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Results for “Program Acceptability”

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PubMed2002

National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan.

OBJECTIVES: Taiwan's National Health Insurance Program (NHI) was implemented on March 1, 1995. This study analyzed the influences of the Case Payment method of reimbursement for inpatient care and of physician financial incentives on a woman's choice for primary cesarean delivery. METHODS: Logistic regressions were used to analyze 11 788 first-time deliveries in a nonprofit hospital system between March 1, 1994, and February 29, 1996. RESULTS: After implementation of the NHI's Case Payment scheme, the likelihood that a woman would choose primary cesarean delivery increased by four to five times compared with the choice behavior of uninsured individuals prior to NHI (P <.0001). CONCLUSION: Out-of-pocket payment discourages the selection of primary cesarean delivery. No robust statistics were found relating physician financial incentives to delivery choice.

Adult↗
PubMed2003

Policy without politics: the limits of social engineering.

The extent of coverage provided by a country's health services is directly related to the level of development of that country's democratic process (and its power relations). The United States is the only developed country whose government does not guarantee access to health care for its citizens. It is also the developed country with the least representative and most insufficient democratic institutions, owing to the constitutional framework of the political system, the privatization of the electoral process, and the enormous power of corporate interests in both the media and the political process. As international experience shows, without a strong labor-based movement willing to be radical in its protests, a universal health care program will never be accepted by the US establishment.

Capitalism↗
PubMed2004

The impact of the SARS epidemic on the utilization of medical services: SARS and the fear of SARS.

Using interrupted time-series analysis and National Health Insurance data between January 2000 and August 2003, this study assessed the impacts of the severe acute respiratory syndrome (SARS) epidemic on medical service utilization in Taiwan. At the peak of the SARS epidemic, significant reductions in ambulatory care (23.9%), inpatient care (35.2%), and dental care (16.7%) were observed. People's fears of SARS appear to have had strong impacts on access to care. Adverse health outcomes resulting from accessibility barriers posed by the fear of SARS should not be overlooked.

Ambulatory Care↗
PubMed1988

Correlation between sperm morphology, acrosin, and fertilization in an IVF program.

Acrosin, a neutral proteinase, is located within the acrosome. The aim of this study was to evaluate acrosin concentrations in patients with severe damage of the sperm head and to determine whether acrosin concentration could predict the chances of fertilization in an IVF program. Sixty patients were accepted into this study, prospectively. The patients were divided into two groups, those with a normal morphology of less than 14% (group I, n = 33) and those with normal morphology less than 14% (group II, n = 27). All patients had a sperm concentration of less than 20 million sperm/ml and less than 30% progressively motile sperm. The acrosin assays were performed on the semen sample obtained on the day of IVF. Routine IVF insemination procedures were used, and only mature oocytes were considered. The only factor that showed a significant correlation of fertilization was normal morphology (p less that 0.01). The mean acrosin level was 73.4 /+- 38.6 mED/10 million sperm in group I and 70.9 /+- 42.7 mIU/10 million sperm in group II (no significant difference). The fertilization rate in group I was 45.4% and in group II, 77.7% p less than 0.002). Acrosin levels were not significantly different in patients with and without fertilization (72.0 /+- 42.1 and 73.6 /+- mIU/10 million sperm, respectively).

Acrosin↗
PubMed1996

Successful donor insemination and its impact on recipients.

Male and female partners of couples who conceived a child by donor insemination (DI) independently completed a questionnaire. Fifty-seven women and 53 men representing 58 couples taking part. Fifty-one were in a continuing relationship and seven were separated. A likert scale (0-7) of "happiness' before, during and after treatment and their perception of their partner's feelings were used as measures. These feelings were evaluated in relation to demographic and clinical factors. Fifty-one women and 49 men who were in a continuing relationship answered questions about their feelings about DI, compared to six and three, respectively, who had separated. Feelings about DI were consistently low before treatment began. For both continuing and separated couples there was an improvement of their feelings about having DI during treatment, and then again after treatment was complete. For the male partner, factors that were associated with greater unhappiness included difficulties with the relationship prior to treatment, waiting time for treatment and subsequent separation. The women, however, had more positive experiences with no measured factors adversely affecting their feelings about DI. The arrival of the DI child had a significant effect in improving the relation-ship. Our findings suggest that for many couples acceptance of the DI program was less than ideal and only improved with having the treatment and then conceiving. The data highlight the need for psychosocial assistance to be made available to couples prior to the commencement of treatment.

Attitude to Health↗
PubMed1977

Preliminary observations on an intervention program for heavy smokers.

Each of 571 smokers selected one of three methods of smoking cessation: group therapy, individual counseling, and hypnosis. One-year results suggest little difference between the three methods in producing ex-smokers. All methods produced an average success rate of approximately 20%. It should be noted, however, that with all types of verbal or verbally related therapy it is not known precisely how these techniques work or whether the outcomes are really a function of what is put into the therapy by the treatment agent and/or the recipient. It was generally found that younger, more educated smokers chose hypnosis; older, more educated smokers chose group therapy; and older, less-formally educated smokers chose individual counseling while the youngest and generally less educated smokers chose to become nonattenders and not take part in therapy. These results have important implications for designing optimal treatment programs which will be acceptable and effective for the greatest number of smokers.

