviot coal mine project and successful negotiation of a unique federal–provincial strategic framework
for grizzly bear conservation. Unfortunately that program was effectively terminated without any substantive implementation
of its research findings. The regional ecosystem approach for conserving grizzlies in the Foothills Model Forest originated
in federal and provincial legislative processes but proved vulnerable to shifting goals and containment by a single powerful
participant. This case study’s results demonstrate vulnerabilities of the ecosystem management approach to conserving large
carnivores. To enable other such conservation efforts to achieve their goals, we recommend supporting emergent small-scale
initiatives and designing collaborative institutions that limit the potential for containment of decision processes. 相似文献
103.
The Mental Health of 13–17 Year-Olds in Australia: Findings from the National Survey of Mental Health and Well-Being 总被引:1,自引:0,他引:1
The prevalence of 3 mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder),
the prevalence of mental health problems, and rates of health-risk behaviours among those with problems, along with patterns
of service utilisation, are reported for 1490 adolescents aged 13–17 years in Australia. Mental disorders were assessed using
the Diagnostic Interview Schedule for Children Version IV completed by parents. Parents and adolescents also completed standard
questionnaires designed to assess mental health problems, health-risk behaviours and service use. On the basis of parent reports,
13% of adolescents were identified as having mental health problems, while 19% were identified as having problems on the basis
of adolescent reports. Many of the adolescents with mental health problems also had problems in other areas of their lives.
Only 31% of those identified by parents as having mental health problems and 20% of adolescents who identified themselves
as having problems, had attended a professional service during the 6 months prior to the survey. School counselling was the
service most frequently attended. Clinical and population health interventions must take into account the presence of co-morbid
problems and low rates of health service usage reported amongst adolescents with mental health problems.
相似文献
M. G. SawyerEmail: |
104.
Tamer Awad Tarek Belal Jack DeRuiter C. Randall Clark 《Forensic science international》2010,194(1-3):39-48
The methoxy methyl phenylacetones share an isobaric relationship (equivalent mass but different elemental composition) to the controlled precursor substance 3,4-methylenedioxyphenylacetone (3,4-methylenedioxyphenyl-2-propanone; 3,4-MDP-2-P). The ten ring substituted methoxy methyl phenylacetones are resolved by capillary gas chromatography on a modified cyclodextrin stationary phase. All ten regioisomeric ketones eluted before the controlled precursor substance 3,4-methylenedioxyphenylacetone. The vapor phase infrared spectra generated from the capillary column effluent clearly differentiated 3,4-MDP-2-P from the various methoxy methyl phenylacetones. Additionally the methoxy methyl phenylacetones provide unique individual infrared spectra. Infrared absorption frequencies and patterns confirmed the relative position of the methoxy-group and the acetone side-chain for the regioisomeric ketones. 相似文献
105.
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107.
108.
John Clark 《Capitalism Nature Socialism》2013,24(1):125-129
Stephen G. Bunker. Underdeveloping the Amazon: Extraction, Unequal Exchange, and the Failure of the Modern State. University of Chicago Press, Chicago, 1985. Susanna Hecht and Alexander Cockburn: The Fate of the Forest: Developers, Destroyers and Defenders of the Amazon. Harper Perennial, New York, 1990. Chico Mendes: Fight for the Forest: Chico Mendes in His Own Words. (Additional material by Tony Gross). Latin American Bureau, London, 1989; distributed in U.S. by Monthly Review Press. 相似文献
109.
110.
David Clark 《West European politics》2013,36(3):134-163
This article compares the strategy of British governments towards elected local government following the onset of fiscal stress in the mid‐1970s with those of two other western European countries with a unitary system of government: France and Sweden. The conclusion reached is that, notwithstanding different national configurations of central‐local government relations and the distinctiveness of the British strategy, there are similar policy and institutional outcomes in each case. In so far as such outcomes are taking place irrespective of the party political or ideological complexion of governments, they are consistent with a neo‐Fordist interpretation of local government restructuring. 相似文献