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At least 379 records · Page 21Linked to original sources
PubMed1975

Ocular myasthenia gravis and Hashimoto's thyroiditis.

Two patients had ocular myasthenia gravis coexistent with Hashimoto's thyroiditis. A 37-year-old woman presented with diplopia and displayed a head tremor and thyroid enlargement. Thyroid function tests showed an elevated thyroid stimulating hormone (TSH). A quantitative Tensilon test yeilded a "perverse" response and a needle biopsy indicated Hashimoto's disease. A 26-year-old woman presented with diplopia and subsequently developed blepharoptosis and thyroid enlargement. Examination revealed Cogan's eyelid twitch sign, a paradoxical quantitative Tensilon test, and laboratory studies revealed normal thyroid function tests. Treatment was directed at each disease entity separately. Ocular myasthenia gravis was managed with an anticholinesterase agent in combination with oral corticosteroids that provided additional control. Suppressive therapy with desiccated thyroid hormone reduced the size of the thyroid gland, diminished the signs and symptoms of hypothyroidism, and lowered the levels of TSH, possibly decreasing the risk of thyroid carcinoma. Both patients showed gratifying responses to therapy.

Adult↗
PubMed1995

Promoting an empiricist agenda within the human services: an ethical and humanistic imperative.

Various meta-contingencies inadvertently promote the perpetuation of bogus psychotherapies and other human service interventions. This article outlines some of these perverse incentives and describes counter-controls which could be adopted by the various professional associations, state licensing boards, accreditation bodies, and service providers. These counter-controls have the potential to move human services in the direction of becoming a truly empirical clinical science. This would directly enhance the ethical appropriateness and humanistic goals of the human service professions.

Behavior Therapy↗
PubMed1996

Outpatient treatment of mentally disordered offenders in Austria.

The mental health system is faced with a growing number of MDOs with treatment orders. For more than 90% of our sample of 157 discharged irresponsible MDOs a mandatory outpatient treatment was ordered. Considering the fact that half of these patients are transferred after discharge to institutions like psychiatric hospitals or nursing homes (Leygraf, 1988), institutional as well as outpatient treatment options are needed (Silver & Tellefsen, 1991). Within the Austrian mental health system here is an enormous lack of post-discharge treatment facilities for forensic patients (Meise, Rossler, & Hinterhuber, 1994). Furthermore, the existing structures obviously do not meet the special needs of forensic patients. Although this point of view is shared by the psychiatric hospitals and their contentment with the settings for forensic outpatient treatment was low, only one hospital intended conceptional change and modifications. Facing the reality that the same psychiatric hospital authorities complained that they could not release MDOs from an inpatient status because of inappropriate outpatient facilities, the responsibility for forensic patients seems to be projected from the medical to the legal system. This can be seen as a symptom of the tendency to a step wise and long-standing exile of forensic patients from the mental health system. Actually, forensic patients were for various reasons refused by mental health professionals and could not get psychotherapy, medication or adequate psychosocial care. A possible answer to these problems is to establish institutionalized outpatient facilities in the "hybrid" gap between the legal and mental health system (Lamb, Weinberger, & Gross, 1988). The new outpatient clinic in Vienna deals with rejected treatment-order patients, most of them with additional treatment problems such as impulsivity, substance abuse, and mental impairment (Cote & Hodgins, 1990). The special structure of the institution (i.e., a multiprofessional team that offers a wide and easily accessible spectrum of interventions, the realization of individual treatment programs with psychotherapeutic and psychosocial as well as biological aspects, and the long-term personal continuity of care by staff members with forensic psychiatric skills) promoted the experience that after some time half of the patients came on a voluntary basis (Fenell, 1992; Winick, 1994). Some pressure by the court was an efficient way to guarantee regular treatment for patients with personality disorders and perversions. The model of a special, structured, multiprofessional outpatient clinic is successful, but the role of such complementary pilot institutions is ambiguous. Simultaneously, the deficit of adequate outpatient care for MDOs has to be opposed by stopping the unacceptable withdrawal of general psychiatry from the forensic sector.

