Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Allocation and cooperation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 325 records · Page 18Linked to original sources
PubMed1990

Global health interdependence and the international physicians' movement.

International Physicians for the Prevention of Nuclear War has had an impressive public impact in the 1980s, helping to shatter the myths of surviving and medically responding to a nuclear attack. The 1990s present a new challenge for the medical community in a different social and international context characterized by increasing global interdependence. Another view of physician activism is presented to complement advocacy for nuclear disarmament in the promotion of peace. A framework for analysis is provided by "fateful visions"--accepted policy views of prospective superpower relations--drawn from practitioners of foreign policy, international relations, and security affairs. A perceptual gap may exist between physicians who wish to address underlying ethical and public health concerns on security issues and policy practitioners who are accustomed to discussion within existing policy frames of reference that can be pragmatically used. A strategy is proposed for physicians to use their specialized training and skills to evaluate trends in global health interdependence. The international physicians' movement may contribute substantively to the formulation of policy by expanding and interpreting an increasingly complex database on interdependence, and by creating a dialogue with policy formulators based on mutual recognition of the value and legitimacy of each professions' expertise and complementary contributions to international security policy.

Developing Countries↗
PubMed1986

Randomised trial of intravenous atenolol among 16 027 cases of suspected acute myocardial infarction: ISIS-1. First International Study of Infarct Survival Collaborative Group.

Between mid-1981 and Jan 1, 1985, 16 027 patients entering 245 coronary care units at a mean of 5.0 h after the onset of suspected acute myocardial infarction were randomised either to a control group or to a group receiving atenolol (5-10 mg iv immediately, followed by 100 mg/day orally for 7 days). Vascular mortality during the treatment period (days 0-7) was significantly lower (2p less than 0.4) in the treated group, 313/8037 (3.89%) versus 365/7990 (4.57%), but this 15% difference has wide 95% confidence limits (from about zero to about a quarter). No subgroups were identified in which the proportional difference in days 0-7 was clearly better, or clearly worse, than 15%. After the treatment period, there was only a slight further divergence (691 vs 703 additional vascular deaths by Jan 1, 1985). Thus, overall vascular mortality was significantly lower in the atenolol group at one year (life-table estimates: 10.7% atenolol vs 12.0% control; 2p less than 0.01) but not at Jan 1, 1985 (crude percentages: 12.5% vs 13.4%; 2p less than 0.07). However, atenolol patients were more likely than controls to be discharged on beta-blockers, which can account for much of the additional difference in vascular mortality after day 7. Immediate beta-blockade increased the extent of inotropic drug use (5.0% vs 3.4%, 2p less than 0.0001), chiefly on days 0-1, but despite this most of the improvement in vascular mortality was seen during days 0-1 (121 vs 171 deaths). Treatment did not appear to decrease the number in whom cardiac enzymes rose to above twice the local upper limit of normal. Slightly fewer non-fatal cardiac arrests (189 vs 198) and reinfarctions (148 vs 161) were recorded in the atenolol group, neither difference being significant. Systematic review of fatal and of non-fatal events in ISIS-1 and in all other randomised trials of iv beta-blockade reinforces the suggestion that treatment reduces mortality in the first week by about 15%, but with a rather less extreme effect in days 0-1 than was observed in ISIS-1 alone. It also provides highly significant (2p less than 0.0002) evidence of an effect on the combined end-point of death, arrest, or reinfarction, suggesting that treatment of about 200 patients would lead to the avoidance of 1 reinfarction, 1 arrest, and 1 death during days 0-7. ISIS-1 suggests these early gains will persist.

Administration, Oral↗
PubMed1993

[Economic analysis and public health. Why does one need economic evaluation applied to diabetes? What methods does one choose: cost effectiveness, cost utility, cost benefit? Are such studies useful in terms of public health?].

The application of economic methods to public health is relatively recent and linked to the context of economic crisis: cooperation between medical doctors is to day in process. The main objective of health economics is the optimization of health care by improving resources allocation to take care of the patients. So, in France, the health system budget, 573 billions, represents 8.3% of the GNP; this percentage is one of the highest of Europe. Can such a growing rate decrease or are we going towards rationing of health system resources? In this context, economic analysis applied to diabetes uses mainly evaluation methods: cost-effectiveness, cost-utility, cost-benefit. Evaluation always supposes a comparison between medical alternative actions in terms of costs and results. Economic crisis made easier the acceptance of evaluation studies but their development supposes great scientific caution.

Budgets↗
PubMed1994

Ethics and financing: overview of the U.S. health care system.

