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At least 1,207 records · Page 67Linked to original sources
PubMed1999

The role of the workplace in the production and containment of health costs: the case of stress-related disorders.

Workplaces vary enormously in the amount of harmful stress they produce, even within specific economic sectors. Stress of certain kinds and at certain levels tend to produce health harms and costs that are borne not only by individual employees and employers but also by families and society at large. Variations in stress levels within economic sectors can be traced to variations in management practices that govern key conditions of work involving demand, effort, control and reward. The costs of stress-related disorders produced by adverse governance practices are transferred outside the workplace in varying degrees. The actual extent of this cost transfer depends on policies and programs within the workplace. We can characterize workplaces according to a typology in which the key dimensions are commitment to abate harm through participatory management practices and the effectiveness and efficiency of harm containment through programs such as employee assistance and health promotion. The most health-promoting and cost-avoiding workplaces foster high control, high reward conditions and support employees with employee assistance and health promotion programs. The policy implications of this observation are drawn out.

Absenteeism↗
PubMed1992

Improved animal production by genetic engineering of ruminal bacteria.

Ruminant production is a major focus of Australian agriculture. The ability of ruminant animals such as sheep and cattle to make productive use of low quality plant materials depends on the activity and efficiency of the anaerobic microbial population that resides in the rumen. Factors that affect ruminant production include the ability of cellulolytic microorganisms to digest plant structural polysaccharides (primarily cellulose and hemicellulose), the capacity of microorganisms to metabolise and detoxify otherwise inhibitory plant products and the efficiency of nitrogen utilisation by ruminal organisms. This review will consider some current Australian research programs aimed at improving ruminant production efficiency by genetic engineering of ruminal bacteria.

Agriculture↗
PubMed1982

Voluntary school screening for scoliosis in Minnesota.

School screening for scoliosis is a well accepted technique for the early detection of spinal deformities. We reviewed the experience in Minnesota over the past eight years, with an average of one-quarter of a million children being screened yearly. Of the children screened, 3.4 per cent were referred for evaluation and scoliosis was found in 1.2 per cent. The number of children requiring operations for adolescent idiopathic scoliosis has diminished since 1970. The average curve for which a surgical procedure was done has also diminished from 60 to 42 degrees. The cost of the program is low, averaging 6.6 cents per student screened. This compares with a so-called time cost averaging thirty-five cents. Voluntary scoliosis screening in Minnesota is an efficient and cost-effective program.

Adolescent↗
PubMed1994

Evaluation of a DUR intervention: a case study of histamine antagonists.

Drug Utilization Review (DUR) programs aim to control inappropriate prescribing and drug costs, but there are few rigorous studies of their impact. This paper presents the evaluation results of a DUR intervention (excessive duration of full-dose histamine-2 receptor antagonists) using a quasi-experimental design. We observe a greater reduction of H2RA use in the intervention group than in the comparison group, and a reduction in drug expenditures which exceeded the cost of targeting and notifying prescribers. The success of DUR programs depends on both their efficiency and the drug issues under consideration; the use of a comparison group is critical in the evaluation of their impact.

Ambulatory Care↗
PubMed2001

Public health explores expanding newborn screening for cystic fibrosis, congenital adrenal hyperplasia, and medium-chain acyl coenzyme A dehydrogenase deficiency (MCAD).

Advances in technology provide new challenges to public health to implement screening programs that are effective, cost-efficient, and available to all infants regardless of ability to pay. The Newborn Metabolic Disorder Screening Program (NMDSP) of the Oklahoma State Department of Health is evaluating the expansion of newborn screening for the disorders of cystic fibrosis, congenital adrenal hyperplasia, and medium-chain acyl coenzyme A dehydrogenase deficiency (MCAD) to the current screening battery of disorders (phenylketonuria, congenital hypothyroidism, galactosemia, and sickle cell disease). The challenge is to offer these new screening tests in a cost-efficient manner that ensures all newborns have access to screening and that an infrastructure exists to diagnose and provide the specialized comprehensive care affected infants will require to reduce the morbidity, mortality, and disability associated with these disorders. Essential components of an effective newborn screening system include the smooth integration of sample collection, laboratory testing, follow-up, diagnosis, timely treatment, and tracking components. The NMDSP has recommended that screening should be expanded, but issues of cost and the establishment of a sustainable infrastructure of comprehensive medical services must be addressed.

