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PubMed1993

Capacity building and resource needs of state health agencies to implement community-based cardiovascular disease programs.

State Health Agencies play a critical role in the Nation's efforts for health promotion and disease prevention. This role is especially critical in efforts to reduce the burden of CVD through community-based programs. Resources SHAs need to facilitate implementation of community-based CVD prevention programs fall into three general categories: (a) Adequate time to plan, carry out and evaluate, (b) Financial resources to support staff, community organization and demonstration programs, and (c) Personnel with requisite technical expertise, skills and technological resources. Six critical activities for building state-level CVD program capacity include: (1) Forming a statewide CVD oversight committee, (2) Developing a state CVD plan, (3) Developing quality assurance standards and guidelines, (4) Developing new paradigms of community assessment and evaluation, (5) Planning for institutionalization, and (6) Translation of research to application. SHA roles vary from direct service delivery to serving as a linking agent, transferring information and resources and coordinating efforts between agencies.

Cardiovascular Diseases↗

PubMed1997

Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications, and resource utilization.

CONTEXT: Although experimental studies show that insulin therapy can be safe and efficacious in improving glycemic control in type 2 diabetes under optimal conditions (ie, using patient volunteers with close monitoring under strict study protocols), little is known about its effectiveness, complication rates, and associated resource utilization in actual clinical practice. DESIGN: Cohort study. SETTING: Large staff-model health maintenance organization. PARTICIPANTS: A total of 8668 patients with type 2 diabetes cared for by generalist physicians from 1990 through 1993. OUTCOME MEASURES: Resource use (hospitalizations, outpatient visits, laboratory testing, and home glucose monitoring) and glycemic control were evaluated using combined clinical, survey, and administrative information systems data. Detailed clinical case-mix data, including a newly validated case-mix method, the Total Illness Burden Index, were collected on a subsample of 1738 patients. RESULTS: Among patients starting insulin therapy, hemoglobin A1c (HbA1c) decreased by 0.9 percentage point (95% confidence interval, 0.7-1.0) at 1 year compared with those receiving stable medication regimens; however, 2 years after starting insulin therapy, 60% still had HbA1c levels of 8% or greater. There was no evidence that some primary care physicians achieved better results than other primary care physicians when starting insulin therapy in their patients. Patients with the poorest baseline glycemic control achieved substantially greater HbA1c reductions; those with a baseline HbA1c level of 13% had a 3-fold greater decline in HbA1c than those whose baseline HbA1c level was 9%. For a subset of all patients for whom detailed clinical case-mix data were obtained, those taking insulin had higher resource use than those taking sulfonylureas, independent of illness severity. After adjusting for age, sex, race, socioeconomic status, disease duration, and severity of diabetes and comorbidities, insulin users had slightly more laboratory tests performed, 2.4 more outpatient visits per year, and almost 300 more fingersticks for home glucose testing per year compared with sulfonylurea users (all P<.01). Although 15% of patients receiving insulin therapy reported weekly symptoms of hypoglycemia, insulin therapy was not associated with an increase in emergency department visits (after case-mix adjustment) and resulted in only 0.5 hypoglycemia-related hospitalizations per 100 patient-years. CONCLUSIONS: For patients with type 2 diabetes who were cared for by generalist physicians, starting insulin therapy was generally safe and effective in achieving moderate glycemic control in patients who initially had poor glycemic control. However, insulin therapy was associated with increases in resource use and was rarely effective in achieving tight glycemic control, even for those with moderate control.

Adult↗

PubMed1998

[A method for the evaluation of resource use in cardiac surgery: application of the ICR beta in an Italian reality].

The decreased availability of economic resources requires the use of methods to assess hospital efficiency. The aim of our study was to retrospectively evaluate the applicability to the Italian reality of a catalogue of medical acts (CdAM-champs beta) set up for the French Health System. We wanted to evaluate the amount of resource utilization of a Cardiothoracic Operating Room of a IRCCS regional general hospital. The study included 83 admissions, occurring in October 1996, to the cardiac surgery department. Medical acts were recorded for all admissions taking into account both the number of acts and the weight of acts expressed as standard cost index or ICR. This takes into account the use of human (medical and nursing staff) and technical resources. Calculation of ICR beta scores was achieved by means of two different expressions. We observed a lack of correlation between the two values of each ICR. The previous formula (1991) gives more emphasis on the different conditions in which the operation was carried out (American Society of Anesthesiology score), duration of anesthesia and patients disease with a statistical significant difference. The last formula (1995) only evaluate patients' disease. None of the two formula of ICR beta turns out to be completely appropriate index of resource utilization during anesthesia; therefore this analysis still remains a difficult problem. Yet it must be recognized that this system deserves the merit of having evaluated the anesthesiological duties, by separating them from the surgical ones.

