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At least 217 records · Page 12Linked to original sources
PubMed2002

Integrating cost-effectiveness evidence into clinical practice guidelines in Australia for acute myocardial infarction.

A teaching hospital is working with the Victorian State Government and universities, integrating cost-effectiveness evidence into clinical practice guidelines (CPGs), protocols and pathways for respiratory and cardiology interventions. Acute myocardial infarction (AMI) findings are reported. Results will stimulate cost-effective practice and inform medical associations, federal and state governments and international organisations developing CPGs. Published CPGs by the American College of Cardiology/American Heart Foundation for AMI in 1999 are reviewed by a large interdisciplinary hospital-based committee given cost-effectiveness evidence. Levels of evidence criteria rating on methodological rigor for effectiveness and costs are applied. National Health and Medical Research Council (NHMRC) grades of recommendation criteria for combinations of relative effectiveness versus relative costs and cut-off points are used. Extrapolating results between countries was addressed by applying the OECD's health purchasing power parity series. Recommendations for revisions to United States guidelines and for local application are formulated. United States Guidelines require updating: Regarding angioplasty, percutaneous transluminal coronary angioplasty (PTCA) is cost-effective for men aged 60 years relative to recombinant tissue plasminogen activator (tPA), with additional cost per life year saved of 274 ecu. PTCA with discharge after 3 days is cost-effective in low-risk AMI. Regarding GP IIb/IIIa drugs, Abciximab during intervention incurred equal mean hospital costs for placebo, abciximab bolus, and abciximab bolus+infusion with incremental 6-month cost for the latter treatment costing 293 US dollars per patient. Agent recouped almost all initial therapy costs with significant benefits. Incremental cost of abciximab per event prevented is 3,258 US dollars. Tirofiban was compared to placebo after high-risk angioplasty for AMI or unstable angina. Tirofiban decreased the rate of hospital deaths, myocardial infarction, revascularisation at 2 days by 36% relative to placebo (8% vs. 12%) without increased cost. Clinical benefits were similar at 30 days. Tirofiban+heparin+aspirin was compared to heparin+aspirin. Tirofiban arm resulted in net savings of 33,418 ecu per 100 patients for the first 7 days of treatment. Regarding thrombolytics, tPA is more cost-effective than streptokinase. Incremental costs for each life saved when streptokinase is substituted by recombinant tissue plasminogen are 31%, 45%, 97% higher in Germany, Italy and the United States than in the United Kingdom. Regarding anticoagulants, enoxaparin is a promising alternative to unfractionated heparin for hospitalised patients with non-Q-wave myocardial infarction or unstable angina, saving 1,485 Canadian dollars per patient over 12 months with 10% reduction in 1 year risk of death, myocardial infarction or recurrent angina. Regarding antiarrhymics, the cost-effectiveness of no amiodarone, amiodarone for patients with depressed heart rate variability (DHRV), and amiodarone for patients with DHRV plus positive programmed ventricular stimulation (PPVS) for high-risk post-AMI was investigated. Amiodarone for DHRV+PPVS patients was dominated by a blend of the two alternatives. Compared to no amiodarone, the incremental cost-effectiveness of amiodarone for DHRV patients was 39,422 US dollars per quality adjusted life year gained. Amiodarone for DHRV is the most appropriate. Other CPG updates concern serum markers, for example, cardiac troponin I assay (c-Tnl), cost advantages of ad hoc angioplasty and secondary prevention through antioxidants and pravastatin. Australian costs are reported later in the paper.

Journal Article↗
PubMed2005

Assessment of local health department smoking policies--North Carolina, July-August 2003.

Secondhand smoke is a cause of disease in healthy nonsmokers, and an increasing number of states have adopted laws prohibiting smoking in private-sector worksites, restaurants, and bars. However, certain state governments have provisions in their state smoking restrictions that preempt more stringent local laws. North Carolina has such a preemptive state smoking law, passed in 1993, which mandates that 20% of the space within state-controlled buildings be designated as smoking areas. Exemptions from the law included local health departments (LHDs), providing an opportunity for public health practitioners to enact more stringent policies. To assess smoking policy gains from this exemption, a research team from the University of North Carolina at Chapel Hill (UNC) surveyed LHD directors. Results of the survey indicated uncertainty regarding the state law, with 37% of LHD directors believing they were prohibited from enacting a 100% tobacco-free policy on LHD grounds and 20% not knowing whether they were prohibited. The North Carolina Association of Local Health Directors used these findings to work with legislators in the North Carolina General Assembly to amend the state smoking law in 2005, specifying that the exemption applies to both LHD buildings and grounds.

Government Agencies↗
PubMed1992

Rabid bat diagnosed in Hawaii.