Acyl-CoA Dehydrogenase↗
PubMed2002

[Delivery and puerperium of women after kinesitherapy--evaluation].

AIM: The attempt to estimate the influence of physical exercises for course of delivery and confinement. MATERIAL AND METHODS: The investigations were conducted at hospitals in following cities and towns: Bielsko--Biala, Nowy Targ, Sucha Beskidzka and in Gliwice. The efficiency of School of Birth program was studied. The 384 women with random chosen and the natural deliveries were examined. The interviews, analysis of hospitals cards and School of Birth specifications were studied. The estimations of efficiency of newborn children in Apgar scale and psychological and physical state of health of the women after delivers conducted by doctors were taken into consideration.

Adult↗
PubMed1998

Medicare program; HCFA market research for providers and other partners--HCFA. General notice with comment period.

This notice seeks public comments on information needs of Medicare risk contract health maintenance organizations (HMOs) and competitive medical plans (CMPs) and communication strategies that could improve the effectiveness and efficiency of the risk contract program. Under section 4002 of the Balanced Budget Act of 1997, and with the implementation of the Medicare + Choice program, all HMOs and CMPs will contract with HCFA under requirements of the Medicare + Choice program. The information sought in this notice will facilitate future changes in the contracting program, as well as improve information needs and communication strategies under the current risk program. Respondents should prioritize issues raised in the preliminary research and identify and additional areas of information needs and best communication strategies. This initiative is one component of our overall effort to develop a comprehensive communication strategy with Medicare providers and HMOs/CMPs and to develop innovative approaches that will assist all program participants to obtain and use information in the most accessible and effective manner. Preliminary research on the information needs of Medicare risk contract HMOs and CMPs and effective communication strategies has identified a number of areas in which we could provide additional information and potential strategies for communicating that information effectively.

Aged↗
PubMed2025

Integrated epigenetic and genetic programming of primary human T cells.

Targeted epigenetic engineering of gene expression in cell therapies would allow programming of desirable phenotypes without many of the challenges and safety risks associated with double-strand break-based genetic editing approaches. Here, we develop an all-RNA platform for efficient, durable and multiplexed epigenetic programming in primary human T cells, stably turning endogenous genes off or on using CRISPRoff and CRISPRon epigenetic editors. We achieve epigenetic programming of diverse targeted genomic elements without the need for sustained expression of CRISPR systems. CRISPRoff-mediated gene silencing is maintained through numerous cell divisions, T cell stimulations and in vivo adoptive transfer, avoiding cytotoxicity or chromosomal abnormalities inherent to multiplexed Cas9-mediated genome editing. Lastly, we successfully combined genetic and epigenetic engineering using orthogonal CRISPR Cas12a-dCas9 systems for targeted chimeric antigen receptor (CAR) knock-in and CRISPRoff silencing of therapeutically relevant genes to improve preclinical CAR-T cell-mediated in vivo tumor control and survival.

Humans↗
PubMed2002

Cost of distributing oral raccoon-variant rabies vaccine in Ohio: 1997-2000.