An overview of the financing decisions that occurred with the U.S. health system during the past five decades was presented in relation to the ethical issues which gave rise to and resulted from those financing decisions. This health system evolved from decision-making grounded in altruism through increasing the access and supply of resources to a position of caution and financial prudence. Recently the decision-making became grounded in pragmatism with the realization that attempts to provide everyone with all possible health services on demand cannot be achieved. Financing decision have resulted in a health care system based on acute care and sophisticated technology but with too many hospital beds and physicians, both geographically maldistributed. Since this acute care system has been successful in preventing premature deaths, our population now lives longer and develops chronic illnesses which require different interventions; the system has neglected to focus on prevention and adequate care for long-term diseases. It has created a growing population of uninsured who are unable to afford health care when illness occurs. Alternative strategies were discussed at three levels of the health system. At the overall system level, the following was proposed: consistent application of ethical principles most appropriate to allocation decisions and the creation of health policy which encompasses chronic care and disease prevention components. At the organizational level, health administrators and local community leaders must cooperatively address local health issues; medical education should focus on long-term care and disease prevention; and medical practice should reduce variation in treatment patterns. At the population level, healthy lifestyles must be encouraged in addition to the development of alternative reimbursement plans to maximize access to health care. Davis and Rowland (1990:298) have stated that our nation's image is strained" ... as a just and humane society when significant portions of the population endure avoidable pain, suffering and even death because of an inability to pay for health." These are turbulent times in health care but addressing the ethical issues at many levels may lead to successful alternatives and ultimately to a workable health strategy for this country.

Decision Making, Organizational↗
PubMed2003

Partially T-cell-depleted allogeneic stem-cell transplantation for first-line treatment of multiple myeloma: a prospective evaluation of patients treated in the phase III study HOVON 24 MM.

PURPOSE: To determine in a prospective study the efficacy, toxicity, and long-term outcome of up-front allogeneic stem-cell transplantation (allo-SCT) in multiple myeloma (MM). PATIENTS AND METHODS: In the prospective phase III study by the Dutch-Belgian Hemato-Oncology Cooperative Group (HOVON), HOVON 24 MM, 53 patients with an HLA-identical sibling (median age at transplantation, 48 years; range, 31 to 56 years) were allocated to a partial T-cell-depleted allo-SCT after induction therapy. RESULTS: The overall response rate after allo-SCT was 89% (47 of 53 patients), including the 19% of patients (10 of 53 patients) with a complete remission (CR). Five patients achieved a CR only after allo-SCT. Five (71%) of seven primary refractory patients obtained a response to allo-SCT, all of whom had a partial remission. With a median follow-up of 38 months (range, 25 to 61 months), 20 patients are alive since allo-SCT and 33 patients have died (14 from progressive disease, 18 from treatment-related mortality [TRM], and one from another cause). Occurrence of acute graft-versus-host disease grades 2 to 4 predicted for higher TRM in a time-dependent analysis. The median progression-free survival time after allo-SCT was 17 months. Median overall survival time after allo-SCT was 25 months, or 29 months from the start of therapy. Only three patients are in continuing CR, indicating that the potential cure rate of this approach is, at best, 6%. CONCLUSION: This first prospective evaluation of up-front allo-SCT of MM in a multicenter setting does not support the use of T-cell-depleted myeloablative allo-SCT as part of first-line therapy.

Adult↗
PubMedDate not supplied

Conceptualizing functional neuroplasticity.

There are at least four major forms of functional neuroplasticity that can be studied in humans: homologous area adaptation, cross-modal reassignment, map expansion, and compensatory masquerade. Homologous area adaptation is the assumption of a particular cognitive process by a homologous region in the opposite hemisphere. Cross-modal reassignment occurs when structures previously devoted to processing a particular kind of sensory input now accepts input from a new sensory method. Map expansion is the enlargement of a functional brain region on the basis of performance. Compensatory masquerade is a novel allocation of a particular cognitive process to perform a task. By focusing on these four forms of functional neuroplasticity, several fundamental questions about how functional cooperation between brain regions is achieved can be addressed.

Brain↗
PubMed1999

A classification based on T cell selection-related phenotypes identifies a subgroup of childhood T-ALL with favorable outcome in the COALL studies.

During T cell selection in the thymic cortex more than 90% of the thymocytes are eliminated by apoptosis. Based on this biology, we propose to define blasts of T cell acute lymphoblastic leukemia (ALL) with the phenotype of cortical thymocytes (CD1+ and/or CD4+ 8+) as selection-related (SR) and all other T-ALL immunophenotypes as non-selection-related (NSR). The COALL cooperative treatment studies for childhood ALL offer a tool to study the outcome in T-ALL subgroups as children with T-ALL are allocated uniformly to the high risk arm of the protocol. In the COALL-85, -89 and -92 protocols, 39/83 cases presented as SR and 44/83 cases as NSR. Five-year event-free survival of SR phenotype is significantly better compared to the NSR group (0.87 +/- 0.06 vs 0.66 +/- 0.07, log rank test, P = 0.01). T-ALL with SR phenotype is a distinct subgroup of leukemia with excellent prognosis under a high risk treatment protocol.

