Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ECONOMICS”

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 361 records · Page 20Linked to original sources
PubMed1995

Short stature as an effect of economic and social conditions in childhood.

Only a few studies on the effect of environmental factors on height are based on adults and none, that we could find, relates adult height to both economic and psycho-social conditions in childhood. The aim of this study is to investigate whether four indicators of economic and psycho-social conditions during childhood are related to a variation in adult height and whether these factors can explain the variation in height between men and women from different childhood classes. The study is based on data derived from a study of living conditions in Sweden conducted in 1991. Beside childhood socio-economic group, indicated by father's occupation, we employ four indicators of economic and psycho-social conditions during the childhood period, previously employed elsewhere. These are economic hardship, large family, dissension in the family and disunited family during childhood. The prevalence of short stature differs significantly by three of the four indicators on economic and psycho-social childhood conditions. It is also more common if the person has grown up in a disunited family, but this effect is not significant. The proportion of short persons also varied significantly by childhood socio-economic group. On the whole, short stature in adulthood seems to be a reflection of a number of adverse conditions in childhood, both economic, status related and psycho-social, and can, consequently, be seen as summing up the whole childhood period rather than merely reflecting differences in nutrition or any other specific condition.

Adolescent↗
PubMed2004

Economic interventions to promote physical activity: application of the SLOTH model.

Physical inactivity is responsible for major health and economic costs in the United States. Despite widespread recognition of the scope and importance of the problem of physical inactivity, only modest progress has been made in improving overall physical activity in the U.S. population. This paper applies a combined economic and public health perspective to better understand physical activity behavior and to guide a search for promising new economically oriented interventions to increase physical activity at the population level. This perspective is operationalized as the SLOTH model-a time-budget model incorporating Sleep, Leisure, Occupation, Transportation, and Home-based activities. Key economic forces that may influence individuals' choices about utilization of time and physical activity are identified. Potential interventions are proposed in response to each of the important forces and are evaluated on four criteria: (1) economic efficiency, (2) equity, (3) effectiveness, and (4) feasibility. The SLOTH model provides guidance regarding interventions that might increase physical activity in each of the four nonsleep domains. Economic intervention strategies are proposed and compared to economic and public health criteria. The results provide a starting point for selecting and evaluating potentially effective and feasible economic interventions that might be implemented as part of a larger effort to address the health crisis of inactive lifestyles and obesity.

Exercise↗
PubMed2005

A simultaneous analysis of neighbourhood and childhood socio-economic environment with self-assessed health and health-related behaviours.

Childhood socio-economic environment and neighbourhood socio-economic environment later in life are closely related. However, few studies have considered their effects simultaneously. Using cross-sectional data of approximately 8000 respondents in 86 neighbourhoods in the city of Eindhoven, The Netherlands, we study associations of both determinants with self-assessed health, smoking, alcohol consumption and overweight. Growing up in a low socio-economic environment increased the probability to live a more deprived neighbourhood in adulthood. Controlling for individual socio-economic characteristics, both childhood and neighbourhood socio-economic environment were related to smoking and overweight, but not with excessive alcohol consumption. Associations between childhood socio-economic environment and smoking and overweight are still substantial after controlling for neighbourhood socio-economic environment. Similarly, neighbourhood inequalities in smoking and overweight remain substantial after controlling for childhood socio-economic environment.

Adult↗
PubMed1998

Economic analyses of radiological procedures: a methodological evaluation of the medical literature.

OBJECTIVE: Increasing pressure to curb health care costs has led to considerable interest in economic analyses, including both cost-effectiveness and cost-benefit analyses. Numerous economic analyses of radiological procedures have appeared in both the radiology and non-radiology literature. The objective of this study was to evaluate the methodological quality of economic analyses of radiological procedures published in the non-radiology medical literature during the years 1990 1995. METHODS: Original investigations from the medical (non-radiological) literature that include economic analyses of radiological interventions were identified from a computerized literature search. Each economic analysis article was evaluated by two independent reviewers for adherence to ten methodological criteria. The criteria were derived from review of the medical and radiological economic analysis methodology literature and consisted of the following: (1) Comparative options stated; (2) perspective of analysis defined; (3) outcome measure identified; (4) cost data included; (5) source of cost data stated; (6) long term costs included; (7) discounting employed; (8) summary measure provided; (9) incremental computation method used; and (10) sensitivity analysis performed. The results were compared to a previous study that evaluated the radiological literature. RESULTS: Of the 56 articles in the medical literature that included economic analyses of radiological procedures, only eight (14%) conformed to all ten methodological criteria. The cost data (98%) and comparative options (89%) criteria exhibited high compliance, while the perspective of analysis (25%) and discounting (32%) criteria had relatively low compliance. Agreement between the reviewers was excellent (kappa = 0.88). CONCLUSIONS: Published economic analyses of radiology procedures usually do not meet accepted methodological standards.

