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PubMed2002

Reimbursement and cost containment: a German perspective.

This paper distinguishes short- and long-term financing problems in social health insurance systems in Germany and other European countries. The first part focuses on recent healthcare reforms in Germany that are directed at short-term problems, in particular measures of cost containment in the pharmaceutical sector such as the introduction of a drug formulary and reforms in the system of risk adjustment to enhance competition between sickness funds. The second part discusses the likely effects of the aging of the population on the sustainability of present types of mandatory insurance coverage in Germany and possible reforms that could solve the problems. It is argued that the proposed distinction between basic and supplementary benefits requires a system of explicit rationing (e.g. by age), which determines the package of basic benefits several decades in advance.

Cost Control↗
PubMed2006

HIV-1 drug-resistance mutations among newly diagnosed patients before scaling-up programmes in Burkina Faso and Cameroon.

We analysed whether mutations associated with resistance to antiretroviral (ARV) drugs circulate among treatment-naive HIV-1-infected individuals at a period when these drugs started to become more widely available in Africa. Overall, major resistance mutations in the pol gene, as defined by the International AIDS Society Resistance Testing-USA panel, were observed in 16 treatment-naive individuals. Eight of the 97 patients tested in Burkina Faso bore mutations conferring resistance to one drug class of ARV drugs: two to nucleoside reverse transcriptase inhibitors (NRTIs; M41L [n = 1], M41L+T69S [n = 1]), four to non-NRTIs (NNRTIs; V106A/V [n = 1] and V1081 [n = 3]) and two to protease inhibitors (PIs; L33F [n = 2]). In Cameroon, resistance mutations were identified in 8 of 102 patients: three to PIs (M461/L [n = 2], L33F [n = 1]), three to NRTIs (T69N/T [n = 1], M184V [n = 1], A62V [n = 1]) and two to NNRTIs (P236L [n = 1], V1081 [n = 1]). It is important to note that not all genotypic drug-resistance algorithms give similar interpretations to the observed mutations. Population surveillance for ARV drug resistance is required and should be included in all implementation programmes.

Adult↗
PubMed1994

Applying population-based case mix adjustment in managed care: the Johns Hopkins Ambulatory Care Group system.

When analyzing medical utilization or other health care-related measurements across provider panels, case mix adjustment is required because "illness burden" is often unevenly distributed across these patient populations. This article develops the rationale for case mix adjustment and walks readers through the case mix adjustment process using the Johns Hopkins Ambulatory Care Group (ACG) Case-Mix System as a model. The ACG system is a population-oriented patient classification tool based on diagnoses assigned by providers and found in payors' data systems. The system categorizes patients according to illness burden. It does not categorize visits, encounters, or episodes. ACGs adjust for case mix differences in the analysis of ambulatory, laboratory, pharmacy, and total health care service delivery.

Ambulatory Care↗
PubMedDate not supplied

Feeding back surveillance data to prevent hospital-acquired infections.

We describe the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance system. Elements of the system critical for successful reduction of nosocomial infection rates include voluntary participation and confidentiality; standard definitions and protocols; identification of populations at high risk; site-specific, risk- adjusted infection rates comparable across institutions; adequate numbers of trained infection control professionals; dissemination of data to health-care providers; and a link between monitored rates and prevention efforts.

Centers for Disease Control and Prevention, U.S.↗
PubMed2006

Mapping the emergence of heart disease in a black, urban population in Africa: the Heart of Soweto Study.

