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PubMed1996

Accessing the Kabat antibody sequence database by computer.

The Kabat antibody sequence database has for many years been the primary site for depositing sequence information on antibodies and other proteins of immunological interest. The chief drawback of this database has been that it has only been available in the form of a printed book (Kabat et al., Sequences of Proteins of Immunological Interest, 1991). These data have recently become available on the global computer Internet, but no method of searching the data has, as yet, been provided. Here, the development of a specialized database program for accessing the antibody data is described. This database software has been made accessible over the World Wide Web, together with a program which allows a novel antibody sequence to be tested against the Kabat sequence database, to identify unusual features of an antibody sequence which may represent cloning artifacts or sequencing errors.

Amino Acid Sequence↗

PubMed1997

Pharmaceutical policies in Canadian family medicine training. Survey of residency programs.

OBJECTIVE: To determine whether family medicine residency training programs have formal policies regarding interactions between residents and the pharmaceutical industry, to identify existing practices, and to find out what issues in industry-physician interaction are addressed during the 2-year core curriculum training in Canada. DESIGN: Mailed survey using a questionnaire. SETTING: The 16 Canadian residency training programs in family medicine. PARTICIPANTS: Program directors of all 16 Canadian family medicine residency training programs replied. MAIN OUTCOME MEASURES: Number of programs with formal pharmaceutical policies; number of programs offering formal curriculum coverage of related topics in the field; program practices regarding industry sampling, detailing, sponsorship, and access. RESULTS: Only four of the 16 programs have formal policies or guidelines. Topics generally covered in core curriculum included critical appraisal (13/16) and cost trends (11/16). Few programs address determinants of prescribing (5/16), marketing techniques (4/16), provincial drug access programs (6/16), or the Canadian Medical Association guidelines on physician-industry interaction (5/16). Industry presence and sponsorship in family medicine training is notable, and screening is limited. Great variation exists, and programs are interested in future initiatives. CONCLUSIONS: Family medicine training in Canada is attempting to address pharmaceutical issues. Interest is strong, but these issues need to be given more emphasis.

Canada↗

PubMed2001

A coupled airflow and source/sink model for simulating indoor VOC exposures.

In this paper, a numerical model is presented to study the indoor air quality (IAQ) in a room with different emission sources, sinks, and ventilation methods. A computer program, ACCESS-IAQ, is developed to simulate the airflow pattern, the time history of the contaminant concentrations in the occupied zone, and the inhalation exposures. The program developed may be useful for IAQ professional to design healthy and comfortable indoor environments. A numerical study has been carried out to predict the effectiveness of a displacement ventilation and a mixing ventilation on volatile organic compound (VOC) removal in a model office. Results from the numerical predictions show that when a "wet" emission source (a freshly painted wood stain) is distributed uniformly across the floor area with sinks (gypsum board) from the four vertical walls, displacement ventilation has consistently lower exposure at the breathing level of the occupant in the room. Such an effect is mainly due to the higher ventilation efficiency of displacement ventilation compared to the mixing ventilation. The simulation results also show that the walls adsorb significant amounts of VOCs during the first hour and act as secondary sources thereafter.

Absorption↗

PubMed1997

Promoting healthy eating and ensuring adequate weight gain in pregnant adolescents: issues and strategies.

The seven specific strategies discussed for promoting the nutritional health of pregnant adolescents can be categorized into three broad areas: (1) improve nutrition knowledge and skills of adolescents, as well as health care providers; (2) improve programs, including access to prenatal care, and developing effective nutrition interventions; and (3) direct research efforts to better understand barriers to behavior change and conduct scientifically rigorous program evaluations of efficacy of nutrition interventions. Nutritional health should be viewed within the context of improving overall health and lifestyles. Simple solutions focused solely at the individual level are not effective. We need to advocate for and support policy efforts to address the economic, familial, and social issues that impact health and adolescent pregnancy.

Adolescent↗

PubMed1996

Health promotion and disease prevention: a look at demand management programs.

This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health care expenditures while improving overall health. This goal can be achieved through the use of health risk appraisals, organizational health risk appraisals, high risk programs, awareness programs, medical call centers, return to work programs, EAPs, and smoking cessation programs. Studies of a health program's cost effectiveness must disentangle the effects of many competing factors on cost effectiveness. For example, a health risk appraisal program may identify health problems of which the patient and the health care provider were unaware, resulting in the treatment of these health problems. At the same time, the employer may have switched from a nonmanaged pharmaceutical program to a managed program with incentives for participants to utilize generic and/or mail order drugs. As a result, when evaluating a health promotion program, the long-run impact on the program's cost effectiveness is most important.

