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PubMed1998

The relationship of pre-treatment Alcoholics Anonymous affiliation with problem severity, social resources and treatment history.

Little research has examined the relationship of substance abuse patients' prior Alcoholics Anonymous (AA) affiliation to important treatment-related variables. This study of 927 individuals seeking treatment in public, health maintenance organization (HMO) and private-for-profit medical programs, found that 82.8% of patients presented at treatment with a history of AA affiliation. Degree of prior AA affiliation was significantly associated with more extensive prior utilization of formal and informal helping resources, current seeking of treatment in the public sector, having low income, being divorced/separated and having more severe alcohol, employment/support and psychiatric problems. Implications for service delivery and future research are discussed.

Adult↗
PubMed1993

Simplification of high-energy collision spectra of peptides by amino-terminal derivatization.

Four-sector tandem mass spectrometry proves extremely useful for providing sequence information for peptides. The complexity of ion fragmentations, however, makes data interpretation difficult and time consuming. Attachment of a fixed positive charge to the peptide amino terminus forces production of only N-terminal fragment ions to yield simplified, predictable fragmentation. Reaction of a peptide at pH 6 with iodoacetic anhydride selectively modifies the N-terminus by exploiting the pK(a) differences between the alpha-amino group and any lysine side-chain epsilon-amino groups. The iodoacetyl peptide can react with many reagents to form a fixed positive charge. We find reaction with dimethyloctylamine forms a quaternary ammonium derivative with good surface activity properties and concomitant increased sensitivity. The high-energy CAD fragment ion spectra of the N-terminally derivatized peptides show predominantly a(n) and d(n) ions. The abundant d(n) ions permit ready distinction of leucine and isoleucine. Fewer fragment ions make data interpretation simpler and lead to more intense peaks since the ion intensity is spread among fewer peaks. The method is particularly useful for peptides which do not otherwise yield sufficient fragmentation to provide either the complete sequence or the locations of modified amino acids.

Amino Acid Sequence↗
PubMed2001

The history man.

Explore the source record for details and available documents.

Archives↗
PubMed1997

Social and cultural factors affecting rates of regular retreatment of mosquito nets with insecticide in Bagamoyo District, Tanzania.

Insecticide-treated mosquito nets have an impact on mortality and morbidity in young children under controlled conditions. When integrated into larger control programs, there is the danger that rates of regular retreatment of the nets with insecticide will drop, greatly limiting their effectiveness as a public health intervention. In Bagamoyo District, Tanzania, rates of retreatment dropped significantly when payment for the insecticide was introduced. A series of neighbourhood (hamlet) meetings were held in all study villages to discuss people's concerns about the insecticide and ways to increase rates of retreatment. Although changes were made in the procedure for retreatment, rates of retreatment remained lower than expected and showed marked variation within as well as between villages. We then conducted unstructured key informant interviews as well as informal discussions in a village with strong variation between different sectors of the villages in rates of retreatment. While logistical problems were most frequently cited as reasons not to bring nets for retreatment, political and social divisions within the community provided a better explanation. This is borne out by the low response to rearrangements in logistics which made retreating the nets significantly easier for households, and the higher response when changes were made in the channels of communication as well as the logistic features. It is clearly more difficult for villagers to appreciate the benefits of the insecticide than those of the nets. Great emphasis needs to be placed on the insecticide and its beneficial effects from the outset for any large-scale programme to be sustainable.

Bedding and Linens↗
PubMed2003

Health: IT leader or laggard? A comparative assessment of IT maturity.

The health industry has acquired a reputation as lagging in the use of IT. This reputation is usually based upon the relatively narrow measure of comparative IT expenditure, often examined as a proportion of total revenue. This study has been undertaken to assess health's use of IT using a broader frame of reference. The health industry was compared to the banking industry, on the basis that the banking industry is widely perceived as a leading IT user. The research confirmed that in these two 'knowledge' industries, health is slower to adopt IT with an apparent lower maturity level. This was the case across a range of best practice management, procedural and cultural topics as well as in the level of resources applied to IT.