Bibliometrics↗
PubMed1997

Health economics in rheumatology.

Economic evaluations of health-care technologies are playing an increasingly central role in determining which therapies are available to clinicians in the treatment of a whole range of conditions. In rheumatology, a large body of work has already been done on the cost effectiveness of alternative non-steroidal anti-inflammatory drugs (NSAIDs), and much of the current work on disease modifying therapies incorporates economic evaluations. This chapter describes the main techniques of economic evaluation and reviews the strengths and weaknesses of each. Two published economic evaluations are discussed in order to highlight what economic evaluations can offer to the care of people with rheumatoid arthritis, as well as the current limitations of economic evaluation. The objective of this chapter is to equip readers with a critical understanding of economic evaluation that can be used in considering the increasing volume of health economic data that they encounter in their clinical work.

Cost-Benefit Analysis↗
PubMedDate not supplied

Meeting the challenge of funding and allocating resources to mental health across Europe: developing the Mental Health Economics European Network.

AIMS: There is growing demand for economic analysis to support strategic decision-making for mental health but the availability of economic evidence, in particular on system performance remains limited. The Mental Health Economics European Network (MHEEN) was set up in 2002 with the broad objective of developing a base for mental health economics information and subsequent work in 17 countries. METHODS: Data on financing, expenditure and costs, provision of services, workforce, employment and capacity for economic evaluation were collected through bespoke questionnaires developed iteratively by the Network. This was augmented by a literature review and analysis of international databases. RESULTS: Findings on financing alone suggest that in many European countries mental health appears to be neglected while mechanisms for resource allocation are rarely linked to objective measure of population mental health needs. Numerous economic barriers and potential solutions were identified. Economic incentives may be one way of promoting change, although there is no 'one size fits all solution. CONCLUSIONS: There are significant benefits and synergies to be gained from the continuing development of networks such as MHEEN. In particular the analysis can be used to inform developments in Central and Eastern Europe. For instance there is much that can be learnt on both how the balance of care between institutional and non-institutional care has changed and on the role played by economic incentives in ensuring that resources were used to develop alternative community-based systems.

Capital Financing↗
PubMed2003

Socio-economic differences in prescription and OTC drug use in Dutch adolescents.

OBJECTIVE: To detect whether there were socio-economic differences in the overall use of prescription and OCT drugs among adolescents. METHODS: This study was a secondary analysis of questionnaire data collected to investigate socio-economic differences in health risk behaviour and decision-making. RESULTS: About 20% of the 741 girls and 10% of the 736 boys reported using at least one prescription drug in the past 14 days, oral contraceptives excluded. For OTC drugs these percentages were 45% and 24%, respectively. No statistically significant socio-economic differences in prescription drug use could be detected. A higher socio-economic status was associated with an increased OTC drug use, especially in boys. The odds of girls who reported medication was about twice that for boys, after adjusting for perceived health and socio-economic status. CONCLUSION: There were socio-economic differences with regard to OTC drug use. No socio-economic differences in prescription medication use could be found. There were gender differences with respect to medication use in adolescence, regardless of perceived health and socio-economic status.

Adolescent↗
PubMed2003

Are there socio-economic inequalities in age of resection of colorectal cancer in people with HNPCC?