Cost Control↗

PubMed2005

[Computer program for antiglaucomatous surgeries analysis].

Computer analysis of long-term results of the surgical treatment of glaucoma needs suitable program for database data download retrospectively and prospectively as well. We composed a universal database program Glaucoma Access 97 for patients' follow-up in glaucoma surgery centers. Data about 1073 antiglaucomatous filtering surgeries from the period 1990-2000 were downloaded. The program permits to download data about the patients before the surgery, details about the operation procedure, and from the follow-up visits into the database using special software questionnaire sheets. Outcome from the database may be data about long-term IOP compensation, visual acuity changes, and treatment after the surgery. Evaluation of the data allows to follow up the successfulness of the treatment of specified groups of patients and to compare results of surgeons and individual departments as well.

Databases as Topic↗

PubMed2000

Managed behavioral healthcare in the public sector.

For over 10 years states and counties have been adding commercially developed managed care products to community-based systems of care. These programs have dramatically altered the landscape in many public systems across the country. Results have varied from modest success to major failure with some managed behavioral healthcare organizations no longer viewing public contracts as desirable commodities. This article examines the reasons why public purchasers turn to managed care, the basis for a program's success or failure, and the impact of some successful programs on access and service array.

Community Mental Health Services↗

PubMed2005

Cost and utilization analysis of a pediatric emergency department diversion project.

OBJECTIVE: States are struggling to find effective means to decrease Medicaid costs. The objective of this pilot study was to compare emergency department (ED) cost and utilization by members who were enrolled in a pilot program (designed to reduce the use of hospital EDs) with the costs and utilization incurred by a control group. METHODS: A large, private, primary care pediatric practice launched a pilot ED diversion program that provided extended office hours, multiple access locations, and care coordination. Participants in the program were Medicaid recipients who were younger than 18 years. Enrollment in the program was through either patient self-selection or mandatory assignment by the state Medicaid agency. A total of 17,382 children who were enrolled in the enhanced access program (intervention group) and 26,066 Medicaid-eligible children who received services from other local community primary care providers (control group) were included in the study. Children who had chronic health conditions and were receiving Supplemental Security Income benefits were excluded from this analysis. Regression analyses and t tests were applied to analyze the medical claim data that were collected for this project. Three variables were used as dependent variables to measure different aspects of the ED cost and utilization: per member per month cost, per thousand member per month encounter frequency, and per encounter cost. These variables were used to compare the intervention group with the control group for ED claims, as well as for the overall cost of care during the study period. RESULTS: In the 12-month period subsequent to program initiation, the average per member per month cost for ED utilization of the intervention group was 1.36 dollars less than that of the control group. However, there was no significant difference in terms of per-visit cost related to ED utilization. Therefore, the savings seemed to come as a result of a reduction in ED visits, not from reduced cost per visit. On average, children in the intervention group visited the ED approximately 8 fewer times per thousand members per month than the control group, yet there was no significant difference in the overall (ED and non-ED) cost of care between the intervention and control groups. CONCLUSION: Analysis from the first year of this pilot program demonstrates that by providing enhanced, coordinated, primary care access to Medicaid children, the utilization of the ED was significantly lowered among healthy children, whereas the overall cost of care remained the same.

Child↗

PubMed1994

The $147,000 misunderstanding: repercussions of overestimating the cost of AIDS.

The increasing incidence of AIDS in the 1980s prompted inquiry into the resources required to meet projected needs. In the first economic study to appear on the illness, the Centers for Disease Control (CDC) estimated that the costs of inpatient care were $147,000 per AIDS patient, heightening concern that the health care system would be overwhelmed by the epidemic. However, every study published subsequently has produced much lower cost estimates. As a result, many have concluded that treatment costs declined due to improved delivery of AIDS care. We offer an alternative interpretation, based on evidence demonstrating that the CDC's methods and assumptions yielded a figure about three times too high. The CDC's erroneous estimate had significant policy repercussions. Using the $147,000 figure, the health insurance industry lobbied successfully for the right to screen applicants for HIV. Next, when a study of San Francisco AIDS patients found local hospital costs per case to be $27,571, many concluded that billions of dollars could be saved if the "San Francisco model" of care (emphasizing home and community-based services and case management) were universalized. Since then, most programs for AIDS services have provided funds for community care. While such programs improve access to vital services, they are unlikely to guarantee "better care for less money." A more informed understanding of the cost of AIDS should lead to programs that also strengthen inpatient care.

