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PubMedDate not supplied

Primary care physicians' use of office resources in the provision of preventive care.

OBJECTIVES: To assess (1) the extent to which office resources (eg, chart aids, educational materials, office staff) are used by primary care physicians in the provision of preventive care; (2) the characteristics of physicians associated with this use; and (3) the relationship of office resource use to reported preventive service provision. DESIGN: Survey. SUBJECTS: Randomly selected active members of the American Academy of Family Physicians, Kansas City, Mo, American Academy of Pediatrics, Elk Grove Village, III, American College of Obstetricians and Gynecologists, Washington, DC, and American College of Physicians, Philadelphia, Pa. MALE OUTCOME MEASURES: Use rates for each of 14 types of office resources, and scores for total office resource use, total preventive service provision, and counseling, screening, and immunization provision. RESULTS: Most types of office resources were used by less than 50% of the physicians. Physicians in small private practices reported less use of resources than those in other settings. The chart flow sheet was the resource that was most strongly and consistently related to preventive service provision. For all organizations, the total resource use score was significantly correlated with scores for total preventive service provision, and counseling and immunization provision. For most organizations, the total resource use score was more highly related to total preventive service provision than was the age or sex of the physician, the percentage of patients uninsured or with Medicaid coverage, or community size. CONCLUSIONS: The use of office resources is an important factor in the provision of preventive care. Intervention efforts to improve office resource use may benefit from targeting by resource type, practice setting, physician specialty, and other physician and practice characteristics.

Adult↗

PubMedDate not supplied

Resources used by general practitioners for advising travelers from New Zealand.

BACKGROUND: The risks of the destination and any specific requirements for travel health advice may be obtained from a variety of resources. This study was designed to investigate the usefulness of various resources available in New Zealand for providing travel health advice and the extent to which GPs used these resources in providing travel health advice. METHOD: Four hundred GPs (400/2830) were randomly selected from the register of the New Zealand Medical Council and sent self-administered questionnaires. Two reminders were sent. RESULTS: Three hundred and thirty-two (332/400, 83%) GPs responded. The usefulness of various resources was reported, including Health Advice for Overseas Travellers (277/289, 96%), New Ethicals (256/278, 92%), New Zealand Public Health Report (79/164, 48%), International Travel and Health (41/144, 28%), computerized databases (6/122, 5%), journals (14/130, 11%), and other resources (44/139, 32%). Health Advice for Overseas Travellers was regarded as significantly more useful than International Travel and Health (x2 = 4,68, df = 1, p <.05). Only 23% (70/309) of respondents indicated that they always used these resources in their practice of travel medicine. Fifty percent (154/309) of respondents indicated that they usually used these resources, while 27% (83/309) of respondents indicated that they used these resources sometimes. Only 1% (2/309) of GPs did not use resources at all for their practice of travel medicine. CONCLUSIONS: The most useful resource was Health Advice for Overseas Travellers, which outlines the New Zealand recommendations for medical practitioners providing travel health advice. It may be useful for GPs to gain access to and training in association with a greater range of specialist resources to use in conjunction with the provision of travel health advice. These might include international guidelines, journals, and access to computerized databases and the internet. With the recent introduction of a widely accessible computerized database in New Zealand, follow-up studies could be instituted to determine if GPs' use of computerized databases becomes more widespread and whether access to and use of these computerized databases influences the provision of travel health advice by GPs. Further studies are needed to examine the appropriateness of the advice provided by the various resources used by GPs in New Zealand.

Communications Media↗

PubMed2000

[Comparison of physical, psychological, and social resources and their effects on mental well-being between young-old and old-old Japanese elderly].