OBJECTIVE: Analysis of the cost of 8 distributions of oral rabies vaccine (ORV) with strains known to infect raccoons in Ohio between 1997 and 2000. DESIGN: Original study. PROCEDURE: Fishmeal bait containing ORV was distributed on foot, by vehicle, and by helicopter and fixed-wing aircraft. The cost of personnel, vehicles, and helicopter and aircraft use and other associated expenses were obtained from field records and interviews with personnel and agencies involved in the ORV program. RESULTS: Each bait distribution lasted approximately 1 week. Areas baited ranged from 1,701 km2 to 6,497 km2. Density varied for each distribution, with means of 79 baits/km2 for ground baiting and 93 baits/km2 for aerial baiting. Typically, 72 people participated in the ground portion of each distribution and 32 in the aerial portion. The cost of ground baiting (mean +/- SD, 19.24 dollars/km2 +/- 6.35 dollars/km2) was consistently less than that for air baiting (mean +/- SD, 24.71 dollars/km2 +/- 4.65 dollars/kml) for each distribution. The total cost of distribution varied from 30,568 dollars to 145,842 dollars (mean, 96,791 dollars), and bait cost varied from 150,714 dollars to 1,029,423 dollars (mean, 543,839 dollars). The total cost of ORV distributions ranged from 102 dollars/km2 to 261 dollars/km2 (mean, 153 dollars/km2). CONCLUSIONS: In the United States, rabies strains that infect raccoons have been responsible for the largest increase in rabies in animals in the past 3 decades. Use of ORV is a promising new tool that can be used to control rabies in raccoons. Documenting the estimated cost of implementing an ORV program may lead to more efficient use of resources to control and limit the spread of rabies. In addition, accurately measured distribution costs can be used to perform an economic cost-benefit analysis for an ORV program.

Administration, Oral↗
PubMed1984

A micro-computer program package for the computation of intraocular lens powers.

An accurate micro-computer software package has been designed to assist in the calculation of IOL powers. This program set should be able to be used on any Z80 computer with the CPM operating system. It accepts measurement data, calculates the implant powers and their estimated postoperative refractions, using the same formulas as the Binkhorst IOL Power Module used in the TI- 58C programmable calculator. The advantages are that the method of entry of data helps to eliminate the clerical errors such as number transposition and impossible value entry. The program also allows for the storage of the patient information in a disc file for future use. This can speed the search for a patient's records and help to increase the efficiency of the office. The program can be executed in much less time and with greater accuracy and legibility than is possible with the TI- 58C programs.

Cell Count↗
PubMedDate not supplied

The HIV epidemic in China: history, response, and challenge.

The first case of AIDS was reported in 1985 in China, but by the early 21st century, the government estimated that there were 840,000 citizens living with HIV/AIDS. The number is increasing rapidly. The major risk groups are injection drug users (IDUSs; 43%) and former plasma donors (27%), but rates among heterosexual groups are rising rapidly. Sentinel surveillance was initiated in 1986, and now includes IDUs, men-who-have-sex-with-men, sexually transmitted disease clinic attendees, antenatal women, long-distance truck drivers, and sex workers. Although the government was slow to respond to the epidemic in the late 20th century, it has made a vigorous response in the early 21st century. Components of that response include implementation and evaluation of harm reduction programs for IDUs, education to increase knowledge and reduce stigma, treatment and social support for rural and poor HIV/AIDS patients, widespread testing, and increased funding for HIV/AIDS programs. International agencies have been generous in their support of the government initiatives. To successfully combat the epidemic, China needs to develop and train the necessary infrastructure to implement its intervention programs, particularly in the rural areas, to vigorously combat stigma and discrimination, support research especially in the universities and research institutions other than the China Centers for Disease Control, develop a system for efficient exchange of research and program information, and update legislation to reflect the current situation.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Dairy herd reproductive management programs with or without synchronization of estrus.