Adult↗
PubMed1993

Characterization of the management practices of the top milk producing herds in the country.

Out of 128 surveys mailed to dairy farms that had been identified by the nine DHI processing centers as the top milk producing herds in the country, 61 surveys were returned. The predominant forage being fed was corn silage, followed by legume hay and haylage. On average, 6.7 feed additives and 3.5 alternative feeds were fed. Producers reported the following incidences of metabolic disorders: parturient paresis, 7.2%; displaced abomasum, 3.3%; ketosis, 3.7%; and nonspecific downer cow syndrome, 1.1%. Producers scheduled detection of estrus 3.1 times per day. Only 18.3% of the herds used routine synchronization of estrus. Artificial insemination was used on 94.8% of the cows and 88.5% of the heifers. The most important trait in sire selection was PTA for milk. For mastitis control, 75.4% of the producers practiced predipping, 85.2% used individual paper towels, 93.4% practiced postdipping, and 95.1% treated all cows at cessation of milking. Increased profitability and lower costs or higher returns were the primary motivators of these producers. Veterinarians were the most frequent source of information, followed by farm magazines. Satellite delivery of educational programs was the least acceptable delivery method. Extension professionals need to be cognizant of the producers' preferred information sources and delivery systems to ensure accurate, timely, cost-effective transfer of technological advances.

Animal Feed↗
PubMed2006

An SPSS implementation of the nonrecursive outlier deletion procedure with shifting z score criterion (Van Selst & Jolicoeur, 1994).

Sophisticated univariate outlier screening procedures are not yet available in widely used statistical packages such as SPSS. However, SPSS can accept user-supplied programs for executing these procedures. Failing this, researchers tend to rely on simplistic alternatives that can distort data because they do not adjust to cell-specific characteristics. Despite their popularity, these simple procedures may be especially ill suited for some applications (e.g., data from reaction time experiments). A user friendly SPSS Production Facility implementation of the shifting z score criterion procedure (Van Selst & Jolicoeur, 1994) is presented in an attempt to make it easier to use. In addition to outlier screening, optional syntax modules can be added that will perform tedious database management tasks (e.g., restructuring or computing means).

Humans↗
PubMed1976

Hycanthone dose-response in treatment of schistosomiasis mansoni in St. Lucia.

Clinical trials of hycanthone (single intramuscular dose) were undertaken in schistosomiasis mansoni patients in St. Lucia at five dose levels: 3.0, 2.5, 2.0, 1.5, and 1.0 mg/kg body weight. The most common side effect, vomiting, decreased in frequency from 51% at the highest dose to 3% at the lowest; minor side effects showed a similar trend. Three fecal specimens were examined before and at 6 months after treatment by qualitative, quantitative, and hatching techniques. All dose levels caused reductions in egg excretion of 89 to 98%. Rates of cure (absence of eggs by all three methods) according to dose (descending), pretreatment egg output (0-19, 20-49, 50-399, 400+ eggs/ml feces), and age (0-7, 8-14, 15-29, 30+ years) were analyzed to estimate the effect of each variable if the others had been constant. For dose, the standardized percentage success rates were 53.9%, 62.0%, 51.2% 54.0%, and 27.4%; for egg output, 67.0%, 51.8%, 43.2%, and 21.7%; and for age, 25.2%, 34.5%, 59.3% and 57.4%. Logit regression analysis shows a significant difference in cure rate (a) between the lowest dose and all others, among which latter there was no difference, (b) between patients excreting 0 to 49 eggs/ml before treatment and those excreting 50+ eggs/ml, and (c) between the age groups 0 to 14 and 15+ years. All dose levels caused some regression in enlargement of liver or spleen. A dose of 1.5 to 2.0 mg/kg body weight is considered to be as effective as one of 3.0 mg/kg and more acceptable for a control program because of the marked reduction in side effects.

Adolescent↗
PubMed1990

Cost-effectiveness of therapeutic drug monitoring.

Cost effectiveness analysis (CEA) has been applied to a wide range of health care procedures including TDM. The need for CEA of TDM has resulted from economic pressures for cost justification exerted by hospital administrators, government and, in the United States, by third party health insurers. The lack of well-designed studies has made it difficult to prove (or disprove) the credibility of TDM on an economic basis. When conducting a cost analysis evaluation of TDM, all costs and benefits must be identified, and to determine the program's viability, a study-specific analytical model is required. Ideally, the study should be controlled, comparative, prospective and have patient outcome as an assessed endpoint. Therapeutic drug monitoring has been shown to be cost-effective when SDCs are used with a sound pharmacokinetic basis, when the drugs monitored show a strong correlation between serum concentration and therapeutic outcome, and when the program has been well accepted by the professional personnel within the institution.

Cost-Benefit Analysis↗
PubMed1992

Increasing women's participation in Pap smear screening in Australia--how can we tell if the national policy is effective?

A national policy on the prevention of cervical cancer was launched in 1991. The success of the policy should be judged in terms of the extent that appropriate screening of the 'at risk' population is achieved by the screening program and the degree of reduction of differential screening rates between population groups. The relative cost-effectiveness of the various recruitment strategies chosen to meet the policy's objectives should also be evaluated. A necessary prerequisite for evaluation of the policy is the availability of data about the population screened.

Adult↗