Cardiac Surgical Procedures↗

PubMed1994

Endogenous population growth and the exploitation of renewable resources.

The authors consider a demo-economic model where the economy consists of two sectors ("hunting and farming" and "industry"), and both sectors depend directly or indirectly on the explanation of a renewable resource. The primary sector harvests a renewable resource (fish, corn, or wood) which is used as the input into industrial production, the secondary sector of our economy. Labor is divided up between these two sectors under the assumption of competitive labor markets. A system of two nonlinear differential equations for the resources and the population is studied by phase space analysis. Using the Hopf bifurcation theorem, the authors obtain two different routes to limit cycles and prove numerically the existence of a stable Malthusian limit cycle.

Conservation of Natural Resources↗

PubMed2006

Uniform resource locator decay in dermatology journals: author attitudes and preservation practices.

OBJECTIVES: To describe dermatology journal uniform resource locator (URL) use and persistence and to better understand the level of control and awareness of authors regarding the availability of the URLs they cite. DESIGN: Software was written to automatically access URLs in articles published between January 1, 1999, and September 30, 2004, in the 3 dermatology journals with the highest scientific impact. Authors of publications with unavailable URLs were surveyed regarding URL content, availability, and preservation. MAIN OUTCOME MEASURES: Uniform resource locator use and persistence and author opinions and practices. RESULTS: The percentage of articles containing at least 1 URL increased from 2.3% in 1999 to 13.5% in 2004. Of the 1113 URLs, 81.7% were available (decreasing with time since publication from 89.1% of 2004 URLs to 65.4% of 1999 URLs) (P<.001). Uniform resource locator unavailability was highest in The Journal of Investigative Dermatology (22.1%) and lowest in the Archives of Dermatology (14.8%) (P=.03). Some content was partially recoverable via the Internet Archive for 120 of the 204 unavailable URLs. Most authors (55.2%) agreed that the unavailable URL content was important to the publication, but few controlled URL availability personally (5%) or with the help of others (employees, colleagues, and friends) (6.7%). CONCLUSIONS: Uniform resource locators are increasingly used and lost in dermatology journals. Loss will continue until better preservation policies are adopted.

Authorship↗

PubMed1988

Hospital costs, resource characteristics, and the dynamics of death for patients with hypertension.

A great deal of interest has begun to focus on outcome data for hospitals. We analyzed hospital resource consumption for 4289 patients with hypertension by outcome (ie, survivors vs mortalities). The 211 mortalities had a much greater intensity of hospital resource utilization and a substantial financial risk under diagnosis related group (DRG) pricing schemes compared with the 4078 survivors. Only mortalities within one week of admission to the hospital were profitable under DRGs. A long hospital length of stay (LOS) for mortalities was very unprofitable (mortalities with greater than 60-day LOS generated a $40,673 loss per patient). Patients admitted under emergency conditions who died tended to have a shorter hospital LOS and less financial risk under DRGs compared with those who were not emergency admissions and died. Mortalities referred from other clinical services tended to have greater resource utilization and financial risk under DRGs compared with nonreferred mortalities. These data suggest notable inequities in the DRG prospective payment system vis-à-vis patients who died with hypertension. They also demonstrated variables predictive of greater hospital resource utilization for patients who died with hypertension, including longer hospital LOS, nonemergency admission, and referral from another clinical service.

Aged↗

PubMed1996

The impact of internal and external resources on functional outcomes in chronic illness.

This study's purpose was to determine if internal and/or external resources could deter negative consequences of physiologic stress in chronic illness. Resource theory was used to test relationships over time among stress (physiologic), distress (functional outcome), and resources (internal-well-being; external-social network). A secondary analysis was done on data from 112 persons with end stage renal disease, collected yearly over 3 years. Physiologic stressors were strongly associated with higher levels of physical dysfunction. Resources were generally unable to reduce deleterious effects of physiologic stress on functional outcomes; functional outcomes were largely determined by preexisting levels of function.