The relationship between socio-economic status and health has been consistently reported and is thought to be causal. Socio-economic inequalities are present in the incidence of and mortality from cancer in general, but not in the incidence of colorectal cancer in particular. However, there are socio-economic gradients in mortality from colorectal cancer. The socio-economic distribution of incidence of and mortality from colorectal cancer in individuals with hereditary non-polyposis colon cancer (Lynch syndrome) is not known. It is possible that increased awareness of and access to screening for colorectal cancer amongst this group of individuals reduces the socio-economic gradients seen in the population as a whole. We investigated the relationship between socio-economic status and age of resection of colorectal cancer in a cohort of individuals with hereditary non-polyposis colon cancer. More affluent individuals tended to undergo surgical resection for colorectal cancers earlier in their lives than less affluent individuals. This relationship was bordering on statistical significance. This trend probably represents socio-economic variations in access to treatment. In addition, age based diagnostic criteria for hereditary non-polyposis colon cancer may, inadvertently, accentuate socio-economic inequalities in outcome.

Adult↗
PubMedDate not supplied

Economic evaluation of breast cancer screening: A review.

PURPOSE: The authors provide a review of the economic evaluation literature of breast cancer screening and identify important trends and gaps in the literature. OVERVIEW: Healthcare resources are limited and economic evaluation plays a critical role in resource allocation, healthcare policy, and clinical decisions. Many economic evaluations of medical practice, however, are unreliable and do not use appropriate analytic techniques. Three important trends were observed. First, two economic evaluation methods are dominant. Second, a wide range of cost estimates exists across studies. Third, a lack of standardization exists across studies with regard to basic economic evaluation principles. These findings should be considered when conducting future research, analyzing economic evaluations of breast cancer screening, and developing clinical guidelines. CLINICAL IMPLICATIONS: Concerns about cost containment in healthcare make it necessary for physicians and clinical administrators to take an active role in resource allocation decisions at the clinical level. For instance, the recent debate on the proper age to begin annual mammography screening involves both resource allocation and clinical issues. Thus, it is important for physicians and clinical administrators to be familiar with the economic evaluation literature of breast cancer screening, economic evaluation methodology, and the associated shortcomings of published estimates.

Age Distribution↗
PubMed2000

Economic evaluation and end-stage renal disease: from basics to bedside.

Economic evaluation is the comparative analysis of alternative health care interventions in terms of their relative costs (resource use) and effectiveness (health effects). High-quality studies of economic evaluation have been increasingly published in medical journals and read by clinicians, although publication of these studies in nephrology journals has been a more recent phenomenon. This article shows how the basic principles of economics can be applied to health care through the use of economic evaluation. Different types of economic evaluation are discussed, and pitfalls common to such studies are identified. A simple framework is introduced that can be used to interpret the results of economic evaluations. Using this framework, selected therapies for patients with end-stage renal disease (ESRD) are categorized to highlight therapies that are very efficient, encourage their use, and draw attention to therapies in current use that are less effective and more expensive (ie, less efficient) than alternative therapy. Using examples pertinent to care of the patient with ESRD, we show how economic evaluation can be used to link medical outcomes, quality of life, and costs in a common index for multiple therapies with disparate outcome measures. This article highlights the need for clinical studies and economic evaluations of therapies in ESRD for which the effects of the therapy on health outcomes and/or costs are unknown.

Cost-Benefit Analysis↗
PubMed2001

The role of economic evaluation in infection control.

Given the rise in health care-related expenditures, decision-makers are increasingly relying on both clinical effectiveness and economic efficiency when making health care decisions. The field of infection control is not immune to this rise in cost-consciousness among health care managers. This article clarifies the role of economic evaluation within infection control for both the user and producer of economic evaluations in this field. The strengths and drawbacks of the several different types of economic analysis--cost minimization, cost-effectiveness, cost-benefit, and cost utility analysis--will be discussed. Additionally, the important features of two specific methods used for economic evaluation-decision analytic modeling and economic analysis alongside a clinical trial-will be outlined. Finally, the criteria by which economic analyses should be judged will be provided. As economic evaluation and health services research continue to play an increasingly important role in health care, it will be vital for infection control advocates to partner with individuals from diverse fields to give decision-makers the type of information they need to make choices.

Clinical Trials as Topic↗
PubMed2003

The socio-economic patterning of survey participation and non-response error in a multilevel study of food purchasing behaviour: area- and individual-level characteristics.

