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PubMed2005

Dual job holding by public sector health professionals in highly resource-constrained settings: problem or solution?

This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings. Such activity is generally driven by a lack of resources in the public sector and low pay, and has been associated with the unauthorized use of public resources and corruption. It is also typically poorly regulated; regulations are either lacking, or when they exist, are vague or poorly implemented because of low regulatory capacity. This paper draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. The approach taken in highlighting these broader social objectives seeks to avoid the value judgements regarding dual working and some of its associated forms of behaviour that have tended to characterize previous analyses. Dual practice is viewed as a possible system solution to issues such as limited public sector resources (and incomes), low regulatory capacity and the interplay between market forces and human resources. This paper therefore offers some support for policies that allow for the official recognition of such activity and embrace a degree of professional self-regulation. In providing clearer policy guidance, future research in this area needs to adopt a more evaluative approach than that which has been used to date.

Career Mobility↗
PubMed2005

Personal resources, coping self-efficacy, and quake exposure as predictors of psychological distress following the 1999 earthquake in Turkey.

This study examined the predictive power of personal resources (i.e., self-esteem, optimism, and perceived control), severity of earthquake experience (i.e., material and human loss and perceived threat), and coping self-efficacy (CSE) on general distress, intrusion, and avoidance symptoms among the survivors of the 1999 Marmara earthquake in Turkey. Specifically, we expected that CSE would mediate the links between personal resources, severity of earthquake experience, and distress. Survivors (N = 336) filled out various measures of earthquake exposure, personal resources, CSE, and distress. Results of the path analyses indicated that personal resources, earthquake experiences, CSE, and gender have direct effects on intrusion and general distress. Personal resources had also an indirect effect on general distress mediated by CSE. Findings were discussed considering the implications for conservation of resources model and social cognitive theory as well as for interventions following natural disasters.

Adaptation, Psychological↗
PubMed2007

Change in psychological resources of younger and older cancer patients during chemotherapy.

Psychological resources were investigated in 150 recently diagnosed adult cancer patients and in 150 healthy control group members. Before the start of chemotherapy, cancer patients reported higher levels of optimism, purpose in life than their healthy peers, and self-esteem (only younger patients) whereas no between-group differences emerged for internal locus of control. However, the mobilization of psychological resources was limited to younger patients, and varied by item content. Over a 9-month period, most psychological resources of cancer patients showed a small but significant decline, and patients with higher illness-related stressors (e.g. stronger functional impairments, low perceived success of therapy) were more likely to decline in resources. We conclude that in line with cognitive adaptation theory cancer diagnosis leads to an initial mobilization of psychological resources in younger patients, but that over the course of therapy psychological resources decline to a level that would be expected in healthy adults.

Adaptation, Psychological↗
PubMed1994

Population dynamics of sexual and resource competition.

Interspecific competition is usually thought of in terms of resource competition. Closely related species, however, may often compete also for a "sexual niche," a sexual resource. Both sexual and resource competition are likely to affect the dynamics of closely related sympatric species. Here, a combined model of sexual and resource competition is developed and analyzed in terms of phase planes. Population dynamics involving sexual competition alone are characterized by competitive exclusion and dependence on relative initial population size of the competing species. This dependence on initial population size is due to the nonlinear equilibrium isoclines of sexual competition, which contrast with the linear isoclines of the Lotka-Volterra competition equations. Dependence on initial population size is stronger when sexual competition is severe and/or when growth rates of the two species are low. Additional dynamic possibilities arise under combined sexual and resource competition. If the sexual competition is strong, competitive exclusion is the only outcome. But if sexual competition is weak, and if stable coexistence would occur without sexual competition, then both stable coexistence and competitive exclusion may occur simultaneously. A species that is relatively rare initially may be excluded, but when both species are initially of comparable abundance both will persist. Adding sexual competition to resource competition thus introduces additional uncertainty concerning the outcome of competition between two sympatric species.

Animals↗
PubMed1996

Virtual resource development in the glycosciences.

