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PubMed2000

[Medical resources consumption of type 2 diabetics in France in 1998].

The research objective of CODE-2 study was to estimate the total direct medical resources use of type 2 diabetes in France and in Europe. Only French data are provided in this paper. Total medical resources consumption of type 2 diabetics on a 6 months retrospective period were collected through a national practitioner survey (including both general practitioners and diabetology/endocrinology specialists). This survey was completed for 751 patients. Data collected were then extrapolated to be representative of all type 2 diabetics in France. Average medical resources consumption of a type 2 diabetic per year is 3 350 US$ (1 US$ =6FF). This figure is a minimum because some costs were underestimated in the study. Extrapolated to all diagnosed and treated type 2 diabetics in France, this expenditure is 4.3 billion US$ and accounts for 3.8 % of the total medical resources consumption in France (prevalence of type 2 diabetes reaches 2.5 % in the general population). Among this consumption, 24.1 % is directly related to diabetes, 26.7 % to potential related diabetes complications and 49.2 % to other diseases. Time since diagnosis, current treatment type and complications are the main factors which increase such consumption. CODE-2 study reveals the high level of medical resources consumption associated with type 2 diabetes complication. It confirms that more efficient therapeutical strategies are needed to avoid these complications.

Costs and Cost Analysis↗
PubMed2000

Achievable standard of care in low-resource settings.

The gap between rich and resource-poor countries has continued to grow as reproductive care providers integrate interventions to limit mother-to-child transmission (MTCT) of HIV in a manner consistent with existing information. There are two major reasons for this difference: access to prophylactic antiretroviral therapy (ARV) for HIV-infected pregnant mothers and availability of alternative feeding for babies. In resource-poor settings, these options are beyond reach for the majority of the women. Infant and under-five mortality rates from other infections are high in these settings and breastfeeding remains the norm. Answering the question, What is an achievable standard of care in resource-poor settings? still remains a major challenge today. Dialogue has begun in most resource-poor settings to address the key elements in the package of interventions to reduce MTCT of HIV. These elements include the following: (1) overall prevention of HIV in mothers and fathers; (2) provision of good-quality voluntary testing and counseling (VCT) in antenatal clinics; (3) a comprehensive package of interventions during pregnancy, during labor, and after delivery, including screening for sexually transmitted diseases (STDs), family planning, and--where possible--ARVs; (4) provision of infant and maternal nutrition within the socioeconomic realities; (5) advocacy and program communication; and (6) other supportive measures, including community mobilization to address issues such as stigmatization of and violence against HIV-infected women. This paper discusses the challenges faced by most resource-poor settings in integrating some of these activities into reproductive care services.

Anti-HIV Agents↗
PubMedDate not supplied

The effects of food presentation and microhabitat upon resource monopoly in a ground-foraging ant (Hymenoptera: Formicidae) community.

In Neotropical wet forests several species of omnivorous, resource-defending ants, live and forage in close proximity to one another. Although the forest floor is heterogeneous in microhabitat and food quantity, little is known about the impact of microhabitat and food variation upon resource monopoly among ants. We investigated how food type and microhabitat influence food monopoly in resource-defending ants in old-growth tropical wet forest in the Caribbean lowlands of Costa Rica. We measured several microhabitat characteristics at 66 points in a 0.5 hectare plot, and baited each point with two categories of tuna bait. These baits were presented in "split" and "clumped" arrangements. We measured the frequency of bait monopoly by a single species, as well as the number of recruited ant foragers at a bait. Out of five common species, two (Wasmannia auropunctata and Pheidole simonsi) more frequently monopolized one bait type over the other, and one (P. simonsi) recruited more ants to the split baits. We then considered the recruitment response by all ant species in the community. We found that the frequency of monopoly, sharing, and the absence of ants at a given point in the rainforest differed with bait type. The frequency of monopoly was associated with microhabitat type in two out of eight microhabitat variables (leaf litter depth and palms); variation in two other types (canopy tree distance and leafcutter ant trails) was associated with changes in forager number. In at least two ant species, food presentation affected monopoly at baits; among all resource-defending ants, the microhabitats where ants foraged for food and the type of food located determined in part the frequency of monopoly and the number of foragers at the food item. These results suggest that the location and presentation of food items determines in part which ant species will utilize the resource.