Reproductive efficiencies were compared among herds with (treated, n = 25) or without (visited control, n = 25) routine synchronization of estrus and herds without investigator visits (unvisited control, n = 22). Treatment groups were subdivided based on participation in veterinary herd health programs. Reproductive tracts were palpated rectally at 21-d intervals for 6 mo in two sets of treated and visited control herds. Data were collected during the visitation period and from the 6-mo period before visits. In treated herds, cows more than 40 d postpartum with a corpus luteum received prostaglandin F2 alpha. In visited control herds, cows received prostaglandin F2 alpha after 82 d postpartum if they were not observed in estrus. Routine synchronization of estrus did not enhance herd reproductive efficiency compared with no synchronization of estrus in visited herds. Small changes in reproductive efficiency occurred during visits in herds with an established reproductive health program. However, herds not using a health program had 15.2 fewer d from calving to insemination, and the pregnancy rate at 120 d postpartum was 13.0 percentage units higher than before herd visits. Consequently, reproductive performance of those herds during visits was similar to that of contemporaries under a herd health program.

Animal Husbandry↗
PubMed1992

Evaluation of six computerized drug interaction screening programs.

Six widely used computerized drug interaction screening programs were evaluated according to criteria developed by a panel of pharmacists. A panel of six pharmacists from various practice settings developed criteria that were used to evaluate six computerized drug interaction screening programs: Medicom Micro Plus, Medical Letter, S-O-A-P, Drug Interactions by Hansten, Drug Therapy Screening Systems (DTSS), and RxTriage. The criteria were that the programs be user friendly and efficient, provide guidance, and be relevant to the user's practice setting. Also, they should detect interactions, quickly alert the user, and guide the user to the appropriate action. The user should be able to set the level of clinical significance, screen only current drugs in a patient profile, and print out summaries. The panel selected nine known drug interactions to test the programs' knowledge bases. Only Medicom Micro Plus and DTSS detected all nine drug interactions; Medical Letter missed three. RxTriage and Drug Interactions received the highest ratings in user friendliness and efficiency, but both missed two interactions. RxTriage was rated most relevant to their practice by hospital and community pharmacists, and Drug Interactions was rated most relevant by faculty practitioners. S-O-A-P received low ratings overall. Of the six drug interaction screening programs evaluated, none was considered by the panel of pharmacists to be ideal.

Data Display↗
PubMed2005

Effect of the CTL proliferation program on virus dynamics.

Experiments have established that CTLs do not require continuous antigenic stimulation for expansion. Instead, responses develop by a process of programmed proliferation which involves approximately 7-10 antigen-independent cell divisions, the generation of effector cells and the differentiation into memory cells. The effect of this program on the infection dynamics and the advantages gained by the program have, however, not been explored yet. We investigate this with mathematical models. We find that more programmed divisions can make virus clearance more efficient because CTL division continues to occur independent from antigenic stimulation when virus load drops to low levels. This results in stronger effector activity at low virus loads, and in a higher chance of virus extinction. On the other hand, the more programmed divisions occur, the less efficient the response is at preventing high acute virus loads and thus acute symptoms. The reason is that the programmed divisions are independent from antigenic stimulation, and an increase in virus load does not speed up the rate of CTL expansion. We hypothesize that the 7-10 programmed divisions observed in vivo represent an optimal solution to this trade-off which maximizes the chances to clear, while preventing excessive acute pathology. If the CTLs fail to clear the virus, however, we find that the properties of the programmed proliferation model are very similar to those derived from models which assume continuous antigenic stimulation. We discuss these results in the context of data from murine virus infections and explore implications for virus dynamics in CD4 helper-deficient hosts.

Animals↗
PubMed2003

Nonadherence to breast and cervical cancer screening: what are the linkages to chronic disease risk?

