Research needs and opportunities. Maintaining the momentum.
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Biomedical subjects
Publications and source records attributed to C Lenfant.
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As the national movement for health care reform gives priority to activities that will achieve better and more efficient delivery of health care services, the cost-effectiveness of services will need to be calculated in some type of standard fashion. Although the cost-effectiveness of preventing and controlling acute diseases (for example, through mass immunization programs) has been well appreciated, less attention has been paid to the chronic diseases, which, in fact, account for the majority of illness and death in the United States today. This paper uses prevention of a common chronic disease, stroke, as a model to illustrate how cost savings measures may be developed and used to guide public policy.
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Despite record levels of support, concerns over the ability of individual investigators to obtain funding for their research have been growing within the biomedical research community. The concerns have been focused almost exclusively upon the outcomes of funding decisions, and have ignored the pressures that produce them. Yet, it is those pressures that constitute our 'common ground for concern'. Resources committed in response to the pressures from special interest groups are unavailable for general competition based upon scientific merit. We in the biomedical research community must recognize that such self-interested efforts to dedicate resources undermine the integrity of the existing processes for making funding decisions. As a community, we should instead attempt to ensure that adequate resources are available to support the best quality research.
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For nearly two decades, the National High Blood Pressure Education Programme has administered a programme of public, patient, and professional education in an effort to reduce uncontrolled hypertension, an important public health problem in the USA. A broad network has been established and many partners have joined forces to form the NHBPEP. During the tenure of the programme, awareness, treatment, and control rates for high BP have increased dramatically, and this has been associated with a nearly 57% reduction in age adjusted stroke mortality. In 1988, stroke cost this nation about $23.3 billion a year in direct and indirect costs. Much of this is attributed to uncontrolled hypertension. It seems likely that controlling hypertension saved nearly $1.5 billion in direct and indirect costs for stroke in one year alone. This is in addition to the other health care costs attributed to coronary heart disease that have been reduced as a result of treating high BP. A portion of this may be related to the NHBPEP.
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