The development of Internet-based virtual resources is a relatively new area of scientific and technical activity that is currently undergoing rapid expansion. Major factors fuelling recent growth include the emergence of multimedia capabilities through the rapid evolution of the World Wide Web, the reduction in cost of high quality personal computers and graphics workstations and the provision of mass-marketed provider services. Prior to 1995 the presence of Internet resources in the glycosciences was virtually non-existent. Existing scientific knowledge was primarily made available on the Net through the provision of databases from gopher and ftp sites. A particular example in the glycosciences is the Carbbank database of biological carbohydrate sequences. We will describe here our efforts in 1994-95 in establishing The Glycoscience Network (TGN, http:@ bellatrix.pcl.ox.ac.uk/TGN/). These activities included the establishment of a newsgroup, mailing lists, Web resources and the running of the First Electronic Glycoscience Conference (EGC-1, http:@bellatrix.pcl.ox.ac.uk/egc/). EGC-1 included many novel initiatives in the glycosciences including electronic posters and papers, a Virtual Conference Centre, a Web-based hyperglossary, Virtual Trade and Employment Centres, refereed electronic publishing, and the creation of a Virtual Reality Gallery. We would like to look towards the near future and discuss several initiatives in virtual resource creation that we believe will have significant scientific impact on the glycosciences including the development of bioinformatics-based servers, sophisticated interactive databases, and videoconferencing. Furthermore, we cherish the belief that these resources will foster international scientific collaboration and progress of an extent never previously possible. Finally, we indulge in speculation and make some suggestions on the form and long-term impact of Glycoscience Virtual Resources. We predict that their development may completely reconstruct the scientific environment that we work in as scientists and we reflect on the probable benefits and pitfalls to be encountered.

Carbohydrates↗
PubMed1984

Resources, life events, and changes in positive affect and depression in older adults.

Hypotheses from a prospective conceptual framework were tested on a sample of 1,166 adults, age 55 and older, who were interviewed three times at 6-month intervals. Older adults with stronger resources had significantly more positive psychological states initially than those with weaker resources, and this advantage was maintained regardless of the levels of life events. There were significant main effects for desirable events and for undesirable events. Those with higher desirable events showed less decline in positive affect. Contrary to the "booster" hypothesis, there was no significant interaction between resources and desirable events. There was a significant interaction between resources and undesirable events on depression but detailed analyses showed that increases in depression over time were limited to the combined condition of weak resources and high levels of undesirable events. Weak resource persons with low or moderate undesirable events, in fact, showed modest improvements in depression.

Adaptation, Psychological↗
PubMed1984

Risk and resource indicators and their relationship to young children's school adjustment.

Relationships between risk-magnifying life situations and events, as well as resources, and school adjustment were explored in a large sample of first through fourth graders. Also studied was the extent to which the presence of resources moderate the effects of risk. Children's risk and resource factors were determined from background-identifying information provided by teachers in four domains: physical and health characteristics, recent critical life events, special school services and activities, and family background variables. A significant negative correlation was found between scores on composite risk and resource indices. Both indices correlated significantly, and in the expected directions, with measures of school problem behaviors and competencies. High risk children with moderate resources were significantly better adjusted than high risk children with few or no resources. Implications of those findings for developing primary prevention programs for children at risk were considered.

Child↗
PubMed1983

Resources, life events, and changes in psychological states: a prospective framework.

A framework is presented that examines resources, environmental changes, and time in relation to one another and to changes in psychological affect. Resources in the aggregate are assumed to have both main effects and interactive effects on changes in psychological states. With undesirable life events, the resource interaction is assumed to be a buffer function, with resources making their strongest contribution at moderate levels of undesirable events. With desirable events, the resource interaction is assumed to be a multiplicative booster function, the effect of resources increasing as the level of desirable events increases. Cumulative undesirable demand is a variable with broader context than life events and is assumed to directly increase negative changes in psychological states. Time is considered a passive moderator, reducing the impact of either desirable or undesirable changes on psychological states. Alternative paths leading to positive change, status quo, and negative change in psychological states are then described, including the "false hope" hypothesis, and relations among variables are specified.

Adaptation, Psychological↗
PubMed1994

Measuring resource use in economic evaluations: determining the social costs of mental illness.

Concern over costs associated with mental disorders has led to an increase in the number of economic evaluations of treatment interventions; unfortunately, methods for measuring resource use have not kept pace with this concern. Although it is well-known that a significant proportion of the costs associated with mental illness are for resources other than treatment, program evaluators and researchers often count only treatment costs in cost-effectiveness comparisons. Further, existing methods for measuring resource use are plagued by faulty assumptions about resource use, poor validity and reliability, and difficulties quantifying resource use. The authors discuss these problems and suggest five ways of improving measurement of nontreatment resources: clarifying assumptions, using multiple data sources, flexible data collection strategies, methods for improving the accuracy of recall, and an episodic approach to measurement.

