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At least 1,279 records · Page 71Linked to original sources
PubMed1993

Large-scale, population-based prospective studies in Japan.

Large scale, population-based prospective studies have increasing importance for the study of common cancers in view of the possibility of advancing the understanding of different risk factors in the initiation, promotion and progression phases during what is thought to be the long process of human carcinogenesis. The permanent registration system in Japan ("Koseki") simplifies the follow-up of registered participants of such cohorts. The population-based cohort studied by Hirayama and the cohort of the atomic bomb survivors started during the 1960s are examples of such possibilities in Japan. Rapidly changing patterns of disease and lifestyles during the last 30 years require new population-based prospective studies focusing on a different set of exposures and with increased detail of exposure assessment. We have established a new population-based prospective study, the "Koseisho" cohort, between 1990 to 1992, following a cross-sectional study, using various biomarkers in five health centre districts. The Koseisho cohort comprises approximately 170,000 people aged 40-59 or 40-69 in 12 different health centre districts. The data are linked with the mass screening program registry data every year, and the sera and buffy coats collected at the beginning of the study will be stored at -80 degrees C for at least 10 years. We intend to integrate various sources of information about health conditions for the prevention of chronic diseases in these cohort areas. Nutritional practices are one of our main interests, and repeated surveys by different methods are planned. Although all death certificates are collected through the health centres, disease registration committees were established in each district to register incident cases of both cancer and certain cardiovascular diseases. Representative population-based prospective studies in Japan are briefly reviewed and introduced.

Adult↗
PubMedDate not supplied

Value-based health care. Part I: Physicians reestablishing clinical autonomy.

Clinical decision-making was once the sole purview of physicians, but no longer. Medical judgment has been usurped by third parties in the name of cost control. To reestablish this rightful authority, physicians must organize to assume the financial risks for their patients' health, using objective, clinical information to deliver superior quality outcomes. To successfully manage their patients' clinical and financial risks, physicians need to: (1) establish a structure independent of the hospital medical staff for outpatient contracting; (2) secure a capital partner that supports their independent, clinical decision-making; and (3) be leaders in acquiring and effectively using clinical information that accurately risk-adjusts and integrates both inpatient and outpatient data for all episodes of care. Physicians who acquire these skills will secure premium contracts from purchasers who are demanding value-based health care delivery.

Capital Financing↗
PubMedDate not supplied

[University training for coordinators].

We need an adequate quality level of information between the building design and manufacturing process for Health and Safety in the work site. A fully-developed communication system is needed, for H&S Coordinators, in order to integrate alphanumerical and graphical protocols. The Aim is: (1) to organise information on the building process, keeping communications in function of everyone's needs; (2) to carry out an audit process ensuring that all levels of contractors personnel are implementing the Project of Health and Safety Management Plan effectively; (3) To make all that with a Program Interface relatively simple. The synergy between Safety Manager and Designers generates a system output integrating all sorts of alphanumerical, graphical information and prescriptions. This system output has several targets: (1) to integrate Design and H&S in a specific Data-Base; (2) to define the preconditions of the work phases; (3) to develop the Work Program of Enterprise in function of the Health and Safety Plan in compliance with the contractor site-specific plan; (4) to develop a program process for the audit; (5) to review the contractor's Project for H & S; (6) to manage responsibility; (7) to keep corrective action.

Education↗
PubMed1999

Integrating cost information with health management support system: an enhanced methodology to assess health care quality drivers.

Changes in health care delivery, reimbursement schemes, and organizational structure have required health organizations to manage the costs of providing patient care while maintaining high levels of clinical and patient satisfaction outcomes. Today, cost information, clinical outcomes, and patient satisfaction results must become more fully integrated if strategic competitiveness and benefits are to be realized in health management decision making, especially in multi-entity organizational settings. Unfortunately, traditional administrative and financial systems are not well equipped to cater to such information needs. This article presents a framework for the acquisition, generation, analysis, and reporting of cost information with clinical outcomes and patient satisfaction in the context of evolving health management and decision-support system technology. More specifically, the article focuses on an enhanced costing methodology for determining and producing improved, integrated cost-outcomes information. Implementation issues and areas for future research in cost-information management and decision-support domains are also discussed.

Data Collection↗
PubMed1996

Integrating multiple publics into the strategic plan. The best plans can be derailed without comprehensive up-front research.

The mission of a health care organization represents its vision for the future. The authors present an approach used to develop an organizational mission for a large multispecialty physician clinic. In implementing the strategic planning process, research objectives must be clearly stated that identify in advance how the data will be used. Failure to integrate strategic data from all relevant publics will likely result in a mission statement that misses the significant interests of one or more stakeholders and reduces the effectiveness of the strategic planning process. Although costly, comprehensive research can uncover some surprising differences in perception that, if ignored, might complete defeat strategic planning efforts.

