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PubMed1999

Problems of transition from tax-based system of health care finance to mandatory health insurance model in Russia.

This article examines three problems burdening the Russian system of health care finance in transition period: (a) unrealistic government promise to cover health care coverage too wide to be achieved with available resources; (b) inefficient management of health care delivery systems; and (c) lack in evidence of actual positive changes effected by the new players: mandatory health insurance carriers and funds. Radical reshaping of the health benefits promised by the government and introduction of patient co-payments are considered as a way to normalize public health sector finance and operations. Two alternative approaches to the reform of the existing eclectic system of health care management are available. Institutional preconditions for operational effectiveness of third-party purchasers of health services in public-financed health sector are defined.

Delivery of Health Care↗
PubMed2002

Transition for youth with chronic conditions: primary care physicians' approaches.

Since the US Surgeon General's conference on health care transitions in 1989, transition from pediatric to adult-oriented health care for youth with chronic conditions continues to develop as an important issue among youth, parents, and health professionals. Key professional organizations, public agencies, and disease-specific organizations have promoted research on transition and the development of transition services. Although there is evidence of the advancement of the science and practice of transition in the context of subspecialty medical care, the same may not be true for transition in the context of primary care practice. Little has been written about the role of the primary care provider in facilitating transition, and little is published in the medical literature about how transition occurs in primary care settings.

Adolescent↗
PubMedDate not supplied

Challenges to the transition to independent investigator in geriatric mental health.

OBJECTIVE: The author reports on the extent to which junior investigators in geriatric mental health successfully make the transition to independent scientists. METHODS: The NIH CRISP database identified all NIMH Level-1 career awards (K01/K07/K08/K23/ R29) in geriatric mental health completed from 1992 to 2001. RESULTS: Of 46 awardees, 14 (30.4%) achieved R01 funding within 1 year of completion. An additional six investigators subsequently achieved R01s in the remaining follow-up period (ranging from 2 to 10 years), for a total of 43.5% (20/46). CONCLUSIONS: These data underscore the relatively small number of junior investigators who successfully make the transition to independent scientist. Their numbers underscore the importance of efforts by the field of geriatric mental health aimed at both increasing the flow into this career as well as ensuring the retention and success of junior investigators at the critical transition to independent investigators.

Aged↗
PubMed1999

Executive directors and community health centers--facing the healthcare transition.

This paper examines the impressions and experiences of administrators who manage Community Health Centers (CHCs) in Region VI, US Department of Health and Human Services, with the goal of identifying leadership skills and intrinsic values that are needed to run integrated service delivery sites. As the delivery of healthcare service shifts to health promotion and disease prevention, Community Health Centers are well positioned to assume major roles in this transition. However, some CHC administrators may need additional skills in order to address the changing healthcare environment. A survey of CHC Executive Directors was conducted to identify their impressions and experiences. Information obtained from this exploratory study should be beneficial in educating the next generation of healthcare administrators.

Administrative Personnel↗
PubMed1986

The effect of a preassembly zeranol implant and post-transit diet on the health performance and metabolic profile of feeder calves.

A total 262 Angus steer calves averaging 207 kg from none (trial 1) and five farms (trial 2) were identified on the farm of origin and one-half of the calves on each farm was implanted with 36 mg of zeranol before entering the feeder calf assembly and marketing system. Calves were assembled, fasted for 24 h and fed hay for 72 h, then shipped 1,368 km. Upon arrival, the following receiving diets were fed for 4 wk to one-third of the calves from each farm and implant group: 1) control diet, 2) high-potassium diet, 3) escape-protein diet using corn gluten meal, which can escape ruminal degradation as a protein source. Implanted calves gained more weight (P less than .10) than nonimplanted calves while on the farm, but changes in weight during assembly, transit and the 28-d receiving period were not different (P more than .10). Plasma glucose and total protein concentrations were higher (P less than .05), while urea nitrogen concentration was lower (P less than .05) for implanted calves following transit. Increasing the potassium concentration of the receiving diet increased (P less than .05) post-transit weight gains, but had no affect on dry matter consumption. Corn gluten meal replaced soybean meal in the escape-protein diet and resulted in similar weight gains. Plasma urea nitrogen concentrations were higher (P less than .05) at 2 wk post-transit in the escape-protein diet group as compared with the control group. Receiving diet had no effect on the incidence or severity of bovine respiratory disease, but affected (P less than .05) performance during the subsequent 69-d stocker phase of ad libitum access to medium quality hay and 2.27 kg of supplement per day.

Animal Feed↗
PubMed2005

Transition planning for youth with special health care needs: results from the National Survey of Children with Special Health Care Needs.