OBJECTIVE: To undertake an assessment of survey participation and non-response error in a population-based study that examined the relationship between socio-economic position and food purchasing behaviour. DESIGN AND SETTING: The study was conducted in Brisbane City (Australia) in 2000. The sample was selected using a stratified two-stage cluster design. Respondents were recruited using a range of strategies that attempted to maximise the involvement of persons from disadvantaged backgrounds: respondents were contacted by personal visit and data were collected using home-based face-to-face interviews; multiple call-backs on different days and at different times were used; and a financial gratuity was provided. PARTICIPANTS: Non-institutionalised residents of private dwellings located in 50 small areas that differed in their socio-economic characteristics. RESULTS: Rates of survey participation - measured by non-contacts, exclusions, dropped cases, response rates and completions - were similar across areas, suggesting that residents of socio-economically advantaged and disadvantaged areas were equally likely to be recruited. Individual-level analysis, however, showed that respondents and non-respondents differed significantly in their sociodemographic and food purchasing characteristics: non-respondents were older, less educated and exhibited different purchasing behaviours. Misclassification bias probably accounted for the inconsistent pattern of association between the area- and individual-level results. Estimates of bias due to non-response indicated that although respondents and non-respondents were qualitatively different, the magnitude of error associated with this differential was minimal. CONCLUSIONS: Socio-economic position measured at the individual level is a strong and consistent predictor of survey non-participation. Future studies that set out to examine the relationship between socio-economic position and diet need to adopt sampling strategies and data collection methods that maximise the likelihood of recruiting participants from all points on the socio-economic spectrum, and particularly persons from disadvantaged backgrounds. Study designs that are not sensitive to the difficulties associated with recruiting a socio-economically representative sample are likely to produce biased estimates (underestimates) of socio-economic differences in the dietary outcome being investigated.

Adolescent↗
PubMed2004

Biological ageing: a fundamental, biological link between socio-economic status and health?

Socio-economic differences in health appear to be universal but the precise pathways that link socio-economic status and health remain unclear. Differential exposure to specific risk and protective factors are often cited as, at least, partial explanations of socio-economic differences in health. However, risk factors are culturally specific and risk factor-specific models of socio-economic differences in health may be inadequate: as soon as prevailing risk factors change, so too must associated explanations of socio-economic differences in health. An alternative, risk factor-independent, model of socio-economic differences in health proposes that fundamental pathways to health and disease exist and that risk and protective factors act by feeding into these pathways. We propose that biological ageing is one such fundamental pathway to health, disease and, thus, socio-economic differences in health. Biological ageing is the progressive decline in physiological ability to meet demands, that occurs over time. It is due to the accumulation of damage at the cellular level and the rate of biological ageing is determined by both environmental and genetic factors. There is increasing evidence that many known disease risk and protective factors influence the rate of cellular damage accumulation and hence biological ageing and that the pathogenesis of some important diseases is related to biological ageing. We discuss these issues and hypothesize that socio-economic differences in health are partly a result of poor people ageing faster than rich people due to the unhealthy environments to which they are exposed.

Aged↗
PubMed2001

Food insecurity is associated with past and present economic disadvantage and body mass index.

Fears and experiences of food restriction influence eating behavior but the association between past and present economic disadvantage, food insecurity and body size is poorly understood. Therefore, we examined these associations in a nationwide, representative sample of 25- to 64-y-old Finnish men and women (n = 6506). The respondents were classified by their body mass index (BMI) into four groups: thin, normal, overweight and obese. Economic disadvantage was assessed by three indicators including low household income, unemployment during past 5 y and long-term economic problems in childhood. Food insecurity was assessed by five separate items concerning economic fears and experiences related to sufficient supply of food during the past 12 mo, and a combined scale in which those with affirmative responses to four to five items were classified as hungry. Multivariable logistic regression analyses were conducted using both the BMI grouping and indicators of economic disadvantage as independent variables to predict food insecurity, controlling simultaneously for age, educational attainment and sex. The results showed that low household income, recent unemployment and economic problems in childhood were all predictors of food insecurity. Thin people were most likely to be hungry and showed most food insecurity in five separate items. In addition, obese people reported more buying cheaper food due to economic problems and fears or experiences of running out of money to buy food than did normal weight subjects. In conclusion, both past and present economic disadvantage is associated with various aspects of food insecurity. The association between food insecurity and BMI is curvilinear.