Allied Health Personnel↗
PubMed1998

A review of the feeding-health-production complex in a dairy herd.

Diseases may be an important link in the relationship between feeding and production in a dairy herd. The low frequency of relevant disorders calls for studies on survey data on a large population. However, this approach suffers from lack of detailed herd feeding data and consequently only few have studied feeding as a risk factor for disease. Therefore, we reviewed information from various studies to integrate what is known of the feeding-health-production complex in a dairy herd. The need for putting together information from different sources, the herd effects, and the fact that the effect of one factor cannot be kept constant for investigation in a real-life dynamic herd call for a conceptual model as a framework for the review. The complexity is minimized to allow the representation of important elements. Within-cow relationships (such as feeding-disease relationships, disease interrelationships, and disease-production relationships) are reviewed specifically for: ketosis, milk fever, displaced abomasum, acidosis, sole ulcers and laminitis, and bloat. The major feeding management factors involved are concentrate feeding (level and how it is provided) and overconditioned cows. Disease interrelationships are important. Generalization of production loss from diseases is complicated due to the variety of estimates and measures used.

Abomasum↗
PubMed2002

Health Economics Unit achievements.

This article describes the activities of the EORTC Health Economics Unit since its inception in early 1994. The aim of the unit is to carry out economic evaluations of competing treatment options in common cancers in order to provide health care decision makers with useful information about the relative benefits and costs of the therapies they have to choose between. These assessments are mainly carried out by integrating collection of economic data in selected phase III randomized controlled clinical trials conducted by the EORTC collaborative groups. Studies with an economic evaluation integrated are currently becoming mature enough for analysis and several publications have resulted or are in press. Some studies with data from other sources than EORTC trials have also been performed and published. In addition, the unit has actively followed and contributed to the continuous methodological development in the field of economic evaluation of health care interventions.

Clinical Trials, Phase III as Topic↗
PubMed1993

Economic impact of the AIDS epidemic in the European Community: towards multinational scenarios on hospital care and costs.

OBJECTIVE: To underpin multinational public-health HIV/AIDS strategy planning in the European Community (EC) by integrating national studies on HIV/AIDS in scenario analysis. METHOD: Three types of data are used: routine surveillance data, information on disease progression and observational studies on the economic impact. The HIV/AIDS epidemic is simulated using two models (MIDAS and PC-Based AIDS Scenarios). Selected simulations, consistent with surveillance data, are connected to economic impact (hospital-bed needs and annual hospital costs for AIDS patients). Parameter values expressing per person-year economic impacts are derived from a structured review of publications on economic aspects of AIDS. RESULTS: Evaluation of published studies on hospital resource use and costs in EC countries shows that there are significant differences between both countries and studies, even after conversion to similar measures (for example, using purchasing power parities). These differences are partly due to factors such as the composition of the patient population. Differences in methodology may also have influenced the results. Economic impact is analysed for combinations of three factors; survival time after AIDS diagnosis, hospital inpatient days needed per person-year and corresponding hospital costs per person-year. All scenarios indicate 1995 hospital-bed needs above the 1990 level of 5400 beds. Hospital cost projections for 1995 vary (up to US$1050 million). CONCLUSIONS: (1) For economic impact assessment, there are important gaps in epidemiological and economic data, and in the methods for linking these. (2) Standardization of studies on the resource use and costs of HIV/AIDS is necessary to provide a sound basis for multinational scenarios. (3) Preliminary multinational scenarios show that by 1995 hospital-bed needs for AIDS might reach 0.45% of all hospital beds available in the EC, and that hospital cost projections for AIDS in that year will range from 0.15% to 0.30% of EC health-care expenditure.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Computerizing an integrated clinical and financial record system in a CMHC: a pilot project.

The authors describe the three-year experience of a mid-sized community mental health center in designing and installing an automated Staff/Management Information System (S/MIS). The purpose of the project, piloted at the heart od Texas Region Mental Health Mental Retardation Center (HOTRMHMR) in Waco, Texas, was to examine the feasibility of a comprehensive data system operating at a local level which would create an effective audit trail for services and reimbursement and serve as a viable mechanism for the transmission of center data to a state system via computer tapes. Included in the discussion are agency philosophy, costs, management attitudes, the design and implementation process, and special features which evolved from the fully integrated system.

Community Mental Health Centers↗
PubMed2003

Preliminary evaluation of several disinfection/sterilization techniques for use with microdialysis probes.