Since 1966, the Hawaii State Government has been conducting Fluorescent Rabies Antibody (FRA) testing on animal brains as part of a statewide rabies-surveillance program. On April 3, 1991, the Department of Health (DoH) laboratory diagnosed the first case of rabies detected in the State. A large brown bat, Eptesicus fuscus fuscus, captured in a transport container that had just been off-loaded from a ship at Honolulu harbor, was caught. It's brain was examined and showed typical fluorescent staining patterns for rabies virus. The USPHS Centers For Disease Control (CDC) rabies laboratory confirmed the diagnosis 2 days later. The successful interception of this rabid animal was the result of close cooperation between the private sector (Sea Land Service, Hawaiian Stevedores) and the Hawaii State Government Departments of Health and of Agriculture.

Animals↗
PubMed2004

Perceptions of dental schools from within and outside the university.

Perceptions of dental schools held by high-level administrators of their parent institutions and officials in the local community have great potential to influence the future of dental education. The intent of this investigation was to gain a preliminary knowledge of such perceptions at seven institutions in the United States and to use this information to formulate hypotheses that can provide the basis for further targeted investigations that provide evidence useful in decision making and planning processes within dental schools. Interviews with university administrators, executive directors of state dental associations, and state government officials in seven areas of the United States were conducted. The hypotheses drawn from these interviews are: 1) dental schools are generally too insular and need to interact more with their parent institutions and external community; 2) dental schools need to systematically and continually get the message of the value of their services out to the public and political constituencies; and 3) multidisciplinarity and integration with other units are important to university administrators but largely outside the concerns of those external to the university. We suggest that these hypotheses form the basis of subsequent, more targeted, follow-up investigations with the intent of formulating specific recommendations for action.

Administrative Personnel↗
PubMed2002

2002 Connecticut health policymaker survey.

In Spring 2002, Connecticut health policymakers in executive and legislative branches of government were surveyed to assess their needs for health policy information and their perceptions of upcoming health challenges facing Connecticut citizens; a similar survey was conducted in 2000. Policymakers receive information from a wide variety of sources; most often from within state government--state agencies and legislative staff--and from health advocacy organizations/coalitions. The most trusted sources of information are legislative staff, journals/publications, and state agencies. The areas of greatest need for information were: health-care financing, the uninsured, prescription drug coverage, long-term care, and mental health/substance abuse. Between 2000 and 2002, concerns over the costs of health care have increased significantly. Connecticut policymakers prefer to receive information in short, one, or two-page fact sheets.

Connecticut↗
PubMed1997

Cost neutrality and welfare reform.

Many states have chosen to reform welfare through the Social Security Act's Section 1115 waivers. When states choose this method, the Departments of Health and Human Services and Agriculture require the states to determine whether these initiatives are cost neutral to the federal government. States using this cost neutrality information as an ongoing piece of evaluation information must be careful in interpreting cost neutrality data. This article discusses two reasons for state and federal policy-makers to be cautious in using cost neutrality data as an indicator of welfare reform success.

Aid to Families with Dependent Children↗
PubMed1999

Developing a state outcomes monitoring system in public health maternal and child health.

State outcomes monitoring systems are increasingly important as state governments develop outcomes-based accountability in response to recent federal legislation. A state outcomes monitoring system developed for state and local maternal and child public health departments allows for outcomes research as well as administration and management.

Case Management↗
PubMed1998

Current and historical American asbestos regulations.

Asbestos, and asbestos-containing materials, are subject to regulation in the USA by both the federal government and each of the 50 state governments. This paper summarizes the federal government asbestos regulations which apply to the use of asbestos, asbestos-containing products, and asbestos fiber releases, in the workplace and in the ambient environment through the USA. Regulations by the 50 states apply only within the jurisdiction of each state and, to a large extent, mimic those of the federal government. The state regulations are not discussed in this paper. The principal American government agencies that deal with asbestos regulation are the Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA). Generally, OSHA regulations apply to regulate asbestos exposures, and potential asbestos exposures, in the occupational workplace while EPA regulations apply to asbestos exposures, and potential asbestos exposures, in the nonoccupational setting. Both agencies set regulatory levels for allowable asbestos exposure. Those levels have changed, in a decreasing progression, since their enactment in the early 1970s. This paper discusses those levels and traces their progression over time.

Asbestos↗
PubMed1977

The United States drug problem and international trafficking. Part II. Denial of safe-havens to illicit drug traffickers.

Excessive reliance on extradition as a means of acquiring prosecutional control over illicit drug traffickers is short-sighted. Informal arrangements, like expulsion, should be given more consideration. A method for developing a unified antitrafficker policy and for implementing that policy through existing diplomatic channels is demonstrated through the use of the safe-haven deprivation/deterrence model. This paper focuses on drug traffickers. Trafficking is a function of the availability of both suppliers and consumers. Other available forms of cooperation within the United States government to induce foreign states to assure that opium crops are either destroyed or controlled within licit user channels should not be overlooked.