Cost of Illness↗
PubMed1996

Race, resource use, and survival in seriously ill hospitalized adults. The SUPPORT Investigators.

OBJECTIVE: To examine the association between patient race and hospital resource use. DESIGN: Prospective cohort study. SETTING: Five geographically diverse teaching hospitals. PATIENTS: Patients were 9,105 hospitalized adults with one of nine illnesses associated with an average 6-month mortality of 50%. MEASUREMENTS AND MAIN RESULTS: Measures of resource use included: a modified version of the Therapeutic Intervention Scoring System (TISS); performance of any of five procedures (operation, dialysis, pulmonary artery catheterization, endoscopy, and bronchoscopy); and hospital charges, adjusted by the Medicare cost-to-charge ratio per cost center at each participating hospital. The median patient age was 65; 79% were white, 16% African-American, 3% Hispanic, and 2% other races; 47% died within 6 months. After adjusting for other sociodemographic factors, severity of illness, functional status, and study site, African-Americans were less likely to receive any of five procedures on study day 1 and 3 (adjusted odds ratio [OR] 0.70; 95% confidence interval [CI] 0.60, 0.81). In addition, African-Americans had lower TISS scores on study day 1 and 3 (OR -1.8; 95% CI-1.3, -2.4) and lower estimated costs of hospitalization (OR (-)$2,805; 95% CI (-)$1,672, (-)$3,883). Results were similar after adjustment for patients' preferences and physicians' prognostic estimates. Differences in resource use were less marked after adjusting for the specialty of the attending physician but remained significant. In a subset analysis, cardiologists were less likely to care for African-Americans with congestive heart failure (p < .001), and cardiologists used more resources (p < .001). After adjustment for other sociodemographic factors, severity of illness, functional status, and study site, survival was slightly better for African-American patients (hazard ratio 0.91; 95% CI 0.84, 0.98) than for white or other race patients. CONCLUSIONS: Seriously ill African-Americans received less resource-intensive care than other patients after adjustment for other sociodemographic factors and for severity of illness. Some of these differences may be due to differential use of subspecialists. The observed differences in resource use were not associated with a survival advantage for white or other race patients.

Adult↗
PubMed2003

[Allocation of cognitive resources during the simultaneous performance of cognitive and sensorimotor tasks].

We review research on the allocation of cognitive resources during the simultaneous performance of cognitive and sensorimotor tasks. From the developmental and clinical perspectives,we emphasize: (1) the distinction between the availability and the allocation of resources, (2) lifespan changes in relation to the environmental validity of sensorimotor functions, and (3) the potentials and limitations for an individuals' adaptations to multi-task constraints. These aspects can be operationalized within the framework of selection, optimization, and compensation (SOC). Related studies focus on older individuals' selective resource allocation and compensatory processes as adaptive means in the context of reduced resources and decreased sensorimotor functioning. Results show that older adults must invest increasing amounts of their cognitive resources into the coordination of bodily functions such as balance and gait. SOC research on Alzheimer's patients provides new insights into the increased risks of falling. We argue that adaptive resource allocation in everyday sensorimotor performance is an instance of intelligent behavior that is insufficiently represented in extant psychometric tests.

Accidental Falls↗
PubMed2004

Resource utilisation for neuropsychiatric disorders in developing countries: a multinational Delphi consensus study.