Adult↗
PubMed2004

A structured review of studies on health-related quality of life and economic evaluation in pediatric acute lymphoblastic leukemia.

BACKGROUND: A comprehensive review was made of the literature on the health-related quality of life (HRQL) and economic outcomes of children with acute lymphoblastic leukemia (ALL), the most common of all cancers in childhood. OBJECTIVES: The primary objectives of the review were to locate and describe measures of HRQL used in pediatrics and in pediatric oncology that might be applicable to ALL, to summarize studies that have applied HRQL measures to ALL, to identify and summarize economic evaluations of the costs and consequences of care for pediatric ALL, and to identify areas requiring further research. DATA SOURCES: To identify the HRQL literature in pediatric ALL, searches were run on the major biomedical and social science bibliographic databases. Search terms included a variety of MeSH and other thesaurus terms, text words, names of HRQL instruments, and the names of key authors in the field. The economic literature searches included most of the same databases, with the addition of the National Health Service Economic Evaluation Database and EconLit. Searches on specific authors and instruments and hand searches were also conducted. STUDY SELECTION: Only English language studies published from 1975 through 2000 were included. DATA EXTRACTION: Standardized data extraction forms were used to abstract information from HRQL and economic evaluation studies. Two reviewers independently screened the search results, and differences were resolved by consensus. DATA SYNTHESIS: A number of generic HRQL measures, both adult and pediatric, have been applied in pediatric ALL. In addition, a number of pediatric oncology-specific instruments and pediatric oncology disease-specific instruments have been developed. Most of these instruments have been used to measure the health status of patients undergoing therapy. Despite the limited numbers of patients and resources available to assess HRQL measures in children with cancer, a fairly substantial body of literature has been published. Economic studies of pediatric ALL have only recently been undertaken. Most studies focus on a particular, narrow aspect of costs associated with the disease. There are relatively few cost-effectiveness studies that compare the costs and consequences of two or more treatment options. There are no published, comprehensive economic evaluations of pediatric ALL. CONCLUSIONS: HRQL measures provide not only important information on the improvements offered by new therapies but also an outcome measure for economic evaluations. Recently developed HRQL measures and applications that include the direct assessments of children are important contributions. By the age of 7 or 8 years, children can generally provide reliable responses. Furthermore, children often provide information that is not available from parental reports (e.g., in the more subjective areas of pain and emotion). However, the use of multiple viewpoints, such as the patient, parent, and health professional perspectives, can provide valid and important complementary information. Expertise in HRQL measurement should be included in the design of most future trials. Funds for HRQL research should be made available to enhance the scope of HRQL activities by organizations such as the Children's Oncology Group. In the near future, further work to generate evidence of validity for available HRQL measures for use in children with ALL will be a high priority. Continuation of inquiries into the methods for HRQL assessment of younger children (i.e., preschoolers) is also a priority.

Child↗
PubMed2005

Economic evaluation of cardiac rehabilitation: a systematic review.

BACKGROUND: Economic evaluation is an important tool in the evaluation of competing healthcare interventions. Little is known about the economic benefits of different cardiac rehabilitation program delivery models. DESIGN: The goal of this study was to review and evaluate the methodological quality of published economic evaluations of cardiac rehabilitation services. METHODS: Electronic databases were searched for English language evaluations (trials, modeling studies) of the economic impact of cardiac rehabilitation. A review of study characteristics and methodological quality was completed using standardized tools. All costs are adjusted to 2004 US dollars. RESULTS: Fifteen economic evaluations were identified which met eligibility criteria but which displayed wide variation in the use of comparators, evaluation type, perspective and design. Evidence to support the cost-effectiveness of supervised cardiac rehabilitation in myocardial infarction and heart failure patients was identified. The range of cost per life year gained was estimated as from 2193 dollars to 28,193 dollars and from - 668 dollars to 16,118 dollars per quality adjusted life year gained. The level of evidence supporting the economic value of home-based cardiac rehabilitation interventions is limited to partial economic analyses. CONCLUSIONS: Evidence to support the cost-effectiveness of supervised cardiac rehabilitation compared with usual care in myocardial infarction and heart failure was identified. Further trials are required to support the cost-effectiveness of cardiac rehabilitation in cardiac patients who have under gone revascularization. The literature evaluating home-based and alternative delivery models of cardiac rehabilitation was insufficient to draw conclusions about their relative cost-effectiveness. The overall quality of published economic evaluations of cardiac rehabilitation is poor and further well-designed trials are required.