Animals↗
PubMedDate not supplied

Hospital resources used for ectopic pregnancy treatment by laparoscopy and methotrexate.

OBJECTIVE: To compare resources used in the medical and laparoscopic treatment of unruptured ectopic pregnancy. METHODS: We prospectively recorded all the medical resources required in the treatment of unruptured ectopic pregnancy. The study period ranged from January 1, 1995 to June 30, 1998. Single-dose intramuscular methotrexate injections were administered in 55 women (group I). This therapeutic option was provided on an outpatient basis in small EP (beta-HCG level < 5000 IU/L and hematosalpinx diameter < 3 cm). Serial clinical controls and biologic tests were performed until bHCG became negative. Forty women underwent a laparoscopic salpingostomy because they refused the methotrexate regimen or had "social" contra-indications (ie, predictable difficulties in the follow-up) (group II). Twenty-one patients underwent conservative laparoscopic treatment because of "medical" contraindications to methotrexate (group III). We recorded the resources used with the outpatient and inpatient treatment in each group (methotrexate consumption, operating room acts, length of hospital stay, clinical examinations, biological tests, and sonograms during the follow-up). RESULTS: We observed similar cure rates in each group, but it took significantly longer for beta-HCG to become negative in group 1. However, hospitalization was significantly less often required, and the length of hospital stay was shorter in this group. But length of follow-up, number of office visits, biological tests, sonograms, and subsequent readmissions were significantly more frequent after methotrexate. Despite more severe clinical presentations for patients in group III, we didn't find any significant differences in the hospital resources used in this group in comparison with those used in group II. CONCLUSIONS: The outpatient methotrexate option may result in low consumption of resources for a hospital because most of the follow-up can be performed by city practitioners and laboratories. For the laparoscopic option, efforts should be made to reduce the postoperative hospital stay.

Adult↗
PubMed1995

Incineration as a method for resource recovery from inedible biomass in a Controlled Ecological Life Support System.

Resource recovery from waste streams in a space habitat is essential to minimize the resupply burden and achieve self-sufficiency. In a Controlled Ecological Life Support System (CELSS) human wastes and inedible biomass will represent significant sources of secondary raw materials necessary for support of crop plant production (carbon, water, and inorganic plant nutrients). Incineration, pyrolysis, and water extraction have been investigated as candidate processes for recovery of these important resources from inedible biomass in a CELSS. During incineration CO2 is produced by oxidation of the organic components and this product can be directly utilized by plants. Water is concomitantly produced, requiring only a phase change for recovery. Recovery of inorganics is more difficult, requiring solubilization of the incinerator ash. The process of incineration followed by water solubilization of ash resulted in loss of 35% of the inorganics originally present in the biomass. Losses were attributed to volatilization (8%) and non-water-soluble ash (27%). All of the ash remaining following incineration could be solubilized with acid, with losses resulting from volatilization only. The recovery for individual elements varied. Elemental retention in the ash ranged from 100% of that present in the biomass for Ca, P, Mg, Na, and Si to 10% for Zn. The greatest water solubility was observed for potassium with recovery of approximately 77% of that present in the straw. Potassium represented 80% of the inorganic constituents in the wheat straw, and because of slightly greater solubility made up 86% of the water-soluble ash. Following incineration of inedible biomass from wheat, 65% of the inorganics originally present in the straw were recovered by water solubilization and 92% recovered by acid solubilization. Recovery of resources is more complex for pyrolysis and water extraction. Recovery of carbon, a resource of greater mass than the inorganic component of biomass, is more difficult following pyrolysis and water extraction of biomass. In both cases, additional processors would be required to provide products equivalent to those resulting from incineration alone. The carbon, water, and inorganic resources of inedible biomass are effectively separated and output in usable forms through incineration.

Biomass↗
PubMed2000

[Systematic analysis of agro-ecoclimatic resources in Gansu Province].

