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At least 685 records · Page 38Linked to original sources
PubMed2004

Review of health economics modelling in rheumatoid arthritis.

As the cost of drug treatment for rheumatoid arthritis (RA) constitutes only a small proportion of total costs of the disease to individuals and society, therapeutic interventions have the potential for significant economic benefit. To take advantage of this potential, clinicians need to gain a global, long-term perspective on patient care. Economic evaluations of RA therapies are critically important in influencing decisions regarding the role of costly, but highly effective new therapies, particularly in settings where there are financial constraints on healthcare provisions. Such evaluations, therefore, need to be methodologically similar with valid results to enhance their value to clinicians and policy decision-makers. This requires the use of appropriate elements in the numerator (i.e. total number of dollars spent on healthcare as a result of the intervention) and the denominator (net health effectiveness) components of the cost-effectiveness equation. Other important design factors also need to be managed properly to ensure validity of the evaluation. In this regard, the guidelines proposed by the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) Task Force represent a useful approach to help create common standards for economic evaluations in RA. Recently, the development of a number of decision analysis models in RA has helped predict the likely cost-effectiveness of new interventions such as the anti-tumour necrosis factor (TNF)-alpha agents, etanercept and infliximab, both of which have been found to be cost-effective relative to other disease-modifying anti-rheumatic drugs (DMARDs) using short-term efficacy endpoints. In comparisons of these two agents in patients with DMARD-resistant RA, etanercept has been shown to be more cost-effective than the combination of methotrexate and infliximab, administered in various dosages, over a period of 1 year using American College of Rheumatology (ACR) response rates as the primary efficacy measure. However, the criteria for determining clinical efficacy is paramount and other studies that use radiographic progression as a measure of clinical effectiveness show no difference between etanercept and infliximab in clinical efficacy. Important issues that need to be considered in developing economic models in RA include consideration of the connection between the prevention of radiographic progression and downstream economic consequences, and the need to employ lifetime models wherever possible because a long time period is necessary to determine the true cost-effectiveness of agents that modify radiographic progression of RA, such as etanercept, infliximab, and adalimumab. In doing so, it is hoped that such studies will provide optimal information to facilitate important decisions on resource allocation.

Antirheumatic Agents↗
PubMedDate not supplied

[Development of urbanization in Japan].

"In Japan urbanisation has developed very rapidly in relation with economic development and concentration of the population and industry in towns; in consequence urbanisation is making rapid progress in the suburbs of large towns. The author emphasises some geographical aspects of urbanisation in Japan: urban growth, spatial urbanisation, transformation of the landscape, regional circulation of capitals and characteristics of urbanisation in Japan." (summary in ENG, JPN)

Asia↗
PubMedDate not supplied

[Multivariate methods in the analysis of the relationships between mortality and socioeconomic, environmental, and individual behavioral variables].

This study is concerned with the relationships between geographic factors and mortality from external causes, such as environmental pollution, nutrition, and socioeconomic factors. It is based on Italian data on the mortality of adult males aged 25 years and over. The results show that "degenerative diseases, from middle age onwards, are typical sicknesses of the more highly industrialised and richer areas, [particularly] where economic development has not been accompanied by action to preserve the environment from pollution. Diseases which medical and therapeutic progress have rendered almost harmless continue to strike the populations of the poorer areas, where adequate hygienic and sanitary structures are lacking." (summary in ENG, ITA)

Adult↗
PubMed1995

South-North migration. The case of Spain.

"International migrations caused by socio-economic and demographic reasons, especially from underdeveloped countries to the rich and prosperous areas of the globe are discussed with the focus on Western Europe and particularly on Maghrebi immigration to Spain. Emigration of the people from a backward region even increases the deterioration of [the] local economy, provoking stagnation and inflation. Therefore emigration only can not be seen as an economic take-off for sustained economic development over the frontier areas between developed and depressed territories. Related social questions as well as economic, religious and political may add factors affecting the structural balance of the societies concerned."

Acculturation↗
PubMed1983

[The development of tuberculosis control and tuberculosis epidemiology in East Germany].

