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PubMedDate not supplied

The Nixon years: failed national health reform from both parties.

In the November 1991 elections, popular support for national health reform (NHR) enabled Harry Wofford to become a U.S. Senator from Pennsylvania. Since then a bevy of congressional proposals to reform America's health care system have emerged, with even national health insurance, or a single payer system, becoming a prominent contender for the first time in 20 years. National health reform is now a regular feature on the evening news. However, this is not the first time that NHR has attracted national attention. As pointed out in the first article in this series (Physician Executive, March-April 1992, page 23), there have been numerous efforts to enact NHR in the U.S. Each has failed because of strident opposition by interest groups, lack of active presidential interest in the specific legislation, and the absence of strong popular interest.

Family Health↗
PubMed1995

Slam-dunked. New law forces insurance carriers to reduce rates.

No one saw it coming. Not consumer groups, not business or special interest groups, and especially not insurance carriers. The Texas Legislature did something this session no legislature had ever done, experts say. It ordered insurance carriers to cut premiums in practically all insurance lines, and for physicians, this will mean a 10% reduction in medical professional liability premiums effective January 1, 1996. Hospitals will see a 13% cut.

Insurance Carriers↗
PubMed2003

[Voting behaviour of the chronic mentally ill].

OBJECTIVE: Voting behaviour of chronic mentally ill patients should demonstrate that this group may act as a political interest group. METHODS: Residents of therapeutic facilities for mentally ill patients were questioned on their voting behaviour after the Federal Election to the Bundestag in 1994, 1998 and 2002. RESULTS: There was a stable preference for the parties from the "left wing", more than (2/3) of the study population voted for the Social Democrats or the Green party. It was important for 17.2 % of the clients that a party puts emphasis on the interests of the mentally ill. CONCLUSIONS: Chronic mentally ill patients show a different voting behaviour than the general population. Their voting decision is partially related to their specific interests, which could give them a lobby-like status. This should be taken into consideration in the future development and planning of mental health care systems.

Adult↗
PubMed1992

[Perioperative prevention of thromboembolism with standard heparin and low molecular weight heparin, evaluation of postoperative hemorrhage. A double-blind, prospective, randomized and mono-center study].

From October 1987 through June 1988 594 patients admitted to the department of visceral surgery, were included in a prospective, randomized double-blind study dealing with postoperative thromboembolic complications. 5000 I.U. heparin were administered twice daily to one group, the other group received a single dose of low molecular heparin (3000 I.U. anti-Xa) daily. In each group more than 290 patients were included. Diagnostic screening was done using LCCT (Liquid Crystal Contact Thermography) and phlebography. 130 patients had to be excluded from the study. 66 patients because of contra-indication, 54 patients because of administrative failing and 10 patients were excluded by the surgeon himself. There was no significant difference between the two groups concerning thromboembolic complications. However analysis of the patients who were excluded from the study shows an increase of thromboembolic complications. Looking at cases of postoperative haemorrhage we found that there was no significant difference between both groups. Interestingly, even compared to the excluded group, there was no difference. In our study postoperative haemorrhagic complications did not depend on the method of prophylaxis but on the surgeon performing the operation. Should a patient have a contra-indication for administration of thromboembolic prophylaxis, he has to take a certain risk of thrombosis. The fact that prophylaxis was not initiated because of neglect or fear of haemorrhagic complications is not only unforgiveable, but dangerous as well.

Adolescent↗
PubMed1994

Consequences of two different doses to the lungs during a single dose of total body irradiation: results of a randomized study on 85 patients.