Based on the over years data from 86 meterological stations in Gansu Province, the agro-ecoclimatic resources in this province was systematically analyzed. Resource indices Cr, efficiency indices Ce and utilization coefficient K were calculated by using the dynamic models of agro-ecoclimatic suitability degree. According to the average monthly efficiency indices Ce, the agro-ecoclimatic resources were divided into 7 types and 3 subtypes by fuzzy cluster. The potentiality matching condition and utility degree of agro-ecoclimatic resources showed the evident characteristic of spatial differentiation. Generally, the south was superior to the north, and the east was superior to the west in terms of these parameters, with the type of South Gansu Mountain much better than that of Hexi Corridor. Some suggestions about the exploitation and utilization of the agro-ecoclimatic resources in Gansu province were proposed.

Agriculture↗
PubMedDate not supplied

Family economic resources in the post-reform era.

Aided by the longest economic expansion in U.S. history and other policy changes designed to make work pay, federal welfare reform legislation has spurred mothers to leave welfare at an unprecedented rate. The majority of mothers who left welfare are working, but most have jobs with low pay and limited benefits. This article discusses the relationship between economic resources and child well-being, and how family economic resources have changed under welfare reform. A survey of the research conducted since reform indicates the following: Families' economic resources clearly matter to child well-being, but the connections are complex and vary by the age of the child. Without the benefit of supports designed to "make work pay," many families working full time at the minimum wage have resources beneath the poverty line, and the poverty line itself falls substantially short of the needs of most working families. Although poverty overall has declined under welfare reform, a significant segment of families are worse off--in part because after leaving welfare, many families do not receive other government supports designed to help them. Most states are still struggling to design more effective systems for delivering supports to help low-income working families move out of poverty. The author cautions that the evolving story of welfare reform will need to be monitored carefully to achieve long-term positive impacts on family economic resources and child well-being.

Child↗
PubMed2002

Use of Web-based library resources by medical students in community and ambulatory settings.

PURPOSE: The purpose was to evaluate the use of Web-based library resources by third-year medical students. SETTING/PARTICIPANTS/RESOURCES: Third-year medical students (147) in a twelve-week multidisciplinary primary care rotation in community and ambulatory settings. METHODOLOGY: Individual user surveys and log file analysis of Website were used. RESULTS/OUTCOMES: Twenty resource topics were compiled into a Website to provide students with access to electronic library resources from any community-based clerkship location. These resource topics, covering subjects such as hypertension and back pain, linked to curriculum training problems, full-text journal articles, MEDLINE searches, electronic book chapters, and relevant Websites. More than half of the students (69%) accessed the Website on a daily or weekly basis. Over 80% thought the Website was a valuable addition to their clerkship. DISCUSSION/CONCLUSION: Web-based information resources can provide curriculum support to students for whom access to the library is difficult and time consuming.

Attitude to Computers↗
PubMed2004

[Risk factors affecting hospital resource use in cardiac surgery].

UNLABELLED: Demographic changes in the society, favorable changes in disease patterns within population cause higher morbidity and higher mortality from cardiovascular diseases and increase need for hospital resource use. It is very important to identify the risk factors, which are responsible for higher health care costs. The objective of this article is to identify risk factors, which are responsible for higher hospital resource use. METHODS: Search in web and meta analysis of the electronic-medical articles within journals under review were performed. RESULTS: The main risk factors for higher hospital resource utilization were identified: longer length of stay in the hospital, type of operation, postoperative mortality, postoperative complications and age. CONCLUSIONS: The main factors affecting higher hospital resource utilization are following: longer duration of stay in the hospital, advanced type of operation, postoperative mortality, postoperative complications and advanced age. Hospital resource utilization depends on patient anamnesis and quality of care in institution.

Age Factors↗
PubMed1992

Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study.