PURPOSES: We compared the availability of physical, psychological, and social resources, and effects of those resources on mental well-being both directly and as stress buffers between the young-old (the age of 65 to 74 years) and the old-old (the age of 75 years and over) people. In addition, if there were a significant difference in level of mental well-being by the age categories, we examined whether the difference could be explained from the different amount of resources possessed by the age groups. METHODS: We utilized an effective sample of 923 young-old and 417 old-old persons excluding cases with missing variables, from 2,200 respondents of a national survey of Japanese adults aged 60 and over. This survey was conducted in 1987. While measure of physical resources included existence of chronic diseases and activities of daily living, psychological resources included self-esteem and locus of control. Social resources were measured by social support. The Center for Epidemiologic Scale-Depression (CES-D) was chosen as an indicator of mental well-being. RESULTS: 1. Although the old-old possessed a smaller amount of physical resources, they had almost the same amount of psychological and social resources as compared with the young-old respondents. 2. There were few differences in the effects of those resources on mental well-being between the young-old and the old-old. 3. Lower amount of physical resource was related to a lower level of well-being in the old-old more than in the young-old. CONCLUSION: The old-old appear to possess similar psychological and social resources as the young-old, quantitatively, and in effects on successful adaptation. Lack of physical resources may be associated with a low level of mental well-being in the old-old.

Activities of Daily Living↗

PubMed2004

[Perception of resources and their meaning for well-being: age-associated similarities and differences among young and old adults].

Personal resources represent important determinants of life-long development. Since the use of the resources is a decisive factor, the perception of resources and changes in them is presumably crucial for the developmental success. In the present study, we investigated whether the perception of resources (i. e., cognition, health, social network) differs between young and old individuals, whether the resource perception is related to well-being and whether these relations are identical among young and old adults. Young and old individuals did not differ with respect to subjective resource status and resource importance; however, the young experienced more gains and the old reported more losses. Resource status explained the highest proportion of variance in well-being in both age groups. Resource loss was of relevance to well-being only in the young, but not in the old group. Thus, the significance of resource loss seems to vary across the life span, which puts the notion of a universal role of resource loss into question. For future studies, domain-specific analyses and the investigation of protective mechanism are proposed.

Adult↗

PubMed2005

Development of a framework for sustainable uses of resources: more paper and less plastics?

Taiwan's EPA has implemented a new guideline called the "Plastic Products Restriction Policy", prohibiting some industries to use plastics as packaging materials for the sake of sustainable use of resources. The significant effect resulting from this policy is the substitution of plastic products with paper products. Is this policy beneficial to achieve future sustainability? I attempt to analyze the resource choice between renewable resources and exhaustible resources for production of final products and services in case of exhaustion of natural resources. In this paper, I develop a framework to examine the dynamic responsiveness of a socio-economical system in facing a continual depletion of natural resources provided by an environmental system. In this framework, the status of an environmental system in terms of carrying capacity is affected by the cumulative impacts caused from human activities, including environmental pollution and resource exploitation. Conversely, it also affects the growth of renewable resources. This framework can serve as a guideline to construct indicators to measure the status of the environmental system and the socio-economical system in order to support a policy planner that formulates an appropriate environmental policy. Based on this framework, I also develop a mathematical model to determine the optimal ratio of resources choice between renewable resources and exhaustible resources.

Conservation of Natural Resources↗

PubMed2000

Competition and the Effect of Spatial Resource Heterogeneity on Evolutionary Diversification.

A model is presented to explore how the form of selection arising from competition for resources is affected by spatial resource heterogeneity. The model consists of a single species occupying two patches connected by migration, where the two patches can differ in the type of resources that they contain. The main goal is to determine the conditions under which competition for resources results in disruptive selection (i.e., selection favoring a polymorphism) since it is this form of selection that will give rise to the evolutionary diversification of resource exploitation strategies. In particular, comparing the conditions giving rise to disruptive selection when the two patches are identical to the conditions when they contain different resources reveals the effect of spatial resource heterogeneity. Results show that when the patches are identical, the conditions giving rise to disruptive selection are identical to those that give rise to character displacement in previous models. When the patches are different, the conditions giving rise to disruptive selection can be either more or less stringent depending upon demographic parameters such as the intrinsic rate of increase and the migration rate. Surprisingly, spatial resource heterogeneity can actually make forms of evolutionary diversification such as character displacement less likely. It is also found that results are dependent on how the resource exploitation strategies and the spatial resource heterogeneity affect the population dynamics. One robust conclusion however, is that spatial resource heterogeneity always has a disruptive effect when the migration rate between patches is low.

Lotka‐Volterra↗

PubMed2005

Assessment of nursing management and utilization of nursing resources with the RAFAELA patient classification system--case study from the general wards of one central hospital.

