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PubMed1998

Application of functional independence measure-function related groups and resource utilization groups-version III systems across post acute settings.

OBJECTIVES: The present study evaluated alternative patient classification systems for skilled nursing facility and rehabilitation facility patients. METHODS: Medicare patients were selected from a random sample of 27 rehabilitation facilities and 65 skilled nursing facilities participating in a national longitudinal study of subacute care. Detailed casemix and resource use data was obtained on 513 patients with hip fracture and 483 stroke patients. The Functional Independence Measure-Function Related Groups (FIM-FRGs) classification system for rehabilitation facilities was replicated on length of stay and tested on resource use for rehabilitation facility patients as well as for skilled nursing facility patients. Modifications to the FIM-FRGs also were tested. The Resource Utilization Groups-Version III classification was tested on rehabilitation facility patients. RESULTS: The FIM-FRGs explained the same amount of variance in length of stay as in the original FIM-FRGs development sample (R2 hip fracture = 0.14, R2 stroke = 0.28), and similar variance in resource use. A modified version of the FIM-FRGs explained more variance in length of stay (R2 hip fracture = 0.19, R2 stroke = 0.39) and resource use (R2 hip fracture = 0.20, R2 stroke = 0.41). Neither model adequately predicted length of stay or resource use in skilled nursing facility patients. The Resource Utilization Groups-Version III rehabilitation groups accounted for little variance in rehabilitation facility patients' per-diem resource use (R2 = 0.11). CONCLUSIONS: The FIM-FRGs are valid for resource use as well as length of stay for rehabilitation facility patients, but are not valid for skilled nursing facility patients. Similarly, the Resource Utilization Groups-Version III system does not apply to rehabilitation facility patients. Related work, however, suggests that development of a single episode-based patient classification system for skilled nursing facility and rehabilitation facility patients is possible and should be pursued.

Activities of Daily Living↗
PubMed2006

Interactions between resource availability and enemy release in plant invasion.

Understanding why some exotic species become invasive is essential to controlling their populations. This review discusses the possibility that two mechanisms of invasion, release from natural enemies and increased resource availability, may interact. When plants invade new continents, they leave many herbivores and pathogens behind. Species most regulated by enemies in their native range have the most potential for enemy release, and enemy regulation may be strongest for high-resource species. High resource availability is associated with low defence investment, high nutritional value, high enemy damage and consequently strong enemy regulation. Therefore, invasive plant species adapted to high resource availability may also gain most from enemy release. Strong release of high-resource species would predict that: (i) both enemy release and resources may underlie plant invasion, leading to potential interactions among control measures; (ii) increases in resource availability due to disturbance or eutrophication may increase the advantage of exotic over native species; (iii) exotic species will tend to have high-resource traits relative to coexisting native species; and (iv) although high-resource plants may experience strong enemy release in ecological time, well-defended low-resource plants may have stronger evolutionary responses to the absence of enemies.

Adaptation, Physiological↗
PubMed1995

Correlates of mammography among women with low and high socioeconomic resources.

BACKGROUND: Although screening mammography rates have increased, even women with higher incomes and more formal education do not all obtain the exam. This study examined why a modest proportion of higher income/higher education women do not get screened and, conversely, why a small percentage of lower income/lower education women do receive screening. METHODS: Data were from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention. A total of 3,014 women, ages 40-75, were in the sample. Low-resource women had incomes of less than $20,000 and less than a high school diploma. High-resource women had incomes of $30,000 or more and at least some college education. RESULTS: Correlates of screening status were similar for both resource groups. Recency of Papanicolaou test, recency of clinical breast exam, and regular breast self-examination were associated with higher rates of screening. Four or more persons in a household were associated with lower rates. Among low-resource women, incomes of $10,000-$19,999 were associated with higher likelihood of screening. An income of $50,000 or more was associated with screening among high-resource women. CONCLUSIONS: The fact that several variables were important for both resource groups suggests that targeted interventions could have benefits across a wide population. Nonetheless, in the high-resource group, 2-year rates never exceeded 80% and repeated screening never exceeded 60%. Rates for low-resource women were over 30% lower. Medical care utilization data did not differ between the two resource groups sufficiently to account for the discrepant rates. Improving screening rates in both resource groups remains a major challenge.