OBJECTIVE: To describe the proportion of youth with special health care needs (YSHCN) who are receiving services for medical transitions and to describe which sociodemographic and health care-related factors are associated with receiving transition services. METHODS: We analyzed responses to questions about medical transitions from the 2001 National Survey of Children With Special Health Care Needs (NS-CSHCN). Parents or guardians of youth aged 13 to 17 years who screened positive for the survey were asked (1) whether they had discussed with health care providers how their child's health care needs might change in adulthood, (2) if they had a plan to address these changing needs, and (3) if their child's health care providers had discussed having their child eventually see a doctor who treats adults. Bivariate and multivariate associations were estimated to identify sociodemographic and health care factors related to receiving medical-transition services. RESULTS: Overall, 50% of respondents had discussed their child's changing health care needs with their physicians, although significantly fewer Hispanic youth compared with other youth reported these discussions. Youth who met criteria for a medical home were more likely to have discussed changing needs and to have a plan addressing these needs. Of those who had discussed changing needs, 59% had a plan to address these needs and approximately 42% had reported discussing shifting care to adult-oriented providers. Younger teens and non-Hispanic black children were less likely to have discussed changing providers. Fifteen percent of YSHCN met the Maternal and Child Health Bureau's core outcome for medical transitions. A multivariate logistic-regression model found that older age and having a medical home were significantly associated with increased odds of meeting the outcome measure. CONCLUSION: The proportion of YSHCN meeting the medical-transition outcome measure is quite low, particularly for youth from ethnic minorities. Higher rates are seen for older teens and those receiving care within a medical home. Significant efforts will be required to meet the proposed goal of all YSHCN receiving the services necessary to transition to adult health care.

Adolescent↗
PubMed2006

What about the carers?: Exploring the experience of caregivers in a chemotherapy day hospital setting.

Interest in the concerns of cancer patients' carers has been growing steadily over the last decade reflected in key cancer service policy documents [DOH, 1995. A Policy Framework for Commissioning Cancer Services (Calman-Hine Report). London, HMSO; DOH, 2002. The NHS Cancer Plan]. Despite this acknowledgement, it can be argued that less is known about carers' experience in the cancer treatment context. Carers can be defined as someone who shares the experience of cancer with the patient. The aim of this study was to explore the lived experience of caregivers in a chemotherapy day hospital and how this compared with their experience of inpatient care. Using a phenomenological approach, face-to-face interviews were conducted with a purposive sample of ten caregivers. Data were analysed using Polkinghorne's [1995. Narrative Knowing & the Human Sciences. University of New York Press, Albany] two stages of narrative analysis. The findings indicated that the caregivers experienced similar transitions to the patients with regards to health-illness transition and organisational transitions. The caregivers adopted various roles in the day hospital such as Companion 'being with' their relative, Protector 'keeping an eye'; Practical Caregiver and assuming an Advocate Role. The findings of this study are important for cancer nursing practice as health professionals need to acknowledge the role of carers in the chemotherapy day hospital setting and facilitate their involvement in care.

Adaptation, Psychological↗
PubMed2007

The proteomic profile of Fusobacterium nucleatum is regulated by growth pH.

Fusobacterium nucleatum is a saccharolytic Gram-negative anaerobic organism believed to play an important role in the microbial succession associated with the development of periodontal disease. Its genome contains niche-specific genes shared with the other inhabitants of dental plaque, which may help to explain its ability to survive and grow in the changing environmental conditions experienced in the gingival sulcus during the transition from health to disease. The pH of the gingival sulcus increases during the development of periodontitis and this is thought to occur by the metabolism of nutrients supplied by gingival crevicular fluid. In comparison with other plaque inhabitants, F. nucleatum has the greatest ability to neutralize acidic environments. The differential expression of soluble cytoplasmic proteins induced by acidic (pH 6.4) or basic (pH 7.4 and 7.8) conditions, during long-term anaerobic growth in a chemostat, was identified by two-dimensional gel electrophoresis and image analysis software. Twenty-two proteins, found to have altered expression in response to external pH, were identified by tryptic digestion and mass spectrometry. Eight differentially expressed proteins associated with increased energy (ATP) production via the 2-oxoglutarate and Embden-Meyerhof pathways appeared to be directed towards either cellular biosynthesis or the maintenance of internal homeostasis. Overall, these results represent the first proteomic investigation of F. nucleatum and the identification of gene products which may be important in the organism's persistence during the transition from health to disease in vivo.

Anaerobiosis↗
PubMedDate not supplied

Academic health center teaching hospitals in transition: a perspective from the field.

A study of 11 Academic Health Center Teaching Hospitals (ATHs) in 11 states found that cost reduction programs, internal reorganizations, reengineering, benchmarking, and broadened entrepreneurial activity were prominent among the strategic initiatives reported in dealing with an increasingly turbulent environment. Although none of the ATHs had experienced negative net margins, we conclude that today's competitive healthcare system requires ATHs be reimbursed separately for their educational and other societally related costs to assist them in competing on a level playing fields.

Academic Medical Centers↗
PubMed2006

Evaluation of the implementation of the folate-neural tube defect health claim and its impact on the availability of folate-fortified food in Australia.

