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At least 253 records · Page 14Linked to original sources
PubMed1997

National health care reform and the 103rd Congress: the activities and influence of public health advocates.

OBJECTIVES: This study examined the activities and influence of public health interest groups and coalitions on the national health care reform debates in the 103rd Congress. METHODS: Congressional staff and representatives of public health interest groups, coalitions, and government health agencies were interviewed. Content analysis of eight leading national health care reform bills was performed. RESULTS: The public health community coalesced around public health in health care reform; nearly all the major interest groups and government health agencies joined two or more public health or prevention coalitions, and half joined three or more. The most effective influence on health care reform legislation was early, sustained personal contact with Congress members and their staffs, accompanied by succinct written materials summarizing key points. Media campaigns and grassroots mobilization were less effective. Seven of the eight leading health care reform bills included one or more of the priorities supported by public health advocates. CONCLUSIONS: The public health community played an important role in increasing awareness and support for public health programs in the health care reform bills of the 103rd Congress.

Health Care Reform↗
PubMed1982

Labor law and physicians' privileged position: an example of structural interest influence.

Health care delivery in the United States may be characterized as a dynamic system of conflicting interest groups. Since the reorganization of the medical profession in 1910, however, physicians have been able to maintain their position as a dominant structural interest group. A dominant structural interest in one which is served by the structure of social, economic, and political institutions. It does not have to reorganize continuously to protect its privileged position. Although several medical sociologists have noted the privileged position of physicians, few have attempted to explicate the process of status maintenance. This paper examines the development of labor law in health care as one example of structural interest influence. Labor law provides an excellent illustration of this influence in that its development and application are far removed from the physicians' sphere of direct influence. It is demonstrated that the ideology that physicians should hold a privileged position is so ingrained that their interests are protected even in their absence.

Collective Bargaining↗
PubMed1984

Congressional voting behavior on hospital legislation: an exploratory study.

This paper analyzes Congressional voting behavior on the Gephardt Amendment to President Carter's hospital cost containment legislation. The impact of opposing interest groups is examined: on one side were hospital and medical interest groups; on the other was the Carter Administration and its political party, as well as states with large Medicaid expenditures. The effect of political contributions from MEDPACs is evaluated, and the relative importance of various factors affecting the vote's outcome is analyzed.

Cost Control↗
PubMed2003

Population health in Canada: a brief critique.

An internationally influential model of population health was developed in Canada in the 1990s, shifting the research agenda beyond health care to the social and economic determinants of health. While agreeing that health has important social determinants, the authors believe that this model has serious shortcomings; they critique the model by focusing on its hidden assumptions. Assumptions about how knowledge is produced and an implicit interest group perspective exclude the sociopolitical and class contexts that shape interest group power and citizen health. Overly rationalist assumptions about change understate the role of agency. The authors review the policy and practice implications of the Canadian population health model and point to alternative ways of viewing the determinants of health.

Canada↗
PubMed1975

The physician, the manufacturer, and medical devices.

Better communication between physicians and manufacturers of medical devices is becoming increasingly important due to wider usage of these devices, as well as more intense scrutiny by consumer interest groups. Physicians should therefore have more complete knowledge of techniques of new product development. A new product typically passes through at least six stages, as follows: (1) idea conception; (2) merit and feasibility study; (3) design and testing; (4) production preparation; (5) market preparation; and (6) marketing. These steps are completed over a period of several years at an ever increasing cost. We propose that interaction procedures be undertaken so as to enhance direct physician-manufacturer communications in the medical device arena. Some possible techniques of improving these communications include the direct training of physicians and manufacturers in each other's problems, the establishment of hospital engineering groups, the placement of medical consultants in industry, and the active participation in device standards-generating groups and other groups of mutual interest.

Biomedical Engineering↗
PubMed1978

Comparative staff values on the community mental health ideology scale.