Aftercare↗
PubMedDate not supplied

Inadequacy of the average reference for the topographic mapping of focal enhancements of brain potentials.

The main reason for doing topographic mapping of EEG or evoked potentials is to assess regional changes in brain potentials. The use of an average reference is shown to have perverse effects in this relation, namely because it imposes on the recorded data a zero-centering effect which can reduce, eliminate or even reverse the focal changes of bit-mapped brain potentials. Concurrent studies on a true 3-shell head model suggest that such distortions of human EEG data occur because the average reference is computed from a set of (scalp) recording electrodes which do not survey the bottom half of the head volume so that the integral of scalp-recorded potentials frequently differs from zero. The results also raise the question whether the actual incidence of radial or near-radial (versus tangential) generators has been underestimated in the published data using average reference mapping.

Adult↗
PubMed1991

The year after Kobuleti: what difference does it make?

Following and pursuant to a conference held in Kobuleti, Soviet Georgia in April, 1990, a paper describing proposed principles for legislation establishing a health insurance system for the U.S.S.R. and Union Republics was published. It proposed supplementing the existing publicly financed medical care system with a system of regionally based 'health insurance' funds, as well as formally recognized direct payments to health care providers. While creating the opportunity for insurance funds which were to be regionally based, the system was to be centrally directed. Since the publication of that paper, the reforms it envisions have progressed more slowly than expected. This is due to at least three factors. First, the general state of the Soviet economy, coupled with a strengthening of the movement toward greater autonomy for the Soviet Republics and an accompanying reluctance on the part of the Republics to contribute to the Union budget, has resulted in a greater reduction of that budget (and a greater budget deficit) than anticipated. Second, due in part to perverse financial incentives, the capacity of the Soviet health care system to increase production, even if the financial resources were available, is limited, and has deteriorated during the past year. Third, the patience of health care workers with their working conditions is wearing thin, resulting in less willingness on their part to cooperate with anything less than total and fundamental reform than has been the case in the past. At this point, it appears that any reform of Soviet health care will emphasize autonomy at the levels of the Republics, and a diminution of central power and control. There is a growing feeling that anything short of a significant improvement in the general Soviet economy linked with total reform of health care financing and delivery will fail to reverse the deterioration of the Soviet health care system.

Financing, Government↗
PubMed1994

The market reform of the New Zealand health care system searching for the Holy Grail in the Antipodes.

Everywhere there is a recognition that the delivery of health care is ineffective and inefficient and that these unpleasant outcomes are a product of the perverse incentives inherent in all health care systems. In New Zealand the Government documented the defects of the health care system and has introduced radical competitive market reforms, with a purchaser-provider split, in the belief that these will improve the system's performance. The nature of these reforms, centred on the purchaser-provider divide, is similar to changes introduced in the Netherlands, the UK, Sweden, Israel and Russia. The reforms which have been introduced in New Zealand are evaluated in terms of the eight major problems its Government sought to eradicate. It is shown that instead of mitigating these problems the reforms may worsen them, with the system becoming fragmented and less equitable. The move away from a single (tax) source of funds (i.e. the single pipe) may make cost control more difficult. The Government is seeking to address the issue of information generation to facilitate market trading but it is not clear how effectiveness and efficiency data will be produced in adequate volume and quality, let alone how it will be used to change producers behaviour. Many of the problems identified by the New Zealand Government are significant and in need of resolution. However whilst the political imperative may require immediate action, the economic case for these reforms is quite poor. Incremental change, with careful evaluation, would 'inform' policy change with knowledge of the attributes of competing management mechanisms and reward systems. Instead there is the too familiar combination of political assertions and an unwillingness to measure the impact of change, behaviours which may create the causes for the advocacy of the next 'redisorganisation' of the health care system.

Community Participation↗
PubMed1996

Are waiting lists inevitable?

Waiting lists are a common phenomenon in markets in which non-price allocation of goods and services occurs. To the extent that waiting lists for in-patient health services are perceived to ration imperfectly, many propose policies which focus on reducing demand or increasing supply. Strategies aimed at increasing supply often create perverse incentives in that they reward hospitals with long waiting lists through the provision of additional resources. This paper describes how supply has been addressed in Victoria by changing the financial incentives relating to waiting lists. The success of this payment policy in reducing waiting lists to public hospitals is reported.