AIDS Serodiagnosis↗

PubMed2006

Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: effectiveness and clinically significant change.

Interdisciplinary pain management programs have an established record of significantly improving the functioning of persons disabled with chronic pain. There is a group of pain sufferers, however, who have difficulty accessing these programs and for whom the effectiveness of these treatments in unknown, these are patients whose mobility and self-care deficits leave them unable to meet the practical demands of many treatment environments. The purpose of this study was to examine the results of a treatment program designed to meet the needs of these highly disabled individuals (n=53) in comparison to results obtained from a standard less-disabled group attending treatment at the same facility (n=234). Results from the highly disabled patients showed statistically significant change after treatment in eight of nine outcome variables, including improvements in pain-related distress, disability, depression, pain-related anxiety, daytime rest, and performance during an activity tolerance test. Effect size calculations showed a number of large treatment effects, for psychosocial disability, depression, and acceptance of pain. Analysis of reliable change and clinical significance demonstrated that results were not merely statistically significant but clinically meaningful. Results appeared stable at three months following treatment. This research plays an important part in establishing an evidence base to inform service development, ensuring that chronic pain services do not exclude people on the basis of the severity of their disability.

Adaptation, Psychological↗

PubMed2002

Effect of medicare payment on rural health care systems.

Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

Aged↗

PubMed1991

The effect of local government outreach efforts on the recipiency of selected Medicaid programs.

This paper investigates whether government outreach programs improve accessibility to and increase recipiency of nonmandatory medical assistance. Using the Bradford, Malt, and Oates (1969) framework in which voters seek desired outcomes, I attempt to explain through an empirical model the variation in recipiency rates across Pennsylvania's 67 counties. The results indicate that outreach efforts have had a significant positive effect on recipiency. Computed elasticities also provide some insights into the relative effectiveness of various outreach efforts and the respective payoff from the two types of medical assistance programs investigated.

Health Services Accessibility↗

PubMed2003

Overview of the community care network demonstration program and its evaluation.

This article provides an overview of the evaluation of the National Community Care Network Demonstration Program,which began with 25 public-private partnerships selected from a diverse range of communities across the United States to address problems of lack of insurance, limited access to health care, and the health status of their most disadvantaged residents. The 25 public-private partnerships included an array of individual organizations representing health care providers, public health and human service agencies, local governments,community-based organizations, and religious and educational institutions. The specific findings of the evaluation are the focus of the articles in this issue. This overview article supplies the underpinnings of the evaluation, including the conceptual framework, methodological challenges, and a brief discussion of each of the papers and how they are linked.

Community Networks↗

PubMed1997

[Stress response of slaughter pigs in two different access systems to electrical stunning].

Investigations on two batches of 25 pigs each were carried out to characterize two different access systems for electrical stunning by physiological responses such as heart frequency (HF) and the blood constituents lactate and cortisol. All animals were of the same hybrid breeding program. The access race in system A, where the animals are separated was 11 m long. The personnel used different equipments including electrical rods to move the pigs forward. The lairage time after transport was between 1 to 2 h. In system B the animals arrived the evening before slaughter and spent the night in groups in straw-littered lairage boxes. The access race was 3.5 m long. The heart frequencies of the pigs in system A were between 80 and 240 beats/min, in system B the average HF were between 60 and 170 beats/min. In the lairage the HF were at about 113 beats/min (system A) and 66 beats/min (system B). Blood samples were taken immediately after stunning. The lactate concentrations differed by 6 mmol/l (8.6 mmol/l in system A, 2.6 mmol/l in system B). Cortisol was distinctly higher in the blood of the animals from system A (166 ng/ml) compared to system B (126 ng/ml). The results show that the used techniques are suitable to examine stress indicators of pigs under practical conditions. Access systems with long races seem to pose a higher stress than short access ways. The influence of handling (human factor) and management (size of groups, origin of pigs) is equally important. The role of longer resting times in the lairage should be investigated in more detail. This should also include the keeping conditions on the farm where the animals are raised.

Animal Husbandry↗

PubMed1978

The scope and limits of equality as a normative guide to federal health care policy.