This study evaluated the suitability of some disinfection and sterilization methods for use with microdialysis probes. Disinfection or sterilization should minimize the tissue inflammatory reaction and improve the long-term health of rats on study and ensure the quality of data obtained by microdialysis sampling. Furthermore, the treatment should not negatively impact probe integrity or sampling performance. The techniques chosen for evaluation included two disinfection methods (70% ethanol and a commercial contact lens solution) and two sterilization methods (hydrogen peroxide plasma, and e-beam radiation). Linear microdialysis probes treated by these processes were compared to untreated probes removed from the manufacturer's packaging as if sterile (the control group). The probes were aseptically implanted in the livers of rats and monitored for 72 hours. The parameters chosen to evaluate probe performance were relative sample mass recovery and the relative in vivo extraction efficiency of the probe for caffeine. Post mortem bacterial counts and histopathology examination of liver tissue were also conducted. The probes remained intact and functional for the entire study period. The methods tested did not acutely alter the probes although hydrogen peroxide plasma and contact lens solution groups showed reduced extraction efficiencies. Minimal tissue damage was observed surrounding the probes and acute inflammatory reaction was mild to moderate. Low numbers of bacterial colonies from the implantation sites indicates that the health of animals in this study was not impaired. This was also true for the control group (untreated probe).

Animals↗
PubMed1998

Associations between wife-beating and fetal and infant death: impressions from a survey in rural India.

This report examines the linkages between wife-beating and one health-related consequence for women, their experience of fetal and infant mortality. Community-based data are used drawn from women surveyed in two culturally distinct sites of rural India: Uttar Pradesh in the north, in which gender relations are highly stratified, and Tamil Nadu in the south, in which they are more egalitarian. Results suggest that wife-beating is deeply entrenched, that attitudes uniformly justify wife-beating, and that few women can escape an abusive marriage. They also suggest that the health consequences of domestic violence--in terms of pregnancy loss and infant mortality--are considerable and that Indian women's experience of infant and fetal mortality is powerfully conditioned by the strength of the patriarchal social system. Results are tentative because of data limitations, but they are consistent and strong enough to warrant concern. They argue for the integration of services to identify, refer, and prevent domestic violence in the primary or reproductive health programs of the country and for the safe motherhood programs to be particularly vigilant, sensitive, and responsive to the conditions of battered women during pregnancy and the postpartum period.

Developing Countries↗
PubMedDate not supplied

Perceptions and practice of health education and heath promotion in acute ward settings.

This paper reports on an overview of the findings from a two-year Department of Health-funded research project. The study had two overall aims: to describe the extent to which health education and health promotion had become integrated into nurses' practice in acute-care settings and to identify the facilitative and inhibitory factors involved. The study comprised separate sequential stages of data collection and utilised a multi-method approach. Findings from a survey of ward sisters and from ward-based case studies are presented and discussed. These suggest that nurses have yet to fulfill their potential as educators and promoters of health and that a number of influences interact at ward level to encourage or impede the development of this role.

Health Promotion↗
PubMed2002

Artificial neural networks for infant mortality modelling.

This work aims to investigate a simple to use and easy to interpret methodology for assessing the relative importance of input variables in artificial neural networks (ANNs) applied to epidemiological modelling. The independent variables were 43 variables of the social, economic, environmental and health sector of 59 Brazilian municipalities, and the outcomes were infant mortality rates from these municipalities. Two assays were developed for the ANN modelling. On the first, all 43 variables were taken as input; and on the second, input variables were chosen with the help of factor analysis (FA). The relative importance of the input variables was investigated by means of bootstrap replications of the ANN model on the second assay. Further, multiple linear regression models (LRMs) were developed with the same data set and compared to the ANN models. The FA analysis allowed the selection of eight variables for the second assay. The percent of explained variance R(2) on the ANNs was in the range 0.74-0.80, while linear models had R(2)=0.4-0.5. These findings were validated by the bootstrap replications, in which the ANN models remained with higher R(2) and lower mean square error than the LRMs. The analysis of the best (second) ANN model indicated the highest ranking of importance for the variables literacy, agricultural and livestock sector jobs, number of commercial establishments and telephones. The approach presented here successfully integrated a data-oriented model with expert knowledge, indicating the potentiality of ANN modelling in the prediction, planning and assessment of public health actions.

Brazil↗
PubMed2004

An integrated method to determine meaningful changes in health-related quality of life.