Adult↗

PubMed2000

Regional differences in health care delivery: implications for a national resource allocation formula.

In several countries formulae for allocating resources to regions are derived using national average relationships between population characteristics and health service use. However, there may be significant regional heterogeneity in health care delivery which, has two main implications for a national resource allocation formula. First, it offers alternative ways of measuring the relative needs of different population groups. Since the primary focus of research and policy is on the difficulty of targeting resources at high-need populations, it is proposed that progressivity in the delivery of health care could be seen as a frontier problem analogous to efficiency. The effects of using the slope parameters from the most progressive region are simulated. Second, regional heterogeneity may thwart the objective of the formula of securing equitable use of resources by different population groups. An adjustment mechanism is developed to illustrate the trade-off between the levels of geographical and vertical equity achieved. A locus of equity possibilities for acute care in Scotland is derived. Traditional formulae represent a corner solution indicating extreme relative aversion to geographical inequity. Because regional variation in need dominates regional variation in progressivity in Scotland, high-need rather than progressive regions gain from the pursuit of vertical equity.

Acute Disease↗

PubMed1986

Stable nitrogen and carbon isotope ratios in bone collagen as indices of prehistoric dietary dependence on marine and terrestrial resources in southern California.

The ratios of 15N to 14N and 13C to 12C tend to be higher in marine than in terrestrial organisms. The concentrations of these isotopes in human bone collagen consequently can be used to make inferences about the contribution of marine and terrestrial resources to prehistoric diets. The utility of studying 15N/14N and 13C/12C ratios in conjunction with each other is illustrated by our analysis of 40 human burials from archaeological sites in the Santa Barbara Channel area of southern California. The mean delta 13C and delta 15N values (in per mil) of collagen from these skeletons decrease progressively from the Channel Islands (delta 13C = -14.0, delta 15N = +16.3) to the mainland coast (delta 13C = -14.5, delta 15N = +14.9) to the interior (delta 13C = -17.2, delta 15N = +10.9). These data suggest that Indians living on the Channel Islands during the late prehistoric period were heavily dependent on marine resources. The inhabitants of the mainland interior, in contrast, had a diet composed largely of terrestrial foods. From their isotope ratios, it appears that the Indians who lived on the mainland coast consumed a mixed diet containing substantial quantities of both marine and terrestrial resources. Differences in 15N/14N and 13C/12C ratios of individuals from mainland sites dating from the early and late prehistoric periods show that the marine component of the diet increased substantially through time. These isotopic data are consistent with pathological, faunal, and artifactual evidence of increased marine resource exploitation during the late prehistoric period.

Animals↗

PubMed1987

Correlates of community resource information needs of arthritis patients.

One hundred eighty-nine ambulatory arthritis patients were interviewed to assess needs for information about community resource services. Participants were asked how frequently they needed 66 specific information items. Three categories of resource needs in arthritis care were identified: general information, personal care and medical services, and assistive devices and equipment. In the first category, results indicated that the greater the impairment in functional ability, the greater the need for general information about arthritis. When functional ability was held constant, younger patients with lower family income displayed a greater need for arthritis resource information. Lower functional ability and family income were associated with a greater need for personal care and medical service information. Lower functional ability contributed the most to the need for information about assistive devices and equipment. We suggest that, as an essential component of the long-term care of patients with rheumatic diseases, individuals who provide educational counseling should clearly understand the community resource needs of patients, and should be able to match articulated needs with the existing services. Health professionals should be aware that certain patient characteristics (specifically, family income, functional ability, and age) are related to a need for this type of information. The large percentage of patients who could not name their rheumatic disease diagnosis (65%) presents a major concern and challenge to patient educators.

Activities of Daily Living↗

PubMed2005

The importance of age in allocating health care resources: does intervention-type matter?

