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PubMed2001

A comprehensive information resource on traditional, complementary, and alternative medicine: toward an international collaboration.

OBJECTIVES: A prototype for a comprehensive information resource for traditional complementary and alternative medicine (TCAM) has been developed to fill the considerable needs of a broad audience for worldwide access to TCAM information. The proposed resource is to be a comprehensive, vocabulary-controlled, integrated, standardized, multimedia information resource for TCAM. It will facilitate international cooperation, promote synergistic development of individual resources, promote dissemination of TCAM knowledge, and map the interrelationships among the TCAM traditions. METHODS: We organized two workshops for representatives of international databases that contain significant information on various aspects of alternative medicine. For the first workshop, we prepared and demonstrated a prototype named Complementary and Alternative Medicine Digital Library (CAMed) to illustrate the anticipated structure, content, and functionality of the comprehensive resource. We then constructed a second prototype to demonstrate the possibilities of searching across the collaborating databases and presented it to the representatives at the second workshop. OUTCOMES: Representatives of nine international databases attended the two workshops, in Bangalore, India (1998), and in Seoul, Korea (1999). We presented the prototypes at the workshops. Prototype I uses a Web interface, and supports browsing and searching from a variety of access points. Prototype II demonstrates a functional system that provides simultaneous access to selected represented databases by searching thesauri of these databases through our system. The group formalized itself as the International Collaboration for Information on Complementary and Traditional Medicine (IC2TM) with a goal of fully realizing the potential of the project.

Complementary Therapies↗
PubMed2000

Impact of new developments in antiretroviral treatment on AIDS prevention and care in resource-poor countries.

Combination antiretroviral treatment (ARV) including protease inhibitors, decreased the morbidity and mortality due to AIDS in the industrialized world. Many obstacles remain before ARVs can be introduced in resource-poor countries: high treatment costs, lack of laboratories to monitor the treatment, weak healthcare systems, and many other competing healthcare needs. The introduction of ARVs in resource-poor countries should be closely monitored. The first priority for the use of ARVs in resource-poor countries is the prevention of mother-to-child transmission of HIV. News about the success of ARV treatment may lead to an increase in unsafe behaviors including a decreased use of condoms. Therefore, prevention efforts should be strengthened; especially the development of an HIV vaccine needs to become a top priority. Funds for ARV treatment cannot come from the already strained healthcare budgets of resource-poor countries. The pressure on politicians and international donor agencies to provide ARVs to resource-poor countries should be used to increase overall healthcare budgets and to improve healthcare services in general.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Shifting attention from objective risk factors to patients' self-assessed health resources: a clinical model for general practice.

The study was designed to present and apply theoretical and empirical knowledge for the construction of a clinical model intended to shift the attention of the general practitioner from objective risk factors to self-assessed health resources in male and female patients. Review, discussion and analysis of selected theoretical models about personal health resources involving assessing existing theories according to their emphasis concerning self-assessed vs. doctor-assessed health resources, specific health resources vs. life and coping in general, abstract vs. clinically applicable theory, gender perspective explicitly included or not. Relevant theoretical models on health and coping (salutogenesis, coping and social support, control/demand, locus of control, health belief model, quality of life), and the perspective of the underprivileged Other (critical theory, feminist standpoint theory, the patient-centred clinical method) were presented and assessed. Components from Antonovsky's salutogenetic perspective and McWhinney's patient-centred clinical method, supported by gender perspectives, were integrated to a clinical model which is presented. General practitioners are recommended to shift their attention from objective risk factors to self-assessed health resources by means of the clinical model. The relevance and feasibility of the model should be explored in empirical research.

Adaptation, Psychological↗
PubMed2002

Adapting to aging losses: do resources facilitate strategies of selection, compensation, and optimization in everyday functioning?

Previous cross-sectional research has shown that older people who are rich in sensorimotor-cognitive and social-personality resources are better functioning in everyday life and exhibit fewer negative age differences than resource-poor adults. Longitudinal data from the Berlin Aging Study was used to examine these findings across a 4-year time interval and to compare cross-sectional indicators of adaptive everyday functioning among survivors and nonsurvivors. Apart from their higher survival rate, resource-rich older people (a) invest more social time with their family members, (b) reduce the diversity of activities within the most salient leisure domain, (c) sleep more often and longer during daytime, and (d) increase the variability of time investments across activities after 4 years. Overall, findings suggest a greater use of selection, compensation, and optimization strategies in everyday functioning among resource-rich older adults as compared with resource-poor older adults.