BACKGROUND: There is increasing evidence that many populations in the developing world are in "epidemiologic transition" with the subsequent emergence of more "affluent" disease states. The "Heart of Soweto Study" will systematically investigate the emergence of heart disease (HD) in a large urban population in South Africa. METHODS: Part of the conurbation of Johannesburg, South Africa, Soweto is a predominantly Black African community of 1 million individuals. During an initial two year period, all individuals presenting to the local Baragwanath Hospital (3500 beds) with any form of HD will be studied. Demographic and diagnostic coding data in those with pre-established HD will form an abbreviated clinical registry of >12,000 "prevalent" cases. Similarly, socio-demographic, clinical and diagnostic data (e.g. echocardiography and ECG) in newly diagnosed patients will form a more detailed clinical registry of >5000 "incident" cases. Sub-studies of the relationship between HIV status and HD and the optimal management of chronic heart failure will also be performed. RESULTS: These data will provide a unique insight into the causes and consequences of a broad spectrum of HD-related conditions in a "developing world" community in epidemiologic transition. Initially documented population rates, in addition to detailed examinations of the underlying risk factors and causes of HD-related morbidity/mortality will provide an important platform for future stages of the study: a community-based, population screening program and culturally specific primary and secondary programs of care. CONCLUSION: There is an urgent need to systematically track the emergence of HD in the developing world. Initially involving more than 15,000 individuals, the unique Heart of Soweto Study has the potential to provide a wealth of information in this regard.

Black People↗
PubMed2003

Incidence and characteristics of falls leading to hospital treatment: a one-year population surveillance study of the Danish population aged 45 years and over.

AIMS: The aim was to quantify and characterize the incidence of fall injury events among middle-aged and older adults who require acute medical attention at Danish hospitals. METHODS: A one-year population surveillance study was carried out, based on the Danish National Hospital Register (DNHR), which covers all somatic hospital discharges and accident and emergency (A&E) services at hospitals in Denmark. RESULTS: During 1996 a total of 81,121 fall injury events were treated at A&E departments or resulted in admission to a somatic hospital department among Danes aged 45 years and over. Up to age 50 years the incidence rates of injurious fall events requiring medical attention were similar in men and women. At age 50 years, the incidence rates in women exceeded the rates in men and remained 1.2-1.8 times higher thereafter. After age 70 years, the rates increased exponentially in both sexes: from 27.4 and 49.3 per 1,000 person-years in men and women, respectively, to peaks of 112.8 and 170.8 per 1,000 person-years, respectively, at age 85 years and over. The proportion of falls occurring indoors and in institutional settings increased with advancing age. Compared with men, women had higher rates of fall-related contusions, distortions and fractures at all ages. CONCLUSIONS: Fall-prevention programmes should be directed towards the population aged 70 years and over, in particular towards women and hazards in residential environments. Our finding of an increasing incidence of injurious fall events among women around the time of the menopause raises the hypothesis that loss of oestrogen production plays a role in the aetiology of falls in women.

Accidental Falls↗
PubMed2004

National policy approaches to social care for elderly people in the United Kingdom and Singapore 1945-2002.

The authors compare policy approaches in the United Kingdom and Singapore on social care for older persons. The context of these approaches is discussed showing the development of policies, in each country from the aftermath of the Second World War to the present. Given that Singapore is a former British colony, it is of interest to scholars of social policy to examine its welfare approach as compared to the welfare state approach espoused by the United Kingdom. Both nations are faced with the challenges of an aging population, which necessitates handling similar problems with strategies that are in harmony with their respective economic, social, and cultural contexts. This paper considers their divergence of philosophies and policies, concluding with the recognition that the major difference lies in national and governmental expectations regarding the extent of the financial and regulatory responsibility for care for older people carried by the individual, the family, and the state.

Aged↗
PubMedDate not supplied

[Current situation of health services in northern districts of the West Bank, Palestine].

We assessed the current situation of health services in the northern districts of the West Bank of Palestine as regards the providers of the services, the services provided, the human resources working in the services and the sufficiency of the services with respect to the size of the populations. We found that 21% of the total population in the northern districts did not have private medical clinics and 13% did not even have primary health care centres. There has been an increase in the number of governmental primary health care centers and a decrease in the number of nongovernmental and charitable centres since the Palestinian National Authority took over responsibility for public health services through the Ministry of Health.

Charities↗
PubMedDate not supplied

[Strategies for protecting the elderly from the health-risks of heat-waves: measures undertaken in Italy in the summer of 2004].