Cost-Benefit Analysis↗
PubMed2005

Economic burden of pertussis and the impact of immunization.

Although routine use of vaccines has diminished the incidence of pertussis disease, it has not eliminated the pathogen. Epidemiologic data confirm that pertussis remains a significant health problem in all age groups. Disease burden is highest in infants, in whom pertussis disease frequently leads to severe complications and mortality, although it is also a significant health burden in adolescents and adults, in whom the reported incidence of pertussis is increasing. The Global Pertussis Initiative reviewed the literature to find data that express the economic impact of this health burden and to review economic evaluations of pertussis immunization. Although only limited data on the direct and indirect costs of pertussis are available, they suggest that it poses a significant economic burden and indicate that the direct medical costs of pertussis depend on the rate of hospitalization and the severity of complications, and are highest in infants. The indirect costs of pertussis also appear to be considerable, particularly among adults, in whom the disease reduces work productivity, because of either personal illness or child care responsibilities. Several health economic models on the cost effectiveness of childhood immunization strategies have been published, and although constrained by missing data, have generally found childhood immunization strategies to be cost-effective. Economic analyses of adolescent and adult immunization strategies have also been conducted, but the findings of these studies have been inconsistent. The most recent evaluations, using much higher estimates of incidence than reported previously, suggest that immunization of adolescents and specific adult subgroups may be cost-effective. The literature review confirmed that the economic burden of pertussis is substantial, but there are gaps in existing information. In the short term, further economic analyses are required, particularly of adolescent and adult immunization. More importantly, collection of primary epidemiologic and economic data should be undertaken in parallel. Despite the existing gaps in data, further research using the most current data should facilitate decisions on new vaccination strategies by describing conditions for favorable results and quantifying the margin of uncertainty.

Adolescent↗
PubMed2003

Economic expansion is a major determinant of physician supply and utilization.

OBJECTIVE: To assess the relationship between levels of economic development and the supply and utilization of physicians. DATA SOURCES: Data were obtained from the American Medical Association, American Osteopathic Assocation, Organization for Economic Cooperation and Development (OECD), Bureau of Health Professions, Bureau of Labor Statistics, Bureau of Economic Analysis, Census Bureau, Health Care Financing Administration, and historical sources. STUDY DESIGN: Economic development, expressed as real per capita gross domestic product (GDP) or personal income, was correlated with per capita health care labor and physician supply within countries and states over periods of time spanning 25-70 years and across countries, states, and metropolitan statistical areas (MSAs) at multiple points in time over periods of up to 30 years. Longitudinal data were analyzed in four complementary ways: (1) simple univariate regressions; (2) regressions in which temporal trends were partialled out; (3) time series comparing percentage differences across segments of time; and (4) a bivariate Granger causality test. Cross-sectional data were assessed at multiple time points by means of univariate regression analyses. PRINCIPAL FINDINGS: Under each analytic scenario, physician supply correlated with differences in GDP or personal income. Longitudinal correlations were associated with temporal lags of approximately 5 years for health employment and 10 years for changes in physician supply. The magnitude of changes in per capita physician supply in the United States was equivalent to differences of approximately 0.75 percent for each 1.0 percent difference in GDP. The greatest effects of economic expansion were on the medical specialties, whereas the surgical and hospital-based specialties were affected to a lesser degree, and levels of economic expansion had little influence on family/general practice. CONCLUSIONS: Economic expansion has a strong, lagged relationship with changes in physician supply. This suggests that economic projections could serve as a gauge for projecting the future utilization of physician services.

Cross-Sectional Studies↗