Activities of Daily Living↗
PubMed2004

A longitudinal study of black-white differences in social resources.

OBJECTIVES: This study examined the differences in levels of social networks and social engagement between older Blacks and Whites and racial differences in rates of change in social resources over time. METHODS: The sample consisted of 5,102 Blacks and Whites, aged 65 and older, from the Chicago Health and Aging Project, who underwent up to three interviews during an average of 5.3 years of follow-up. Repeated measures of social networks were based on the number of children, relatives, and friends seen at least once a month. Social engagement was measured at each interview with four items related to social and productive activity. Random effects models were fitted to test the effect of race on social resources and change in resources over time. RESULTS: Blacks had smaller social networks and lower levels of social engagement than Whites. Racial differences in these resources were stable during follow-up. Socioeconomic status reduced racial differences in social engagement but not social networks. DISCUSSION: The findings provide evidence for lower levels of social resources among older Blacks. There was little evidence that racial differences were the result of greater decline during old age itself.

Black or African American↗
PubMed1984

Social resources and mental health: an empirical refinement.

A factor analysis of the social resources measures included in the Older Americans Resources and Services instrument (Blazer, 1978) yielded four factors. These factors were labeled attachments, social interaction, social support, and adequacy of social resources. Of these, attachments and social interaction measures were found to have a very limited degree of association with mental health measures (self- and interviewer-rated mental health and the Minnesota Multiphasic Personality Inventory). The overall rating of social resources and the perceived adequacy of social resources, however, had a higher degree of association with the mental health measures.

Aged↗
PubMed2002

Geographic patterns of deprivation in South Africa: informing health equity analyses and public resource allocation strategies.

There is a growing interest in the use of small area analyses in investigating the relationship between socioeconomic status and health, and in informing resource allocation decision-making. However, few such studies have been undertaken in low- and middle-income countries (LMICs). This paper reports on such a study undertaken in South Africa. It both looked at the feasibility of developing a broad-based area deprivation index in a data scarce context and considered the implications of such an index for geographic resource allocations. Despite certain data problems, it was possible to construct and compare three different indices: a general index of deprivation (GID), compiled from census data using principal component analysis; a policy-perspective index of deprivation (PID), based on groups identified as priorities within policy documents; and a single indicator of deprivation (SID), selected for relevance and feasibility of use. The findings demonstrate clearly that in South Africa deprivation is multi-faceted, is concentrated in specific areas within the country and is correlated with ill-health. However, the formula currently used by the National Treasury to allocate resources between geographic areas, biases these allocations towards less deprived areas within the country. The inclusion of the GID within this formula would dramatically alter allocations towards those areas suffering from human development deficits. The area in which analysis was undertaken was not, however, sufficiently small to identify pockets of deprivation within the less deprived metropolitan areas. These findings suggest that it is feasible to conduct small area analyses in LMICs but that specific attention needs to be given to the size of the geographic unit used in analysis. In addition, they highlight the importance of considering deprivation in resource allocation mechanisms if vertical equity goals are to be promoted through resource allocation, particularly within decentralized health systems.

Censuses↗
PubMed1993

Family stress and resources: potential areas of intervention in children recently diagnosed with diabetes.

This article examines the relationships among family stress, family capabilities, and the health status of 53 children diagnosed with insulin-dependent diabetes mellitus. Assessments were done at an outpatient diabetes clinic of family coping, resources, and stress; disease-related knowledge; metabolic control (HbA1); and endogenous insulin (C peptide). Results indicated that higher levels of family stress and lower levels of family resources as reported by fathers were significantly associated with poor metabolic control. Multiple regression analyses revealed that levels of family stress and resources were more strongly related to metabolic control than were disease variables such as C peptide levels. Moreover, family stress was directly associated with metabolic control, and family resources showed indirect linkages. Findings suggest that family stress and resources are potential areas for social work intervention in children recently diagnosed with diabetes.