Attitude to Computers↗
PubMed1996

Optimal filtering of EIT data in spectral expansion analysis.

The signal-to-noise rations for some EIT measurements are very low, and for in vivo EIT measurements these are dependent on the electrode positioning and the distance from the current drive. The effect of removing noisy measurements to produce higher-fidelity images was investigated for the case of gastric emptying data. A consequence of this filtering was the reduction in the size of the sensitivity matrix and its subsequent singular-value decomposition. Several different filters were tested and for each of these spectral expansion regularization filter was optimized using a chi 2 test. Filtering out the measurement made by the spinal electrode, where the spinal bone barrier lies directly in the current path to the stomach, produced improved images by reducing the artefact content in the spinal sector of the conductivity map. For stomach imaging little useful information is produced by the spinal electrode, and the benefits of filtering dominate. However artefact images may be generated. In contrast consistent small improvements were produced by filtering out some of the weakest signals.

Data Interpretation, Statistical↗
PubMed2004

The cost of HIV/AIDS to businesses in southern Africa.

BACKGROUND: Information on the potential costs of HIV/AIDS to the private sector is needed if companies are to be given a financial incentive to invest in prevention and treatment interventions. OBJECTIVES: To estimate the cost of HIV/AIDS to businesses in southern Africa using company-specific data on employees, costs, and HIV prevalence. METHODS: : Six formal sector enterprises in South Africa and Botswana provided detailed human resource, financial, and medical data and carried out voluntary, anonymous HIV seroprevalence surveys. The present value of incident HIV infections with a 9-year median survival and 7% real discount rate was estimated. Costs included were sick leave; productivity loss; supervisory time; retirement, death, disability, and medical benefits; and recruitment and training of replacement workers. RESULTS: HIV prevalence in the workforces studied ranged from 7.9 to 25.0%. HIV/AIDS among employees added 0.4-5.9% to the companies' annual salary and wage bills. The present value of an incident HIV infection ranged from 0.5 to 3.6 times the annual salary of the affected worker. Costs varied widely across firms and among job levels within firms. Key reasons for the differences included HIV prevalence, levels and stability of employee benefits, and the contractual status of unskilled workers. Some costs were omitted from the analysis because of lack of data, and results should be regarded as quite conservative. CONCLUSIONS: AIDS is causing labor costs for businesses in southern Africa to rise and threatens the competitiveness of African industry. Research on the effectiveness of workplace interventions is urgently needed.

Botswana↗
PubMed2003

The effect of publicly reporting hospital performance on market share and risk-adjusted mortality at high-mortality hospitals.

BACKGROUND: It is unclear whether publicly reporting hospitals' risk-adjusted mortality affects market share and mortality at outlier hospitals. OBJECTIVES: To examine hospitals' market share and risk-adjusted mortality from 1991 to 1997 at hospitals participating in Cleveland Health Quality Choice (CHQC). RESEARCH DESIGN: Time series. SUBJECTS: Changes in market share were examined for all patients hospitalized with acute myocardial infarction, heart failure, gastrointestinal hemorrhage, obstructive pulmonary disease, pneumonia, or stroke at all 30 nonfederal hospitals in Northeast Ohio. Patients insured by Medicare were used to examine changes in mortality. MEASURES: Trends in market share (proportion of patients with the target conditions discharged from a given hospital) and risk-adjusted 30-day mortality. RESULTS: CHQC identified several hospitals with consistently higher than expected mortality. The five hospitals with the highest mortality tended to lose market share (mean change -0.6%, 95% CI -1.9-0.6), but this was not significant. The only outlier hospital with a large decline in market share had declining volume for 2 years before being declared an outlier. Risk-adjusted mortality declined only slightly at hospitals classified by us as "below average" (-0.8%; 95% CI, 2.9-1.8%) or "worst" (-0.4%; 95% CI -2.3-1.7). However, risk-adjusted mortality at one hospital changed from consistently above expected to consistently below expected shortly after first being declared an outlier. CONCLUSION: Despite CHQC's strengths, identifying hospitals with higher than expected mortality did not adversely affect their market share or, with one exception, lead to improved outcomes. This failure may have resulted from consumer disinterest or difficulty interpreting CHQC reports, unwillingness of businesses to create incentives targeted to hospitals' performance, and hospitals' inability to develop effective quality improvement programs.

