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PubMed2004

Health care resource utilization and costs of NSAID-induced gastrointestinal toxicity. A population-based study in Switzerland.

BACKGROUND AND AIMS: The well-recognized gastrointestinal toxicity of NSAIDs ranges from mild symptoms to severe complications requiring medical attention and leading to work loss. The present study evaluates the economic burden derived from health care resource utilization and work loss caused by NSAID-induced gastrointestinal toxicity in the Swiss population. The costs induced by conventional and COX2-selective NSAIDs were calculated separately, and the results were then extrapolated for the United States. METHODS: A computer-generated random sampling of the Swiss population (n = 6,118) was administered a questionnaire by phone. Questions investigated NSAID intake, occurrence of adverse effects, consumption of gastroprotective drugs, health care resource utilization and work loss. Country-specific direct and indirect costs associated with NSAID-induced gastrointestinal toxicity were calculated according to current reimbursement costs in Switzerland and the United States. Medication expenses were used to compute separate iatrogenic cost factors for conventional and COX2-selective NSAIDs. The ability of demographic variables and symptoms to predict resource utilization was analyzed by univariate and multivariate analyses. RESULTS: From among the 6,085 responders (99.5% response rate), 294 subjects had gastrointestinal adverse effects associated with NSAID intake. The annual amount spent on NSAID-related adverse effects was CHF 432.2 million for Switzerland and USD 7,425.7 million for the United States. This amount corresponded to CHF 581 and USD 272 per NSAID user, and was primarily due to costs derived from work loss. For Switzerland, 91.1% of total costs were associated with the use of conventional NSAIDs and could be saved by using COX2-NSAIDs instead. While additional 13% of the medication purchase costs are spent for gastrointestinal adverse effects among COX2-selective NSAID users, additional 315% are spent for the same reason among conventional NSAID users. Thus, given similar efficacy and purchase costs in the two drug groups, COX2-selective NSAIDs are 25.1 times more cost-effective than conventional NSAIDs. Language region, place of residence, nationality, marital status, epigastric pain, diarrhea, hematemesis and melena predicted resource utilization. CONCLUSIONS: Costs arising from NSAID-induced gastrointestinal toxicity are considerable and primarily associated with conventional NSAIDs. COX2-selective NSAIDs could decrease this economic burden.

Absenteeism↗
PubMed2005

Assessing mental health and its association with income and resource utilization in old-old Chinese in Hong Kong.

OBJECTIVES: The authors assessed mental health status and its association with income and resource utilization in old-old Chinese citizens in Hong Kong. METHODS: Stratified disproportional random sampling in 1991-92 assembled a cohort of 1,696 elderly community-dwelling subjects who were age 70 or above, measuring the age and education adjusted mean level of cognitive functioning and geriatric depression, by income groups and further investigating the association between mental health and income by incorporating deficiencies in activities of daily living (ADL) and the presence of major chronic conditions in the multivariate regressions. The association between mental health and resource utilization, including physician visits and use of medication, was examined by multivariate regression analyses. RESULTS: Better cognitive functioning was associated with higher income across groups. Lower geriatric depression was associated with higher income. Cognitive impairment was associated with the ADL deficiencies, and geriatric depression was associated with a number of major chronic conditions and higher resource utilization, including physician visits and medication use. CONCLUSIONS: Income was significantly associated with cognitive functioning and geriatric depression in elderly persons in Hong Kong. Mental health, ADL deficiency, major chronic conditions, and resource utilization are interrelated. The fact that aging in the population is associated with increasing cognitive impairment and geriatric depression presents new challenges in financing and delivering efficient and equitable health care in the region.

Activities of Daily Living↗
PubMed2000

Coping resources of African-American and white patients hospitalized for bipolar disorder.

Forty-two African-American and 80 white patients hospitalized for bipolar disorder completed the Coping Resources Inventory. Total resource scores of the African Americans were significantly higher than scores of the whites, although differences in background variables between the two groups were not evident. The African-American group also scored significantly higher than the whites on the three scales indicating internal resources-cognitive, emotional, and spiritual-philosophical. No statistically significant differences were found for the two groups on the social and physical scales. Cultural orientations influencing personal life philosophies may explain the differences between the African-American and white patients on perceptions of their coping resources.