The fight against tuberculosis in the German Democratic Republic was performed from the very beginning as a task of the state and the society; it was developed according to the progress of economic possibilities and the epidemiological situation. The contribution of the community and of the social-economic development on tuberculosis epidemiology has proved to be decisively important factors in tuberculosis control. The specific methods applied in tuberculosis control in the course of more than 30 years have changed in their importance effectiveness and efficiency with the reduction of the tuberculosis problem and the development of new techniques. Therefore a continuous evaluation of the tuberculosis situation is necessary to recognize the most effective approach. By reducing the estimated annual infection rate to less than 0.05%, the incidence of smear positive pulmonary tuberculosis to less than 5/100,000 and the practical disappearance of tuberculosis among children tuberculosis has become an endemic localized disease among predominantly old citizens. People's mass x-ray examinations have considerably lost their value for finding tuberculosis. Early coverage and examination of persons with respiratory symptoms (21-days-coughers), of contact persons and high risk groups will determine the future activities of the chest clinics. Their integration into the system of outpatient clinics and the system of primary health care were an important step on this way. Successful treatment of each case of tuberculosis is now possible and must be attained. Early case finding + treatment considered as an united activity has become the decisively important measure in the control of tuberculosis. The endemic foci of tuberculosis in some communities have to be surveyed and eliminated with priority. Moreover, the cooperation of all physicians of public health is necessary. Only by this way tuberculosis can be eradicated in GDR in a defined time. (Aim of WHO and IUaT: 1 case of smear positive tuberculosis among 1,000,000 inhabitants.) Up to that time tuberculosis control should remain an obligatory task of public health.

Adolescent↗
PubMed1994

Christian mission hospitals as family practice educational resources.

With the worldwide family practice movement, a need has arisen to develop new residency training programs in economically developing countries. Christian mission hospitals exist in many areas where there is a need for more family physicians. These hospitals have been providing service and education, and some are now becoming training sites for family physicians. Currently, seven such institutions have operational family practice residency programs, all of which welcome personnel exchanges with faculty or residents in North American training programs. Christian mission hospitals with family practice residency programs exist in South America, Asia, and Africa.

Christianity↗
PubMed1977

Health: an essential component of long-term economic and social development.

Isolated growth of the economy in a developing country, without due consideration of social aspects, does not necessarily increase the welfare of all its population. In such cases, there will always be a large group with poor education and negligible health care. Health services in these countries should not try to duplicate those of the technologically developed nations and should be more health-oriented than disease-oriented. This entails wider utilization of auxiliary and paramedical personnel and, above all, community involvement. At the same time, the teaching of medicine should be based on the needs of the country rather than try to emulate developed countries' programmes, which can only result in dissatisfaction among physicians and/or in emigration. The Inter-American Development Bank considers that health is a component of long-term economic development; it is therefore fostering and participating in the expansion of rural health services with strong emphasis placed on community participation. In this process health education, both of the public and of local and national authorities, is paramount. Of particular importance is the interaction of health officials and the community itself in order to enlist the rural dweller in spontaneous and active participation that will ensure the success of health programmes.

Allied Health Personnel↗
PubMedDate not supplied

National health system steps in Turkey: concerns of family physician residents in Turkey regarding the proposed national family physician system.

Many countries are currently struggling with the public desire for improved health care and provision of basic services on the one hand, and the rising costs of health care on the other. Turkey is acutely experiencing this problem because of its relatively advanced level of economic development and its relatively low level of health status compared to Organization for Economic Cooperation and Development and European Union countries. Since 1990, there has been vigorous debate in the Turkish society regarding the best way to improve public health through improved primary health care. The current government is pursuing a proposal that has been mentioned before, but in a more serious effort than has been previously made. This is an approach to primary care based on systems such as those in the United Kingdom and in Germany, and the basic components are family physicians who have a particular list of patients whom they provide care for. Financing of the system is to be provided with a new general health insurance scheme. In this study, 38 family practice residents at the 3 major training hospitals for this specialty completed an investigator-designed questionnaire for the purpose of characterizing their concerns regarding this proposed system of primary health care delivery. The participants' responses indicated that the new system, which is known as the Family Physician System, will contribute importantly toward raising the overall level of health in Turkey. Specific expected benefits include closer patient-physician relationships, increased job satisfaction on the part of family physicians, and an overall increase in income for the physicians working in the system.

Adult↗
PubMed1988

Infection control in developing countries.