OBJECTIVE: To evaluate the implementation of the folate-neural tube defect (NTD) health claim and its impact on the availability of folate-fortified food in Australia. METHODS: During late 2005, a survey was conducted in 16 supermarkets across all Australian capital cities to identify the use of the folate-NTD health claim on the labels of the 128 food products listed in food standard 1.1A.2: 'Transitional standard--Health claims' and the number of products fortified with folic acid. RESULTS: Seventy-nine per cent of existing listed food products were found and two of these were implementing the folate-NTD health claim. Forty-four per cent of these listed products, previously fortified with folic acid, were no longer fortified. One hundred and seventeen generally available food products were fortified with folic acid, predominantly breakfast cereals (73%). Twenty-seven per cent of these folate-fortified products were listed in the transitional standard. CONCLUSIONS: The health claim was not used widely to inform women of child-bearing age of the importance of periconceptional folate intake. The increased availability of folate-fortified products generally has occurred independently of the health claim. Deficiencies in the verification system of the tested regulatory framework are identified. The voluntary regulatory provisions for both folate fortification and the use of the health claim diminished the States' influence over their implementation of public health tools.

Australia↗
PubMed1995

Transitions in functional status and active life expectancy among older people in Japan.

This study analyzes the patterns and determinants of the transitions in functional status among elderly Japanese persons. Data for this research came from a two-wave national probability sample survey of persons aged 60 and over conducted between 1987 and 1990 in Japan. The study focuses on the transitions from two states of origin, "not disable" and "disabled," to three states of destination, "not disabled," "disabled," and "dead." Through multinomial logit analyses, the effects of sociodemographic factors, social relationships, health, and health behavior on transitions in functional status were examined. To assess the impact of panel attrition, the risk of nonresponse was analyzed in conjunction with health transition within the same framework. Finally, an increment-decrement active life table for Japanese elderly people was derived on the basis of the multivariate analyses. According to the life table, a Japanese older person at age 60 is expected to spend about 18.7 years (81%) in functional independence and about 4.4 years (19%) in disability throughout his or her remaining lifetime.

Age Factors↗
PubMed2002

Looking at the future of geriatric care in developing countries.

During the next 20 years, many less developed countries (LDC) will have age structures approaching those of the present time in more developed countries (MDC). This is occurring more rapidly in the LDC of Asia and Latin America. The future of aging populations in LDC is dependent on the degree of poverty in these countries. Poverty is a major determinant of disability and mortality in older persons. With the march of globalization, diseases in LDC are changing from infectious to noncommunicable diseases, such as diabetes. Nevertheless, infections such as tuberculosis still take a major toll on the elderly. The epidemiological transition in LDC has created a need for health care transitions from systems based on cure to ones that highlight prevention and long-term care. LDC have the opportunity to develop systems that differ from those in MDC by capitalizing on the lack of infrastructure to produce more home-based rather than institution-based long-term care systems. Involvement of the elderly in the planning of their own futures is of paramount importance. Appropriate planning now will decide the future of the elderly in LDC during the next 20 to 40 years.

Aged↗
PubMed1998

Quality adjusted survival analysis with repeated quality of life measures.

One way of examining trade-offs between quantity and quality of life (QOL) is to combine them into a single measure such as quality-adjusted life year (QALY). If censoring occurs, then estimation presents some difficulties. One approach, known as Q-TWiST, is to define a series of health states, use a 'partitioned' survival analysis to calculate the average time in each state, and then weight each state according to its quality of life to calculate QALYs. Such health-state models, however, are unhelpful when the transitions between health states are unclear or if they do not adequately reflect variations in quality of life. We therefore examine an alternative analysis to be used when repeated measures of quality of life are available from individual patients in a clinical trial. The method proceeds by separating quality of life and survival, that is, dQALY/dt = S(t)Q(t), where S(t) is the survival curve, estimated from the standard Kaplan-Meier method, and Q(t) is the quality of life function, derived from individual repeated measures of quality of life. We derive single health-state (QALY) and multiple health-state (Q-TWiST) models and illustrate the approach by comparing different durations of adjuvant chemotherapy for breast cancer.

Adult↗
PubMed1997

Psychiatry of the elderly: a consensus statement.

This consensus statement, published by The Division of Mental Health and Prevention of Substance Abuse of the World Health Organisation, was co-sponsored by WHO and the Geriatric Section of the World Psychiatric Association, under the Section presidency of Professor J. Wertheimer. The final statement was prepared by an inter-disciplinary group representing the principal international association, at a meeting in Lausanne, 5-7 February 1996, chaired by Professor H. Hafner. Professor Cornelius Katona and Dr. Nori Graham were co-rapporteurs. A full list of participants is available from Professor Wertheimer.

Aged↗
PubMed1999

The paucity of effects in community trials: is secular trend the culprit?

BACKGROUND: The most recent major U.S. trials that evaluated community-level programs to influence risk factors and health behaviors identified secular trends in the risk factors and health behaviors among the factors that might have limited community-level effects. The research reported in this paper uses data from one of the trials to examine the secular trend explanation directly. METHODS: Data from the 22-community Community Intervention Trial for Smoking Cessation (COMMIT) were analyzed to test a hypothesis based on secular trend reasoning: program effects for smoking prevalence were larger for treatment communities matched to control communities with small declines in smoking than in treatment communities matched to control communities with larger declines in smoking. RESULTS: Consistent with the secular trend explanation, program effects were larger when control communities had relatively small declines in smoking prevalence. CONCLUSIONS: The findings suggest that secular trends masked community-level program effects in COMMIT.

Canada↗