OBJECTIVE: We describe an integrated method for determining meaningful change in health-related quality of life (HRQOL) that combines information from anchor-based and distribution-based methods and illustrate this method using data aggregated from weight loss studies. STUDY DESIGN AND SETTING: A total of 1476 participants in weight loss studies were evaluated at baseline and at 6 months using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). Severity of baseline impairment was determined by comparing scores with those obtained from a normative sample of 534 normal/overweight individuals. The precision of the IWQOL-Lite was evaluated using standard error of measurement corrected for regression to the mean. Weight loss was used as an anchor for evaluating changes in IWQOL-Lite scores. RESULTS: Change in HRQOL varied as a function of weight loss and baseline severity of HRQOL. Using this integrated method, an improvement of 7.7 to 12 points (depending on baseline severity) on IWQOL-Lite total score is considered meaningful. CONCLUSION: Meaningful change in HRQOL can be determined using an integrated method that (1) combines information from anchor-based and distribution-based methods, (2) reconciles discrepancies between these two methods, and (3) adjusts for baseline severity and regression to the mean. This method may be applied to other types of HRQOL measures and conditions.

Adult↗
PubMed2005

Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders.

OBJECTIVE: Women with co-occurring mental health and substance use disorders frequently have a history of interpersonal violence, and past research has suggested that they are not served effectively by the current service system. The goal of the Women, Co-occurring Disorders, and Violence Study was to develop and test the effectiveness of new service approaches specifically designed for these women. METHODS: A quasi-experimental treatment outcome study was conducted from 2001 to 2003 at nine sites. Although intervention specifics such as treatment length and modality varied across sites, each site used a comprehensive, integrated, trauma-informed, and consumer-involved approach to treatment. Substance use problem severity, mental health symptoms, and trauma symptoms were measured at baseline, and follow-up data were analyzed with prospective meta-analysis and hierarchical linear modeling. RESULTS: A total of 2,026 women had data at the 12-month follow-up: 1,018 in the intervention group and 1,008 in the usual-care group. For substance use outcomes, no effect was found. The meta-analysis demonstrated small but statistically significant overall improvement in women's trauma and mental health symptoms in the intervention relative to the usual-care comparison condition. Analysis of key program elements demonstrated that integrating substance abuse, mental health, and trauma-related issues into counseling yielded greater improvement, whereas the delivery of numerous core services yielded less improvement relative to the comparison group. A few person-level characteristics were associated with increases or decreases in the intervention effect. These neither moderated nor supplanted the effects of integrated counseling. CONCLUSIONS: Outcomes for women with co-occurring disorders and a history of violence and trauma may improve with integrated treatment.

Adult↗
PubMed1998

[Treatment of colorectal cancer. Pharmaco-economic aspects].

Cancer patients care is mainly based on scientific studies, but sometimes approaches are empiric. Rapid growth of health care expenses force the physician to take pharmacoeconomic aspects into consideration. New clinical studies have to analyse clinical benefits but also cost-effectiveness. We will review the various aspects of colorectal cancer from primary prevention to post-treatment follow-up. Scientific data are integrated in a pharmacoeconomic analysis.

Antineoplastic Agents↗
PubMed2001

What are the principles and processes of inspiring hope in cognitively impaired older adults within a continuing care environment?

This study focuses on the principles and processes that psychiatric/mental health (P/MH) nurses use to inspire hope in cognitively impaired older adults within a National Health Service (NHS) continuing care environment. Using a grounded theory method, the data were coded and analysed, in an attempt to produce an integrated conceptual framework of hope inspiration. This comprised four core variables: applied humanistic code, pragmatic knowledge, interpersonal relations and nurse as utilizer. The authors postulate a relationship between the function of caring, the activity of helping and the practice of instilling hope, as a basis for suggesting that inspiring hope to clients is one of the primary acts of P/MH nursing. The authors conclude that the four core variables are intertwined and inseparable from one another, and bound up with P/MH nursing practice. From this position, it is suggested that the processes of inspiring and instilling hope cannot be separated from the qualities of being a P/MH nurse. However, a more detailed and complete understanding of the concept of hope can increase the nurse's effectiveness as a carer.

Age Factors↗
PubMedDate not supplied

Integrating mental health services into primary care for HIV-infected pregnant and non-pregnant women: Whole Life--a theoretically derived model for clinical care and outcomes assessment.

Poor women of color who are disproportionately both infected and affected by HIV/AIDS also face multiple lifestyle and psychosocial burdens that complicate effective delivery of health care, thereby contributing to their poorer prognosis. Addressing these factors within the context of HIV/AIDS primary care for women is the aim of Whole Life, a program to integrate mental health services into primary care for HIV-infected pregnant and non-pregnant women. Whole Life utilizes a theoretically derived clinical services model that provides data for both clinical care and patient outcomes research within the constraints of a clinical setting. During a woman's first two clinic visits, data are gathered in structured interviews with standardized instruments-adapted for relevance to the population-that meet clinical and service needs, as well as measure components of the Whole Life model. Interviews are conducted by existing front-line staff who have been trained in using these instruments to gather information typically recorded in clinical notes. The implementation of Whole Life to date clearly demonstrates the feasibility of mental health-primary care services integration in a publicly funded HIV primary care clinic serving poor women of color.

Adult↗