The level of socio-political and economic development achieved by a country determines the quality and quantity of the health care its citizens receive. These factors also govern the amount of attention given to hospital-acquired infection. The problems of infection control in 'developing' countries include, first, the international problems that arise from clashes of personality and viewpoint among those responsible for it, exacerbated in some places by ethnic or religious traditions. Second are problems imposed by factors that affect the spectrum of infectious disease, and third is a variable deficiency of human and financial resources. In the search for solutions, an analysis suggests that nurses are particularly suited to take the lead in the prevention of infection, so that a special initiative directed towards their education in the rapidly developing science of hospital infection and its control is likely to be the most cost effective and appropriate initial approach. This needs to be accompanied by parallel improvements in the education of medical undergraduates. Anything else should be applied in response to measured need, and then only as money and manpower permit. Careful thought is required to avoid squandering scarce resources by applying inappropriate infection control technology.

Communicable Disease Control↗
PubMed1992

[Migration, urbanization, and development policy in Senegal].

"The various studies focussing on human settlements in Senegal show that the share of population living in cities is ever increasing because of the massive and continuous flow from rural areas. The persistance of such migration trends from the country to cities deepens regional disparities, compounds the difficulties and cost of city management and development, specially in the case of Dakar, and runs counter to the goals of social and economic development plans.... The growing importance of such phenomena calls for the designing of corrective measures in favour of rural areas and small towns in order to settle rural populations and halt the inordinate and chaotic geographical growth of large cities. Failing this, development efforts may well be compromised." (SUMMARY IN ENG)

Africa↗
PubMed1983

[Medicine and society. Schools of thought in the health field].

The article considers the answers given by different schools of thought to the fundamental questions about the degree of autonomy of medicine and the kind of articulation between medicine and society as a whole and in its "parts." The answers vary with the thinking in the different social sciences and the philosophic schools associated with them. The author divides his presentation in two broad chapters: The first covers schools of thought in the health field, and attempts to delineate the philosophical foundations underlying the principal current schools of thought in this field, without attempting a history of the philosophical schools or analyzing each of them in detail. Thus, two idealist currents are studied which have exerted great influence in the health field--neopositivism and neo-Kantianism--and marxism as the materialist school, which recognizes the primary of matter, nature, and objective reality, and views consciousness as a property of matter. The second chapter considers the theoretical contest now going on among the schools of thought discussed in the first chapter, which try to explain the relationship between medicine and the social structure; the effectiveness of medical action, and the social determinants of disease. Prior to the seventies, the author says, the dominant view of the autonomy of medicine, its effectiveness, the potential for social change of the medical institutions, and the benefits to health of economic development, was endorsed by the predominance of positivism among these schools of medical thought. The view that medicine was broadly autonomous and at the same level with other subsystems such as the economic, the political and the educational subsystems, assumed the possibility of changing society by an effort begun through any of these "sectors." The enormous growth of productive forces that took place in the developed capitalist countries during the fifties, and even more during the sixties, collided at the end of the latter decade with the existing social production relations, which checked the progress of the production forces and generated a series of challenges in civil society to the aims of economic development and the achievements of science in relation to the inequality of the distribution of wealth. In the health sector, this was a time of criticism of the positivist view and of pointing out the negative effects of medicalization, highlighting the ideological and self-perpetuating character of medical institutions, and proposals for the demedicalization of society.(ABSTRACT TRUNCATED AT 400 WORDS)

History, 19th Century↗
PubMed2006

Impact of 100-year human interventions on the deltaic coastal zone of the Inner Thermaikos Gulf (Greece): a DPSIR framework analysis.

The Axios River delta and the Inner Thermaikos Gulf coastal zone have experienced a long period of human interventions during the past 100 years. A post-evaluation of long run coastal zone changes under the Drivers-Pressures-State-Impacts-Response (DPSIR) conceptual framework is presented. The DPSIR approach is then used to project out into possible futures in order to connect with policy and management options proposed for the improvement of the current conditions and the achievement of sustainable development, in the coastal zone. Socio-economic driving forces with their origins in the end of the 19th century have generated numerous pressures in the coastal environment that changed the state of the environment. In the first part of the last century, there was no coupling between change of state and policy. Due to increasing environmental awareness, a coupling became more apparent over the last thirty years. Human interventions include river route realignment, extensive drainage of the plains, irrigation network, roads and dam constructions. The consequences were positive for the economic development of the area, human health, and navigation for the port of Thessaloniki. In contrast, the manipulation and over-use of natural resources has led to a reduction of wetlands, biodiversity loss, stress on freshwater supplies, and subsidence of coastal areas, aquifer salinization, and rapid coastal erosion. Three plausible future scenarios are utilised in order to investigate the implications of this environmental change process and possible socio-economic consequences.