Adult↗
PubMed2003

The evolution of resource use.

The evolution of a consumer exploiting two resources is investigated. The strategy x under selection represents the fraction of time or energy an individual invests into extracting the first resource. In the model, a dimensionless parameter alpha quantifies how simultaneous consumption of both resources influences consumer growth; alpha<0 corresponds to hemi-essential resources, 0 1 corresponds to antagonistic resources. An analysis of the ecological and evolutionary dynamics leads to five conclusions. First, when alpha< or =1, there is a unique singular strategy x* for the adaptive dynamics and it is evolutionarily stable and globally convergent stable. Second, when alpha=1, the singular strategy x* corresponds to the populations exhibiting an ideal free distribution and a population playing this strategy can invade and displace populations playing any other strategy. Third, when alpha>1, the strategies x=0 and x=1 are evolutionarily stable and convergent stable. Hence, if the populations initially specialize on one resource, evolution amplifies this specialization. Fourth, when alpha is slightly larger than one (i.e. the resources are slightly antagonistic), there is a convergent stable singular strategy whose basin of attraction is almost the entire strategy space (0,1). This singular strategy is evolutionarily unstable and serves as an evolutionary branching point. Following evolutionary branching, our analysis and numerical simulations suggest that evolutionary dynamics are driven toward an end state consisting of two populations specializing on different resources. Fifth, when alpha>>1, there is only one singular strategy and it is convergent unstable and evolutionarily unstable. Hence, if resources are overly antagonistic, evolutionary branching does not occur and ultimately only one resource is exploited.

Animals↗
PubMed2005

Fine root chemistry and decomposition in model communities of north-temperate tree species show little response to elevated atmospheric CO2 and varying soil resource availability.

Rising atmospheric [CO2] has the potential to alter soil carbon (C) cycling by increasing the content of recalcitrant constituents in plant litter, thereby decreasing rates of decomposition. Because fine root turnover constitutes a large fraction of annual NPP, changes in fine root decomposition are especially important. These responses will likely be affected by soil resource availability and the life history characteristics of the dominant tree species. We evaluated the effects of elevated atmospheric [CO2] and soil resource availability on the production and chemistry, mycorrhizal colonization, and decomposition of fine roots in an early- and late-successional tree species that are economically and ecologically important in north temperate forests. Open-top chambers were used to expose young trembling aspen (Populus tremuloides) and sugar maple (Acer saccharum) trees to ambient (36 Pa) and elevated (56 Pa) atmospheric CO2. Soil resource availability was composed of two treatments that bracketed the range found in the Upper Lake States, USA. After 2.5 years of growth, sugar maple had greater fine root standing crop due to relatively greater allocation to fine roots (30% of total root biomass) relative to aspen (7% total root biomass). Relative to the low soil resources treatment, aspen fine root biomass increased 76% with increased soil resource availability, but only under elevated [CO2]. Sugar maple fine root biomass increased 26% with increased soil resource availability (relative to the low soil resources treatment), and showed little response to elevated [CO2]. Concentrations of N and soluble phenolics, and C/N ratio in roots were similar for the two species, but aspen had slightly higher lignin and lower condensed tannins contents compared to sugar maple. As predicted by source-sink models of carbon allocation, pooled constituents (C/N ratio, soluble phenolics) increased in response to increased relative carbon availability (elevated [CO2]/low soil resource availability), however, biosynthetically distinct compounds (lignin, starch, condensed tannins) did not always respond as predicted. We found that mycorrhizal colonization of fine roots was not strongly affected by atmospheric [CO2] or soil resource availability, as indicated by root ergosterol contents. Overall, absolute changes in root chemical composition in response to increases in C and soil resource availability were small and had no effect on soil fungal biomass or specific rates of fine root decomposition. We conclude that root contributions to soil carbon cycling will mainly be influenced by fine root production and turnover responses to rising atmospheric [CO2], rather than changes in substrate chemistry.

