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Animal-based medicines: biological prospection and the sustainable use of zootherapeutic resources.

Animals have been used as medicinal resources for the treatment and relieve of a myriad of illnesses and diseases in practically every human culture. Although considered by many as superstition, the pertinence of traditional medicine based on animals cannot be denied since they have been methodically tested by pharmaceutical companies as sources of drugs to the modern medical science. The phenomenon of zootherapy represents a strong evidence of the medicinal use of animal resources. Indeed, drug companies and agribusiness firms have been evaluating animals for decades without paying anything to the countries from where these genetic resources are found. The use of animals' body parts as folk medicines is relevant because it implies additional pressure over critical wild populations. It is argued that many animal species have been overexploited as sources of medicines for the traditional trade. Additionally, animal populations have become depleted or endangered as a result of their use as experimental subjects or animal models. Research on zootherapy should be compatible with the welfare of the medicinal animals, and the use of their by-products should be done in a sustainable way. It is discussed that sustainability is now required as the guiding principle for biological conservation.

Animal Experimentation↗

Cost of schizophrenia: direct costs and use of resources in the State of São Paulo.

OBJECTIVE: To estimate the direct costs of schizophrenia for the public sector. METHODS: A study was carried out in the state of São Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. RESULTS: Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US $191,781,327 (2.2% of the total health care expenditure in the state). Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. CONCLUSIONS: Most schizophrenia patients in the state of São Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.

Brazil↗

[Evaluation of the United Nations Declaration on HIV/AIDS resource targets].

This study evaluates the targets of the United Nations Declaration on HIV/AIDS Resource Targets, the attainment of which are premised on promoting three fronts: reduction of material and services costs, increased efficiency in access to and management of funds, and the channeling of new funds. Data were derived from studies of National Accounts of HIV/AIDS in Latin America and the Caribbean and from the recent available literature on the global dynamics of HIV/AIDS resources. The economic concept of global public good occurs throughout the text. The article discusses factors that constrain funding, and thus compel the adoption of new strategies in Brazil. The issues addressed include: difficulties in maintaining the downward tendency in the cost of items related to the HIV/AIDS epidemic, the incorporation each year of thousands of persons needing antiviral therapy, the rise in patient survival and increased diagnosis for the control of HIV/AIDS transmission. It is concluded that, in order to guarantee additional resources to combat the epidemic, the discussion on funding must necessarily focus on both the share of AIDS support for the Brazilian Ministry of Health, and, more importantly, on an increase in health funding as a whole. The recognition that HIV/AIDS control contributes to the global public good should facilitate increases in development assistance from international funding sources.

Acquired Immunodeficiency Syndrome↗

Human health improvement in Sub-Saharan Africa through integrated management of arthropod transmitted diseases and natural resources.

A concept of an ecosystem approach to human health improvement in Sub-Saharan Africa is presented here. Three factors mainly affect the physical condition of the human body: the abiotic environment, vector-transmitted diseases, and natural resources. Our concept relies on ecological principles embedded in a social context and identifies three sets of subsystems for study and management: human disease subsystems, natural resource subsystems, and decision-support subsystems. To control human diseases and to secure food from resource subsystems including livestock or crops, integrated preventive approaches are preferred over exclusively curative and sectorial approaches. Environmental sustainability - the basis for managing matter and water flows - contributes to a healthy human environment and constitutes the basis for social sustainability. For planning and implementation of the human health improvement scheme, participatory decision-support subsystems adapted to the local conditions need to be designed through institutional arrangements. The applicability of this scheme is demonstrated in urban and rural Ethiopia.

Africa South of the Sahara↗

Health, biodiversity, and natural resource use on the Amazon frontier: an ecosystem approach.

