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At least 703 records · Page 39Linked to original sources
PubMed2002

A penalized likelihood approach for an illness-death model with interval-censored data: application to age-specific incidence of dementia.

We consider the problem of estimating the intensity functions for a continuous time 'illness-death' model with intermittently observed data. In such a case, it may happen that a subject becomes diseased between two visits and dies without being observed. Consequently, there is an uncertainty about the precise number of transitions. Estimating the intensity of transition from health to illness by survival analysis (treating death as censoring) is biased downwards. Furthermore, the dates of transitions between states are not known exactly. We propose to estimate the intensity functions by maximizing a penalized likelihood. The method yields smooth estimates without parametric assumptions. This is illustrated using data from a large cohort study on cerebral ageing. The age-specific incidence of dementia is estimated using an illness-death approach and a survival approach.

Journal Article↗
PubMed2004

The Social Transition in the North: collection and data access protocols.

OBJECTIVE: These protocols were designed to provide access to the Social Transition in the North (STN) collection and data set. METHOD: Staff at the (UAA) Institute for Circumpolar Health Studies (ICHS) reviewed, organized, inventoried, and cataloged the STN collection. RESULTS: Most of the materials in the collection are available from the UAA Archives and Manuscripts Department, Consortium Library. Documents and data containing sensitive information are maintained by ICHS to assure confidentiality of research participants. CONCLUSION: These access protocols allow researchers to obtain access to this valuable data set consistent with US research policy while protecting the integrity of the data and the confidentiality of the participants.

Alaska↗
PubMed2005

Barriers to cervical cancer screening: a qualitative study with women in Serbia.

Serbia employs opportunistic approaches to cervical cancer screening, leading to inequitable health care access. To better understand the health care needs of women, we investigated their knowledge of and perceived barriers to cervical cancer screening. Data reported in the paper arise from nine focus group discussions with 62 women from diverse socio-economic backgrounds. They were recruited in two cities with contrasting social settings, Belgrade, the Serbian capital, and a regional town, Smederevo. Thematic analysis identified that the interplay of social and personal barriers influenced women's poor presentation for screening. Inadequate public health education, lack of patient-friendly health services, socio-cultural health beliefs, gender roles, and personal difficulties were the most salient barriers to screening. We suggest how within the context of opportunistic screening patient education may be employed. The introduction of compulsory cervical cancer screening, suggested by some participants, is also discussed.

Adult↗
PubMed2002

Is the Turkish health care system ready to be a part of the European Union?

Lately, Turkey is struggling to recover from the economic effects of the economic crisis so that the government officials are trying to impose budget cuts in health and education sectors. After the United States, the country's national defense expenditures are the highest among the NATO countries. Therefore, Turkey allocates only 3-4% of the gross domestic product for health care expenses. Overall, the health status in Turkey is the lowest among the European Union countries; infant mortality rate is about 45 per 1000 live births, which is the highest on the European continent, and per capita health care expenditure is $120. Although 75% of the people are covered by some type of public insurance, 25% of the Turkish people do not have any insurance coverage. The national system is funded by taxes (43%), out of pocket payments (32%), and social and private insurance premiums (25%). This study examines whether Turkey is ready to be a part of the European Union in terms of the health sector of its economy and health status of its people.

Birth Rate↗
PubMed2004

Trends in childhood obesity in Japan over the last 25 years from the national nutrition survey.

OBJECTIVE: To describe the 25-year changes in BMI (measured in kilograms per meters squared) and the prevalence of obesity in Japanese children with special reference to urban-rural differences. RESEARCH METHODS AND PROCEDURES: We used the data sets from the cross-sectional annual nationwide surveys (National Nutrition Survey, Japan) conducted from 1976 to 2000 and comprising 29,052 boys and 27,552 girls between 6 and 14 years of age. We carried out the trend analyses with the data on sex and age groups and on residential areas according to the size of the municipality (metropolitan areas, cities, and small towns). RESULTS: The mean (age-adjusted) BMI increased by +0.32 kg/m(2) per 10 years in boys and by +0.24 kg/m(2) per 10 years in girls, increases that were remarkable in small towns. The prevalence of obese boys and girls increased from 6.1% and 7.1%, respectively, in the time-period 1976 to 1980, to 11.1% and 10.2% in 1996 to 2000. The increasing trend was most evident in 9- to 11-year-old children of both sexes living in small towns, whereas no changes were observed in girls in metropolitan areas. DISCUSSION: Our data clearly show increasing trends in obesity prevalence in Japanese school children. Degrees of the increasing trends, however, differed across sex and age groups and residential areas, demonstrating a particular phenomenon that girls in metropolitan areas were unlikely to become obese. These epidemiological aspects indicate the priorities for intervention in population strategies to control obesity in children.