Heat waves constitute an important public health problem because of their potential serious health impact on vulnerable populations such as the elderly and individuals living in poor health, socioeconomic, cultural or environmental conditions. The summer of 2003 was the hottest summer, with respect to both minimum and maximum temperatures, of the last fifty years. During that summer, an increased mortality was found especially in the elderly population = 75 years. The Ministry of Health therefore released guidelines for the regions and other local authorities, regarding the measures be undertaken in order to safeguard the elderly and other vulnerable populations from the health risks associated with heat waves. Subsequently, a survey was performed to collect information regarding the projects put into practice in the summer of 2004 by the various regions and local authorities. The aim of the study was to promote a comparison and sharing of appropriately documented experiences. This article classifies and describes the various interventions that were put into practice.

Aged↗
PubMed2003

Evaluation of the effect of a long-term trap-neuter-return and adoption program on a free-roaming cat population.

OBJECTIVE: To evaluate the effect of a long-term trap-neuter-return program, with adoption whenever possible, on the dynamics of a free-roaming cat population. DESIGN: Observational epidemiologic study. ANIMALS: 155 unowned free-roaming cats. PROCEDURES: Free-roaming cats residing on a university campus were trapped, neutered, and returned to the environment or adopted over an 11-year period. RESULTS: During the observation period (January 1991 to April 2002), 75% of the cats were feral, and 25% were socialized. Kittens comprised 56% of the original population. Male cats were slightly more numerous (55%) than females. At the conclusion of the observation period, 47% of the cats had been removed for adoption, 15% remained on site, 15% had disappeared, 11% were euthanatized, 6% had died, and 6% had moved to the surrounding wooded environment. Trapping began in 1991; however, a complete census of cats was not completed until 1996, at which time 68 cats resided on site. At completion of the study in 2002, the population had decreased by 66%, from 68 to 23 cats (of which 22 were feral). No kittens were observed on site after 1995, but additional stray or abandoned cats continued to become resident. New arrivals were neutered or adopted before they could reproduce. CONCLUSIONS AND CLINICAL RELEVANCE: A comprehensive long-term program of neutering followed by adoption or return to the resident colony can result in reduction of free-roaming cat populations in urban areas.

Animal Welfare↗
PubMed1997

Cancer incidence in the Hmong of Central California, United States, 1987-94.

The Hmong are an ethnic minority in China, some of whom migrated to the mountainous areas of North Vietnam, Laos, and Thailand in the 19th and 20th centuries. Because of their support for the United States during the Vietnam war, many Laotian Hmong fled to Thailand and eventually were re-settled in the US after the end of that conflict. Approximately 100,000 Hmong currently live in the US, of whom about half reside in the Central Valley of California. The purpose of this study was to measure cancer incidence in this unique new immigrant population. Using the resources of the Cancer Registry of Central California (CRCC), a population-based cancer registry, cancer incidence in the Hmong was evaluated by calculating age-adjusted incidence rates as well as by calculating proportional incidence ratios. Compared with all races combined, elevated rates of cancer in the Hmong were observed for the following sites: nasopharynx, stomach, liver, pancreas, leukemia, and non-Hodgkin's lymphoma. Cervical cancer incidence overall was elevated, but more noteworthy, invasive cervix cancer rates were much higher than expected. Lower cancer rates were found for breast, prostate, and colorectal cancer. Hmong also experienced advanced stage and grade of disease at diagnosis for many cancer sites in addition to cervical cancer, which may be explained by cultural factors, including avoidance of Western medical care and low rates of participation in screening programs. This population should be followed closely and monitored for patterns of cancer incidence in the future since it provides a natural laboratory for studies of cancer etiology as this population gradually becomes acculturated to the Western lifestyle.

Adolescent↗
PubMed2006

[Immigration and aging: new challenges in public health].