Atmosphere↗
PubMed2007

Investment in defense and cost of predator-induced defense along a resource gradient.

An organism's investment in different traits to reduce predation is determined by the fitness benefit of the defense relative to the fitness costs associated with the allocation of time and resources to the defense. Inherent tradeoffs in time and resource allocation should result in differential investment in defense along a resource gradient, but competing models predict different patterns of investment. There are currently insufficient empirical data on changes in investment in defensive traits or their costs along resource gradients to differentiate between the competing allocation models. In this study, I exposed tadpoles to caged predators along a resource gradient in order to estimate investment in defense and costs of defense by assessing predator-induced plasticity. Induced defenses included increased tail depth, reduced feeding, and reduced swimming activity; costs associated with these defenses were reduced developmental rate, reduced growth, and reduced survival. At low resource availability, these costs predominately resulted in reduced survival, while at high resource availability the costs yielded a reduced developmental rate. Defensive traits responded strongly to predation risk, but did not respond to resource availability (with the exception of feeding activity), whereas traits construed as costs of defenses showed the opposite pattern. Therefore, defensive traits were highly sensitive to predation risk, while traits construed as costs of defense were highly sensitive to resource allocation tradeoffs. This difference in sensitivity between the two groups of traits may explain why the correlation between the expression of defensive traits and the expression of the associated defense costs was weak. Furthermore, my results indicate that genetic linkages and mechanistic integration of multiple defensive traits and their associated costs may constrain time and resource allocation in ways that are not addressed in existing models.

Adaptation, Physiological↗
PubMed2006

Use of diabetes resources in adults attending a self-management education program.

OBJECTIVE: To identify the types of resources used to acquire information or assistance in the management of diabetes, and to identify persons who are more or less likely to use a variety of diabetes resources. METHODS: Through the use of a questionnaire and review of patient records, sociodemographic, clinical, and health care service utilization characteristics were obtained for 267 individuals with type 2 diabetes from a culturally diverse diabetes education centre. Descriptive analyses were performed to provide information on the types of diabetes resources used by age, sex and primary language spoken. Multivariable Poisson regression was used to predict low from high users of a variety of diabetes resources. RESULTS: On average, most patients used four different resources. The most commonly cited were physicians or endocrinologists; diabetes educators; and magazines, newspapers, books or television. Those who did not speak English, were born outside of Canada, had a lower level of education, or who were older used fewer diabetes resources. CONCLUSION: Notably, the characteristics of individuals who are less likely to use resources or a variety of resources reflect the basic determinants of health (i.e., age, sex, ethnicity or primary language spoken, and education). PRACTICE IMPLICATIONS: We need to develop resources that are equitably accessible and of interest to all patients, particularly for individuals who do not speak English, who have lower education and literacy levels, and who are older. Furthermore, imparting the skills on how to find and utilize currently existing resources to assist in chronic disease self-management should be promoted as a core aspect of self-management education.

Adult↗
PubMed2000

Effects of body size and resource availability on dispersal in a native and a non-native estuarine snail.

I manipulated snail densities of two coexisting species of salt marsh snail, Cerithidea californica Haldeman (native) and Batillaria attramentaria Sowerby (non-indigenous) to investigate how resource levels set by intraspecific competition may influence dispersal rates. I used two distinct size classes of the snails (mature and immature) to determine if the effects of competition on dispersal differed between developmental stages of a consumer. Dispersal attempts were measured within enclosure pens by counting snails climbing the sides of the enclosure. The influence of snail density per se and resource levels (which were set by snail densities) on dispersal rates were separated by comparing responses of snails to density before and after resources became depleted. For large snails of both species, dispersal increased as resource levels decreased, supporting the hypothesis that competition influences dispersal rates. Small snails of both species, in contrast, always dispersed at relatively higher rates than larger individuals, but were not influenced by variation in resource levels. This result corroborates other studies that have shown reduced competition in these species at smaller size, and suggests that another mechanism, such as genetically coded behavior to disperse when young, influences their behavior. Previous experiments demonstrated Batillaria's superior resource conversion efficiency; therefore, I had hypothesized that for any given resource level, Cerithidea would disperse more, because it was more affected by resource availability. Adult Batillaria, however, responded more sensitively to resource levels (i.e., dispersed more at any given resource level) than Cerithidea. This counter-intuitive result illustrates the potential importance of genetic limitations on behavioral responses available to a species. Constraints on behavioral responses may have been accentuated since Batillaria is a non-indigenous species whose evolved behavioral responses are not necessarily adapted to its present, non-native environment.