Adolescent↗
PubMed1999

"Nurses as health evangelists"?: The evolution of public health nursing in Canada, 1918-1939.

Public health nurses provided leadership for the advancement of public health in Canada in the early decades of this century, although leadership by nurses is not celebrated in public health history. The historical period (1918-1939) selected for this inquiry is one in which public health nurses created a legacy of achievements in public health nursing education, practice, and the organization of community health services within the most challenging of social, economic, and political contexts. The practice of public health nursing in Canada during the interwar years included strategies that were then and still are integral to the discipline--those of forming connections with the community, providing leadership in the public health movement, and facilitating community organization. It is vital to understand the significance of these origins of public health nursing as forces in the present context of practice threaten to alter fundamentally the nature of public health nursing's connection with the community. The purpose of this article is to highlight aspects of this historical legacy so that its influence can be more fully understood and strengthened in current health system transitions.

Canada↗
PubMed2002

Health care reform and changes: the Malaysian experience.

Health care reform is an intentional, sustained and systematic process of structural change to one or more health subsystems to improve efficiency, effectiveness, patient choices and equity. Health care all over the world is continuously reforming with time. Health care reform has become an increasingly important agenda for policy change in both developed and developing countries including Malaysia. This paper provides an overview of the Malaysian health care system, its achievements, and issues and challenges leading to ongoing reform towards a more efficient and equitable health care system that possess a better quality of life for the population.

Delivery of Health Care↗
PubMed2005

Long-acting risperidone compared with oral olanzapine and haloperidol depot in schizophrenia: a Belgian cost-effectiveness analysis.

Patients with schizophrenia suffer numerous relapses and rehospitalizations that are associated with high direct and indirect medical expense. Suboptimal therapeutic efficacy and, in particular, problems with compliance are major factors leading to relapse. Atypical antipsychotic agents offer improved efficacy and a lower rate of extrapyramidal adverse effects compared with conventional antipsychotic drugs. Long-acting intramuscular risperidone combines these benefits with improvements in compliance associated with depot injections. To assist decision making regarding the place of long-acting risperidone in therapy, a cost-effectiveness analysis of strategies involving first-line treatment with long-acting risperidone, oral olanzapine or depot haloperidol was performed from the perspective of the Belgian healthcare system. A decision tree model was created to compare the cost effectiveness of three first-line treatment strategies in a sample of young schizophrenic patients who had been treated for 1 year and whose disease had not been diagnosed for longer than 5 years. The model used a time horizon of 2 years, with health state transition probabilities, resource use and cost estimates derived from clinical trials, expert opinion and published prices. The four health states in the model were derived from an analysis of the literature. The principal efficacy measure was the proportion of patients successfully treated, defined as those who responded to initial treatment and who had none to two episodes of clinical deterioration without needing a change of treatment over the 2-year period. Comprehensive sensitivity analysis was carried out to test the robustness of the model. A greater proportion of patients were successfully treated with long-acting risperidone (82.7%) for 2 years, compared with those treated with olanzapine (74.8%) or haloperidol (57.3%). Total mean costs per patient over 2 years were 16,406 Euro with long-acting risperidone, 17,074 Euro with olanzapine and 21,779 Euro with haloperidol (year of costing 2003). The mean cost-effectiveness ratios were 19,839 Euro, 22,826 Euro and 38,008 Euro per successfully treated patient for long-acting risperidone, olanzapine and haloperidol, respectively. Results of the sensitivity analysis confirmed that the results were robust to a wide variation of different input variables (effectiveness, dosing distribution, patient status according to healthcare system). Long-acting risperidone was the dominant strategy, being both more effective and less costly than either oral olanzapine or depot haloperidol. Long-acting risperidone appears to represent a favourable first-line strategy for patients with schizophrenia requiring long-term maintenance treatment.