The community mental health ideologies of groups composed of profession and nonprofessional mental health service providers were measured by use of the Baker-Schulberg Community Mental Health Ideology (CMHI) Scale. The study was designed to: (1) compare current CMHI scores with the original criterion scores of mental health workers, (2) compare CMHI scores of mental health workers from different disciplines who work in the same community mental health setting, and (3) measure CMHI scores for previously nonreported workers, ministers, and board and care operators. Results of the present study indicate that CMHI scores had not changed from the criterion scores over a series of studies, and that score consistency is such that the scale appears to be a reliable discriminatory tool. Contrary to previously reported findings, psychiatrists scored as high as other mental health professionals in the system, and no significant difference was found between disciplines within the professional group. The paraprofessional group, however, ranked significantly lower than the professional group. Clerical and administrative staff, and board and care operators had CMHI scores that were significantly lower than all other study groups. Interestingly, the minister group had a mean score higher than all other groups studied. Our findings suggest that the CMHI Scale differentiates, not only between disciplines of mental health workers who work in the same setting, but also between groups of human services providers in the community.

Attitude of Health Personnel↗
PubMed2006

Mood disorders affect drug treatment success of drug-dependent pregnant women.

This study examined the impact of co-occurring Axis I disorders on drug treatment outcomes of drug-dependent pregnant women. Participants (N = 106) were women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for opioid dependence and were receiving methadone. Based on DSM-IV Axis I criteria, participants were categorized into three groups: (1) absence of mood/anxiety disorder (ND, n = 29), (2) primary mood disorder (MD, n = 39), or (3) primary anxiety disorder (AD, n = 38). Demographically, the groups were similar. The MD group was significantly more likely to be positive for drugs while in treatment compared with both the ND and AD groups. The MD and AD groups had more psychosocial impairment and higher incidence of suicidal ideation compared with the ND group. Interestingly, the AD group spent more days in treatment compared with the ND or MD group. These findings highlight the need to treat co-occurring Axis I disorders, particularly given the higher relapse risk for those with mood disorders.

Adult↗
PubMed2001

Resistance of the dentate gyrus to induced apoptosis during ageing is associated with increases in transforming growth factor-beta1 messenger RNA.

Up-regulation of endogenous neurotrophic factors may protect against apoptosis during ageing. Recent studies showed that the expression of several neurotrophic factors increased with age in specific regions of the rat brain. Previously, we showed that removal of trophic adrenal steroids by adrenalectomy induced apoptosis in the dentate gyrus of adult rats, which was accompanied by increased expression of transforming growth factor-beta1 (TGF-beta1) messenger RNA. In this study, we compared the relative densities of apoptotic cells in the dentate gyrus with TGF-beta1 messenger RNA expression in virgin male Fischer 344 rats ranging from 2 to 26 months of age across three treatment groups: adrenalectomy, adrenalectomy with corticosterone replacement, or sham operation. Seven days after adrenalectomy an increase in the density of apoptotic cells was observed in rats of all age groups compared with sham-operated and corticosterone-treated groups. By in situ hybridisation, the glial messenger RNAs, TGF-beta1 and glial fibrillary acidic protein as a marker of ageing, increased following adrenalectomy in the dentate gyrus in rats of all ages compared with control groups. Interestingly, within adrenalectomy groups, both the number and density of apoptotic cells decreased significantly by 6-8 months with a further decrease at 24-26 months of age. Furthermore, the amount of apoptosis corresponded to changes in TGF-beta1 expression, notably in: (i) adrenalectomised rats showing a significant inverse correlation and (ii) 24-26-month-old rats with the lowest induced apoptosis showing increased expression at the time of adrenalectomy. These studies show that resistance to adrenalectomy-induced apoptosis in the dentate gyrus is associated with increases in TGF-beta1 messenger RNA expression. Furthermore, the endogenous up-regulation of neurotrophic factors, such as the increase in TGF-beta1 expression in the oldest rats, suggests that the aged brain may have compensatory mechanisms, which protect against apoptosis.