This study aims to improve the health of rural Amazonian communities through the development and application of a participatory ecosystem approach to human health assessment. In the study area marked seasonal fluctuations dictate food availability, water quality and disease outbreak. Determining the causal linkages between ecosystem variables, resource use and health required a variety of forms of inquiry at multiple scales with local participation. Landscape spatial mapping of resource use demonstrated the diversity of the ecological resources upon which communities depend. Household surveys detailed family and individual consumption and production patterns. Anthropometric measurements, parasite loading, water quality and anemia levels were used as indicators of health status. This was complemented with an ethnographic and participatory health assessment that provided the foundation for developing community action plans addressing health issues. Discussion is focused on three attributes of an ecosystem approach; (a) methodological pluralism, (b) cross-scale interactions and (c) participatory action research.

Conservation of Natural Resources↗

Impact of nesiritide on health care resource utilization and complications in patients with decompensated heart failure.

STUDY OBJECTIVE: To determine the impact of nesiritide on health care resource utilization and complications in patients hospitalized with decompensated heart failure. DESIGN: Retrospective case-control study. SETTING: United States hospitals. PATIENTS: Two hundred sixteen patients hospitalized for decompensated heart failure. MEASUREMENTS AND MAIN RESULTS: One hundred eight patients who received a nesiritide infusion for a minimum of 12 hours during the first 48 hours after hospital admission were matched with 108 patients not receiving nesiritide. Health care resource utilization, consisting of hospital length of stay (LOS), rate of rehospitalization within 90 days, concomitant drugs administered, and laboratory and diagnostic tests, was determined for each hospital admission. Rates of adverse events also were recorded. Patients receiving nesiritide had a significantly shorter LOS in a critical care unit (p=0.03). General medical ward or step-down unit LOS was not different between the treatment groups. A favorable trend toward a lower rate of rehospitalization over the 90-day follow-up period was observed with nesiritide (p=0.07). The number of patients who developed life-threatening ventricular arrhythmias and hypotension was similar for both treatment groups. However, in patients receiving nesiritide, significantly less atrial fibrillation (p=0.03) and renal dysfunction (p=0.04) occurred compared with patients not receiving nesiritide. CONCLUSION: Nesiritide therapy is associated with significant reductions in both health care resource utilization and complications in patients with decompensated heart failure.

Aged↗

Resource allocation, health policy, and rationing craniofacial care.

The United States allocates health care without an overt system of rationing. This article analyzes the forces that guide resource allocation to craniofacial care. Various possible allocation systems are reviewed for how decision makers might evaluate proposed programs for legislative funding. Using a case-based exercise, readers are asked to weigh the potential costs and benefits of six health and social programs. These programs are also systematically examined for factors that are likely to affect resource allocation decisions. Eleven factors that affect decision-making are utilized in the analysis, ranging from the cost per client to emotional or human interest content of the proposed programs. Decisions about preventive programs are compared with those involving therapeutic programs. The allocation of resources to craniofacial programs, including those for children with rare major craniofacial conditions, is considered in the context of social justice and broad contemporary ethical and health care delivery issues.

Acquired Immunodeficiency Syndrome↗

In collaboration: the Jackson Laboratory Craniofacial Resource.

Dr. Sandy C. Marks, Jr., has been a longtime collaborator of the Mouse Mutant Resource at The Jackson Laboratory and, most recently, was involved in the development of a Craniofacial Resource at TJL. The goals of this resource are to discover and supply to the scientific community mouse models of human craniofacial disease. A brief description of this collaboration is presented in Sandy's honor.

Animals↗

Allocating HIV-prevention resources: balancing efficiency and equity.

The primary goal of HIV prevention is to prevent as many infections as possible. This requires allocating HIV-prevention resources according to cost effectiveness principles: those activities that prevent more infections per dollar are favored over those that prevent fewer. This is not current practice in the United States, where prevention resources from the federal government to the states flow in proportion to reported AIDS cases. Although such allocations might be considered equitable, more infections could be prevented for the same expenditures were cost-effectiveness principles invoked. The downside of pure cost-effective allocations is that they violate common norms of equity. In this article, we argue for a middle ground that promotes both equity and efficiency in allocating federal HIV-prevention resources.

Acquired Immunodeficiency Syndrome↗

Effect on water resources from upstream water diversion in the Ganges basin.

