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PubMed2004

Access to essential drugs in 11 Brazilian cities: a community-based evaluation and action method.

The Brazilian Institute for Defense of Consumers' (IDEC) health and legal professionals gathered with partner associations and researchers from the University of Brasilia shaped this study to develop and apply simple methods for community and consumer organizations to monitor the availability of essential drugs for primary care in their local public health services. A cross-sectional study was conducted in 11 Brazilian cities. The instrument gave priority to the feasibility of use by community organizations over statistically representative designs. It also worked from the assumption that all Health Centers should stock the drugs recommended for ambulatory care on Brazil's national list of essential drugs, in agreement to federal legislation. The instrument was found to be feasible for use by the participating organizations, and its utilization revealed a picture of severe deficiency of essential medicines in the Brazilian public health system, expressed as an overall availability of only 55.4% of the 61 drugs investigated. Models for legal action in support of individual and community access to essential drugs were developed by IDEC's legal staff to assist community organization in following up the results with an action program. These models were made available on the organization's web-site and widely disseminated nationally.

Brazil↗
PubMedDate not supplied

Popularity of ethics committees seen in nonhospital ventures.

Ethics committees, as a means of focusing discussion and reviewing options regarding ethical problems, is catching on. National consumer organizations are endorsing them, provider groups are acknowledging them, communities are exploring their use in noninstitutional settings, and institutions continue to search for the appropriate committee framework that works for them, as the following articles show.

Accreditation↗
PubMed1992

Altered glutamine metabolism in rat portal drained viscera and hindquarter during hyperammonemia.

In normal rats, muscle is the major glutamine releasing organ and gut is the major glutamine consuming organ. It has been suggested that enhanced muscle ammonia detoxification and gut ammonia production occurs during liver insufficiency-induced hyperammonemia. Therefore, ammonia and amino acid fluxes across portal-drained viscera and hindquarter, and muscle concentrations were measured in portacaval shunted and acute liver ischemia rats. Arterial ammonia and most amino acids were increased after portacaval shunting and increased progressively during liver ischemia, but net hindquarter ammonia uptake was not observed. Net hindquarter glutamine efflux was increased during portacaval shunting, but it decreased during liver ischemia, while muscle glutamine concentrations increased. The comparable net portal drained viscera glutamine uptake in normal and portacaval shunted rats changed during liver ischemia from net uptake to release, coinciding with release of most other amino acids. These results cast doubt on the ammonia detoxifying role of muscle during acute liver ischemia-induced hyperammonemia in the rat. The portal drained viscera glutamine release during severe hyperammonemia could be due to intestinal damage.

Amino Acids↗
PubMed2002

Online patient information.

Information appropriate for patients with skin diseases is readily available on the Internet. Patients primarily seek disease-related information, but may also search for a dermatologist, shop for skin care products, or look to a consumer organization for support. Authoritative educational material is supplied by academic dermatologic associations and institutions and distributed by independent websites, large health portals, and search directories. Interactive opportunities include bulletin boards, ask-an-expert forums, and live chat. Although it is easy to find excellent dermatological information, the Internet is dynamic and unmoderated and patients can be misled or exploited by inaccurate or fraudulent websites. Health on the Net and other organizations have developed ethical principles to aid consumers in evaluating the quality of health-related information.

Dermatology↗
PubMed1993

Community-based study on the relationship between serum cholesterol/triglyceride and dietary habits/life styles in Pu-Li, Taiwan.

This is a community-based study on the relationship between serum cholesterol (CHO)/triglyceride (TG) and dietary habits/life styles of persons living in a central Taiwan Town. Door-to-door interviews were carried out by the Yang-Ming Crusade, and fasting blood for CHO and TG tests was drawn by public health nurses from Pu-Li Health Station. Univariate analysis found that significant variables correlated with CHO were age (+), locality, non-fish seafood (+) and pungent food (+). Significant variables correlated with TG were age (+), sex, locality, smoking (+), alcohol (+) and physical activity (-). Stratified by age (> or = 50 and < 50) and by sex respectively, only one significant interaction item--age x organ meat consumption--was found; those who consumed organ meat more frequently had higher TG, if they were less than 50 years of age. This was not true for those aged 50 and over. Multivariate analysis using logistic regression revealed that after controlling for all of the other covariates, significant variables correlated with CHO were age (OR = 1.92, 95% C.I. = 1.37-2.69), pungent food (OR = 1.91, 95% C.I. = 1.26-2.89); locality (OR = 0.53, 95% C.I. = 0.35-0.80 for sub urban area; and OR = 0.74, 95% C.I. = 0.50-1.08 for rural area); sea food consumption (OR = 1.50, 95% C.I. = 0.94-2.40); and smoking (OR = 0.69, 95% C.I. = 0.48-0.99).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Phylogenetic constraints and adaptation explain food-web structure.