Journal Article↗
PubMed1997

The Nuclear Receptor Resource Project.

We have expanded the original Glucocorticoid Receptor Resource (GRR) database to include several individual resources as part of a larger project called the Nuclear Receptor Resource (NRR). In addition to the GRR, the NRR currently features the Thyroid Hormone Receptor Resource, the Androgen Receptor Resource, the Mineralocorticoid Receptor Resource, the Vitamin D Receptor Resource, and the Steroid Receptor Associated Proteins Resource. The goal of the NRR project is to provide a comprehensive resource for information on the nuclear receptor superfamily, and to provide a forum for the dissemination and discussion of both published and unpublished material on these proteins. Although the individual resources are managed from different servers, all the files are integrated and can be accessed through the project's Home Page, housed at http://nrr. georgetown.edu/nrr.html. In the near future, we hope to expand the project to contain information on other nuclear receptors and to better our electronic publication system. To accomplish this, we encourage the involvement of nuclear receptor investigators in the NRR.

Amino Acid Sequence↗
PubMed2006

Application of random effects to the study of resource selection by animals.

1. Resource selection estimated by logistic regression is used increasingly in studies to identify critical resources for animal populations and to predict species occurrence. 2. Most frequently, individual animals are monitored and pooled to estimate population-level effects without regard to group or individual-level variation. Pooling assumes that both observations and their errors are independent, and resource selection is constant given individual variation in resource availability. 3. Although researchers have identified ways to minimize autocorrelation, variation between individuals caused by differences in selection or available resources, including functional responses in resource selection, have not been well addressed. 4. Here we review random-effects models and their application to resource selection modelling to overcome these common limitations. We present a simple case study of an analysis of resource selection by grizzly bears in the foothills of the Canadian Rocky Mountains with and without random effects. 5. Both categorical and continuous variables in the grizzly bear model differed in interpretation, both in statistical significance and coefficient sign, depending on how a random effect was included. We used a simulation approach to clarify the application of random effects under three common situations for telemetry studies: (a) discrepancies in sample sizes among individuals; (b) differences among individuals in selection where availability is constant; and (c) differences in availability with and without a functional response in resource selection. 6. We found that random intercepts accounted for unbalanced sample designs, and models with random intercepts and coefficients improved model fit given the variation in selection among individuals and functional responses in selection. Our empirical example and simulations demonstrate how including random effects in resource selection models can aid interpretation and address difficult assumptions limiting their generality. This approach will allow researchers to appropriately estimate marginal (population) and conditional (individual) responses, and account for complex grouping, unbalanced sample designs and autocorrelation.

Animals↗
PubMed1997

Stability and change in psychosocial resources during caregiving and bereavement in partners of men with AIDS.

This study examines the effects of caregiving and bereavement on psychosocial resources in HIV+ and HIV- caregivers of men with AIDS. We explored three hypotheses regarding these effects: the "wear and tear" hypothesis, which asserts that the chronic stress of caregiving and bereavement diminishes resources; the "enhancement" hypothesis, which asserts that caregiver resources may increase in response to increased demands; and the "personality" hypothesis, which asserts that psychosocial resources reflect stable personality characteristics. We addressed four questions: (a) What are the effects of caregiving on resources? (b) How do these resources vary by the imminence of the partner's death? (c) What is the effect of the partner's death on these resources? and (d) How does the caregivers' HIV serostatus influence the effects of caregiving and bereavement on resources? Support for the personality hypothesis predominated, with some support for the wear and tear hypothesis, depending on the resource in question. In general, HIV seropositivity did not put people at additional risk for resource depletion.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Availability of and attitudes toward resources on alternative medicine products in the community pharmacy setting.