PURPOSE: To evaluate the incidence of lung complications and leukemia recurrences after two different doses to the lungs during total body irradiation. METHODS AND MATERIALS: Seventy-nine patients with acute leukemia (AML or ALL) in first complete remission or chronic myeloid leukemia in the chronic phase, five patients with high grade lymphoma, and one with chronic lymphocytic leukemia were entered in the study. They were given a single dose of total body irradiation (10 Gy over 4 h) with two different doses to the lungs (6 Gy or 8 Gy) prior to bone marrow transplantation. The median dose rate was 0.04 Gy/min. The median follow-up for both groups of patients was 24 months. RESULTS: The actuarial 5-year overall survival rate was similar in both groups, 59% and 43% for patients given 8 Gy and 6 Gy to the lungs, respectively. The lung complication rate was similar in the two groups (28% vs. 22% for the 8 Gy and 6 Gy group, respectively). The actuarial leukemia recurrence rate was significantly higher in the group of patients given 6 Gy to the lungs (25%) vs. 0% in the 8 Gy group. Interestingly, all recurrences occurred in the group of patients who were given 6 Gy to the lungs, who had acute leukemia, and no chronic graft vs. host disease (GVHD). CONCLUSIONS: Although the number of patients was not very large and the follow-up relatively short, these findings suggest that a lower dose to the lungs could lead to an increased incidence of leukemia recurrences due to a lower dose to the thoracic wall or to lower incidence of chronic GVHD.

Adolescent↗
PubMed2005

Variety of morphological and electrophysiological properties of area postrema neurons in adult rat brain slices.

Whole-cell recordings were performed to examine the morphological properties of electrophysiologically classified area postrema (AP) neurons in rat brain slices. Using electrophysiological criteria, AP neurons were subdivided into three groups: (1) cells displaying both the hyperpolarization-activated cation current (I(h)) and the fast transient outward current (fast I(to)); (2) cells displaying only the fast I(to); (3) cells displaying only the slow I(to). All AP neurons had a single axon that was distinctly thinner than the cells' dendrites. No systematic differences, across groups, in the orientation of dendrites or axons were identified. Mean values of cell size and capacitance of neurons from group 3 were significantly larger than those of the other groups. Interestingly, a number of cells from groups 1 and 3 but not group 2 were found to extend their dendrites into the nucleus tractus solitarius (NTS), suggesting that AP neurons could receive vagal afferent inputs at their dendritic termini within the NTS. Although the AP has been implicated to contain uniformly shaped neurons, this study indicates the presence of significantly different subpopulations of AP neurons, which were characterized not only electrophysiologically but also morphologically.

Animals↗
PubMed2003

Replication of a peer support program designed to prevent disordered eating: is a life skills approach sufficient for all middle school students?

The evaluation of a school-based peer support group previously shown to improve body esteem and global self-esteem and reduce dieting in young adolescent girls was replicated in the present study. A total of 282 girls in grades 7 and 8, 196 of whom were in the control group, completed self-report questionnaires immediately before and after the life skills intervention, and 3 months later. Contrary to the findings reported in the original study, participation in the 10-session peer support group did not lead to improvements in body esteem or eating attitudes and behaviors beyond what was experienced by the control group. Interestingly, participants of the current intervention group exhibited higher disordered eating scores at baseline than those participants in the original study. Implications for matching prevention curriculum with the developmental and symptom levels of students are discussed.

Journal Article↗
PubMed2000

VEGF, its receptors and the tie receptors in recurrent miscarriage.

The aetiology of recurrent miscarriage (at least three consecutive miscarriages) usually remains unsolved. The vascular endothelial growth factor (VEGF) family of proteins, together with their receptors and the Tie (tyrosine kinase with immunoglobulin and epidermal growth factor homology domains) receptors, are crucial for embryonic development. Therefore, we used immunohistochemistry to analyse the expression of VEGF, the VEGF receptors (VEGFR)-1, -2, and -3, and the Tie-1 and Tie-2 receptors in placental and decidual tissue of women with a history of recurrent miscarriage and missed abortion (MA; n = 12) or blighted ovum (BO; n = 6), and from normal early terminated pregnancies (n = 12). Compared with controls, the MA and BO groups showed: (i) diminished placental trophoblastic VEGF immunoreactivity; (ii) weaker VEGFR-1 and -2 immunoreactivity in decidual vascular endothelium; (iii) reduced placental trophoblastic Tie-1 receptor immunoreactivity; and (iv) reduced decidual vascular endothelial Tie-1 and -2 receptor immunoreactivity. The absence of VEGFR-3 immunoreactivity in decidual vascular endothelium was also noted in all study groups. Interestingly, placental villi from the BO group presented blood vessel-like structures negative for von Willebrand factor, but positive for VEGF, VEGFR-1, -2, -3, Tie-1 and Tie-2 receptor. We conclude that the expression of these antigens may be altered in recurrent miscarriages.