Antipsychotic Agents↗
PubMed2002

The transition of adolescents with diabetes from the children's health care service into the adult health care service: a review of the literature.

Adolescents with diabetes have unique health needs, which impact upon their transition from children's health care services into adult health care services. These health needs result from the precarious period in their lives, when they have to cope with the stresses of being a maturing person. This coincides with their move from the children's into the adult health care service. Whilst coping with these pressures they must also keep their diabetes under control. The impact of emotional and physical demands upon the adolescent means that they are more susceptible to non-adherence, which may result in reduced diabetic control. This literature review identifies some of the many barriers erected to the transition into the adult health care system; these barriers may be constructed by any one of the parties involved: the children's health care team, adult health care team, the adolescent or their family. Principles of a successful transition are explored, along with the prerequisite qualities required of health care providers and the health care service.

Adaptation, Psychological↗
PubMed1990

GR 38032F (ondansetron), a selective 5HT3 receptor antagonist, slows colonic transit in healthy man.

The newly recognized class of 5-hydroxytryptamine receptors (5HT3) may be involved in the induction of nausea, since their pharmacological antagonists are effective against emesis induced by chemotherapy. 5HT3 receptors are present on enteric neurons, and 5HT3 blockers may produce mild constipation; we thus hypothesized that 5HT3 receptors would modulate colonic motility. To determine if GR 38032F, a selective 5HT3 antagonist known to have antiemetic effects, influences colonic transit in health, a randomized, double-blind, placebo-controlled crossover study was performed. Using a radiopaque marker technique, colonic transit was quantified in 39 healthy volunteers (19 men, 20 nonpregnant women) 18-70 years of age. On a standard 25-g fiber diet, 16 mg of GR 38032F was given orally thrice daily. Gastrointestinal peptides (peptide YY, human pancreatic polypeptide, neurotensin, motilin, gastrin-cholecystokinin, substance P) were also measured in plasma fasting and postprandially. Mean total colonic transit time on placebo was 27.8 hr, while on GR 38032F it was 39.1 hr (P less than 0.0005). Transit times through the left colon (P less than 0.0005) and rectosigmoid (P less than 0.05) were prolonged by the drug, but right colonic transit was not significantly altered. Transit times did not correlate with age or gender, but subjects with shorter transit times were significantly more affected than were those with longer transit times. The peak release of peptide YY was minimally decreased following GR 38032F (P less than 0.01), but the peak and integrated postprandial responses of human pancreatic polypeptide, neurotensin, motilin, gastrin-cholecystokinin, and substance P were not significantly altered by the drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMedDate not supplied

Statistical methods that distinguish between attributes of assessment: prolongation of life versus quality of life.

The authors propose a method to generate information relevant to the decision tree that adds additional perspective to the characterization of health quality during survival. Their approach uses survival data to distinguish two attributes of utility: prolongation of life and quality of life (QOL). Health-state transition probabilities correspond to the prolongation of life and are modeled in a discrete-time transient semi-Markov process. Quality-of-life-state transition probabilities are derived from the assumptions of a simple recurrent Markov process. They reflect events within the health-state sojourn time that differentiate perceptions of pain and suffering over a short fixed time period. Outcomes for these two dimensions of utility are highly relevant to the assessment of medical technology that might prolong life at the cost of increased pain and suffering, implying a reduced QOL. The methods are demonstrated on a subset of follow-up data from the Beta-Blocker Heart Attack Trial (BHAT).

Adult↗
PubMed2001

Transition from pediatric to adult-oriented health care: a challenge for patients with chronic disease.

Pediatric providers can expect that 1 of every 10 patients they see will have a chronic, activity-limiting health condition. Thanks to earlier diagnosis and improved therapies, most of these children will live well into adulthood. This means that eventually they will require care that focuses on adult health issues. Providers in the United States and around the world are recognizing the need for coordinated processes to transition adolescents and young adults with chronic conditions to adult health care. These models rely on the participation and input of the adolescent, his or her family, and pediatric and adult health professionals. This paper distinguishes medical transition from medical transfer; discusses potential barriers to transition; examines new initiatives to develop and study transition models; and reviews federal legislation influencing health care transitions.

Adolescent↗