OBJECTIVE: To examine the availability of resources on dietary supplements in the community pharmacy setting and to assess the attitudes of community pharmacists toward these resources. DESIGN: Cross-sectional study. SETTING: Community pharmacies in New York and New Jersey that serve as experiential sites for senior student pharmacists at the Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University. PARTICIPANTS: Preceptors or full-time pharmacists. INTERVENTION: Mailed survey. MAIN OUTCOME MEASURES: Frequency of use, availability of, and pharmacists' satisfaction with resources on alternative medicines, defined in the survey as any product including herbal remedies, vitamins, minerals, and natural products that may be purchased at a health food store, pharmacy, supermarket, alternative medicine store/magazine for the purpose of self-treatment. RESULTS: A total of 64 pharmacists characterized their frequency of use of resources on alternative medicines while formulating responses to questions as: never (n = 5; 7.8%), seldom (n = 31; 48.4%), often (n = 24; 37.5%), or always (n = 4; 6.3%). A total of 30 different resources were available to 40 respondents. The most commonly available resources were the PDR for Herbal Medicines (42.5%), The Review of Natural Products (20.0%), and the Web site of the National Center for Complementary and Alternative Medicine (12.5%). Of 54 respondents, 4 (7.1%) reported being completely dissatisfied with the available resources; 17 (31.5%) were somewhat dissatisfied; 25 (46.3%) were somewhat satisfied; and 8 (14.8%) were completely satisfied with the resources available to them. Topics the pharmacists most commonly wanted to see improved included safety (72.7%), interactions (70.9%), and uses (69.1%). CONCLUSION: Community pharmacists do not use information resources on alternative medicine products frequently, and many are not satisfied with the resources available to them.

Attitude of Health Personnel↗
PubMed2004

A resource allocation model describing consequences of artificial selection under metabolic stress.

Long-term selection on production results in increased environmental sensitivity. This often is expressed through decreased fertility and increased health problems. The phenomenon has been described in all common farm animal species. One theory is that potential resource intake is insufficient to express production potential. Additional resources are drawn away from fitness-related traits, such as fertility and health, to further increase observed production. In addition, resources for maintaining fitness depend on the demands by the environment. In a harsh environment, more resources are required for fitness-related traits than in an optimal environment. Literature results show that selection in an optimal environment will increase sensitivity to less optimal environments. The objectives of this paper were to increase understanding of the underlying mechanism behind the development of environmental sensitivity and to gain insight into correlated response(s) when selection is on observed production. A resource allocation model was defined where observed production depended on production potential, resource intake potential, and the allocation of resources to production or fitness, including maintenance, health, and reproduction. Penalties for reproductive performance and probability of survival were included when the proportion of resources assigned to fitness dropped below a certain, environment-related, threshold. Mass selection was practiced on observed production during 40 generations using stochastic simulation. Depending on the heritabilities of the underlying components and on the environment, selection on observed production resulted in a decrease in reproductive rate and in the development of environmental sensitivity when resource intake becomes limiting. Correlations of observed production with underlying components changed across generations, following a nonlinear pattern. The proposed model is simple, but increases the understanding of underlying mechanisms and consequences of selection for production when resources are limiting.

Animal Husbandry↗
PubMed2005

Knowledge of resources and competitors in human foraging.