Adrenalectomy↗
PubMed1998

Application of the comet assay for monitoring DNA damage in workers exposed to chronic low-dose irradiation. II. Base damage.

In the preceding paper [M. Wojewodzka, M. Kruszewski, T. Iwanenko, A.R. Collins, I. Szumiel, Application of the comet assay for monitoring DNA damage in workers exposed to chronic low dose irradiation. I. Strand breakage., Mutat. Res. 416 (1998) 21-35], we reported the results of DNA damage examination carried out for a group of people (49 individuals) professionally at risk of exposure to low doses of ionizing radiation as measured by the alkaline comet assay. Here, we used the method in combination with oxidative base damage-specific endonucleases to estimate base damage in the same individuals. These were endonuclease III (endoIII) and formamidopyrimidine glycosylase (FPG). In contrast to the previous investigations, we found no statistically significant difference in base damage between the control and hazard groups. Interestingly, the hazard group exhibited lower level of enzyme-sensitive sites than the control; however, this different was not significant. No correlation of base damage with age was found, similarly as in the case of DNA damage measured by the alkaline comet assay. Interindividual variability of base damage precluded exposure estimation for single individuals, since several members of the control group exhibited high comet parameters.

Adult↗
PubMed2006

Which reliable pharmacodynamic breakpoint should be advised for ciprofloxacin monotherapy in the hospital setting? A TDM-based retrospective perspective.

OBJECTIVES: To define in critically ill patients receiving intravenous (iv) ciprofloxacin (200 mg or 400 mg twice daily) and undergoing routine therapeutic drug monitoring (TDM) the interindividual pharmacokinetic variability and the reliable pharmacodynamic breakpoint enabled by these fixed dosing regimens according to the PK/PD principles and to the pattern of susceptibility to this antibiotic. METHODS: Ciprofloxacin plasma concentrations [trough (Cmin) and 30 min post-dose peak (Cmax) levels] were analysed by means of an HPLC method. Optimal pharmacodynamic exposure was assessed by estimating the theoretical pharmacodynamic breakpoints (PD BP) for either Cmax or AUC. RESULTS: The final database included 177 sets of Cmin and Cmax performed in 89 patients (200 mg twice daily group, n=68; 400 mg twice daily group, n=21). A very wide interindividual scatter of results was observed for both the 200 mg group and the 400 mg group. Interestingly, for both groups only moderate log-linear relationships between estimated renal function (CLCR) on one hand and either Cmin (r2=0.08, 0.28) or estimated AUC24 (r2=0.10, 0.34) on the other hand were found. Median PD BP, respectively, in the 200 mg twice daily group and the 400 mg twice daily group, were 0.16 and 0.28 mg/L for Cmax, and 0.19 and 0.29 mg/L for AUC24. CONCLUSIONS: Lowering ciprofloxacin dosage in the presence of renal failure seems in most cases unnecessary, since drug accumulation occurred only in a few cases. Optimal pharmacodynamic exposure with fixed 200 or 400 mg twice daily regimens of ciprofloxacin may be ensured only against fully susceptible microorganisms with an MIC<0.3 mg/L. This supports the use of higher dosages in critically ill hospitalized patients, whereas the wide unpredictable interindividual pharmacokinetic variability suggests the usefulness of TDM with the intent of optimizing efficacy with ciprofloxacin therapy.

Analysis of Variance↗
PubMed1989

Elderly patients' satisfaction with care under HMO versus private systems.

In one community, 100 elderly persons (25 HMO and 75 private patients) completed a 20-item scale that measured satisfaction with medical care. Data on demographics, health care utilization, and self-assessed health status also were collected to determine whether these variables would relate to HMO membership. Satisfaction scores were compared between HMO and private care groups by multivariate analysis of variance. Satisfaction with the doctor-patient relationship and convenience of care was higher in the private care group, whereas satisfaction with cost was higher in the HMO group. Interestingly, the HMO group evaluated private care and HMO care similarly. The private group rated HMO care less favorably. Additional comments reveal specific areas of satisfaction/dissatisfaction.