Environmental Health↗
PubMed2001

Modelling sustainable development planning: a multicriteria decision conferencing approach.

Development planning is multidimensional in nature. On the one hand, it addresses economic growth, and on the other, it deals with economic development of the whole nation. Sustainable development, on the other hand, emphasizes the need for integration of economics and environment, as well as promoting intra- and intergenerational equity. While the literature deals extensively with the issues of sustainable development, it lacks a prescription of an easy-to-use, yet rigorous, methodology for it. In this paper, we offer a decision conferencing approach to sustainable development planning based on a multicriteria model. The integrated model is presented and applied to a sustainable development planning exercise in a third world country. Sample results are presented and detailed sensitivity analyses show the environmental variables that are of major concern.

Animals↗
PubMed2004

Exposures and health outcomes from outdoor air pollutants in China.

China's economy has developed rapidly in the recent two decades. Economic development is usually linked with increase in energy consumption and consumption emissions, which in turn leads to worsening of air quality. Due to the adoption of various control measures, the ambient air quality in a number of large cities in China has actually improved. The ambient air TSP and SO(2) levels in China have been decreasing in the last decade. However, ambient air NO(x) level has been increasing due to the increased number of motor vehicles. Coal has been and is still the major source of energy in China. Ambient air pollution in large cities has changed from the conventional coal combustion type to the mixed coal combustion/motor vehicle emission type. A series of epidemiological studies on air pollution and health effects ranging from mortality, morbidity to functional changes have been conducted in China. The results showed that ambient air pollution had acute and chronic effects on mortality, morbidity, hospital admissions, clinical symptoms, lung function changes, etc. The exposure-response relationship between air pollutants and daily mortality, morbidity, hospital admissions, and lung function has been established accordingly.

Adult↗
PubMed2003

The contribution of health-care services to a sound and sustainable malaria-control policy.

HIV and AIDS, tuberculosis, and malaria, besides presenting a large mortality and morbidity burden in developing countries, are also responsible for poor economic development. In the past international agencies devoted resources and efforts to control malaria and other diseases without taking into account health-system performance and sustainability. Even assuming that the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM)--a recent international initiative--would provide the necessary funds, a poorly performing health-care system will not be able to use these funds optimally. Moreover, even if all interventions are cost-effective, their impact on mortality and morbidity will only be marginal if access to proper care is not guaranteed. It is the responsibility of scientists and health managers to highlight to donor agencies the importance of an accessible and well functioning health-care system at all levels for the control of specific diseases.

Bedding and Linens↗
PubMed2002

Some aspects of secular changes in Hungary over the twentieth century.

Growth and maturation are considered the most reliable indicators of health status. Their progression rates in turn are strongly influenced by nutrition and socio-economic status, a well-documented relationship. The pattern of the so-called positive secular changes, i.e. the increase in size and earlier maturation, fits the populations' historical model of economic development very well. The historical, political and economic changes occurring in this century in Hungary have had a remarkably strong impact. Until World War I Hungary was an agrarian part of the Austro-Hungarian monarchy, its ethnic composition was most variegated. Both World Wars caused fundamental changes, namely in respect of post-war Hungary they were associated with marked territorial losses and considerable population mobility. In interpreting the developmental differences in the data collected before and after these wars one should take account of the important facts that, in addition to the changes in socio-economic conditions, affected the gene pool of the populations in Hungary. Over the past 100 years profound changes have occurred in the mean body size, growth rate and timing of maturation of the country's population. This paper is a brief analytic summary of the tendencies observed in adult stature, maturation and some socio-economic conditions. It also compares the cohorts of sub-populations as reflected by the reviewed reports. In summarizing the change in adult stature estimated by the data on recruits, soldiers and students of higher education, it could be stated that adult mean stature had become markedly taller in Hungary since the end of the fifties. However, any estimation of the absolute increment and the exact rate is severely biased by the variable character of the samples' representativeness. Similar problems arose in dealing with sexual maturation, because the retrospective and status-quo methods of assessment were found incomparable. Nevertheless, menarche was observed to have shifted to an appreciably younger age lately, a trend that by the end of the 20th century seemed to have reached a more or less stable level.

Anthropology, Physical↗