Adolescent↗
PubMed2004

Private finance and sustainable growth of national health expenditures.

This analysis explores the role of the private sector relative to all health spending among Organization for Economic Cooperation and Development (OECD) countries. Bi-variate regression was employed for 31 countries using current data. It was found that the share of GDP allocated to health varies among countries, ranging from 5 percent in Turkey to 14 percent in the United States. Variation in per capita income explains much of this difference but other factors are important too. One appears to be the role of the private sector in financing health expenditures. Our analysis concludes that concern about rising health sector costs should be placed in a larger context: rising health care costs may be justified if benefits are large enough and cover the opportunity costs of alternative uses of resources.

Data Collection↗
PubMed1998

[Self-assessment of the medical expert and his cooperation with the practicing medical team].

This article reflects the roles of medical experts concerned with assessment and evaluating and their co-operation with treating doctors. Mutual role assignments are described as well as role allocation and role acceptance. Procedures and contents of co-operation between expertising and treating doctors are listed. Co-operation is understood as an integrative task.

Expert Testimony↗
PubMed2006

Donor funding priorities for communicable disease control in the developing world.

Prior research has considered donor funding for developing world health by recipient and donor country but not by disease. Examining funding by disease is critical since diseases may be in competition with one another for priority and donors may be making allocation decisions in ways that do not correspond to developing world need. In this study I calculate donor funding for 20 historically high-burden communicable diseases for the years 1996 to 2003 and examine factors that may explain variance in priority levels among diseases. I consider funding for developing world health from 42 major donors, classifying grants according to the communicable disease targeted. Data show that funding does not correspond closely with burden. Acute respiratory infections comprise more than a quarter of the burden among these diseases but receive less than 3% of direct aid. Malaria also stands out as a high-burden neglected disease. The evidence indicates that neither developing world need nor industrialized world interests explain all funding patterns, and that donors may be imitating one another in ways that do not take into account problems in the developing world. There is an urgent need for a major increase in funding for communicable disease control in the developing world, and for more balanced allocation of the resources already provided.

Communicable Disease Control↗
PubMed1989

Ethical problems in prenatal diagnosis: a cross-cultural survey of medical geneticists in 18 nations.

In order to provide a basis for international discussion of ethics among geneticists, we surveyed the responses of medical geneticists to a questionnaire describing 14 hypothetical cases that posed ethical dilemmas. The cases were selected through discussions with leading geneticists in 12 nations, as representative of the most difficult problems of moral choice experienced in practice. Six cases involved indications for prenatal diagnosis or disclosure of information. All medical geneticists in each of 18 nations were included. Of 1053 asked to participate, 677 (64 per cent) responded. A large majority (83 per cent) would perform prenatal diagnosis for parents who oppose abortion but request the service. A smaller majority (63 per cent) would do so for maternal anxiety, and a minority (25 per cent) would perform for sex selection in the absence of X-linked disease. Most would disclose conflicting controversial, or ambiguous test results, and two-thirds would disclose colleagues' differences of opinion.

Beneficence↗
PubMed1993

International challenges and opportunities in health.

It is not easy to fit an introductory address to the topics of AIDS, transplantation, women's health, reproductive health, national health insurance and epidemiology and public health. I have been asked to speak on international challenges and opportunities in health care in the hope that the global context might frame your specific discussions in the broadest possible perspective. I will speak primarily about the widening gap in health status between rich and poor people and rich and poor nations -- a gap which poses great risks for the poor but increasing risks for all of us as well.

Bioethical Issues↗
PubMed1991

The place of IVF in infertility care.

In vitro fertilization has become standard treatment for infertility without the benefit of thorough evaluation. Today, the effectiveness of IVF is the subject of ongoing debate, the medical and non-medical risks of treatment are not adequately understood, and there is great concern about the true costs of care both for individuals and society. Added to this debate are ethical dilemmas which have changed the way we think about reproductive rights, the family, parenthood, intergenerational responsibilities, and the legal status of children and embryos. In order to address these issues, the World Health Organization Regional Office for Europe held a meeting in June 1990 on the Place of In Vitro Fertilization in Infertility Care. The recommendations from the meeting are presented.

Adoption↗