Drug and Narcotic Control↗
PubMed1993

Health insurance coverage for smoking cessation services.

The health benefits from quitting smoking have been well documented; however, most health insurance plans in the United States, both public and private, have excluded coverage of smoking cessation services. Since 1988, numerous public health policy documents have called for health insurance coverage of smoking cessation services, although there is little agreement over what kinds of services or interventions are most appropriate for health insurance coverage. The purposes of this paper are to (1) describe current public policy for health insurance coverage of smoking cessation services; (2) review the current status of policy adoption by private health insurance carriers, health maintenance organizations, self-funded employers, as well as public insurance programs including Medicare and Medicaid; (3) analyze the major barriers faced by health insurers, health care providers and policy makers in offering coverage for smoking cessation services; and (4) outline the specific policy options that the federal government, state governments, employers and anti-smoking coalitions can take to increase insurance coverage for smoking cessation services. The paper concludes with recommendations for practitioners, researchers and policy makers.

Accounting↗
PubMed2004

Anthrax versus the flu.

As state governments in the United States slash their public health budgets, federal money is pouring in for bioterror preparedness.

Anthrax↗
PubMedDate not supplied

Managing child malnutrition in a drought affected district of Rajasthan--a case study.

Rajasthan is the largest state in the country frequently affected by droughts. The year 2002 happened to be the fifth consecutive year of drought. Almost all districts of the State were hit by it. The district of Baran located in South-East of Rajasthan has 'Sahariya' tribal population concentrated in its Kishanganj and Shahabad blocks. Press reports of starvation deaths amongst tribal children in these blocks created a stir in the local district and the State Government set ups. The paper describes an objective and professional approach to deal with the situation. Rapid nutritional assessment indicated very high prevalence of severe under weight (28.3%) and wasting (4.7%) amongst under five children. Nutrition Care Centres (NCC) were set up in selected villages to provide targeted feeding and care to these children as per WHO guidelines. Local 'Sahariya' community was involved to run these NCC. Intensive public education campaign was carried out to promote improved child caring practices and referral of malnourished children with complication to hospitals. Orientation of press and electronic media on factual details regarding the situation helped create an enabling environment to implement remedial measures. The impact of 'Nutrition Care Centres' assessed after six months was found to be positive in terms of reduction in prevalence of under nutrition in children from 66.7% to 59.6%. Successful management of severe malnutrition amongst children by workers at Nutrition Care Centes and in family settings using standard protocols led to the wide scale replication of the approach by Anganwadi centres in different district of Rajasthan. The State Government also created an additional cadre of worker called 'Sahayogini' to support Anganwadi worker and promote better child caring practices at family level.

Child Health Services↗
PubMed1999

Maintaining an adequate supply of RNs in California.

PURPOSE: Over the past 2 years, concerns have arisen about the adequacy of the supply of RNs in California and the rest of the United States. Nurse leaders have called upon the California State Legislature to respond to concerns by increasing funding for RN education at public colleges and universities. DESIGN: Descriptive--to ascertain whether California faces a shortage of RNs and whether greater state government funding of RN educational programs is necessary to alleviate such a shortage. Secondary data from several sources were analyzed. METHODS: Cross-sectional analysis of data from the 1996 National Sample Survey of Registered Nurses concerning California RNs' demographic characteristics and employment patterns was conducted. Longitudinal analysis of data was examined for trends in California's population, utilization of RNs, and graduations from RN education programs. FINDINGS: Approximately 230,000 RNs lived in and were licensed to practice in California; 77% of California RNs were employed in nursing (70% working full-time; 30% part-time). Only a small number of California RNs were not currently working in nursing but were likely to enter the labor market. Most RNs who were not working were older retired women. CONCLUSIONS: A large increase in the RN workforce is needed to keep pace with the rapid growth of California's population. For California to maintain a stable ratio of RNs to population, we estimated an additional 43,000 RNs will be needed by 2010, and an additional 74,000 will be needed by 2020. Educators, employers, and state policymakers should implement concerted and coordinated efforts to avert a shortage. The magnitude of the impending shortage of RNs in California is too large for the RN labor market to resolve. State government should provide additional resources for basic RN education programs.

Adult↗
PubMed1991

The designated forensic professional program: a state government-university partnership to improve forensic mental health services.

As the law/mental health field has expanded and matured in the last 20 years, the sophistication required by mental health professionals in order to respond appropriately to legal questions has grown significantly. Courts and legislatures define a growing number of legal competencies. Judges and attorneys are more familiar with mental health law than they were 10 or 20 years ago.