Bangladesh faces at least 30 upstream water diversion constructions of which Farakka Barrage is the major one. The effects of Farakka Barrage on water resources, socioeconomy, and culture have been investigated downstream in the basins of the Ganges and its distributaries. A diversion of up to 60% of the Ganges water over 25 yr has caused (i) reduction of water in surface water resources, (ii) increased dependence on ground water, (iii) destruction of the breeding and raising grounds for 109 species of Gangetic fishes and other aquatic species and amphibians, (iv) increased malnutrition, (v) deficiency in soil organic matter content, (vi) change in the agricultural practices, (vii) eradication of inland navigable routes, (viii) outbreak of waterborne diseases, (ix) loss of professions, and (x) obstruction to religious observances and pastimes. Further, arsenopyrites buried in the prebarrage water table have come in contact with air and formed water-soluble compounds of arsenic. Inadequate recharging of ground water hinders the natural cleansing of arsenic, and threatens about 75,000,000 lives who are likely to use water contaminated with up to 2 mg/L of arsenic. Furthermore, the depletion of surface water resources has caused environmental heating and cooling effects. Apart from these effects, sudden releases of water by the barrage during the flood season cause devestating floods. In consideration of such a heavy toll for the areas downstream, strict international rules have to be laid down to preserve the riparian ecosystems.

Adult↗

Healthcare resource utilisation and costs of treating NSAID-associated gastrointestinal toxicity. A multinational perspective.

OBJECTIVE: The aim of the study was to perform an economic analysis of a new therapy in 11 countries (Australia, Belgium, Finland, France, Germany, Italy, The Netherlands, Spain, Sweden, Switzerland and the UK) to assess the cost of treating the gastrointestinal (GI) events associated with the use of nonsteroidal anti-inflammatory drugs in patients with osteoarthritis and rheumatoid arthritis. METHODS: Estimates of GI event-related costs were based on the results of resource utilisation questionnaires. Resources required for the treatment and follow-up of GI events were identified and converted into costs from society and payer perspectives. RESULTS: From the perspective of society, the total per-event cost of managing GI-related events varies from $US51 to $US772 for GI discomfort, from $US108 to $US1100 for anaemia, from $US145 to $US1200 for ulcer and from $US1923 to $US5473 for serious GI events requiring hospitalisation. From the payer perspective, the total per-event cost varies from $US47 to $US680 for GI discomfort, from $US144 to $US762 for anaemia, from $US229 to $US795 for ulcer and from $US1787 to $US6729 for serious GI events requiring hospitalisation. The total cost is driven by hospital expenses for those events requiring hospital admission. For GI discomfort, physician consultations are generally the cost driver, whereas for ulcer and anaemia, cost is primarily driven by the rate of endoscopy. CONCLUSIONS: Costs associated with nonsteroidal anti-inflammatory drug-related GI events differ significantly across countries as a result of variations in resources consumed and price/tariff policies.

Anti-Inflammatory Agents, Non-Steroidal↗

Tackling regional health inequalities in france by resource allocation : a case for complementary instrumental and process-based approaches?

This article aims to evaluate the results of two different approaches underlying the attempts to reduce health inequalities in France. In the 'instrumental' approach, resource allocation is based on an indicator to assess the well-being or the quality of life associated with healthcare provision, the argument being that additional resources would respond to needs that could then be treated quickly and efficiently. This governs the distribution of regional hospital budgets. In the second approach, health professionals and users in a given region are involved in a consensus process to define those priorities to be included in programme formulation. This 'procedural' approach is employed in the case of the regional health programmes. In this second approach, the evaluation of the results runs parallel with an analysis of the process using Rawlsian principles, whereas the first approach is based on the classical economic model.At this stage, a pragmatic analysis based on both the comparison of regional hospital budgets during the period 1992-2003 (calculated using a 'RAWP [resource allocation working party]-like' formula) and the evolution of regional health policies through the evaluation of programmes for the prevention of suicide, alcohol-related diseases and cancers provides a partial assessment of the impact of the two types of approaches, the second having a greater effect on the reduction of regional inequalities.