In American political culture, as in much of Western political thought, the proposition that men are and ought to be treated as equal in the eyes of polity, law, and society is highly valued. Whether traditional arguments for equality can be properly extrapolated from the political and social spheres to a third sphere--the distribution of resources and services under public welfare state policies--is another question, rarely explored with care. In one of these policy areas, health care, the notion that each citizen is entitled by right to equal access to medical care has grown very popular. Federal programs that equalize access among groups by means of biomedical research, hospital construction and renovation, and financial aid for the elderly and poor have dominated federal health care policy since the end of the Second World War. Empirical consideration of the nature of medical care services, the structure of the health care system, and the consequences of programs to equalize access suggests, however, that public expectations and federal policy may have placed more weight on the principle of equality than it can properly bear. In recent years policy analysts have begun to insist that the equal access issue be viewed in the context of the national cost of medical services relative to that of other social goods, the cost effectiveness of medical services, and the degree to which health and illness result from behavior in an individual's power to pursue or avoid. Attracted by the new revisionist thinking, but unwilling to follow its arguments to their logical policy implications, federal policy makers have institutionalized their ambivalence. The mainstream equalizing programs continue to receive strong support, but they are now challenged by another set of federal programs based largely on revisionist premises. This seemingly inconsistent policy solution is probably the most rational approach to preserving the claims of equality of medical care services, while assigning the principle of equality an appropriately delimited scope.

Federal Government↗

PubMed2003

Signal search analysis server.

Signal search analysis is a general method to discover and characterize sequence motifs that are positionally correlated with a functional site (e.g. a transcription or translation start site). The method has played an instrumental role in the analysis of eukaryotic promoter elements. The signal search analysis server provides access to four different computer programs as well as to a large number of precompiled functional site collections. The programs offered allow: (i) the identification of non-random sequence regions under evolutionary constraint; (ii) the detection of consensus sequence-based motifs that are over- or under-represented at a particular distance from a functional site; (iii) the analysis of the positional distribution of a consensus sequence- or weight matrix-based sequence motif around a functional site; and (iv) the optimization of a weight matrix description of a locally over-represented sequence motif. These programs can be accessed at: http://www.isrec.isb-sib.ch/ssa/.

Consensus Sequence↗

PubMed2005

Vancouver Island Health Authority (VIHA) in house Perioperative Nursing Program.

The Vancouver Island Health Authority (VIHA) in liaison with the University of Victoria (UVIC) offers an introduction to Perioperative Nursing Program to 4th Year undergraduate nursing students. The aim of this program is to help recruit Registered Nurses to the Operating Room. It has been advantageous to the recruitment and retention of nurses graduating from UVIC. Its importance is increased by the fact that a significant quantity of Victoria's perioperative nurses will be retiring in the next few years. Due to the high cost of nursing education and the financial investment that has already been committed by nursing students, the Perioperative nursing program is free to the student as the program can be included, for the successful candidate, as part of the UVIC nursing course. The intention is to encourage participation by reducing the financial burden, stress, and anxiety for the new graduate who intends to specialize. In return, the student is required to work in the VIHA for a minimum of one year, thus supporting the retention efforts of the hospital. For eligible nursing students, this program provides access to extensive perioperative nursing experience. Over the course of 3 months they are exposed to extensive theory in a classroom setting as well as clinical practice through a preceptorship program. The mentoring relationships that develop between perioperative nurses and students lead to meaningful relationships and professional growth for staff. The perioperative focus of the program improves the knowledge and skill set of nursing students. The intent is to increase nursing student's interest in pursuing a career as a perioperative nurse and to help ensure continued growth of the perioperative nursing profession in Victoria.

Clinical Competence↗

PubMedDate not supplied

Children in need of Pharmacare: medication funding requests at the Toronto Hospital for Sick Children.

OBJECTIVES: Although a national Pharmacare program ensuring access to and affordability of needed medications has repeatedly been cited as a priority to policymakers, 20% of families remain either uninsured or under-insured. The Hospital for Sick Children's Patient Amenities Fund (PAF) covers out-of-pocket medication expenses for inpatient and outpatient children. The research objectives were to 1) examine family demographics and socio-economic status (SES), the types of medications requested and government program process issues of PAF applicants in 1998 and 1999, and 2) describe trends in PAF requests from 1998 to 2000. METHODS: Data were extracted retrospectively from fund requests, charts and social work and discharge planning reports. Descriptive statistics were used to summarize the data and to examine time trends. RESULTS: Eighty-six applicants submitted 112 requests from 1998-1999. Most were for children with cancer, neurological disorders and transplant patients. Medication expenditures were 22,408 dollars in 1999, a 39% increase over 1998. Most requests came from two-parent nuclear families where one or both parents were employed. High deductibles, waiting time, application form complexity and request denials were cited as problems encountered with government drug plans. DISCUSSION: The findings suggest that for provinces that do not provide universal drug insurance programs, relying on a patchwork of government plans and community agencies may not be effective in ensuring easy and timely access to necessary medications for children.

Child↗