BACKGROUND: Recent proposals to reform cost-effectiveness analysis (CEA) by weighting health benefits [(Quality-adjusted life-years) QALYs] by recipients' age are based on studies examining age-related preferences in life-saving contexts. We investigated whether the perceived importance of age in resource allocation decisions differs among intervention-types. METHODS: 160 individuals were recruited from a cafeteria of a university medical centre and asked to choose between hypothetical health care programmes. Scenario A described two programmes treating life-threatening conditions and Scenario B two programmes providing palliative care. Programmes were identical except in average patient age (35 versus 65). Respondents also directly rated the importance of age for allocating resources for six types of interventions. RESULTS: Responses for the life-saving scenario favoured younger age groups while those for the palliative care scenario showed no age preference. The difference between scenarios was statistically significant. When directly rating the importance of age in allocating treatment resources, people placed greatest importance on age in treating infertility and life-saving, and least importance in treating depression. DISCUSSION: The importance people place on age as a resource allocation criterion depends on the clinical context. As QALYs serve as a common measure of health benefits for all intervention types, age weighting of QALYs is premature.

Adult↗

PubMed2001

Resourcefulness and health practices of diabetic women.

More than one fourth of the millions of Americans with Type 2 diabetes experience depression, of which two thirds are women. Unless the individual is resourceful, coexisting diabetes and depression adversely affect one' health practices. The effects of diabetic and depressive symptoms on health practices and the mediating and moderating role of learned resourcefulness in this relationship were examined in 90 women with Type 2 diabetes. Regression analyses showed direct negative effects of diabetic and depressive symptoms on health practices. The effects of depressive, but not diabetic, symptoms were partially mediated by resourcefulness; no moderating effects were found. The results suggest the need to test interventions to minimize symptoms associated with diabetes, particularly depression. Teaching resourcefulness to Type 2 diabetic women may promote their positive health practices by minimizing their depression.

Adaptation, Psychological↗

PubMed2004

The RESID Database of Protein Modifications as a resource and annotation tool.

The RESID Database of Protein Modifications is a comprehensive collection of annotations and structures for protein modifications and cross-links including pre-, co-, and post-translational modifications. The database provides: systematic and alternate names, atomic formulas and masses, enzymatic activities that generate the modifications, keywords, literature citations, Gene Ontology (GO) cross-references, protein sequence database feature table annotations, structure diagrams, and molecular models. This database is freely accessible on the Internet through resources provided by the European Bioinformatics Institute (http://www.ebi.ac.uk/RESID), and by the National Cancer Institute--Frederick Advanced Biomedical Computing Center (http://www.ncifcrf.gov/RESID). Each RESID Database entry presents a chemically unique modification and shows how that modification is currently annotated in the protein sequence databases, Swiss-Prot and the Protein Information Resource (PIR). The RESID Database provides a table of corresponding equivalent feature annotations that is used in the UniProt project, an international effort to combine the resources of the Swiss-Prot, TrEMBL and PIR. As an annotation tool, the RESID Database is used in standardizing and enhancing modification descriptions in the feature tables of Swiss-Prot entries. As an Internet resource, the RESID Database assists researchers in high-throughput proteomics to search monoisotopic masses and mass differences and identify known and predicted protein modifications.

Databases, Factual↗

PubMed1998

Position of operant costs affects visits to resources by laboratory mice, Mus musculus.

A recently recognized problem in consumer demand studies has been whether subjects should be allowed free exit from a resource cage that they have paid to enter. If decisions related to switches in behaviour are affected by the position of operant costs, then demand studies that offer free return routes from resources may result in different behavioural organization from those that split the same payment between entry to and exit from resources. We aimed to assess the extent of any such differences by comparing results from four operant treatments. The closed economy treatments differed in the position of the operant costs required to allow a mouse to enter a food cage and then return to the home cage. Three of the treatments carried the same overall cost: a full cost to enter the food cage; a full cost to leave the food cage; or with the cost split equally between entering and leaving the food cage. The fourth treatment imposed a half cost to enter the food cage but allowed free exit. The mice spent longer in whichever cage carried an exit cost. The most even distribution of their time was with the split cost. The number of visits undertaken depended on the magnitude of the cost, and on the resource cage for which the mice were paying. Significantly more visits were made when payment was required to enter the home cage. The mice responded to the immediate costs of entry to the cages, rather than the overall costs of a round trip. The lower number of visits made under higher costs was compensated for by the greater duration of those visits. Copyright 1998 The Association for the Study of Animal Behaviour. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed2000

Cognitive resource limitations during sentence comprehension in Parkinson's disease.