Diagnosis-Related Groups↗
PubMed1982

Insurance, competition and cost containment.

Most economists have suggested that the growing presence of insurance, including Medicare, Medicaid, Blue Cross and the commercial insurers, is largely responsible for the rapid rise of health care costs in the United States. It is the contention of this paper, however, that the insurance industry in the private sector in the United States may help in the effort to contain costs rather than solely stimulating rapidly increasing costs. A number of methods that insurers have employed to contain costs, including monitoring provider behavior and prospective reimbursement, are identified. It is cautioned, however, that although health insurer cost containment efforts will continue to expand in the future, perversities in the U.S. tax laws, potential provider opposition and the complexities of medicine will continue to make cost containment a difficult task.

Cost Control↗
PubMed1991

Coordinating community and public-institutional mental health services: some unintended consequences.

Where a target group such as the mentally ill tend to use multiple and varied services over a long period of time, service coordination is often seen as the key to continuity of care. This article argues that coordination also has its perverse effects. To demonstrate, two types of community organizations (COs) working in mental health in the Canadian province of Québec are examined: alternative COs, which have their roots in community action and maintain few formal links with each other or with institutional resources; and transitional structures, COs which are developed with the cooperation of psychiatric professionals, are closely linked to hospitals and are often part of a tightly coordinated system of community services. With respect to access, continuity, programs, internal structure and flexibility, each type of community resource has particular strengths and weaknesses. In the first part of the article, these are described and compared. In the second part of the article, we examine the possible effects of Québec's new mental health policy on COs working in mental health. The policy seeks to create comprehensive systems coordinating all services at the regional level-including alternative organizations, transitional structures and public institutions. The imperatives of the complex planning process risk diluting or even eradicating the differences between the two types of mental health COs described earlier. The process may thus rob certain service users of the particular advantages they found in alternative COs. For those mentally ill who, by choice or by chance, remain marginal to the coordinated system, there may ultimately be no resources available at all.

Community Mental Health Services↗
PubMed1983

Interstate migration in Mexico: variations on the Todaro theme.

"This study of migration in Mexico is based upon a modified Todaro approach and utilizes census data in a simultaneous equations model of 13 variables. It is unique in several ways: (a) it introduces proxy variables for employment probability and cost of migration that have not heretofore been found in the literature, but for which data are often available; (b) it illustrates that in some important cases census data have advantages not available through surveys; and (c) it finds that in some sense land reform in Mexico may have operated perversely. Finally, the study opens a new avenue for the study of informal sector growth."

Agriculture↗
PubMed1992

Pathological infatuation or the Blue Angel syndrome.

The term masochism has undergone an evaluation since first being introduced solely in relation to sexual perversion by Kraft Ebing in 1906. Masochism can be defined as any behavior that is repetitively self destructive. Relationships in which partners sacrifice themselves and their own best interests can be considered masochistic. There is a difference between a normal pattern of falling in love and a masochistic pattern. The concept of pathological infatuation or what this author has termed the Blue Angel syndrome is presented. A case history with clinical examples is examined to further illustrate these concepts.

Humans↗
PubMed2005

Occupational medicine: the case for reform.

The specialty of occupational medicine is in peril, in large part because of its reliance on financing by industry, which has powerful incentives to limit costs and to favor physicians who are useful to their employers. Occupational physicians generally practice within the framework of the workers' compensation system. Serious flaws in the incentive structure of workers' compensation constrain objectivity in their practice. Under present law they are unavoidably subject to perverse influences from employers and insurance companies. A fundamental reform of workers' compensation law and practice is urgently needed to separate occupational physicians from the control of employers and workers' compensation insurers, whose interests should not be allowed to override the physicians' integrity or to compromise the specialty.

Delivery of Health Care↗
PubMed2005

Efficacy and safety of topiramate in the treatment of obese subjects with essential hypertension.