Foreign migration in Spain is at present a priority in the social and demographic context the country. At a worldwide level, trends in the evolution of population and social, political and economical indicators, appear to maintain for the coming years, the present trends on migrations from poor countries to the rich ones. In the health area, considering migration as a relatively recent phenomena in Spain, and considering that is mainly constituted by young and healthy population, there are not still data available on the main health needs of migrants related to aging. Data from other countries with a longer migrant tradition, shows mental health disorders and social and cultural barriers for adaptation, as basic health determinants for older migrants. Related to the effects in the health system, the inclusion of the aging factor in general population and migrant needs, offer an optimistic panorama for future planning. Migrant aging in Spain, despite of its middle and long term perspective, do require a progressive adaptation of knowledge and resources to cover future needs. Considering this coming future, health professionals do need to be trained in intercultural skills and knowledge.

Adolescent↗
PubMed1983

Baseline chronic disease risk factors in a racially heterogeneous elementary school population: The "Know Your Body" program, Los Angeles.

The Los Angeles "Know Your Body" (KYB) program is an organized health education activity for children designed to encourage positive health behavior and discourage or interrupt behavioral patterns that are linked to illness, injury, disability, or death. Components of KYB include a 20-week curriculum; a survey of health knowledge, attitudes, and behaviors; in-service training for elementary school teachers; and a clinical screening that provides feedback to students on selected indices. As part of a KYB field demonstration in Los Angeles conducted by the UCLA Division of Cancer Control, Jonsson Comprehensive Cancer Center, 1,503 Los Angeles and Santa Monica-Malibu children ages 9-11 in grades 4 and 5 underwent baseline health screening evaluations in March 1981, measuring height, weight, triceps skinfold thickness, serum cholesterol, pulse rate recovery following exercise, and blood pressure. The population mean for serum cholesterol was 182.6 mg/dl, with no significant racial/ethnic, sex, or age differences. Significant racial/ethnic differences were found in obesity, with Hispanics having the highest prevalence, Asians the lowest. Black students scored significantly higher in pulse rate recovery following exercise, suggesting better relative cardiovascular fitness, and Asians scored lowest. Blacks were more likely to exceed the 95th percentile in diastolic and systolic blood pressure. Overall, 48% of the children had one or more chronic disease risk factors.

Age Factors↗
PubMed1997

Thrombophilia in Patients with Hypertriglyceridemia.

Objectives: To investigate a possible relationship between hypertriglyceridemia and the coagulation system, a Cardiovascular Risk Factor Two-township Study was conducted in Taiwan. Design: A case-control study. This longitudinal, prospective study focused on the evolution of cardiovascular disease risk factors with emphasis on haemostatic factors. Subjects: Hypertriglyceridemic subjects (triglyceride <2.26 mmoll+1, n = 327) and age-matched normal controls from a population screening program. Main outcome measures: Haemostatic parameters measured in this study included prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, factors VIIc and VIIIc, and antithrombin-III and plasminogen levels. Results: In our male hypertriglyceridemic subjects, aPTT was not significantly reduced, while significant elevations of factor VIIIc, factor VIIc, and plasminogen and antithrombin-III levels were noted. In the female hypertriglyceridemic subjects, the elevation of factor VIIc, factor VIIIc, and plasminogen and antithrombin-III levels was highly-significant, whereas aPTT was not significantly reduced. Unexpectedly, the levels of the established coronary risk factor, fibrinogen, did not show a statistically different change. Similar to previous data, our hypertriglyceridemic subjects also presented with hyperinsulinemia, glucose intolerance, upper body obesity, and elevated blood pressure. Conclusions: Despite the fact that in population studies, triglycerides do not consistently appear to be an independent risk factor for coronary heart disease, our data suggest that a pronounced increase in triglycerides warrants aggressive therapy, because this increase may be associated with a hypercoagulable state. This phenomenon contributes another perspective to the study of higher cardiovascular mortality in hypertriglyceridemic subjects.

Journal Article↗
PubMed2000

Measuring immunization coverage.