Abortion, Habitual↗
PubMedDate not supplied

A comparison of biofeedback-assisted cardiodeceleration in type A and B men: modification of stress-associated cardiopulmonary and hemodynamic adjustments.

The primary purpose of this experiment was to examine the cardiac effects of instructions and biofeedback to reduce heart rate during both rest and a behavioral stressor. A second purpose was to assess respiratory, hemodynamic, and metabolic function in conjunction with heart rate. A final aim was to compare the effects of biofeedback on Type A and B men. Type A subjects fell in the upper 10% of the distribution of Jenkin's Activity Survey scores and Type B subjects fell in the lower 10%. Subjects experienced one of three instructional sets during an initial session: instructions to reduce heart rate with biofeedback; instructions to reduce heart rate without biofeedback; and instructions to sit quietly. During a second session, all subjects received identical instructions prior to the behavioral stressor. Heart rate, pulmonary gas exchange, and ventilation were measured breath-by-breath. During the first session, the groups did not differ in any measured parameter, but Type As had higher heart rates than did Type Bs across all conditions. During the second session, subjects given instructions to reduce heart rate with and without biofeedback did not differ in heart rate; as expected, however, both of these groups had smaller increases in heart rate than did the control group. Interestingly, the tachycardia of the control group occurred without an increase in oxygen consumption, indicating a cardiac-metabolic dissociation in this group. The modification of heart rate without a concomitant change in metabolism is important in understanding the association between cardiac and metabolic function.

Biofeedback, Psychology↗
PubMed1998

Trend of psychological distress in a Swedish population from 1989 to 1995.

The economic recession which began in Sweden in 1991 was followed by a large increase in the unemployment rate, especially in the younger labour force. The main purpose of the present study was to examine whether this recession has resulted in an increase in psychological distress in the population. Self-reported symptoms of anxiety, anguish, depression and sleeplessness have been analysed in repeated cross-sectional surveys conducted every other year from 1989 to 1995 in the County of Ostergötland. The study was confined to the 20-39 years age group and includes 3122 male and 3440 female respondents. The analysis was restricted to symptoms reported as occurring often or constantly. There was a significant increase in the 12-month prevalence of psychological distress among both men and women. At the beginning of the period 5% of the men in the 20-29 years age group reported frequent symptoms of psychological distress. By 1995 this had increased to 10%. The largest increase in prevalence, however, was found in men in the 30-39 years age group and women in the 20-29 years group Interestingly, when the non-employed groups were excluded from the analysis, the increasing trends of reported distress remained statistically significant with the exception of women aged 30-39 years.

Adult↗
PubMed2006

Lack of mutual respect in relationship: the endangered partner.

Violence in a relationship and in a family setting has been an issue of concern to various interest groups and professional organizations. Of particular interest in this article is violence against women in a relationship. While there is an abundance of knowledge on violence against women in general, intimate or partner femicide seems to have received less attention. Unfortunately, the incidence of violence against women, and intimate femicide in particular, has been an issue of concern in the African setting. This article examines the trends of intimate femicide in an African setting in general, and in Botswana in particular. The increase in intimate femicide is an issue of concern, which calls for collective effort to address. This article also examines trends of femicide in Botswana, and the antecedents and the precipitating factors. Some studies have implicated societal and cultural dynamics as playing significant roles in intimate femicide in the African setting. It is believed that the patriarchal nature of most African settings and the ideology of male supremacy have relegated women to a subordinate role. Consequently, respect for women in any relationship with men is lopsided in favor of men and has led to abuse of women, including intimate femicide. Other militating factors in intimate femicide are examined and the implications for counseling to assist the endangered female partner are discussed.

Adult↗
PubMed1990

Policy and research on health manpower regulation: never too late to deregulate?