BACKGROUND: Substantial information is now available at a global and regional level relating to the burden of mental disorders, yet hardly any international data are available on the resources that are needed to respond to this global burden. AIMS: The aim of this study was to develop consensus-driven estimates of resource utilisation, coverage and adherence for key mental health care interventions capable of reducing leading neuropsychiatric causes of disease burden. METHODS: A resource utilisation questionnaire was developed for a series of mental health care interventions for schizophrenia, affective and anxiety disorders, alcohol misuse, epilepsy and Alzheimer's disease. Expert opinion surveys using a Delphi approach were conducted in seven countries (Brazil, China, Egypt, Ghana, India, Mexico and Thailand). Initial results were fed back to participants in order to elicit a second, final set of consensus estimates. Mean and median values were calculated, together with measures of dispersion and agreement. RESULTS: Sixty-seven psychiatrists took part in the first Delphi round and 60 completed the seven consensus panels in the second Delphi round. Expected resource use was highest for acute psychosis, mania, severe depression and severe dementia (at least monthly outpatient visits, and over 25% of cases admitted to hospital with an average length of stay one month). Aggregated estimates for current treatment coverage ranged from below 20% for Alzheimer's disease to 60% for epilepsy. Coverage and adherence levels for affective disorders were both below 50%. CONCLUSION: The Delphi technique proved to be a feasible and efficient method for data collection and consensus generation concerning mental health care resource utilisation. Results provide a set of range estimates for mental health resource planning and evaluation in a variety of developing regions.

Delphi Technique↗
PubMed1998

Valuation of Ecological Resources and Functions

/ Ecological resources are natural resources that provide certain necessary but overlooked system maintenance functions within ecosystems. Environmental economics is in search of an appropriate analysis framework to determine economic values of such resources. This paper presents a framework that estimates and compiles the components of value for a natural ecosystem. The framework begins with the ecological processes involved, which provide functions within the ecosystem and services valued by humans. We discuss the additive or competive nature of these values, and estimate these values through conventional and unconventional techniques. We apply the framework to ecological resources in a shrub-steppe dryland habitat being displaced by development. We first determine which functions and services are mutually exclusive (e.g., farming vs soil stabilization) and which are complementary or products of joint production (e.g., soil stabilization and maintenance of species). We then apply benefit transfer principles with contingent valuation methodology (CVM), travel cost methodology (TCM), and hedonic damage pricing (HDP). Finally, we derive upper-limit values for more difficult-to-value functions through the use of human analogs, which we argue are the most appropriate method of valuation under some circumstances. The highest values of natural shrub-steppe habitat appear to be derived from soil stabilization.KEY WORDS: Natural resource economics; Ecological economics; Ecological resources; Shrub-steppe; Environmental valuation; Cost; Benefit; Value

Journal Article↗
PubMed2003

The effect of mean and variance in resource supply on survival of annuals from Mediterranean and desert environments.

Resource availability is often characterized by mean annual amounts, while ignoring the spatial variation within habitats and the temporal variation within a year. Yet, temporal and spatial variation may be especially important for identifying the source of stress in low productivity environments such as deserts where resources are often pulsed and resource renewal events are separated by long periods of low resource availability. Therefore, the degree of stress will be determined in part by the length of time between recharge events. Here, we investigated the effect of timing and total amount of water application on two congeneric pairs, each with a population from a low (desert) and a high (Mediterranean) productivity habitat. As expected, highest survival and greatest growth were found at low or intermediate recharge intervals, and the magnitude of response to increases in total seasonal amounts was greater for Mediterranean species than desert species. The species that had greater survival switched in the hierarchy under high total water depending on interval length. These results demonstrate that temporal variation in resource availability can be as important as annual total amounts for plant performance and that response to temporal dynamics can vary between species. This has implications for community-level processes, as competitive hierarchies may switch based on resource dynamics rather than only total availability.

Analysis of Variance↗
PubMed2005

Variation in resource limitation of plant reproduction influences natural selection on floral traits of Asclepias syriaca.

The availability of both pollen and resources can influence natural selection on floral traits, but their relative importance in shaping floral evolution is unclear. We experimentally manipulated pollinator and resource (fertilizer and water) availability in the perennial wildflower Asclepias syriaca L. Nine floral traits, one male fitness component (number of pollinia removed), and two female fitness components (number of pollinia inserted and number of fruits initiated) were measured for plants in each of three treatments (unmanipulated control, decreased pollinator access, and resource supplementation). Although decreasing pollinators' access to flowers did result in fewer pollinia inserted and removed, fruit set and phenotypic selection on floral traits via female and male fitness did not differ from the control. In contrast, resource supplementation increased fruit set, and phenotypic selection on seven out of nine floral traits was stronger via female than male fitness, consistent with the prediction that selection via female fitness would be greater when reproduction was less resource-limited. Our results support the hypothesis that abiotic resource availability can influence floral evolution by altering gender-specific selection.

Analysis of Variance↗
PubMed1986

Character displacement and niche shift analyzed using consumer-resource models of competition.