OBJECTIVE: Information about immunization coverage comes from five major sources: the National Immunization Survey, the National Health Interview Survey, retrospective school-entry surveys, the Health Plan Employer Data and Information Set (HEDIS) measures reported by managed care plans, and assessments performed on clinics and private practices. In this article, we describe the methodology of the major surveys, discuss technical and policy issues in measuring immunization coverage, and identify issues that must be addressed to harmonize immunization rates calculated from different sources. METHODS AND TOPICS: We describe the (1) design and methodology of the five major sources of immunization coverage assessments, (2) issues and controversies in measuring immunization coverage, and (3) preliminary efforts to harmonize calculation of immunization coverage. Technical and policy issues involve dose and interval requirements, which vaccines are included in the series-completion calculations, and who is excluded from each method of calculation. CONCLUSIONS: The purpose of measuring up-to-date immunization coverage determines the way that it is measured. The tension between measuring immunization coverage to monitor population protection against disease and measuring immunization coverage to determine how well the health care delivery system is working leads to different ways of selecting a sample and reporting coverage. These differences create confusion for the public policymakers who try to identify problems and to set priorities for immunization efforts. Although some unavoidable differences may occur because of differences in purpose of the measurement, greater harmonization is possible.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

[Indicators for the evaluation of the impact of hydatidosis control programs on the health status of a human population].

The importance of measuring the impact of the hydatidosis control program activities on the health of human populations has been emphasized. The different rates used, as well as their limitations defining new hydatidosis cases, are described. The specific incidence rates for the age group of 0-10 years should be considered, together with the standardization of serologic and echographic screening in young groups, in order to achieve the epidemiological evaluation of the control programs impact on a human population in the short term.

Adolescent↗
PubMedDate not supplied

The health and functional status of US veterans aged 65+: implications for VA health programs serving an elderly, diverse veteran population.

As the US population is aging, so too is the US veteran population. Chief among the challenges facing the Department of Veterans Affairs (VA) is developing health programs and services that mesh with the needs of an aging veteran population and therefore improve the health status of elderly veterans. Meeting this challenge requires an understanding of the health needs of the older veteran population, including health disparities that exist across racial ethnic populations. This study examines the self-rated health and functioning of a national sample of veterans aged 65+ participating in the National Survey of Veterans. The results show that over one half of elderly veterans report difficulty in functioning and rate their health status as fair or poor. Additionally, elderly African American and Hispanic veterans report worse health than non-Hispanic white veterans across the majority of health indicators. Given the health profile of older veterans found in this study, it would seem necessary that programs serving older veterans be adept at the ongoing medical management of chronic disease and the provision of long-term care services.

Activities of Daily Living↗
PubMed2002

Creating a CD-ROM program for cancer-related patient education.

PURPOSE/OBJECTIVES: To describe the process of developing a cancer-related patient and family education CD-ROM program and initial evaluation results. DATA SOURCES: Published research, theory, practice, and personal experience. DATA SYNTHESIS: CD-ROM programs can be far more comprehensive than the booklets and videotapes used more commonly in patient education. Developing CD-ROM programs requires funding, organizational skills, access to content experts, and a team composed of people who have the varied skills required for a finished multimedia product. The time frame for CD-ROM production is often longer than that of other patient-education formats. Published reports and this institution's experience confirm that patients accept this medium. Evaluation to date suggests that CD-ROMs may be more useful to patients and their families than any other single information source. CONCLUSIONS: CD-ROM technology is more expensive than videotapes and booklets, but it allows for greater depth of content and may satisfy a broader range of educational needs than other media. Funding often can be obtained through foundations and with unrestricted educational grants from pharmaceutical companies. IMPLICATIONS FOR NURSING: Nurses can lead multidisciplinary teams to produce CD-ROMs for their patient populations. These programs can be used before a patient has a first consultation to introduce a cancer or treatment and anytime during cancer diagnosis and treatment. They can reinforce one-on-one teaching or provide greater depth of content than ever could be provided in individualized teaching sessions. They can facilitate patients' self-directed learning and may allow nurses and doctors to teach on a different level. These programs also can complement patients' Internet searches either by creating a solid foundation for further investigation or by confirming the reliability of information gained through a variety of Internet sources.

CD-ROM↗