The effect of topiramate on weight and blood pressure (BP) was examined in a randomized, placebo-controlled trial in obese subjects who had hypertension. After a 4-week, placebo, run-in period, 531 obese subjects (body mass index 27 to 50 kg/m(2)) who had established hypertension were randomly assigned to placebo or 96 or 192 mg/day of topiramate. All subjects received a standardized diet, exercise advice, and behavioral modification from run-in through study end. Initially scheduled for 60 weeks on medication, the sponsor ended the study early to develop a new controlled-release formulation. As a consequence, efficacy was assessed within a predefined modified intent-to-treat population (subjects who enrolled early enough to potentially complete 28 weeks on medication). The placebo and 96- and 192-mg groups had respective weight losses of 1.9%, 5.9%, and 6.5% from baseline (p <0.001 for each comparison with placebo) and decreases in diastolic BP of 2.1, 5.5, and 6.3 mm Hg (p <0.015 vs placebo). Systolic BP was decreased by 8.6 and 9.7 mm Hg in the 96- and 192-mg groups and 4.9 mm Hg in the placebo group (p = NS). Compared with placebo, the topiramate groups had larger proportions of subjects whose weight decreased by > or =5% and 10%, whose diastolic BP decreased by > or =5 and 10 mm Hg, and who achieved normalization of BP (BP <130/85 mm Hg). Adverse events included paresthesia, fatigue, taste perversion, loss of appetite, and difficulty with concentration and attention. In conclusion, topiramate produced clinically relevant effects in reducing body weight and BP, with generally mild to moderate adverse effects.

Administration, Oral↗
PubMed2004

[Impact of the law of the 4 March 2002 relative to patients' rights on request for medical information received in a medical dispatching center and mobile intensive care unit (Samu 93)].

INTRODUCTION: Law of the 4 March 2002 allowed patient's access to his medical record. This law could increase the number of requests in medical dispatching centers and prehospital intensive care units. OBJECTIVE: The aim of this study was to evaluate the impact of this law on the number of requests for medical information received in our unit. METHODS: Since the promulgation of the law, from March to December 2002, medical requests were prospectively collected and classified in categories including request for transmission of medical record. Requests received before the law, from January 2000 to February 2002 were classified according to the same items. Number of requests received during the two periods were compared according to the total number of medical record managed in our medical dispatching center and prehospital intensive care unit. RESULTS: The total number of requests for medical information significantly increased since the law of March 2002 (results are expressed as cases per month per 10 000 record: 4.8 +/- 2.5 vs. 8.0 +/- 4.5; p = 0.04). Specific request for transmissions of medical record significantly increased since the law (1.3 +/- 1.6 vs. 3.0 +/- 3.0; P = 0.046). This increase was progressive and constant since March 2002. DISCUSSION: Physicians and patients should take in consideration consequences of this law. Physician should be vigilant with the quality of their medical dossiers. Interpretation of this law and its ethics consequences will probably be discussed again as one should not exclude perverse impact of this law. In effect, insurances and mutual insurances companies could find in this law a way to obtain medical information, such as circumstances of death, previously unavailable. CONCLUSION: The law of 4 March 2002 relative to patients' rights significantly increased number of requests for medical information received in our dispatching center and prehospital intensive care unit.

Access to Information↗
PubMed2006

Sex chromosome specialization and degeneration in mammals.

Sex chromosomes--particularly the human Y--have been a source of fascination for decades because of their unique transmission patterns and their peculiar cytology. The outpouring of genomic data confirms that their atypical structure and gene composition break the rules of genome organization, function, and evolution. The X has been shaped by dosage differences to have a biased gene content and to be subject to inactivation in females. The Y chromosome seems to be a product of a perverse evolutionary process that does not select the fittest Y, which may cause its degradation and ultimate extinction.

Animals↗
PubMed2005

Characteristics of female child sexual abuse in Hungary between 1986 and 2001: a longitudinal, prospective study.