Aged↗
PubMed1996

Phylogeny of some mycoplasmas from ruminants based on 16S rRNA sequences and definition of a new cluster within the hominis group.

Almost complete (> 96%) 16S rRNA sequences from nine ruminant mycoplasmas have been determined by solid-phase DNA sequencing. Polymorphisms were found in four of the 16S rRNA sequences, which indicated the existence of two different rRNA operons. Seven polymorphisms were found in Mycoplasma agalatiae, three were found in Mycoplasma bovis, one was found in Mycoplasma alkalescens, and one was found in Mycoplasma bovirhinis. The sequence data were used for construction of phylogenetic trees. All but one of the ruminant mycoplasmas sequenced in this work clustered in the hominis group. A close relationship was found between M. agalactiae and M. bovis, with a 99% nucleotide similarity between their 16S rRNA sequences. They were also found to be members of the Mycoplasma lipophilum cluster of the hominis group. Furthermore, the 16S rRNA comparisons showed that Mycoplasma alkalescens and Mycoplasma canadense are closely related (> 98.5%), and these species were found to cluster in the Mycoplasma hominis cluster of the hominis group. Interestingly, M. bovirhinis grouped in a new phylogenetic cluster of the hominis group. The new cluster, which was supported by bootstrap percentage values, signature nucleotide analysis, and higher-order structural elements, was named the Mycoplasma synoviae cluster. Mycoplasma bovoculi, Mycoplasma conjunctivae, and Mycoplasma ovipneumoniae clustered in the Mycoplasma neurolyticum cluster of the hominis group. Mycoplasma alvi clustered with Mycoplasma pirum in the M. pneumoniae cluster of the pneumoniae group.

Animals↗
PubMed2006

Challenges in a larger bladder replacement with cell-seeded and unseeded small intestinal submucosa grafts in a subtotal cystectomy model.

OBJECTIVE: To evaluate small intestinal submucosa (SIS), unseeded or seeded, as a possible augmentation material in a canine model of subtotal cystectomy. MATERIALS AND METHODS: In all, 22 male dogs had a 90% partial cystectomy and were then divided into three groups. At 1 month after the initial cystectomy, dogs in group 1 (unseeded, six) and group 2 (seeded, six) received a bladder augmentation with a corresponding SIS graft. The dogs in group 3 (ten) received no further surgery and were considered the surgical control group. All dogs were evaluated before and after surgery with blood chemistry, urine culture, intravenous urography, cystograms and cystometrograms. After surgery (at 1, 5 and 9 months), the bladders were examined using routine histology and immunohistochemistry. RESULTS: All 22 dogs survived the subtotal cystectomy, and 18 survived their intended survival period. One dog, in group 2 (seeded), was killed at 1 month after augmentation due to bladder perforation caused by a large piece of incompletely absorbed SIS. Three other dogs (group 1, two; and group 2, one) were killed within 2 months after augmentation due to bladder obstruction by stones. Group 1 and group 2 SIS grafts had moderate to heavy adhesion, graft shrinkage, and some had bone and calcification at the graft site. Histologically, there was limited bladder regeneration in both groups. Interestingly, dogs in group 3 at 1 month after cystectomy (when group 1 and 2 received their augmentations) had severely shrunken bladders and histologically had severe inflammation, fibroblast infiltration and muscle hypertrophy. These results verify the subtotal cystectomy model. CONCLUSIONS: The use of seeded or unseeded SIS in a subtotal cystectomy model does not induce the same quality and quantity of bladder regeneration that is seen in the 40% non-inflammatory cystectomy model. This study provides important insights into the process of regeneration in a severely damaged bladder. The results led us to re-evaluate the critical elements required for a complete bladder replacement using tissue-engineering techniques.

Animals↗
PubMed1980

The influence of raphe nucleus lesions on fertility in the female rat.