Consumer Behavior↗
PubMed1998

Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study.

OBJECTIVES: To determine the demands on healthcare resources caused by different types of illnesses and variation with age and sex. DESIGN: Information on healthcare use was obtained from all 22 healthcare sectors in the Netherlands. Most important sectors (hospitals, nursing homes, inpatient psychiatric care, institutions for mentally disabled people) have national registries. Total expenditures for each sector were subdivided into 21 age groups, sex, and 34 diagnostic groups. SETTING: Netherlands, 1994. MAIN OUTCOME MEASURES: Proportion of healthcare budget spent on each category of disease and cost of health care per person at various ages. RESULTS: After the first year of life, costs per person for children were lowest. Costs rose slowly throughout adult life and increased exponentially from age 50 onwards till the oldest age group (> or = 95). The top five areas of healthcare costs were mental retardation, musculoskeletal disease (predominantly joint disease and dorsopathy), dementia, a heterogeneous group of other mental disorders, and ill defined conditions. Stroke, all cancers combined, and coronary heart disease ranked 7, 8, and 10, respectively. CONCLUSIONS: The main determinants of healthcare use in the Netherlands are old age and disabling conditions, particularly mental disability. A large share of the healthcare budget is spent on long term nursing care, and this cost will inevitably increase further in an ageing population. Non-specific cost containment measures may endanger the quality of care for old and mentally disabled people.

Accidents↗
PubMed2000

The impact of molecular genetics on oral health paradigms.

As a result of our increased understanding of the human genome, and the functional interrelationships of gene products with each other and with the environment, it is becoming increasingly evident that many human diseases are influenced by heritable alterations in the structure or function of genes. Significant advances in research methods and newly emerging partnerships between private and public sector interests are creating new possibilities for utilization of genetic information for the diagnosis and treatment of human diseases. The availability and application of genetic information to the understanding of normal and abnormal human growth and development are fundamentally changing the way we approach the study of human diseases. As a result, the issues and principles of medical genetics are coming to bear across all disciplines of health care. In this review, we discuss some of the potential applications of human molecular genetics for the diagnosis and treatment of oral diseases. This discussion is presented in the context of the ongoing technological advances and conceptual changes that are occurring in the field of medical genetics. To realize the promise of this new molecular genetics, we must be prepared to foresee the possibilities and to incorporate these newly emergent technologies into the evolving discipline of dentistry. By using examples of human conditions, we illustrate the broad application of this emerging technology to the study of simple as well as complex genetic diseases. Throughout this paper, we will use the following terminology: Penetrance--In a population, defined as the proportion of individuals possessing a disease-causing genotype who express the disease phenotype. When this proportion is less than 100%, the disease is said to have reduced or incomplete penetrance. Polymerase chain reaction (PCR)--A technique for amplifying a large number of copies of a specific DNA sequence flanked by two oligonucleotide primers. The DNA is alternately heated and cooled in the presence of DNA polymerase and free nucleotides, so that the specified DNA segment is denatured, hybridized with primers, and extended by DNA polymerase. MIM--Mendelian Inheritance in Man catalogue number from V. McKusick's Mendelian Inheritance in man (OMIM, 1998).

Chromosome Aberrations↗
PubMedDate not supplied

E-pharmacy: improving patient care and managing risk.

While far behind certain other sectors of the American economy, health care will increasingly use information technology for content provision, communication, commerce, and complete integration of systems. In emerging electronically based health care systems, pharmacists have a great opportunity because of their specialized knowledge, accessibility, and the trust people have in them. A variety of technologic innovations under development will help create a safer medication-use system. Although consumers are increasingly using the Internet for health-related purposes, they need to be cautious when making important decisions using Web-based interactions.

Humans↗