Adaptation, Psychological↗
PubMed2002

Internet resources available to otolaryngologists.

During recent years, the Internet has evolved into the largest computer network in the world, allowing access to vast amounts of information and services. Medical information is increasingly available to both patients and professionals, and ever more biomedical resources are becoming available on-line to assist in research, clinical medicine, and education. The Internet has always provided useful resources to otolaryngologists, implemented at various academic departments and national organizations or by specialists or specific medical web sites offering technical, scientific, and biomedical information. The purpose of this article is to provide as complete a list as possible of the World Wide Web sites accessible through the Internet that are of interest to otolaryngologists. It summarizes different types of resources available, including educational material, audiology sites, outcomes research, discussion lists, research laboratories, publications, medical libraries, news and medical conferences, organizations, academic departments, otolaryngological and medical resources, medical and surgical equipment and suppliers, and miscellaneous other sites of interest to otolaryngologists. This review is intended to present the wealth of the accessible information on the Internet and to promote the use of the network to otolaryngologists who do not have extensive experience in computers or telecommunications.

Computer User Training↗
PubMed2004

Personal resources and depression in the transition to adulthood: ethnic comparisons.

Based on a representative sample of 1,803 South Florida young adults, we examine the extent to which personal attributes mediate or moderate the ethnicity-depression relationship and condition the effects of social stress on depression. Our sample contains nearly equal proportions of African American, Cuban American, "other" Hispanic, and non-Hispanic white respondents. Findings suggest that there are ethnic variations in four of the five personal resources considered. Additionally, when accounting for ethnic differences in response tendencies and in the confounding of personal resources with depression, there is strong evidence for both direct and stress-buffering effects of personal resources. Although naïve comparisons of within group findings imply a number of ethnic variations in those effects, few statistically significant differences are observed. It is suggested that ethnic similarities outweigh differences, at least with respect to the mental health significance of the personal resources considered. Overall, the results highlight some of the complexities inherent in making multi-ethnic comparisons.

Adult↗
PubMed1992

Resource management in community residential facilities for adults with learning disabilities.

The trend towards community living for people with learning disabilities puts pressure on traditional hierarchical lines of resource management. A sample of 150 community residential facilities is surveyed in order to describe the systems used to manage resources in the community and to assess the impact they have on the quality of service provided. There are marked differences amongst provider agencies in the degree to which responsibility for resource management is devolved to facility managers and this has a direct effect on the quality of care. Residential homes which operate under centralised management systems are more institutional in their care practices and less responsive to individual clients' needs. In contrast, homes in which responsibility is delegated to the facility manager provide a service more in keeping with current philosophies of care. The results of this survey suggest that more responsibility for resource management can be delegated to facility managers without losing control of expenditure and with improvements in the efficiency and effectiveness of care.

Adult↗
PubMed2000

Depression, psychosocial resources, and functional ability in older adults.

The purpose of this study was twofold: to examine the differences between two groups of older adults (depressed, nondepressed) for physical health impairment, psychosocial resources, and functional abilities, and to describe the impact of depression, physical health impairment, and psychosocial resources on functional ability. Seventy-eight community-dwelling older adults, age 60 to 75 years, were divided into two groups based on their depression scores. Depressed and nondepressed participants were not significantly different for demographic and illness characteristics, except for income. Depressed participants reported greater physical health impairment, decreased social resources, diminished feelings of economic well-being, and decreased functional abilities when compared to nondepressed participants. Mastery, physical health impairment, and social support were significant predictor variables of functional ability. Mastery was a particularly salient psychological resource for total functional abilities and interventions should be targeted to increasing mastery in older adults.

Activities of Daily Living↗
PubMed2006

Resource utilization with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies in children with asthma.