This paper analyzes the adaptive responses to competition (both character displacement and niche shift) in a two consumer-two resource model. The model includes density dependence that is unrelated to the resources that are explicit in the model. This could be due to another resource dimension, parasites, or interference competition. Competitors adapt by changing their relative consumption rate constants on the two resource types. This model can result in mutually divergent, parallel, or mutually convergent displacement of competitors. Parallel displacement may entail net divergence, net convergence, or no net change. Parallel change with net convergence is most likely when the competitors have similar constraints on the possible values of consumption rate constants, unequal allopatric abundances, and significant intraspecific density dependence. Numerical calculations of displacements are presented for several models and the effect of a number of different possible alterations of the model are discussed. The evolution of resource handling and processing efficiency, and displacement in the presence of additional selective pressures on the character are considered in detail. The results have implications for questions about maximization of population size, the relationship of character displacement and the competition coefficient, and "null" models in the study of competition. Differences between this and previous theoretical works are discussed. It is argued that conditions allowing parallel or convergent displacement are not biologically unlikely, and possible examples are discussed. Data on resource partitioning seem to be more consistent with the results reached here than with previous theory.

Animals↗
PubMed2004

Resource allocation and somatosensory P300 amplitude during dual task: effects of tracking speed and predictability of tracking direction.

OBJECTIVE: The amount of attentional resources allocated to a task is determined by the intrinsic demands, also denoted as task load or difficulty of the task. Effects of resource allocation on the somatosensory N140 and P300 were investigated in an inter-modal situation using a dual-task methodology. METHODS: Under a dual-task condition, subjects concurrently performed a visuomotor tracking task and a somatosensory oddball task, while they performed just the oddball task under an oddball-only condition. In the tracking task, the subjects tracked the target line, which was presented on an oscilloscope and automatically moved, with the line which represented their own force generated by grip movement with the left hand. Tracking speed (experiment 1) and tracking predictability (experiment 2) were manipulated to vary task difficulty. N140, P300, and reaction time (RT) in the oddball task and tracking accuracy in the tracking task were measured. RESULTS: The P300 and N140 amplitudes were reduced in the dual-task condition compared to those in the oddball-only condition. The fastest tracking speed produced lower tracking accuracy and later RT. However, the tracking speed did not affect the P300 or N140 amplitudes. In contrast, the P300 amplitude was smaller when the change in tracking direction was unpredictable than when it was predictable, without any differences in tracking accuracy or RT, N140. CONCLUSIONS: The differences in behaviors among N140, P300, and RT following manipulation of task difficulty support the multiple-resource hypothesis, which defines functionally separate pools of resources. SIGNIFICANCE: The present study may show that the P300 amplitude reflects modality-unspecific resource at more central level, and that the N140 amplitude involves perceptual resource.

Adult↗
PubMed2004

Nonemergent ED patients referred to community resources after medical screening examination: characteristics, medical condition after 72 hours, and use of follow-up services.

INTRODUCTION: Limited access to medical care has resulted in large numbers of patients seeking primary care for non-emergent emergency conditions in emergency departments. This influx of patients is contributing to overcrowding and delays in care for patients with emergencies. In response, a system was implemented in which persons with non-emergent medical conditions, following a medical screening examination, did not receive further ED assessment or treatment and instead were referred to community resources. The purpose of this study was to describe the characteristics of individuals who were referred to community-based services, their condition after 72 hours, and their use of follow-up health care services. METHODS: All referred cases (n=225) were reviewed for chief complaint and demographics. Phone contact was attempted after 72 hours to determine the person's condition and if community resources were utilized. RESULTS: Of the 225 cases, 52% were female, with a mean age of 33 years. Their most common chief complaints were extremity problems (16%), toothache (9%), and medication refill (8%). Follow-up phone contact was successful with 82 people (37%) an average of 14 days after their ED visit. The majority (55%) reported their condition had improved; 39%were unchanged, and 6% were worse. Thirty-one people(40%) accessed community resources and 8 (26%) returned to another emergency department. No clinically significant associations were found between patient demographics and use of community resources. DISCUSSION: Most people who were successfully contacted for follow-up and who had come to the emergency department with non-emergent chief complaints did not access community resources and their condition frequently improved. Additional studies, with improved follow-up, are needed before suggesting that referring individuals to community resources is an acceptable practice.

Adult↗