Research on health manpower regulation has reached a consistent conclusion for the last two decades that is likely to carry into the 1990s: deregulate. Research has progressed in recent years, however, and research in the 1990s will be quite different from that of the past two decades. While the battle cry "never too late to deregulate" will continue to be heard, the "easy" targets, those markets with the least extensive or least important information asymmetry, have already been attacked. What is (or should be) finally emerging in the 1990s is a more challenging appraisal of health manpower regulation, one that recognizes greater complexity in health care markets and consumer preferences than has been recognized in past research. Lessons for the 1990s include the need to recognize, accept, and study information asymmetry and its consequences, and to more closely analyze the hypothesis that occupational interest groups, while meeting their self-interest, also may be serving the commonwealth. Such a reorientation leads us to ask different questions of regulation in future research, all directing attention to the informational attributes of markets: (1) How much information asymmetry exists in different health care markets, and how important is it? In which information-asymmetric markets is manpower regulation most likely to benefit consumers? (2) How can information asymmetry between consumers and providers be reduced, thereby facilitating deregulation? (3) How many regulations, of what type, are consumers willing to eliminate, for what benefits? Simplistic policy recommendations are less likely with this new orientation, and there is a great deal of interesting research awaiting health services researchers.

Consumer Behavior↗
PubMed2001

A shared vision of healthcare quality improvement.

SHEA and the American Society for Quality's Health Care Division have been collaborating in areas of common concern to improve healthcare quality. We each possess a heritage of different but complementary approaches and stand a better chance of success together than apart. This presentation describes rapid growth of our interdisciplinary, international, special interest group and progress made thus far, as well as challenges facing hospital epidemiologists and quality improvement professionals.

Cooperative Behavior↗
PubMed2005

ESHRE guideline for the diagnosis and treatment of endometriosis.

The objective was to develop recommendations for the diagnosis and treatment of endometriosis and its associated symptoms. A working group was convened comprised of practising gynaecologists and experts in evidence-based medicine from Europe, as well as an endometriosis self-help group representative. After reviewing existing evidence-based guidelines and systematic reviews, the expert panel met on three occasions for a day during which the guideline was developed and refined. Recommendations based solely on the clinical experience of the panel were avoided as much as possible. The entire ESHRE Special Interest Group for Endometriosis and Endometrium was given the opportunity to comment on the draft guideline, after which it was available for comment on the ESHRE website for 3 months. The working group then ratified the guideline by unanimous or near-unanimous voting; finally, it was approved by the ESHRE Executive Committee. The guideline will be updated regularly, and will be made available at http://www.endometriosis.org/guidelines.html with hyperlinks to the supporting evidence, and the relevant references and abstracts. For women presenting with symptoms suggestive of endometriosis, a definitive diagnosis of most forms of endometriosis requires visual inspection of the pelvis at laparoscopy as the 'gold standard' investigation. However, pain symptoms suggestive of the disease can be treated without a definitive diagnosis using a therapeutic trial of a hormonal drug to reduce menstrual flow. In women with laparoscopically confirmed disease, suppression of ovarian function for 6 months reduces endometriosis-associated pain; all hormonal drugs studied are equally effective although their side-effects and cost profiles differ. Ablation of endometriotic lesions reduces endometriosis-associated pain and the smallest effect is seen in patients with minimal disease; there is no evidence that also performing laparoscopic uterine nerve ablation (LUNA) is necessary. In minimal-mild endometriosis, suppression of ovarian function to improve fertility is not effective, but ablation of endometriotic lesions plus adhesiolysis is effective compared to diagnostic laparoscopy alone. There is insufficient evidence available to determine whether surgical excision of moderate-severe endometriosis enhances pregnancy rates. IVF is appropriate treatment especially if there are coexisting causes of infertility and/or other treatments have failed, but IVF pregnancy rates are lower in women with endometriosis than in those with tubal infertility. The management of severe/deeply infiltrating endometriosis is complex and referral to a centre with the necessary expertise is strongly recommended. Patient self-help groups can provide invaluable counselling, support and advice.

Endometriosis↗
PubMed2006

The necessary contradictions of 'community-led' health promotion: a case study of HIV prevention in an Indian red light district.