By lesioning brain raphe nuclei, the effect of decreasing the activity of the serotoninergic (5-HT) system on the fertility of the female rat was investigated. The females were mated on the 10th day after lesioning. On both the 15th and 21st day of pregnancy the numbers of live and resorbed foetuses and the weights of placentas in the lesioned groups did not differ statistically as compared with the control group. Interestingly, the lesioned group showed an increase in the number of ovulating cells on the one hand, and decrease in the number of implantations on the other. The data obtained strongly suggest that midbrain serotoninergic cell groups (B7, B8) inhibit ovulation and are not associated with initiation of labour in the female rat.

Animals↗
PubMed1997

Effect of varying amino acid levels on protein metabolism in nephrotic rats during total parenteral nutrition.

In an attempt to determine appropriate diet in nephrotic syndrome, nephrotic rats, induced by puromycin aminonucleoside, were nourished by total parenteral nutrition fluid containing the same energy, but three different levels (1.65, 3.3, and 6.6%) of amino acids for 7 d. The fractional rate of total protein synthesis in the liver was determined by injecting a flooding dose of [3H]phenylalanine. The proportion of newly synthesized proteins retained and exported by the liver was estimated by injecting a tracer dose of [14C]leucine and then measuring the protein radioactivity remaining in the liver and present in the plasma after secretion was completed. Nephrotic animals synthesized more protein than control animals. Although the absolute synthesis rates of total protein in liver were increased with increasing amino acid administration, the absolute rates of synthesis of albumin were higher in the 3.3% group than in the other groups in nephrotic rats. However, kidney protein synthesis in nephrotic rats was higher in the 1.65% group than in the 3.3% group. Interestingly, the 3.3% group revealed the smallest urinary excretion of total protein and albumin. In addition, in the 3.3% group, plasma concentrations of total protein and albumin were higher, and plasma concentrations of total cholesterol and triglyceride were lower than in other groups. It was concluded that the 3.3% group, corresponding to a normal protein diet, has the greatest salutary effect on urinary protein excretion, followed by protein and lipid metabolism, in nephrotic rats. Not only protein intake but also the energy:protein ratio are important for diet therapy in nephrotic animals. The technique of total parenteral nutrition may be useful in defining the factors involved in glomerular permeability or permselectivity and intracellular protein metabolism.

Amino Acids↗
PubMed2002

Challenges in medical informatics: perspectives of an international medical informatics organization.

OBJECTIVE: As an international organization with the missions to promote informatics in health care and biomedical research, advance international cooperation, stimulate research, development and education, and disseminate and exchange information, the International Medical Informatics Association (IMIA) must be constantly cognizant of new developments in medical informatics and address the challenges to the discipline. From an international organization standpoint, it perceives three major challenges viz. the Identity, Organizational and Leadership challenges. METHOD: This paper attempts to identify and discuss these challenges and to offer ways to overcome them through the activities of an international organization for medical informatics. RESULTS AND CONCLUSION: From an international organization standpoint, IMIA can help overcome these organizational challenges by ensuring strong leadership throughout its echelon, actively promoting its goals and objectives worldwide through its national and institutional members as well as its regional groups and encouraging strategic partnerships between its many Working Groups and Special Interest Group on Nursing with other international organizations and industry to further promote the awareness and the perception of the relevance of medical informatics to health and medicine by the international community.

International Cooperation↗
PubMed1994

Inequalities in South African health care. Part II. Setting the record straight.

UNLABELLED: While Part I of this article analysed the problem of structural inequalities in South African health care, this follow-up explores feasible and socially accountable principles as well as a policy strategy to equalize existing discrepancies and disparities. In addition, the prospects of equalizing the disparities and discrepancies are weighed against prevailing realities. THE CONCLUSION: for the foreseeable future the chances for equality in South African health care appear to be rather slim; a myriad interest groups with vested interests in the status quo are at play, opposing any fundamental reform to ensure greater equality. However, what is more important than the acceptance of this fate is our sincere endeavours to minimise these inequalities.

Delivery of Health Care↗