OBJECTIVE: To examine whether specialty and system of care exert independent effects on resource utilization. STUDY DESIGN: Cross-sectional analysis of just over 20,000 patients (greater than or equal to 18 years of age) who visited providers' offices during 9-day periods in 1986. Patient- and physician-provided information was obtained by self-administered questionnaires. SETTING: Offices of 349 physicians practicing family medicine, internal medicine, endocrinology, and cardiology within health maintenance organizations, large multispecialty groups, and solo practices or small single-specialty group practices in three major US cities. OUTCOME MEASURES: Indicators of the intensity of resource utilization were examined among four medical specialties (family practice, general internal medicine, cardiology, and endocrinology) and five systems of care (health maintenance organization, multispecialty group-fee-for-service, multispecialty group-prepaid; solo practice and single-specialty group-fee-for-service, and solo practice and single-specialty group-prepaid) before and after controlling for the mix of patients seen in these offices. The indicators of resource utilization were hospitalizations, annual office visits, prescription drugs, and common tests and procedures, with rates estimated on both a per-visit and per-year basis. RESULTS: Variation in patient mix was a major determinant of the large variations in resource use. However, increased utilization was also independently related to specialty (cardiology and endocrinology), fee-for-service payment plan, and solo and single-specialty group practice arrangements. After adjusting for patient mix, solo practice/single-specialty groups-fee-for-service had 41% more hospitalizations than health maintenance organizations. General internists had utilization rates somewhat greater than family physicians on some indicators. CONCLUSION: Although variations in patient mix should be a major determinant of variations in resource use, the independent effects of specialty training, payment system, and practice organization on utilization rates need further explication. The 2- and 4-year outcomes now being analyzed will provide information critical to interpretation of the variations reported herein.

Adult↗
PubMed2003

Rural health resource databases: a little nurturing goes a long way.

Access to rural health research information together with the type and availability of educational resources in rural areas, are important to rural health care providers, community members, researchers, students, planners and policy makers. The Rural Health Research Register (RHRR) focuses on current and recent research activity being undertaken in Australia in the field of rural health, while the Health Education Rural Remote Resources Database (HERRD) focuses on education courses and resources relevant to the practice and professional development of rural and remote health professionals throughout Australia. Early versions of these databases were established between 1992 and 1997, and in the period 1998-2001 both information resources were systematically updated through targeted promotion, registrations and the creation of web-accessible search facilities. They continue to be maintained and updated. Detailed information is available by searching the RHRR and HERRD databases via the web or by contacting the relevant coordinator. This article examines some of the issues in developing and maintaining these resources and demonstrates the usefulness of their contents to rural healthcare workers.

Journal Article↗
PubMed2005

Risk markers for disappearance of pediatric Web resources.

OBJECTIVES: The authors sought to find out whether certain Webometric indexes of a sample of pediatric Web resources, and some tests based on them, could be helpful predictors of their disappearance. METHODS: The authors performed a retrospective study of a sample of 363 pediatric Websites and pages they had followed for 4 years. Main measurements included: number of resources that disappeared, number of inbound links and their annual increment, average daily visits to the resources in the sample, sample compliance with the quality criteria of 3 international organizations, and online time of the Web resources. RESULTS: On average, 11% of the sample disappeared annually. However, 13% of these were available again at the end of follow up. Disappearing and surviving Websites did not show differences in the variables studied. However, surviving Web pages had a higher number of inbound links and higher annual increment in inbound links. Similarly, Web pages that survived showed higher compliance with recognized sets of quality criteria than those that disappeared. A subset of 14 quality criteria whose compliance accounted for 90% of the probability of online permanence was identified. Finally, a progressive increment of inbound links was found to be a marker of good prognosis, showing high specificity and positive predictive value (88% and 94%, respectively). CONCLUSIONS: The number of inbound links and annual increment of inbound links could be useful markers of the permanence probability for pediatric Web pages. Strategies that assure the Web editors' awareness of their Web resources' popularity could stimulate them to improve the quality of their Websites.

Humans↗
PubMed2005

Effect of water resource development and management on lymphatic filariasis, and estimates of populations at risk.