Health promotion interventions with marginalised groups are increasingly expected to demonstrate genuine community participation in their design and delivery. However, ideals of egalitarian democratic participation are far removed from the starting point of the hierarchical and exploitative social relations that typically characterise marginalised communities. What scope is there for health promotion projects to implement ideals of community leadership within the realities of marginalisation and inequality? We examine how the Sonagachi Project, a successful sex-worker-led HIV prevention project in India, has engaged with the unequal social relations in which it is embedded. Our ethnographic study is based on observation of the Project's participatory activities and 39 interviews with a range of its stakeholders (including sex worker employees of the Project, non-sex-worker development professionals, brothel managers, sex workers' clients). The analysis shows that the project is deeply shaped by its relationships with non-sex-worker interest groups. In order to be permitted access to the red light district, it has had to accommodate the interests of local men's clubs and brothel managers. The economic and organisational capacity to run such a project has depended upon the direct input of development professionals and funding agencies. Thus, the 'community' that leads this project is much wider than a local grouping of marginalised sex workers. We argue that, given existing power relations, the engagement with other interest groups was necessary to the project's success. Moreover, as the project has developed, sex workers' interests and leadership have gained increasing prominence. We suggest that existing optimistic expectations of participation inhibit acknowledgement of the troubling work of balancing power relations. Rather than denying such power relations, projects should be expected to plan for them.

Community Participation↗
PubMed2005

The perils of relying on interested parties to evaluate scientific quality.

Recently, there has been a trend in both civil litigation and regulatory law to circumvent the scientific community's collective judgment on the quality of individual studies with an adversarial process of evaluating scientific quality using interest groups. The Supreme Court's Daubert v Merrell Dow Pharmaceuticals, Inc opinion and two recent "good science" laws passed by Congress adopt an adversarial process informed by affected parties for reviewing and screening scientific quality. These developments are unwise. Both theory and experience instruct that an adversarial, interest group-dominated approach to evaluating scientific quality will lead to the unproductive deconstruction of science, further blur the distinction between policy and scientific judgments, and result in poor decisions because the courts and agencies that preside over these "good science" contests sometimes lack the scientific competency needed to make sound decisions.

Drug Industry↗
PubMed2006

Expressions of N-methyl-D-aspartate receptors NR2A and NR2B subunit proteins in normal and sulfite-oxidase deficient rat's hippocampus: effect of exogenous sulfite ingestion.

Sulfites whether ingested or produced through the sulfur-containing amino acids metabolism of the animal are very active molecules and can cause cellular toxicity. Sulfite oxidase (SOX), a heme- and molybdenum containing mitochondrial enzyme, prevents mammalian cells from adverse effects of sulfite toxicity by metabolizing sulfite to sulfate. The present study was aimed to investigate effect of sulfite on the N-methyl-D-aspartate (NMDA) receptor (NMDAR) NR2A and NR2B subunits in hippocampus of normal and SOX-deficient rats. Rats were divided into four groups; (1) control group, which was given rat chow and tap water ad libitum (C), (2) sulfite group, treated with sulfite (25 mg/kg) in drinking water and commercial rat chow ad libitum (S), (3) SOX-deficient group, maintained on high-W/Mo-deficient regimen to produce SOX deficiency (D), and (4) SOX-deficient + sulfite group (DS), prepared as those in the third group and were afterwards given sulfite (25 mg/kg) additionally. Whole treatment schedule were continued for 6 weeks. Sulfite treatment caused a decrease of NR2A and NR2B subunits of the NMDAR in hippocampus of rats in S and DS groups. Interestingly, similar decrement was observed in D group, probably due to increased endogenous sulfite production. In summary, the results indicated that feeding sulfite to the rats may cause down-regulation of NMDARs by degrading NR2A and NR2B subunits of it, which may be considered as a neuro-compensatory mechanism.

Animals↗
PubMedDate not supplied

Impulsiveness and compulsiveness in alcoholics and nonalcoholics.

Impulsiveness and compulsiveness questionnaires were completed by recovering alcoholics (n = 54) and by a community sample (n = 351). No relationship was found, indicating these traits are independent, distinct constructs. Alcoholics scored significantly higher on impulsiveness than nonalcoholics, and impulsiveness was negatively associated with age for both groups. Interestingly, the significant difference between the two groups on impulsiveness was maintained across age groups. Alcoholic and nonalcoholic compulsiveness scores showed no difference; however, compulsiveness was negatively related to age in nonalcoholics, but not alcoholics.

Adult↗