OBJECTIVE: To determine resource utilization in controller naïve children diagnosed with asthma receiving initial therapy with fluticasone propionate (FP) and salmeterol (SAL) in a single inhaler (FSC), FP alone, montelukast (MON), inhaled corticosteroid (ICS) + SAL from separate inhalers, or ICS + MON. RESEARCH DESIGN AND METHODS: A retrospective, observational, 18-month (6-month pre-index and 12-month follow-up) database study using medical and pharmacy claims from a 5 million member managed care organization. Multivariate modeling was used to evaluate post-index resource utilization and asthma-related costs. Refill rates during the 12-month follow-up period were compared across cohorts. RESULTS: The study included controller-naïve children (n = 9192) aged 4-17 years with an asthma diagnosis. Children treated with FSC were significantly less likely to receive additional prescriptions for short-acting beta-agonists compared with all other cohorts (p <or= 0.007) and oral corticosteroids compared with the MON, ICS + SAL, and ICS + MON cohorts (p <or= 0.009). Children receiving FSC were also significantly less likely to add another controller therapy compared with children started on FP alone, MON, or ICS + SAL (p <or= 0.001) and to receive care in an emergency department or hospital compared with children receiving ICS + MON (p < 0.001). The number of prescriptions for FSC in the 12-month post-index period was greater (p < 0.05) than the number of ICS claims in the FP, ICS + SAL, and ICS + MON cohorts. Compared with FSC, the adjusted total asthma-related post-index costs were greater (p <or= 0.008) in the MON and ICS + MON cohorts. Although adherence was greater with MON compared with FSC, MON was associated with less favorable clinical outcomes and greater resource utilization and costs. CONCLUSION: FSC in children is associated with improved clinical outcomes and decreased resource utilization compared with other controller regimens.

Adolescent↗
PubMedDate not supplied

Food resource allocation patterns in lactating females in a long-term selection experiment for litter size in mice.

Resource allocation patterns, as quantified by residual food intake (RFI), and the consequences for offspring development were investigated during lactation in 96 females of a mouse line selected for 104 generations for high litter size at birth (S-line) and in 87 females of a non-selected control line (C-line). Litters of 45 C-line dams (Cs) and 48 S-line dams (Ss) were standardised (s) at birth; other dams (ns) supported total number of pups born (Cns and Sns, respectively). RFI during lactation was significantly lower in Sns-dams than in C-line dams and Sns-dams. After weaning Sns-dams seemed to be able to restore the negative resource situation. Sns-pups were about 25% less mature than Cns-pups at all times. Maturity was similar for Cs- and Ss-pups from 2 d in lactation on, and about 18% and 53% higher than Cns- and Sns-pups. The pre-weaning mortality rate was significantly higher in Sns-litters (35.6 +/-2.76) than in Cns-litters (4.95 +/-2.23). The results suggest that S-line dams allocated considerably more resources to maintenance of offspring than C-line dams. This was insufficient to provide the offspring with an adequate amount of resources, resulting in reduced pup development and increased pre-weaning mortality rates.

Animals↗
PubMed2006

An analysis of the Sargasso Sea resource and the consequences for database composition.

BACKGROUND: The environmental sequencing of the Sargasso Sea has introduced a huge new resource of genomic information. Unlike the protein sequences held in the current searchable databases, the Sargasso Sea sequences originate from a single marine environment and have been sequenced from species that are not easily obtainable by laboratory cultivation. The resource also contains very many fragments of whole protein sequences, a side effect of the shotgun sequencing method.These sequences form a significant addendum to the current searchable databases but also present us with some intrinsic difficulties. While it is important to know whether it is possible to assign function to these sequences with the current methods and whether they will increase our capacity to explore sequence space, it is also interesting to know how current bioinformatics techniques will deal with the new sequences in the resource. RESULTS: The Sargasso Sea sequences seem to introduce a bias that decreases the potential of current methods to propose structure and function for new proteins. In particular the high proportion of sequence fragments in the resource seems to result in poor quality multiple alignments. CONCLUSION: These observations suggest that the new sequences should be used with care, especially if the information is to be used in large scale analyses. On a positive note, the results may just spark improvements in computational and experimental methods to take into account the fragments generated by environmental sequencing techniques.

Amino Acid Sequence↗
PubMed2005

Sal-Site: integrating new and existing ambystomatid salamander research and informational resources.