Food webs are descriptions of who eats whom in an ecosystem. Although extremely complex and variable, their structure possesses basic regularities. A fascinating question is to find a simple model capturing the underlying processes behind these repeatable patterns. Until now, two models have been devised for the description of trophic interactions within a natural community. Both are essentially based on the concept of ecological niche, with the consumers organized along a single niche dimension; for example, prey size. Unfortunately, they fail to describe adequately recent and high-quality data. Here, we propose a new model built on the hypothesis that any species' diet is the consequence of phylogenetic constraints and adaptation. Simple rules incorporating both concepts yield food webs whose structure is very close to real data. Consumers are organized in groups forming a nested hierarchy, which better reflects the complexity and multidimensionality of most natural systems.

Adaptation, Physiological↗
PubMed1998

Finnish physicians' attitudes towards preconsultation information: menopausal treatment practices as an example.

The purpose of this study was to investigate Finnish physicians' attitudes towards consumer groups provision of information about physicians' treatment practices, using menopause as a specific example. A questionnaire to be used to make a public brochure listing physicians by their menopausal and postmenopausal treatment practice was sent by consumer organizations to 812 physicians [gynecologists and general practitioners (GPs)] in 1995, after contacting the physicians' associations for support for this activity. The gynecological association had a negative attitude towards the study while that of the GPs' association was more favorable. The response rate was 38% (n = 307). Only 5% of the physicians who got the questionnaire wanted to participate in the planned brochure and only 21% of those responding considered preconsultation information a good idea. The most common reasons for not wanting to participate were that preconsultation information is medically unfeasible and that it would be incompatible with physician's current working practice. Approaches other than public brochures about physicians' treatment patterns are needed if we want to increase patients' participation in decision-making.

Adult↗
PubMed2006

Beliefs about using consumer consultants in inpatient psychiatric units.

A key recommendation of consumer organizations and governments has been the employment of consumer consultants in inpatient psychiatric facilities, but the attitudes of mental health clinicians towards this measure remain inconsistent. The aims of this study were to examine mental health clinicians' attitudes about the role of mental health consumer consultants in inpatient psychiatric units, and to ascertain if participants' age, type of inpatient unit, or grade of staff influenced their attitudes towards consultants. The Consumer Participation and Consultant Questionnaire was used, which was adapted from the Mental Health Consumer Participation Questionnaire. A convenience sample of 47 mental health professionals from two adult inpatient psychiatric units located in a large Australian public general hospital participated in the study. The findings, overall, showed that participants supported the inclusion of consumer consultants in psychiatric units in areas that indirectly impinged on their current roles. Age, level of nurses, and place of employment did not affect their beliefs, but type of occupation was influential. Nurses were less supportive of aspects of consumer consultants' roles that overlapped with the traditional roles of the nurse. The findings have implications for clinical practice, education, and further research, and these are discussed.

Adult↗
PubMed1987

Reviewing the quality of care: priorities for improvement.

Rapid and substantial change in our health care system has prompted careful analysis of the quality of health care and the effectiveness of the methods used to review and improve quality. Although welcome, those applying this scrutiny must recognized that improvement in the quality of health care will take the concerted and cooperative efforts of health policymakers, health care practitioners, health care organizations, consumers of care, purchasers of care, and those organizations that define the state of the art and monitor the quality of care. Particular attention should be devoted to: Gaining a common understanding of the definition of high quality care. Utilizing review programs that are continuous, priority-oriented, and effective. Assuring that the indicators and criteria used in monitoring care are consistent with the practical state of the art. Recognizing the importance of and improving the effectiveness of peer review. Investing in improved diffusion of current clinical knowledge to practitioners. Being properly circumspect about how one best achieves improvement in areas of substandard care.

Evaluation Studies as Topic↗
PubMed1980

Community organizing lessons for health care consumers.