BACKGROUND: Several preventive practices that reduce chronic disease risk have been associated with breast and cervical cancer screening, including maintenance of normal weight and avoidance of cigarette smoking. A history of certain chronic illnesses such as diabetes and cardiovascular disease has also been related to cancer screening. Nevertheless, studies that have attempted to identify women who are less likely to have had a recent breast or cervical cancer screening test have infrequently examined the associations of breast and cervical cancer screening with multiple health factors that influence chronic disease risk. METHODS: To clarify relationships between cancer screening and health behaviors and other factors that influence chronic disease risk, we examined the self-reported breast and cervical cancer screening practices of women in the United States by using data from the 1999 Behavioral Risk Factor Surveillance System. The women were described according to their recent use of mammography and the Papanicolaou test, physician visits within the past year, health insurance coverage, and preventive practices that reduce chronic disease risk. RESULTS: Overall, 74.5% (95% CI, 73.9%-75.1%) of the women in this sample aged 40 years or older (n = 56,528) had received a mammogram within the past 2 years. The percentage of women who had been screened for breast cancer, however, varied widely by factors associated with reducing the risk of chronic disease (e.g., cholesterol check in the past 2 years, blood pressure check in the past 2 years, normal weight, avoidance of cigarette smoking) and having access to health care (e.g., health insurance coverage, recent physician visit). Similarly, 84.4% (95% CI, 83.9%-84.9%) of all women aged 18 years or older who had not undergone a hysterectomy (n = 69,113) had received a Papanicolaou test in the past 3 years, and factors associated with reduced chronic disease risk and health care access were related to having had a recent Papanicolaou test. CONCLUSION: The results of this study suggest that underscreened women who are at risk for breast and cervical cancer are likely to benefit from programs that identify and address coexisting prevention needs. The identification of coexisting prevention needs might assist in developing interventions that address multiple risks for chronic disease among women and might subsequently help improve the efficiency and effectiveness of prevention programs.

Adolescent↗
PubMed1987

The role of conjugation reactions in detoxication.

The role of conjugating enzymes is best understood by looking at the interaction between phase I (mostly cytochromes P-450) and phase II (conjugation) enzymes of drug metabolism. A balance between phase I and II enzymes of detoxication largely determines the disposition to drug toxicity. Reactive electrophilic metabolites, generated by phase I enzymes, are often controlled by GSH-transferases, whereas nucleophilic metabolites such as phenols are controlled by UDP-glucuronosyltransferases (GT) and sulfotransferases. It is more and more recognized that the control of the more stable and more abundant nucleophiles is as important as the control of electrophiles, since the former can be readily converted to electrophiles. For example, phenols and quinols can undergo quinone/quinol redox-cycles with the generation of reactive oxygen species. In the case of benzo(a)pyrene-3,6-quinol toxicity can be prevented by glucuronidation. Conjugating enzymes consist of families of isoenzymes with distinct but overlapping substrate specificity. Rather than dealing with individual isoenzymes, adaptive programs are emphasized by which gene expression of a battery of phase I and II enzymes is turned on by certain types of inducing agents. Mechanistically best known is the program turned on by 3-methylcholanthrene-type inducers which includes enhanced synthesis of certain isoenzymes of cytochrome P-450, GT and probably GSH-transferase. The program may adapt the organism to efficiently detoxify and eliminate aromatic compounds such as benzo(a)pyrene. Evidence is presented that this program exists in both rodents and humans.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

The administration of eligibility for community long-term care.

Eligibility assessment systems for community long-term care vary widely across current programs funded by states and Medicaid and in proposals to expand federal funding. Improved equity and efficiency in both current and proposed programs will require better specification of eligibility criteria, timing and setting of assessments, language of assessment items, training of assessors, procedures for appeal and review, and consideration of the costs of care management. Recent research and demonstrations provide models and technology for more uniform approaches in national programs.

Activities of Daily Living↗
PubMed2003

International developments in newborn screening quality assurance.

The five dimensions of quality are Accessibility, Acceptability, Effectiveness, Efficiency and Safety. A newborn screening program consists of a number of interlinked parts, not usually managed by the same individual, and the quality of the program is dependent on the quality of program planning, specimen collection, laboratory testing and follow up, diagnosis and treatment. Outcome assessment and feedback into program planning complete the loop. Use of the quality parameters can quantify ongoing improvements to our screening programs.

Efficiency, Organizational↗