Budgets↗

The use of quality benchmarking in assessing web resources for the dermatology virtual branch library of the National electronic Library for Health (NeLH).

BACKGROUND: In 1998, the U.K. National Health Service Information for Health Strategy proposed the implementation of a National electronic Library for Health to provide clinicians, healthcare managers and planners, patients and the public with easy, round the clock access to high quality, up-to-date electronic information on health and healthcare. The Virtual Branch Libraries are among the most important components of the National electronic Library for Health. They aim at creating online knowledge based communities, each concerned with some specific clinical and other health-related topics. OBJECTIVES: This study is about the envisaged Dermatology Virtual Branch Libraries of the National electronic Library for Health. It aims at selecting suitable dermatology Web resources for inclusion in the forthcoming Virtual Branch Libraries after establishing preliminary quality benchmarking rules for this task. Psoriasis, being a common dermatological condition, has been chosen as a starting point. METHODS: Because quality is a principal concern of the National electronic Library for Health, the study includes a review of the major quality benchmarking systems available today for assessing health-related Web sites. The methodology of developing a quality benchmarking system has been also reviewed. Aided by metasearch Web tools, candidate resources were hand-selected in light of the reviewed benchmarking systems and specific criteria set by the authors. RESULTS: Over 90 professional and patient-oriented Web resources on psoriasis and dermatology in general are suggested for inclusion in the forthcoming Dermatology Virtual Branch Libraries. The idea of an all-in knowledge-hallmarking instrument for the National electronic Library for Health is also proposed based on the reviewed quality benchmarking systems. CONCLUSIONS: Skilled, methodical, organized human reviewing, selection and filtering based on well-defined quality appraisal criteria seems likely to be the key ingredient in the envisaged National electronic Library for Health service. Furthermore, by promoting the application of agreed quality guidelines and codes of ethics by all health information providers and not just within the National electronic Library for Health, the overall quality of the Web will improve with time and the Web will ultimately become a reliable and integral part of the care space.

Dermatology↗

Resource requirements for interventional radiologic management of long-term ambulatory hemodialysis patients.

OBJECTIVE: The purpose of this study was to determine how many and what type of procedures a vascular and interventional radiology service should provide for patients at ambulatory-patient dialysis centers and to determine the necessary resource requirements. These data may provide a realistic starting point for those engaged in the planning and provision of contractual services to dialysis centers. MATERIALS AND METHODS: Patient records at three dialysis centers for a recent 3-year period were examined, and demographic and clinical data were recorded. Records were cross-correlated with records from the vascular and interventional radiology service that had contractually provided all dialysis-related procedures. These data generated a monthly procedure volume and case mix per 100 dialysis patients. Facility usage times for 121 dialysis-related procedures were obtained prospectively and used to calculate the expected resources needed to service the dialysis patients. RESULTS: The three centers provided 5795 hemodialysis-months to 386 patients. Of the 386 patients over the 36-month period, 101 died and 92 transferred from the centers. Three hundred and sixteen patients required 1580 interventional procedures. Monthly procedure volume per 100 dialysis patients averaged 27.1 procedures. Observed procedure times were used to calculate expected room-time hours required to service the monthly procedural volume and case mix per 100 dialysis patients. CONCLUSION: On average, 500 ambulatory dialysis patients will require the full-time use of an interventional suite and the services of a full-time technologist, nurse, and physician to provide necessary dialysis-related procedures. If resources cannot accommodate this volume, the quality and timeliness of care for these patients is jeopardized.

Ambulatory Care Facilities↗

Family physician resource use for inpatient care: a comparison between military medical center and community hospital.