The allocation of human participants to resources was studied by observing the population dynamics of people interacting in real time within a common virtual world. Resources were distributed in two spatially separated pools with varying relative reinforcement rates (50-50, 65-35, or 80-20). We manipulated whether the participants could see each other and the distribution of the resources. When the participants could see each other but not the resources, the richer pool was underutilized. When the participants could see the resources but not each other, the richer pool was overutilized. In conjunction with prior experiments that correlated the visibility of agents and resources (Goldstone & Ashpole, 2004), these results indicate that participants' foraging decisions are influenced by both forager and resource information. The results suggest that the presence of a crowd at a resource is a deterring, rather than an attractive, factor. Both fast and slow oscillations in the harvesting rates of the pools across time were revealed by Fourier analyses. The slow waves of crowd migration were most prevalent when the resources were invisible, whereas the fast cycles were most prevalent when the resources were visible and the participants were invisible.

Awareness↗
PubMed2006

A multicenter, retrospective pilot study of resource use and costs associated with severity of disease in glaucoma.

OBJECTIVE: To examine resource consumption and the direct costs of treating glaucoma at different disease severity levels. DESIGN: Observational, retrospective cohort study based on medical record review. PARTICIPANTS: One hundred fifty-one records of patients with primary open-angle or normal-tension glaucoma, glaucoma suspect, or ocular hypertension (age > or =18 years) were randomly selected from 12 sites in the United States and stratified according to severity based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients had to have been followed up for a minimum of 5 years. Patients with concomitant ocular disease likely to affect glaucoma treatment-related resource consumption were excluded. METHODS: Glaucoma severity was assessed and assigned using a 6-stage glaucoma staging system, modified from the Bascom Palmer (Hodapp-Anderson-Parrish) system. Clinical and resource use data were collected from the medical record review. Resource consumption for low-vision care and vision rehabilitation was estimated for patients with end-stage disease based on specialist surveys. For each stage of disease, publicly available economic data were then applied to assign resource valuation and estimate patient-level direct costs from the payer perspective. MAIN OUTCOME MEASURES: Average annual resource use and estimated total annual direct cost of treatment were calculated at the patient level and stratified by stage of disease. Direct costs by specific resource types, including ophthalmology visits, glaucoma surgeries, medications, visual field examinations, and other glaucoma services, were also assessed. RESULTS: Direct ophthalmology-related resource use, including ophthalmology visits, glaucoma surgeries, and medication use, increased as disease severity worsened. Average direct cost of treatment ranged from $623 per patient per year for glaucoma suspects or patients with early-stage disease to $2511 per patient per year for patients with end-stage disease. Medication costs composed the largest proportion of total direct cost for all stages of disease (range, 24%-61%). CONCLUSIONS: The study results suggest that resource use and direct cost of glaucoma management increase with worsening disease severity. Based on these findings, a glaucoma treatment that delays the progression of disease could have the potential to significantly reduce the health economic burden of this chronic disease over many years.

Adult↗
PubMed2003

Prediction of resource use during acute pediatric illnesses.

BACKGROUND: Significant resources are used for acute illnesses in children. Identifying predictors of resource use can focus interventions to reduce this use. OBJECTIVE: To determine the relative effects of maternal, infant, social milieu, and demographic characteristics, the mother-child interaction, and perception of illness severity on the use of resources during acute illnesses in children. DESIGN: At the 2-week and 6-, 15-, and 24-month well-child care visits of a cohort of mother-infant dyads, the mother-well-child interaction was assessed by using the Biringen Emotional Availability Scales, and data were gathered regarding maternal depression and sense of competence, infant temperament, maternal social support, the home environment, and demographic characteristics. At each of the cohort's 1983 ill-child care visits during 30 months of follow-up, the mother-ill-child interaction was assessed by using the Emotional Availability Scales, and mothers and pediatricians independently assessed illness severity using the Acute Illness Observation Scales. Resources used during the illnesses-over-the-counter and prescription medications, tests, hospitalizations, follow-up visits, and the emergency department-were assessed. SETTING: A hospital primary care center and an urban and a suburban private practice. Patients Between February 1, 1995, and March 30, 1998, a consecutive sample of 380 dyads were asked to enroll at the 2-week well-child care visit; 316 (83.2%) consented, and complete data were available for analysis of 243 dyads. MAIN OUTCOME MEASURES: A path analytic framework using a structural equation model assessed the presence and strength of predictive relationships between demographic, maternal, infant, and social milieu data, the Biringen Emotional Availability Scales, and the Acute Illness Observation Scales and the main outcome measure, resource use. RESULTS: Three variables predicted greater mean resource use during each acute illness episode: a less optimal mother-child interaction (beta = -.53), lower scores for parenting sense of competence (beta = -.26), and greater perception of illness severity by mothers (beta =.33). By using the coefficient of determination (R2), these 3 predictors account for 55% of the reliable variance in resource use during acute illnesses. CONCLUSION: The quality of the mother-child interaction, maternal sense of competence, and maternal assessment of severity of the illness are major predictors of resource use during acute pediatric illnesses, and should be important foci of interventions to reduce resource use.