OBJECTIVE: To summarize the characteristics of female child sexual abuse and to explore common features that may be utilized as targets for possible methods of prevention. DESIGN: Prospective, longitudinal study. SETTING: A Hungarian county, University of Debrecen. PARTICIPANTS: Between 1986 and 2001, 209 girls under the age of 18 who had been exposed to sexual abuse visited the Department of Adolescent Gynecology. METHODS: We prospectively collected data illustrating the characteristics of all cases. Events in which victim and perpetrator were members of the same family were recorded as intrafamilial. Subsequent legal procedures were also evaluated. MAIN OUTCOME MEASURES: We describe the medical and legal approaches to handling child neglect. RESULTS: Seventy-five percent of the victims were students, and 47% of them were between 11 and 14 years of age. The perpetrator was familiar to the victim in 66% of the cases, and a stranger in 34%. Fifty-two (25%) perpetrators were members of the victims' families. In 11% of cases, the perpetrator was the victim's father and in 10%, her stepfather. The abuse had occurred on multiple occasions in 21%. The occurrence rate of assault was highest in the summer season (59%). Thirty-nine percent of victims were accompanied by their mothers when they attended the clinic and 43%, by police. officers. Vaginal penetration was the type of abuse in 80%, and sexual perversion in 20%. Sixty-six victims were physically injured, and in 38 cases the presence of sperm was confirmed in vulvo-vaginal smears. One pregnancy occurred as the result of the abuse. In all, 127 cases were reported to the police; 56 of the perpetrators were sentenced as a result of legal proceedings. CONCLUSION: A high proportion of female child sexual abuse takes place within the family and is revealed only after multiple episodes. The low reported prevalence of sexual assault is the consequence of the lack of cooperation between the emergency services in Hungary and the Hungarian criminal law. Prevention requires vigilance in out-of-school times, child education, early involvement of healthcare professionals, and adjustment of the administration of justice.

Adolescent↗
PubMed2005

Feasibility first: developing public performance indicators on patient safety and clinical effectiveness for Dutch hospitals.

This paper describes the development and implementation of the first national, public and obligatory set of hospital performance indicators in the Netherlands. Focusing on effectiveness and safety, the set was developed by the Dutch Health Care Inspectorate to improve the effectiveness and efficiency of their task: monitoring the quality of the care delivered by providers. In addition, the set would enhance the transparency of the hospital sector, and stimulate individual hospitals to improve their scores. Bridging some of the classic distinctions between 'internal' and 'external' indicators, the Inspectorate's vision was to rapidly produce a feasible set of indicators that would fulfill these aims, while maximally preventing 'side effects' such as misinterpretations, defensive or perverse reactions. Explicitly avoiding the trap of searching for exhaustive validity of the indicators, the inspectorate's motto was 'feasability first'. This paper describes how this simultaneously philosophical, political and pragmatic strategy played out successfully, and how the indicator set was ultimately embraced by all parties involved.

Benchmarking↗
PubMed2006

A pricing policy towards the sourcing of cheaper drugs in Cyprus.

In contrast to other EU countries, Cyprus lacks comprehensive health care coverage for its population, thus a significant portion of the population lacks insurance for medicines. Due to the small size of the country and small indigenous pharmaceutical industry, pharmaceuticals are mainly imported. Prices in the private sector are determined based on the ex-factory price from the country of origin. Distribution margins are calculated as a percentage of the import price, which creates perverse incentives for wholesalers to import products from high price countries, or import very expensive products, to maximize their income. In this article, we compare pharmaceutical prices in Cyprus to other EU counties with higher or similar GDP per capita and found Cyprus to be a high price country. We then propose a new pricing system to change wholesaler incentives, which would encourage them to shop around for the best buy in Europe. Prices can be set based on average prices from a basket of European countries, and adjusted to reflect the GDP per capita level in Cyprus. This will establish the wholesale price that the government will accept, and wholesalers can procure products from any country at a lower rate. Thus, wholesalers would be encouraged to go for the lowest prices and the authorities would be indifferent to the actual price they obtain, so long as the necessary criteria (good manufacturing practice, safety, effectiveness and efficacy) are met. Our proposal has implications for low and middle income countries where this system of pharmaceutical pricing and wholesaler incentives can be used.

Commerce↗