Credentialing↗
PubMed1987

A retrospective study of nine years' hospital records of schistosomiasis in north-eastern Nigeria.

We have studied reports of new cases at 11 State Government Hospitals in the state of Borno, over a period of 9 years from 1976 to 1984. Urinary schistosomiasis was the second most common communicable disease, while intestinal schistosomiasis ranked sixth. The rise in prevalence of schistosomiasis since 1979 probably reflects increased public awareness of the beneficial role of hospitals. The decline in the number of cases seeking treatment in 1982 and 1983 may be due to the decline in rainfall and thus of agricultural and fishing activities involving contaminated irrigation ponds.

Humans↗
PubMed2025

Properties Governing Native State Entanglements and Relationships to Protein Function.

Non-covalent lasso entanglements are structural motifs found in a majority of globular proteins, and their misfolding has been linked to a range of biological consequences. Here, we characterize these motifs' structural and physicochemical properties, sequence biases, functional site correlations, and universal features across E. coli, S. cerevisiae, and H. sapiens. We find that the crossing residues, which pierce the plane of the entanglement loop, are 11-times more likely to be a β-strand than an α-helix or random coil, and that around this position the protein sequence is 2.5-times more likely to be composed of a stretch of all hydrophobic residues (most often Val, Ile, or Phe) compared to other sequence motifs. Functionally, crossing residues are enriched at enzyme active sites in S. cerevisiae and small molecule binding residues across all species to degrees greater than expected by random chance. Metal binding residues are enriched in these entanglements in H. sapiens. Increasing statistical power by pooling together these species data, we find RNA-binding residues are enriched in these entanglement components. On the other hand, there is a spatial depletion of crossing residues at sites involved in protein binding. Using machine learning, we identified eight robust features predictive of these entanglements, achieving AUROC scores of 0.8 across species. These results are significant because they suggest a direct role for components of native entanglements in particular protein functions, as well as identifying strong secondary structure and sequence preferences in native entanglements.

Humans↗
PubMed2002

Social actors and discourse on abortion in the Mexican press: the Paulina case.

The "Paulina case" is the story of a 13-year-old girl in Mexico who became pregnant in 1999 after being raped. Although she received permission to obtain a legal abortion, the hospital convinced her mother through misleading information to decline the abortion. This case has become an almost obligatory point of reference when abortion is discussed in Mexico. This paper analyses how the Mexican press portrayed the Paulina case and the social actors who participated in it--Paulina herself, Paulina's allies, the state government, the Catholic Church, members of the political party PAN and the National Human Rights Commission. One of the great breakthroughs of this case was that the denial of an abortion was judged to be a form of negligence. In demanding justice for Paulina, Paulina's allies were given moral authority in the press to denounce those who denied her an abortion. While the government of Baja California state and members of the PAN were held responsible for their role in the case, the Catholic Church, who was also responsible, seemed to escape criticism. It is probable that the large emotional weight of the Paulina case accomplished more in terms of changing public opinion in support of women's right to decide on abortion than any other single event to date.

Abortion, Legal↗
PubMed2026

Epigenetic Gene Networks Governing Immune State Transitions Across the Lifespan.

Immune function across development, tissue repair, aging, and disease depends not only on signaling pathways but also on epigenetic architectures that determine whether coordinated transcriptional programs can be accessed and resolved. Increasing evidence indicates that epigenetic gene networks regulate the accessibility and reversibility of semi-stable immune states, shaping plastic, homeostatic, reparative, and degenerative configurations. We propose the concept of epigenetic transition windows, defined as temporally and contextually restricted intervals during which epigenetic constraints are relaxed, permitting coordinated and reversible transitions between immune states. During development, these windows are broad and support immune tolerance and adaptive plasticity. In adulthood they become spatially and temporally restricted, preserving stability while enabling conditional adaptation. With aging, they progressively narrow, contributing to chronic inflammation, impaired repair, and increased vulnerability to neurodegeneration. Conversely, pathological persistence of regulatory permissiveness may underlie immune evasion and sustained plasticity in cancer. We outline operational genomic readouts for quantifying transition windows, including chromatin accessibility variance, enhancer switching dynamics, reversibility metrics, and cross-cell coordination indices, and derive experimentally testable predictions that distinguish this model from pathway-centric or damage-centric explanations. By reframing immune dysfunction as a failure of regulated state transition rather than excessive signaling alone, this framework integrates inflammaging, trained immunity, immune resolution failure, and tumor immune escape within a unified regulatory architecture and provides a systems-level perspective on immune adaptability across the lifespan.

Epigenesis, Genetic↗