Acute Disease↗
PubMed1983

Planning and politics of resource allocation for primary health care: promotion of meaningful national policy.

Securing resources for primary health care (PHC) involves consideration of the entire health sector: the higher levels of the health service as well as the primary level, and the private and/or social security sub-sectors as well as the government service. Reshaping resource distribution is less a redistribution of existing resources than the allocation of new resources in accordance with PHC priorities. In this the planning of future current costs is a crucial element and requires a budgetary system that identifies expenditures by geographical area and level of care. Resources should be allocated geographically to reduce health care inequalities through the provision of an appropriate mix of different levels of care. Central resource planning and local health care programming (with 'dialogue' between the two) should be the basic planning division of labour, which largely resolves the so-called top-down/bottom-up dichotomy. The private medical sub-sector exerts economic, ideological and political influences on the public health service. Compulsory health insurance schemes can have some similar effects. Success of a PHC policy requires that governments adopt a holistic approach to the health sector. The allocation of health care resources on the bases of need and equity, as opposed to demand, is a political decision. The establishment of a national PHC policy backed up by adequate resources involves a specific politico-technical exercise with four components: research, planning, policy formulation, and government policy decision-making. The resource planning method, based on social epidemiology, is contrasted with conventional health planning methods, based on epidemiology. The articulation of these two approaches is discussed in terms of WHO's Managerial Process for National Health Development.

Costs and Cost Analysis↗
PubMed2006

Estimating the resource needs of scaling-up HIV/AIDS and tuberculosis interventions in sub-Saharan Africa: a systematic review for national policy makers and planners.

Considerable effort has been made to estimate the global resource requirements of scaling-up HIV/AIDS and tuberculosis (TB) interventions. There are currently several medium- and long-term global estimates available. Comprehensive country specific estimates are now urgently needed to ensure the successful scaling-up of these services. This paper reviews evidence on the global resource requirements of scaling-up HIV/AIDS and TB interventions. The purpose of this review is to summarise and critically appraise the methods used in the global estimates and to identify remaining knowledge gaps, particularly those relevant to country level estimation. This review found that the estimates of global resource requirements provide sound methodological guidance for countries on the basic steps to follow. However, there are still many areas that require further development or evidence. These include the following. Firstly, the methods used to assess the capacity to scale up HIV/AIDS and TB services need to be further refined. In particular countries need simple methods to assess human resource capacity. Secondly, investments need to be made to improve country level data on the costs and effectiveness of HIV/AIDS and TB services. In particular efforts should be focused on producing standardised unit costs for each intervention by country, which reflect the reality of domestic resource use. Thirdly, simple costing models, which appropriately integrate systems costs need to be developed for use at the country level. Finally, resources needs estimation needs to be embedded by countries in multi-sectoral expenditure planning processes. Countries and global agencies will continue to need estimates for different purposes at different times. Therefore attention should move away from specific estimates, to the longer term aim of building capacity at the country level, supported by global agencies. This will be of mutual benefit. Those making national resource estimates can learn from the experience of global estimation. Concurrently, global resource estimates can build on the evidence emerging from improved national resource estimates.

Africa South of the Sahara↗