Adaptation, Psychological↗
PubMed1995

Geographical resource allocation in the English National Health Service, 1971-1994: the tension between normative and empirical approaches.

The policy response to the problem of developing a geographical resource allocation formula sensitive to relative population needs for hospital and community health services resources in the National Health Service demonstrates a continuing tension between normative and empirical solutions. Since 1988, the balance has shifted in favour of a more empirical approach to identifying and weighting population needs indicators in response to concerns about the theoretically justified, but essentially approximate, nature of the Resource Allocation Working Party formula introduced in 1977-1978. However, judgements and assumptions about the nature of 'need' have still to be made in order to construct a usable resource allocation formula since empirical data on what is cannot provide a complete guide to what ought to be a fair distribution of resources in relation to need.

Capital Financing↗
PubMed2000

Invertebrate carcasses as a resource for competing Aedes albopictus and Aedes aegypti (Diptera: Culicidae).

Terrestrial invertebrate carcasses are an important resource for insects developing in pitcher plants. However, little is known of the role of these carcasses in other containers, which also receive leaf fall and stemflow inputs. This experiment investigated effects of accumulated invertebrate carcasses as a resource for two competing mosquitoes, Aedes albopictus (Skuse) and Aedes aegypti (L.), whether either species differentially benefited from accumulated carcasses, and if such a benefit affected interspecific competition. First, we measured accumulation of invertebrate carcasses in standard containers at a field site. We then used a replacement series with five different species ratios at the same total density, and varied the input of invertebrate carcasses [dead Drosophila melanogaster (Meigen) ] in three levels: none, the average input from our field site, or the maximum input recorded at our field site. Survivorship, development time, and mass were measured for each mosquito species as correlates of population growth, and were used to calculate a population performance index, lambda'. There were strong positive effects of invertebrate carcass additions on all growth correlates and lambda'. Differences in performance between species were pronounced in small or no carcass additions and absent in large inputs of invertebrate carcasses, but there was little evidence that inputs of invertebrate carcasses altered the competitive advantage in this system. These results suggest that terrestrial invertebrate carcasses may be an important resource for many types of container communities, and large accumulations of dead invertebrates may reduce resource competition between these mosquitoes, thus favoring coexistence. We propose that the total amount of resource, including accumulated invertebrate carcasses, may explain observed patterns of replacement involving these mosquitoes.

Aedes↗
PubMed1989

Family resources as resistance factors for psychological maladjustment in chronically ill and handicapped children.

The hypothesis that their psychological adjustment is related in part to resources present in their families was investigated in 153 children, age 4-16, who had one of five chronic physical disorders: juvenile diabetes, juvenile rheumatoid arthritis, chronic obesity, spina bifida, or cerebral palsy. Their mothers completed standardized psychometric instruments to measure specific dimensions of family psychological and utilitarian resources and of child adjustment. Variation in children's psychological adjustment was related both to their psychological and utilitarian family resources. Psychological family resources contributed uniquely to the prediction of adjustment beyond that provided by utilitarian family resources. These results are discussed as having implications for the identification of chronically ill and handicapped children at risk for adjustment difficulties.

Adaptation, Psychological↗
PubMed2003

Relationships among shoot sinks for resources exported from nodal roots regulate branch development of distal non-rooted portions of Trifolium repens L.

Two manipulative experiments tested hypotheses pertaining to the correlative control exerted by nodal roots on branch development of the distal non-rooted portion of Trifolium repens growing clonally under near-optimal conditions. The two experiments, differing in their pattern of excision to manipulate the number of branches formed at the first 9-10 phytomers distal to the youngest nodal root, each found that after 20 phytomers of growth the total number of lateral branches formed on the primary stolon remained between five and seven regardless of where the branches formed along the stolon. Additional treatments established that nodal roots influenced branch development via relationships among shoot sinks for the root-supplied resources rather than through variation in the supply of such resources induced by fluctuations in photosynthate supply to roots from branches. Regression analysis of data pooled from treatments of both experiments confirmed that shoot-sink relationships for root- supplied resources controlled the branching processes on the non-rooted portion of plants. A disbudding treatment, which removed all the apical and axillary buds present on basal branches, but left other branch tissues intact, increased branch development of the apical region in the same way as did complete excision of the basal lateral branches. The apical buds and the elongation processes occurring immediately proximal to the buds were thus identified as strong sinks for the root-supplied resources. Such results suggest that branch development on the non-rooted shoot portion distal to the youngest nodal root is regulated by competition among sinks for root-derived resources, of limited availability, necessary for the processes of elongation of axillary buds and the primary stolon apical bud.

