Articles: health.
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In order to assess the validity of self-reports of physical conditions, symptoms, and ailments, the nine-year mortality experience of a random population sample of 4590 adults, aged 35-94, in Alameda County, California, was examined. Consistently, increased risks of death from any cause and from ischemic heart disease were found for several self-reports. Multiple logistic analyses of deaths from ischemic heart disease showed that the best predictors for men were reports of "high blood pressure," "heart trouble," and "shortness of breath" and for women were "heart trouble," "swollen ankles," and "chest pain." The strength and consistency of the relationships between these self-reports and risk of death from all causes and from ischemic heart disease argues for the validity of such reports as measures of underlying disease state.
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In 1983, the federal and state governments spent +340 million to provide contraceptive services--four percent more than they spent during the previous year. Title X of the Public Health Service Act, still the leading source of funding, accounted for +117 million, or 34 percent of all public expenditures. Almost as important was the +108 million (32 percent of total expenditures) provided through Title XIX of the Social Security Act (Medicaid). ⋯ Ninety percent of sterilization expenditures were made by the federal government--86 percent through the Medicaid program. In addition, the states and the federal government spent +71 million to provide 216,000 abortions in 1983. Unlike public funding for either contraceptive services or sterilization, almost all of the funding for abortion came from the states rather than from the federal government.
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Historical Article
Health personnel training in the Nicaraguan health system.
The "Unified National Health System" of Nicaragua was established in 1979, in an attempt to transform some of Latin America's worst health indices. This system, based on the stated principles of planning, regionalization, public participation, and primary care, has prioritized the development of health professions training programs appropriate to its special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. ⋯ Training for allied health personnel has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a tremendous need for educational resources both human and material. This article reviews the status of health personnel training in Nicaragua today, the integration of these programs into planning for the health system, and problems arising from their rapid appearance.