This article analyzes the efforts of health care consumers to organize independently of, but with reference to, the Health Systems Agency in east central Illinois. Beginning with a tactical investigation which disclosed a lack of effective public participation, consumers formed an organization which conducted a series of community forums to provide information and generate publicity about local health care issues, sponsored training workshops for consumer leaders and HSA board members, worked to delay the final designation of the agency, and organized to take control of the local HSA board. They recruited a large number of new HSA members, enlisted provider and consumer candidates to run for the board, conducted a vigorous election campaign, and finally claimed a majority of seats. Among the conclusions drawn are that health care planning cannot be considered apart from a context of politics, and that community organization is important for consumers wishing to exercise power.

Community Participation↗
PubMedDate not supplied

Interorgan ammonia metabolism in liver failure.

In the post-absorptive state, ammonia is produced in equal amounts in the small and large bowel. Small intestinal synthesis of ammonia is related to amino acid breakdown, whereas large bowel ammonia production is caused by bacterial breakdown of amino acids and urea. The contribution of the gut to the hyperammonemic state observed during liver failure is mainly due to portacaval shunting and not the result of changes in the metabolism of ammonia in the gut. Patients with liver disease have reduced urea synthesis capacity and reduced peri-venous glutamine synthesis capacity, resulting in reduced capacity to detoxify ammonia in the liver. The kidneys produce ammonia but adapt to liver failure in experimental portacaval shunting by reducing ammonia release into the systemic circulation. The kidneys have the ability to switch from net ammonia production to net ammonia excretion, which is beneficial for the hyperammonemic patient. Data in experimental animals suggest that the kidneys could have a major role in post-feeding and post-haemorrhagic hyperammonemia.During hyperammonemia, muscle takes up ammonia and plays a major role in (temporarily) detoxifying ammonia to glutamine. Net uptake of ammonia by the brain occurs in patients and experimental animals with acute and chronic liver failure. Concomitant release of glutamine has been demonstrated in experimental animals, together with large increases of the cerebral cortex ammonia and glutamine concentrations. In this review we will discuss interorgan trafficking of ammonia during acute and chronic liver failure. Interorgan glutamine metabolism is also briefly discussed, since glutamine synthesis from glutamate and ammonia is an important alternative pathway of ammonia detoxification. The main ammonia producing organs are the intestines and the kidneys, whereas the major ammonia consuming organs are the liver and the muscle.

Ammonia↗
PubMed2001

Fermentation of xylose into acetic acid by Clostridium thermoaceticum.

For optimum fermentation, fermenting xylose into acetic acid by Clostridium thermoaceticum (ATCC 49707) requires adaptation of the strain to xylose medium. Exposed to a mixture of glucose and xylose, it preferentially consumes xylose over glucose. The initial concentration of xylose in the medium affects the final concentration and the yield of acetic acid. Batch fermentation of 20 g/L of xylose with 5 g/L of yeast extract as the nitrogen source results in a maximum acetate concentration of 15.2 g/L and yield of 0.76 g of acid/g of xylose. Corn steep liquor (CLS) is a good substitute for yeast extract and results in similar fermentation profiles. The organism consumes fructose, xylose, and glucose from a mixture of sugars in batch fermentation. Arabinose, mannose, and galactose are consumed only slightly. This organism loses viability on fed-batch operation, even with supplementation of all the required nutrients. In fed-batch fermentation with CSL supplementation, D-xylulose (an intermediate in the xylose metabolic pathway) accumulates in large quantities.

Acetic Acid↗
PubMed1998

An improved biotonometric method for determination of haemoglobin oxygen equilibrium curves.

A new biotonometric method for the determination of haemoglobin oxygen equilibrium curves is described. The procedure is based on the mixing of an oxygen-consuming organism, the yeast cell (Saccharomyces cerevisiae), with an oxidized blood/plasma mixture. The yeast cell consumes oxygen at a uniform rate, thus reducing the partial pressure of oxygen in the mixture. This in turn induces the dissociation of oxygen in a characteristic manner. The study of the whole blood samples from 26 healthy volunteer subjects gave the following results: p50 = 3.63 kPa +/- 0.23 kPa (mean +/- 1 S.D.); Hill slope n = 2.44 +/- 0.16; and CO2 Bohr factor = -0.47 +/- 0.11. For the within-run imprecision the coefficients of variation for the different parameters were: p50 C.V. = 4.4%; Hill slope n C.V. = 4.7%; and CO2 Bohr factor C.V. = 19%. The determination can be carried out with simple equipment: a blood gas analyzer with a coupled recorder.