Lymphatic filariasis (LF) is a debilitating disease overwhelmingly caused by Wuchereria bancrofti, which is transmitted by various mosquito species. Here, we present a systematic literature review with the following objectives: (i) to establish global and regional estimates of populations at risk of LF with particular consideration of water resource development projects, and (ii) to assess the effects of water resource development and management on the frequency and transmission dynamics of the disease. We estimate that globally, 2 billion people are at risk of LF. Among them, there are 394.5 million urban dwellers without access to improved sanitation and 213 million rural dwellers living in close proximity to irrigation. Environmental changes due to water resource development and management consistently led to a shift in vector species composition and generally to a strong proliferation of vector populations. For example, in World Health Organization (WHO) subregions 1 and 2, mosquito densities of the Anopheles gambiae complex and Anopheles funestus were up to 25-fold higher in irrigated areas when compared with irrigation-free sites. Although the infection prevalence of LF often increased after the implementation of a water project, there was no clear association with clinical symptoms. Concluding, there is a need to assess and quantify changes of LF transmission parameters and clinical manifestations over the entire course of water resource developments. Where resources allow, integrated vector management should complement mass drug administration, and broad-based monitoring and surveillance of the disease should become an integral part of large-scale waste management and sanitation programs, whose basic rationale lies in a systemic approach to city, district, and regional level health services and disease prevention.

Elephantiasis, Filarial↗
PubMed2005

Implementing a new diabetes resource for Wisconsin schools and families.

BACKGROUND: Diabetes is one of the most common diseases in the nation. Students with diabetes face the daily task of balancing food, physical activity, and medication to survive. Teachers and school personnel often lack the knowledge needed to assist them. CONTEXT: An estimated 2647 schoolchildren in Wisconsin have diabetes. The Wisconsin Diabetes Prevention and Control Program frequently receives anecdotal reports from parents and diabetes educators on the care of children with diabetes in the schools; the program also manages requests for information on new diabetes-related equipment from school personnel. METHODS: A statewide workgroup convened to develop Children with Diabetes: A Resource Guide for Wisconsin Schools and Families, aimed at improving the school staff's knowledge of diabetes and its management and their awareness of the benefits of maintaining glucose control. Training sessions for school professionals were developed and conducted around the state. All attendees were asked to complete an evaluation of the training. In addition, the workgroup included an evaluation form with each guide distributed and conducted a follow-up survey on the impact of the guide and changes to school policies. CONSEQUENCES: Of the 762 people who attended training sessions, 631 (83%) completed the evaluation form. On questions about the training session's content, quality, organization, and appropriateness, responses averaged 4.42 points on a scale of 1 (poor) to 5 (excellent). More than 9713 resource guides were distributed to more than 1359 individuals; 58 recipients responded to the evaluation form included with the resource guide, with 57 (98%) of these indicating that they would recommend the guide to others. Preliminary results of the follow-up impact survey show that many positive changes have been implemented to improve the school environment for children with diabetes since the resource guide was implemented. INTERPRETATION: This model of working with school professionals, health care practitioners, parents, and community organizations to create a resource guide with accompanying training sessions can be used in other states to accomplish similar goals of increasing knowledge about diabetes and improving social and policy environments.

Adolescent↗
PubMed2006

Do GPs use electronic mental health resources? - a qualitative study.

BACKGROUND: The Better Outcomes in Mental Health Care (BOMHC) initiative encourages general practitioners to use electronic mental health resources (EMHRs) during consultation with patients requiring psychological assistance. However, there is little data on GPs' acceptance and use of EMHRs. METHOD: Semistructured interviews were conducted with 27 GPs to determine their attitude toward EMHRs, and their use during consultation with patients. RESULTS: Few GPs reported frequently using EMHRs in consultation. Identified barriers to use included lack of familiarity with information technology, and insufficient knowledge of available resources. Identified advantages of electronic resources included high patient acceptance, time efficiency, and improved quality of information. DISCUSSION: General practitioners recognise several advantages of utilising electronic resources for managing patients with mental illness. However, GPs are not sufficiently familiar with electronic resources to use them effectively. This could be overcome by education.

Attitude of Health Personnel↗
PubMed2006

Informatics-based learning resources for patients and their relatives in recovery.