Homeostasis↗
PubMed1997

Funding a primary care led NHS: achieving a model for more equitable allocation of healthcare resources at a sub-district level.

BACKGROUND: Current resource allocation for health services have developed in a haphazard and inequitable way. This project aimed to determine a fairer and more rational way to distribute health authority's (HA's) money to general practitioners (GPs). METHODS: A dataset was developed to examine the way resources were spent on patients at the level of general practice. Important managerial aspects of the project were addressed. This involved the establishment of the 'Equity Group' of GPs to work with the HA. The group sought a measure of health need that was rigorous and scientifically based but was also practical and politically acceptable to GPs and the HA. The York Relative Needs Index (RNI) was chosen, and applied to populations at practice level. An implementation plan was then developed by the Equity Group. RESULTS: Results demonstrated considerable inequalities between practices in age-adjusted use of healthcare resources. There was low correlation between the level of need in practices and the per capita expenditure. Applying the York RNI to practice populations indicated current practice allocations were within the range 82-126 per cent of their needs-based target. The managerial implications of the proposed changes are described. CONCLUSIONS: The new methods for resource allocation appear to be an advance on the unplanned methods which have evolved. Full evaluation of the long-term results of redistributing health resources will be needed. Important aspects of this project were the participation of GPs and general development of the concept of equity in North Derbyshire.

Age Factors↗
PubMed1999

Allocative efficiency in the use of health resources in Portugal.

BACKGROUND: This is the first time that a resource allocation technique based on a marginal met need approach has been used in Portugal, and the objective of the study is to attain the improvement of allocative efficiency. METHODS: The utilities of health states with and without treatment have been measured using the rating scale technique and a cost-utility analysis has been made. The value resulting from multiplying the avoided days of incapacity by a weight, on a scale from zero to one, has been considered as an indicator of utility corresponding to the difference between a health state with and without treatment. This study has been carried out using the main causes of morbidity from the National Health Survey, 1987, at a regional level. A sample of 150 local authorities was considered to be sufficient. A second objective of this study was to carry out a cost-utility analysis for the main causes of declared morbidity. RESULTS: This analysis has shown that the ratio of cost-utility is highest for hypertension, followed by influenza, asthma and digestive ill-functioning. Pharyngitis-amygdalitis, cold, osteoarthrosis, chronic bronchitis, spondylous arthrosis and diabetes are the illnesses with a more favourable cost-utility ratio which, in a rational resource allocation, should be treated first. CONCLUSIONS: So that an increase in the allocative efficiency could be achieved, a transfer of resources between regions is required up to the point at which the use of these resources would be equally efficient. Resources should be transferred from two regions - Interior Centre Region and Littoral Lisbon Region - towards all the other regions, in particular the Interior North Region.

Adult↗
PubMed2002

Patient web-resource interest and internet readiness in pediatric inflammatory bowel disease.

OBJECTIVE: The internet has been touted as a cost-effective method of providing valuable patient education and support resources. However, little is known of the level of internet interest in or access to web-based resources of most chronically ill populations generally, and pediatric populations in particular. Web-based patient resources could be especially applicable to the pediatric inflammatory bowel disease (IBD) population given the potential appeal of an anonymous forum for this group. METHODS: Tertiary-care clinic patients aged 8-18 years and diagnosed with IBD were surveyed by mail. chi and/or analysis of variance were used to compare demographic data from nonresponders and responders and for subgroup analyses. RESULTS: Of 162 eligible patients, 63 (38.9%) completed the survey. Responders did not differ significantly from nonresponders by age, sex, or distribution of disease. Overall, 98.4% of those surveyed had internet access, with 61.9% having access at school. Ninety-five percent had used the internet, while 91% expressed interest in visiting a pediatric IBD website for general IBD information (83%), for support (73%), to pose questions (78%) or read (73%) or respond (60%) to questions, or to chat with others (46%). Despite expressed interest, far fewer had ever used the internet as an IBD information (52.4%) or support (9.5%) resource. Similarly, although 15.8% anticipated visiting a pediatric IBD site weekly, only 1.5% had done so in the week of the survey. CONCLUSIONS: Reported levels of interest in web-based patient resources are high among pediatric IBD patients, yet use may be infrequent.