OBJECTIVE: Family physicians' use of resources in different inpatient settings has not been explored. The hypothesis is that family physicians use fewer resources in a community hospital than in a medical center. METHODS: Patients consecutively discharged from the family practice services of an academic medical center and a community hospital (5,060) were compared with respect to length of stay, testing, and consultation rate. RESULTS: The military academic medical center had an increased average length of stay, diagnostic testing, and consultations on univariate analysis. However, on multivariate analysis, length of stay was no different but the laboratory testing and consultation rate were higher for the academic center. CONCLUSION: Family physicians at this military academic medical center used more testing and requested consultations more often than those practicing in a community hospital, controlling for patient demographics and illness severity. There may be a culture at the academic center that encourages increased use of resources.

Adult↗

[The effect of human immunodeficiency virus infection on the consumption of hospital resources. A correlation with the degree of immunodeficiency].

BACKGROUND: To calculate the real cost of the Human Immunodeficiency Virus (HIV) infection in the use of hospital resources. PATIENTS AND METHODS: All the episodes of hospitalization of the years 1993, 1994 and 1995 of a general hospital have been analyzed. The patients have been classified according to the Patients Management Categories version 5.0 system. The patients with HIV infection were also classified according to the CD4+T-lymphocyte counts and the existence of AIDS. The derived cost of the stay and the consumption of diagnostic and complementary tests were calculated according to PMC Relative Intensity Score. RESULTS: In 293 hospitalizations the hospital cost of the HIV patients ascended to 145,372,650 ptas, what represents 40,230,000 ptas 100,000 person-years. HIV patients presented mean of stay (12 vs 5 days, p < 0.001) and hospital cost (433,029 vs 218,646 ptas, p < 0.001), significantly higher than non-HIV patients. 79% of hospitalizations corresponded to patient with AIDS. As much the stay as the hospital cost vary significantly in function of the degree of immunologic deterioration (lymphocyte count and AIDS diagnostic). During the years of study a stabilization was observed in the cost and the hospital stay of these patients. CONCLUSIONS: HIV infection originates a high consumption of hospital resources, mainly in patient with advanced immunodeficiency. The hospital stay is very high to the general population. In the last years it seems to exist a tendency toward the stabilization in the use of hospital resources, possibly to expense of the non hospital cost.

Adolescent↗

[Variability in resource utilization in primary care].

OBJECTIVE: To measure variability in the use of primary care resources and identify factors that explain the differences. DESIGN: An ecological observation study. SETTING: Primary care. PARTICIPANTS: The 1996 index of frequency of attendance was chosen as the indicator of primary care resource use throughout the territory managed by INSALUD. INTERVENTIONS: The analysis was conducted on a provincial basis, using the statistical technique of multiple linear regression. The index of frequency of attendance was chosen as dependent variable; and demographic, social and economic, mortality, organisation, and offer and accessibility indicators were chosen as explanatory or independent variables. MEASUREMENTS AND RESULTS: There was wide variability in frequency of attendance in the areas managed by INSALUD during 1996, with a variation coefficient of 20.5%. The simple linear regression analysis showed that the population's income explained 55% of variability. Income, the number of doctors per 1,000 inhabitants and the percentage of children under 3 explained 70% of the variability of frequency of attendance at primary care. CONCLUSIONS: There are differences between provinces in primary care health resource use. Attendance for primary care consultation in INSALUD is more frequent in provinces with a low social and economic level, more doctors per 1000 inhabitants and more children under 3.

Age Factors↗

The New South Wales Resource Allocation Formula: a method for equitable health funding.

The Resource Allocation Formula has been developed to guide the allocation of health resources in NSW. The aim of the formula is to achieve a more geographically equitable distribution of resources compared to the concentration of facilities which resulted from the historical method of allocating on the basis of past expenditure. A key innovation in the formula is the separation of funding for tertiary referral services using Diagnosis Related Groups. Tertiary services are funded separately and assessed on the present and projected statewide activity levels. By contrast, primary and secondary health services are to be funded on the basis of adjusted population relativities. The formula, which has been approved for use in NSW sets notional target shares for each Area and Region ten years hence. Implementation of these shares is to be achieved through a progressive redistribution of funds.

Ambulatory Care↗