BACKGROUND: RAFAELA is a new Finnish PCS, which is used in several University Hospitals and Central Hospitals and has aroused considerable interest in hospitals in Europe. AIMS AND OBJECTIVES: The aim of the research is firstly to assess the feasibility of the RAFAELA Patient Classification System (PCS) in nursing staff management and, secondly, whether it can be seen as the transferring of nursing resources between wards according to the information received from nursing care intensity classification. METHODS: The material was received from the Central Hospital's 12 general wards between 2000 and 2001. The RAFAELA PCS consists of three different measures: a system measuring patient care intensity, a system recording daily nursing resources, and a system measuring the optimal nursing care intensity/nurse situation. The data were analysed in proportion to the labour costs of nursing work and, from that, we calculated the employer's loss (a situation below the optimal level) and savings (a situation above the optimal level) per ward as both costs and the number of nurses. RESULTS: In 2000 the wards had on average 77 days below the optimal level and 106 days above it. In 2001 the wards had on average 71 days below the optimal level and 129 above it. Converting all these days to monetary and personnel resources the employer lost 307,745 or 9.84 nurses and saved 369,080 or 11.80 nurses in total in 2000. In 2001 the employer lost in total 242,143 or 7.58 nurses and saved 457,615 or 14.32 nurses. During the time period of the research nursing resources seemed not have been transferred between wards. CONCLUSIONS: RAFAELA PCS is applicable to the allocation of nursing resources but its possibilities have not been entirely used in the researched hospital. The management of nursing work should actively use the information received in nursing care intensity classification and plan and implement the transferring of nursing resources in order to ensure the quality of patient care. RELEVANCE TO CLINICAL PRACTICE: Information on which units resources should be allocated to is needed in the planning of staff resources of the whole hospital. More resources do not solve the managerial problem of the right allocation of resources. If resources are placed wrongly, the problems of daily staff management and cost control continue.

Activities of Daily Living↗

PubMed2002

The impact of consumer-resource cycles on the coexistence of competing consumers.

This article seeks to determine the extent to which endogenous consumer-resource cycles can contribute to the coexistence of competing consumer species. It begins with a numerical analysis of a simple model proposed by Armstrong and McGehee. This model has a single resource and two consumers, one with a linear functional response and one with a saturating response. Coexistence of the two consumer species can occur when the species with a saturating response generates population cycles of the resource, and also has a lower resource requirement for zero population growth. Coexistence can be achieved over a wide range of relative efficiencies of the two consumers provided that the functional response of the saturating consumer reaches its half-saturation value when the resource population is a small fraction of its carrying capacity. In this case, the range of efficiencies allowing coexistence is comparable to that when two competitors have stable dynamics and a high degree of resource partitioning. A variety of modifications of this basic model are analyzed to investigate the consequences for coexistence of different resource growth equations, different functional and numerical response shapes, and other factors. Large differences in functional response shape appear to be the most important factor in producing robust coexistence via resource cycles. If the unstable species has a concave numerical response, this greatly expands the conditions allowing coexistence. If the stable consumer species has a convex (accelerating) functional and/or numerical response, the range of conditions allowing coexistence is also expanded. We argue that large between-species differences in functional response form can often be produced by between-consumer differences in the adaptive adjustments of foraging effort to food density. Consumer-resource cycles can also expand the conditions allowing coexistence when there is resource partitioning, but do so primarily when resource partitioning is relatively slight; this makes the ease of coexistence relatively independent of consumer similarity.

Ecosystem↗

PubMed1991

Conservation of resources in community intervention.

Evaluated the applications of principles of resource conservation and management in community interventions and compared these to a more individual, perception-based psychological perspective. Conservation of resource theory suggests that promotion of well-being and prevention of disease depend on the availability and successful management of resources. When resources are lacking, lost, or when invested without consequent gain, people become vulnerable to psychological and physical disorder and debilitated functioning. Resources, in this context, are defined as those things people value or those things that may help people obtain that which they value. Conservation of resource theory further suggests that resources are to a large extent common to all people, more common within a given culture and time in the developmental cycle, and only to a small extent idiographic. Further, conservation of resource theory posits that resources operate within an ecological context where feedback, sharing, and exchange operate between the individual, social context, and environment. Given these principles, it is reasoned that community interventions must acknowledge the solid base of most problems and accept that interventions must target resources and be intensive enough to change the ecology in which resources operate.