Salamanders of the genus Ambystoma are a unique model organism system because they enable natural history and biomedical research in the laboratory or field. We developed Sal-Site to integrate new and existing ambystomatid salamander research resources in support of this model system. Sal-Site hosts six important resources: 1) Salamander Genome Project: an information-based web-site describing progress in genome resource development, 2) Ambystoma EST Database: a database of manually edited and analyzed contigs assembled from ESTs that were collected from A. tigrinum tigrinum and A. mexicanum, 3) Ambystoma Gene Collection: a database containing full-length protein-coding sequences, 4) Ambystoma Map and Marker Collection: an image and database resource that shows the location of mapped markers on linkage groups, provides information about markers, and provides integrating links to Ambystoma EST Database and Ambystoma Gene Collection databases, 5) Ambystoma Genetic Stock Center: a website and collection of databases that describe an NSF funded salamander rearing facility that generates and distributes biological materials to researchers and educators throughout the world, and 6) Ambystoma Research Coordination Network: a web-site detailing current research projects and activities involving an international group of researchers. Sal-Site is accessible at http://www.ambystoma.org.

Animals↗
PubMed2004

Facilitators' influence on student PBL small group session online information resource use: a survey.

BACKGROUND: In problem-based learning curricular research has focused on the characteristics of good facilitators and how they influence student performance and satisfaction. Far less frequently addressed has been the question of how PBL facilitators influence the small group session activity of students. We investigated the impact that facilitators' encouragement of use or non-use of the Internet would have on the students' use of online information resources. METHODS: Survey of student and facilitator perceptions of facilitator behavior and student use of online information resources. RESULTS: Students who used online information resources rated their facilitators' behavior as more encouraging, while students in groups who didn't use online information resources during problem-based learning small group sessions rated their facilitators' behavior as less encouraging. This result was statistically significant. CONCLUSIONS: Our study supports the role of the facilitator as an influence on medical students in small groups, particularly with respect to facilitator verbal behavior encouraging or discouraging student use of information technology in the problem-based learning small group session.

Attitude of Health Personnel↗
PubMed2004

Health, human rights and mobilization of resources for health.

BACKGROUND: There has been an increased interest in the role of a human rights framework to mobilize resources for health. DISCUSSION: This paper argues that the human rights framework does provide us with an appropriate understanding of what values should guide a nation's health policy, and a potentially powerful means of moving the health agenda forward. It also, however, argues that appeals to human rights may not necessarily be effective at mobilizing resources for specific health problems one might want to do something about. Specifically, it is not possible to argue that a particular allocation of scarce health care resources should be changed to a different allocation, benefiting other groups. Lack of access to health care services by some people only shows that something has to be done, but not what should be done. SUMMARY: The somewhat weak claim identified above together with the obligation to realize progressively a right to health can be used to mobilize resources for health.

Journal Article↗
PubMed2004

Public sector reform and demand for human resources for health (HRH).

This article considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector.Fiscal reform results in pressure to measure the staff outputs of the health sector. Financial decentralisation often leads to hospitals becoming "corporatised" institutions, operating with business principles but remaining in the public sector. The introduction of market mechanisms often involves the formation of an internal market within the health sector and market testing of different functions with the private sector. This has immediate implications for the employment of health workers in the public sector, because the public sector may reduce its workforce if services are purchased from other sectors or may introduce more short-term and temporary employment contracts.Decentralisation of budgets and administrative functions can affect the health sector, often in negative ways, by reducing resources available and confusing lines of accountability for health workers. Governance and regulation of health care, when delivered by both public and private providers, require new systems of regulation.The increase in private sector provision has led health workers to move to the private sector. For those remaining in the public sector, there are often worsening working conditions, a lack of employment security and dismantling of collective bargaining agreements.Human resource development is gradually being recognised as crucial to future reforms and the formulation of health policy. New information systems at local and regional level will be needed to collect data on human resources. New employment arrangements, strengthening organisational culture, training and continuing education will also be needed.

Journal Article↗
PubMed2006

Estimating health workforce needs for antiretroviral therapy in resource-limited settings.