Patients with idiopathic Parkinson's disease (PD) were asked to identify the agent of the action in orally presented sentences with subject-relative or object-relative center-embedded clauses while simultaneously performing a secondary task that was less resource-demanding (finger tapping) or more resource-demanding (recognition span). We found that a subgroup of PD patients with impaired sentence comprehension at baseline (no secondary task) did not differ from random in their accuracy understanding all types of sentences during the more demanding (recognition span) condition and also had difficulty understanding the most complex sentences during the less demanding (finger tapping) condition. Control subjects and PD patients without baseline sentence comprehension difficulty were random only in their comprehension of the most complex sentences under the more demanding (recognition span) secondary task condition. Examination of response latencies for accurately understood sentences revealed only an effect for the type of sentence, and this was equally evident across all groups of subjects and regardless of the condition under which the sentences were administered. The sensitivity of PD patients' sentence comprehension accuracy to secondary task resource demands is most consistent with the hypothesis that limited cognitive resources contribute to sentence comprehension difficulty in PD.

Aged↗

PubMed2002

Assessing resource demands during sentence processing in Parkinson's disease.

Patients with Parkinson's disease (PD) have sentence comprehension difficulty, but it is unclear whether this is due to a deficit in grammatical processing or to an executive resource limitation. To assess grammatical processing in PD while minimizing task-related demands, PD patients and healthy control subjects performed a word detection procedure that assesses sensitivity to grammatical agreements in sentences in an "on-line" fashion. With this technique, we found that control subjects and PD patients are equally sensitive to grammatical agreement violations in sentences. A traditional, resource-demanding measure of sentence comprehension was also administered to the same PD patients. In comparison to healthy controls, PD patients were significantly impaired in their relative comprehension of sentences containing object-gap subordinate clauses compared to subject-gap subordinate clauses. Performance on several executive resource measures was also impaired in PD, and this correlated with their comprehension performance. Sensitivity to grammatical agreements with the word detection procedure, in the context of sentence comprehension difficulty on a traditional measure, suggests that PD patients' executive resource limitations contribute to their sentence comprehension difficulty.

Aged↗

PubMed1997

A system to define and allocate health care resources on a territory to improve the life quality of the populations in developing countries.

In this paper the health resource allocation problem is discussed. An object-oriented system is proposed and its implemented prototype is illustrated. It consists of two parts: a Geographical Information System, which is able to acquire and store both geographical and social-epidemiological information (including the resource distribution on that territory), and a Decision Support System, able to decide, using optimization algorithms, the new resource allocation in order to obtain a quasi-optimal solution for the cost/benefit ratio minimization problem, after having fixed the goal (e.g., the decrease of the incidence of a given disease) and constraints (e.g., a fixed budget, a given set of available resources, etc.). The object-oriented database which is part of the system can simulate and store different scenarios, depending on the different goals and constraints defined in input, by means of a user friendly interface.

Algorithms↗

PubMed1995

Genome resource banking for species conservation: selection of sperm donors.

The systematic banking of genome resources using cryopreserved germ plasm offers the opportunity to further conservation strategies of endangered species by assisting in the effective genetic management of captive populations. Cryopreserved germ plasm will allow indefinite preservation of the presently available gene diversity represented in either captive or wild populations. If properly utilized, genome resource banks have the potential to decelerate the loss of gene and allelic diversity in captive populations through reintroducing "original" genetic material through time to counter genetic drift. However, in order for any genome resource bank to be effective, strategies need to be developed to identify genetically valuable individuals to bank which will represent optimal gene diversity of the specific population. Four selection strategies were evaluated to identify individual donors from four North American captive populations representing differently structured pedigrees. The strategies consisted of selecting: (1) all males in the population ("All Male Bank"); (2) only living founders and early generation descendents ("Founder Method Bank," FMB); (3) males remaining after culling to minimize mean kinship ("Culled Male Bank 1"); and (4) males remaining after culling to minimize mean kinship, with the males reduced to the number in the FMB ("Culled Male Bank 2"). The effectiveness of each strategy was based on the comparison of genetic variation metrics in each bank with the genetic variation in the present living managed population. Although maximal retention of allelic diversity was achieved by banking genes from all living animals, nearly optimal retention of allelic and gene diversity was obtained by utilizing the selection strategy based on minimizing mean kinships. As a consequence, properly designed and utilized, genome resource banks can become effective tools for preserving gene diversity in future generations of living populations.

Animals↗