Adult↗
PubMedDate not supplied

Consumer-driven health plans: are they more than talk now?

This paper reports marketplace developments for consumer-driven health plans in spring 2002. Findings are from interviews with executives from start-up and health insurance firms, benefit consultants, employee benefit managers, Wall Street analysts, consumer organizations, thought leaders, and policymakers. We detail available evidence about the performance of consumer-driven health plans concerning access to care, risk selection, cost containment, use of information, and legal issues. We find that these health plans are now a central pillar of health insurers' business strategy and that an estimated 1.5 million persons are enrolled in them.

Community Participation↗
PubMed2005

Determinants of consumer behavior related to organic foods.

There have been many studies of what influences consumers in their decisions to purchase or consume organic foods, mainly concerned with fresh organic foods. These show a discrepancy between attitudes and behavior with people being positive about organic foods but often not purchasing them. This discrepancy seems to be explained by the fact that consumers do not consider "organically produced" to be an important purchase criterion, that organic foods are not perceived to surpass conventional foods regarding taste and shelf life (two qualities rated to be of great importance), and because of the perceived premium prices of organic foods. In two Swedish studies, health benefits were demonstrated to be more strongly related to attitudes and behavior toward organic foods than were perceived environmental benefits. A new European Union (EU) project will investigate the influences on both fresh and processed organic foods and investigate the role of moral, ethical, and affective influences on choice across eight EU countries.

Choice Behavior↗
PubMed1999

A measuring instrument for evaluation of quality systems.

OBJECTIVE: To develop an instrument for provider organizations, consumers, purchasers, and policy makers to measure and compare the development of quality systems in provider organizations. DESIGN: Cross-sectional study of provider organizations using a structured questionnaire to survey managers. SETTING: The Netherlands. STUDY PARTICIPANTS: Provider organizations of six health care fields: primary health care, care for the disabled, mental health care, care for the elderly, hospital care and welfare care. MAIN MEASURES: Existence of quality assurance and quality improvement activities. RESULTS: The study presents a survey instrument for assessing the quality assurance and improvement activities of health care provider organizations and the developmental stage of quality systems. The survey instrument distinguishes five focal areas for quality improvement activities and four developmental stages. The study also reports data on the reliability and validity of the survey instrument. CONCLUSION: The instrument is reliable, easy to administer, and useful across health care fields as well as different kinds of organizations. Developing quality systems provide a common language across all parts of the health care sector. By assigning the activities to focal areas and developmental stages the instrument gives insight into the implementation of quality systems in health care. Comparable information on quality assurance activities increases the accountability of providers. Because of the efficient (not time consuming) approach, the instrument complements existing accreditation reviews.

Cross-Sectional Studies↗
PubMed2005

Simultaneous utilization of acetate and hydrogen by Geobacter sulfurreducens and implications for use of hydrogen as an indicator of redox conditions.

Dissolved hydrogen concentrations, in conjunction with other geochemical indicators, are becoming an accepted means to determine terminal electron acceptor processes (TEAPs) in groundwater aquifers. Aqueous hydrogen concentrations have been found to fall within specific ranges under methanogenic, sulfate-reducing, iron-reducing, and denitrification conditions. Although hydrogen is gaining in acceptance for determining subsurface TEAPs, there is a dearth of data with regards to the kinetic coefficients for hydrogen utilization in the presence or absence of an additional electron donor under different TEAPs. This study expands the kinetic data for hydrogen utilization through a series of batch experiments, which were conducted to study the utilization of acetate and hydrogen by Geobacter sulfurreducens under iron-reducing conditions. The results of these experiments indicate that the kinetic coefficients (cell yield and first-order degradation rate) describing the rate of hydrogen utilization by G. sulfurreducens under iron-reducing conditions correlate energetically with the coefficients found in previous experiments under methanogenic and sulfate-reducing conditions. In addition, with acetate and hydrogen as simultaneous electron donors, there is slight inhibition between the two electron donors for G. sulfurreducens, and this can be modeled through competitive inhibition terms in the classic Monod formulation. Finally, a key result of this study is that the TEAP-dependent hydrogen concentration in aquifers is not related solely to the microbial kinetics of the hydrogen-consuming organisms as previously suggested but is affected by the multi-substrate kinetics of hydrogen being consumed simultaneously with other electron donors as well as the availability of the electron acceptor.

Acetates↗