BACKGROUND: Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART), for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes. METHODS: We reviewed the published literature and selected plans and scaling-up proposals, interviewed experts and collected data on staffing patterns at existing treatment sites through a structured survey and site visits. RESULTS: We found a wide range of staffing patterns and patient-provider ratios in existing and planned treatment programmes. Many factors influenced health workforce needs, including task assignments, delivery models, other staff responsibilities and programme size. Overall, the number of health care workers required to provide ART to 1000 patients included 1-2 physicians, 2-7 nurses, <1 to 3 pharmacy staff, and a much wider range of counsellors and treatment supporters. We estimate from these data that the equivalent of 20,000 to 100,000 physicians, nurses, pharmacists and other core clinical staff will be needed to meet the WHO target of treating 3 million people by the end of 2005. The total number of staff, including counsellors, administrators and other cadres, could be substantially higher. DISCUSSION: These data are consistent with other estimates of human resource requirements for antiretroviral therapy, but highlight the considerable variability of current staffing models and the importance of a broad range of factors in determining personnel needs. Few outcome or cost data are currently available to assess the effectiveness and efficiency of different staffing models, and it will be important to develop improved methods for gathering this information as treatment programmes are scaled up.

Journal Article↗
PubMed2005

Analysis of adequacy levels for human resources improvement within primary health care framework in Africa.

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels looking into the following aspects:- adequacy between skills-based profiles for health system professionals, quality of care and service delivery (health care system /medical standards), needs and expectations from the populations,- adequacy between allocation of health system professionals, quality of care and services delivered (health care system /medical standards), needs and expectations from the populations,- adequacy between human resource management within health care system and medical standards,- adequacy between human resource management within education/teaching/training and needs from health care system and education sectors,- adequacy between basic and on-going education and realities of tasks expected and implemented by different categories of professionals within the health care system body,- adequacy between intentions for initial and on-going trainings and teaching programs in health sciences for trainers (teachers/supervisors/health care system professionals/ directors (teaching managers) of schools...). This tool is necessary for decision-makers as well as for health care system professionals who share common objectives for changes at each level of intervention within the health system. Setting this adequacy implies interdisciplinary and participative approaches for concerned actors in order to provide an overall vision of a more broaden system than health district, small island with self-rationality, and in which they operate.

Journal Article↗
PubMed2004

Non-adherence to antipsychotic medication regimens: associations with resource use and costs.

BACKGROUND: Several factors are thought to influence resource use and costs in treating schizophrenia. AIMS: To assess the relative impact of non-adherence and other factors associated with resource use and costs incurred by people with schizophrenia. METHOD: Secondary analyses were made of data from a 1994 national survey of psychiatric morbidity among adults living in institutions in the UK. Factors potentially relating to resource use and costs were examined using two-part models. RESULTS: Patients who failed to adhere to their medication regimen were over one-and-a-half times as likely as patients who did adhere to it to report use of in-patient services. Non-adherence is one of the most significant factors in increasing external service costs, by a factor of almost 3. Non-adherence predicted an excess annual cost per patient of approximately 2500 British pounds for in-patient services and over 5000 British pounds for total service use. CONCLUSIONS: Resource use and costs are influenced by various factors. Medication non-adherence consistently exhibits an association with higher costs. Further important factors are patient needs and the ability of the system to address them.

Adult↗
PubMed2004

Information resources used in antimicrobial prescribing.

To describe resources clinicians use when they prescribe antimicrobials, the authors surveyed prescribers by telephone within hours (median 2.9) after they ordered one or more antimicrobials for a patient. Among 157 prescribers, 87 (55%) used one or more external resources to aid in decisions about their order. The other 70 (45%) used only their own knowledge and experience. Fifty-nine (38%) consulted another person. Fifty-four (34%) used a print, computer, or Internet resource. In multivariate analysis, use of an external resource was associated with the clinician being on the medical service (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.41-6.3) or being an intern (OR 13.65, 95% CI 1.44-128). Eighty percent of providers said information about antimicrobial prescribing at the point of electronic order entry would be helpful. It was concluded that decision support at the point of electronic order entry is likely to be used and might improve antimicrobial prescribing.

Anti-Bacterial Agents↗