In this paper we describe experiences from design of an informatics-based learning resource for patients and relatives. The prototype, REPARERE (learning REsource for PAtients and RElatives during REcovery), aims to support patients and their family recovering from heart surgery in meeting challenges in to daily living post discharge. Using recovery experiences and patient teaching material, REPARERE includes examples of textual information, video-clips, images and illustrations relevant to the recovery trajectory and a user's digitally represented profile. The development of the prototype focuses on flexibility and usability, tailoring and sequencing resources, and inclusion of recommendations for universal access. Development of web-based learning resources allows for exploration of 'just-in-case' and 'just-in-time' strategies to information retrieval and knowledge construction in health and learning trajectories. Findings from the literature, discussions with patients as well as health care providers indicate that unfulfilled information needs in the recovery period are common. Resources like REPARERE would be valuable supplement to facilitate patient learning about symptom management, self-care and coping while recovering.

Family↗
PubMed2007

Family medicine clerkship curriculum: competencies and resources.

Funded by the Health Resources and Services Administration (HRSA) from 2000-2005, the Family Medicine Curriculum Resource Project (FMCRP) developed a set of resources to improve medical student education. As part of this project, the FMCRP Clerkship Workgroup created and organized resources for developing, teaching, and evaluating a family medicine clerkship. Using the Accreditation Council for Graduate Medical Education competencies as the overarching structure, the organizational scheme incorporated family medicine principles and themes in covering core topics. This curricular resource was designed to be flexible and adaptable to different medical schools and curricular settings.

Clinical Clerkship↗
PubMed2006

Health care resource use associated with integrated psychological treatment.

BACKGROUND: Mental health policies, advocating outpatient as well as community mental health care for the severely mentally ill, are aiming towards health system cost containment and patient quality of life. Programs with cognitive behavioral therapy, such as the Integrated Psychological Therapy (IPT), added to standard medical therapy for patients with schizophrenia have been associated with improved outcomes. A Quebec version of the IPT program was integrated in outpatient clinics and improvements were observed in overall symptoms, subjective experiences, cognitive and social functioning, and quality of life. In light of these results we deemed it relevant to describe the health system cost and patient resource use associated with the program. The costs related to IPT have not been previously reported and this study will elucidate on effective health services and budget allocation needed to include IPT. AIMS: To describe health care resource use and related costs associated with participating in an IPT program included as standard medical therapy in nine clinical settings. METHODS: A cohort of patients with schizophrenia participating in the IPT program were followed up to one year preceding the start of the program and concurrently until the end to compare the resource use and costs incurred by patients with schizophrenia during their participation. A health and social service system and patient perspective was adopted, and the medical and non-medical costs associated with the IPT program were measured. Valuation (2001 CDN dollars) was based on information provided by provincial billing systems. Statistical differences were assessed using the Wilcoxon signed-rank test. RESULTS: The IPT program induced a one time fixed cost (2347 dollars) for the training of mental health professionals and costs related to patient participation (1350 dollars). Our results show that there was an average decrease in health care system resource use per patient during the IPT program (26,133 dollars) as opposed to the preceding year (26,750 dollars). There was a significant decrease in the number of visits and in physician fees paid out to psychiatrists, the number of hospitalizations and related costs, and visits to the emergency department per patient during the IPT program as compared to the preceding year. No significant difference was observed in patient related costs which averaged 7295 dollars and 7537 dollars, before and during the IPT program, respectively. DISCUSSION: Although the IPT program induces a one time fixed cost for training, the integration of IPT, as part of an individualized standard medical therapy, is associated with a change from inpatient towards outpatient resource use with no significant increase in health system related costs. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Given clinical and quality of life improvements, the findings suggest that offering IPT to more patients with severe mental illness may prove more cost beneficial by decreasing the health system related costs per user in the long term. IMPLICATIONS FOR FURTHER RESEARCH: Additional research is needed to examine in parallel the long-term clinical and cost impact of the IPT program in different clinical settings (young adults to long term mentally ill). This will elucidate to which patient population IPT is most cost-effective.

Adult↗