Adolescent↗
PubMed1996

Comparison of resource costs of free and conventional TRAM flap breast reconstruction.

Resource costs, which are the costs to the hospital of providing a service, were measured for 154 patients who underwent mastectomy and immediate breast reconstruction with TRAM flaps. Unilateral and bilateral reconstructions were evaluated separately. The resource costs required to perform mastectomy and reconstruction with free TRAM flaps were then compared with those required when conventional TRAM flaps were used. The mean total resource cost in the free TRAM group was slightly higher than in the conventional TRAM group, but the difference was small (4.1 percent) and not statistically significant (p = 0.290). The mean resource cost of performing bilateral mastectomy and reconstruction was higher than that of unilateral mastectomy and reconstruction, but the difference was only 5.0 percent (p = 0.046). This study shows that the cost to an institution of providing breast reconstruction with free TRAM flaps is not significantly higher than that of performing reconstruction with conventional TRAM flaps. Also, our findings show that the resource costs of performing bilateral mastectomy and reconstruction are not much higher than those of treating only one breast.

Female↗
PubMed2005

Identification and evaluation of mental health and psychosocial preparedness resources from the Centers for Public Health Preparedness.

An exemplar group of disaster mental health subject matter experts was formed as part of the CDC Center for Public Health Preparedness program to develop a "toolkit" of relevant CPHP disaster mental health training and education curricula and resources. The group developed a charter, compiled relevant CPHP training materials, developed an objective review template, and collectively reviewed the assembled resources. Curricular reviews were presented at a March 2005 meeting where an asset matrix was developed to categorize and compare the training and education curricula and resources. This article describes findings and next steps for toolkit development and refinement. Some recommendations for the toolkit identified thus far are to develop standardized disaster mental health nomenclature, add training exercises to the array of CPHP training and education resources, develop disaster mental health competencies for public health workers, add more advanced trainings to the current repertoire, and add resources to the toolkit during the coming years. The group also plans to disseminate the mental health/psychosocial preparedness toolkit to practice partners engaged in training disaster response personnel.

Disaster Planning↗
PubMed2005

Implementation of a quality systems approach for laboratory practice in resource-constrained countries.

Under the direction of the US Global AIDS Coordinator's Office, Department of Health and Human Services, the CDC Global AIDS programme helps resource-constrained countries to address the global HIV/AIDS pandemic. Activities include laboratory capacity and laboratory infrastructure development in 25 resource-constrained countries. Medical practitioners and public health programme leaders in industrialized countries rely on the use of quality laboratory data for evidence-based medical decision-making to determine policy for the implementation of disease control measures, to monitor disease to determine the impact of control programmes, and to support surveillance activities. In these countries, laboratory data to support decision-making processes have a level of quality attributable to laws, regulations and guidelines developed over many years. However, resource-constrained countries have not had similar experiences. Few countries have developed laws, regulations or guidelines, nor is there a data-use culture (e.g. evidence-based medicine) for those in the decision-making environment in resource-constrained countries. The strengthening of laboratory capability and capacity in resource-constrained countries is an important goal to improve accurate and reliable data for the diagnosis, treatment and monitoring of disease.A process for the implementation of a quality systems approach for a laboratory is presented: (i) acknowledgement of the need to improve the laboratory programme in the country at the Ministry of Health and at all decision-making levels within the provinces/states of the country; (ii) assessment of capabilities, capacities, infrastructure, and training needs; (iii) implementation of a national meeting of laboratorians; (iv) designation of a national Quality Assurance Office and leadership within that office; (v) the development and provision of technical training.

Developing Countries↗