Community Mental Health Services↗

PubMed1993

Exploitative competition in the chemostat for two perfectly substitutable resources.

After formulating a general model involving two populations of microorganisms competing for two nonreproducing, growth-limiting resources in a chemostat, we focus on perfectly substitutable resources. León and Tumpson considered a model of perfectly substitutable resources in which the amount of each resource consumed is assumed to be independent of the concentration of the other resource. We extend their analysis and then consider a new model involving a class of response functions that takes into consideration the effects that the concentration of each resource has on the amount of the other resource consumed. This new model includes, as a special case, the model studied by Waltman, Hubbell, and Hsu in which Michaelis-Menten functional response for a single resource is generalized to two perfectly substitutable resources. Analytical methods are used to obtain information about the qualitative behavior of the models. The range of possible dynamics of model I of León and Tumpson and our new model is then compared. One surprising difference is that our model predicts that for certain parameter ranges it is possible that one of the species is unable to survive in the absence of a competitor even though there is a locally asymptotically stable coexistence equilibrium when a competitor is present. The dynamics of these models for perfectly substitutable resources are also compared with the dynamics of the classical growth and two-species competition models as well as models involving two perfectly complementary resources.

Cell Division↗

PubMed1991

Interactive Query Workstation: standardizing access to computer-based medical resources.

Methods of using multiple computer-based medical resources efficiently have previously required either the user to manage the choice of resource and terms, or specialized programming. Standardized descriptions of what resources can do and how they may be accessed would allow the creation of an interface for multiple resources. This interface would assist a user in formulating queries, accessing the resources and managing the results. This paper describes a working prototype, the Interactive Query Workstation (IQW). The IQW allows users to query multiple resources: a medical knowledge base (DXplain), a clinical database (COSTAR/MQL), a bibliographic database (MEDLINE), a cancer database (PDQ), and a drug interaction database (PDR). Descriptions of each resource were developed to allow IQW to access these resources. The descriptions are composed of information on how data are sent and received from a resource, information on types of query to which a resource can respond, and information on what types of information are needed to execute a query. These components form the basis of a standard description of resources.

Artificial Intelligence↗

PubMed2000

Competition and the Effect of Spatial Resource Heterogeneity on Evolutionary Diversification.

Journal Article↗

PubMed2003

Adaptive plasticity in ontogenetic niche shifts stabilizes consumer-resource dynamics.

Ontogenetic niche shifts, changes in the diet or habitats of organisms during their ontogeny, are widespread among various animal taxa. Ontogenetic niche shifts introduce stage structure in a population with different stages interacting with different communities and can substantially affect their dynamics. In this article, I use mathematical models to test the hypothesis that adaptive plasticity in the timing of ontogenetic niche shifts has a stabilizing effect on consumer-resource dynamics. Adaptive plasticity allows consumers in one ontogenetic niche to perform an early shift to the next ontogenetic niche if the resource density of the first niche is low. The early shift will reduce predation by the consumer on the scarce resource. On the other hand, adaptive plasticity allows consumers to delay their shift to the next niche if the resource density of the first niche is high. The delayed shift will increase the predation on the abundant resource. As a result, the scarce resource will tend to increase, and the abundant resource will tend to decrease. This causes density-dependent negative feedback in the resource dynamics, which stabilizes the consumer-resource dynamics. To test this hypothesis, I compare three consumer-resource models differing in terms of mechanisms controlling the timing of the ontogenetic niche shift: the fixed-age model assumes that the age at which the ontogenetic niche shift occurs is fixed; the fixed-size model assumes that the size at the shift is fixed; and the adaptive plasticity model assumes that the timing of the shift is such that the individual fitness of the consumer is maximized. I show that only the adaptive plasticity model has a locally stable equilibrium and that the stabilizing effect is due to the density-dependent negative feedback in the resource dynamics. I discuss the ontogenetic niche shifts of lake fish in light of the obtained result.

Adaptation, Biological↗

PubMed1980

Use of social resources by the disabled: primary and secondary group influences.

Use of social resources by the disabled in the rehabilitation and recovery process has been viewed primarily as those derived from formal agencies and services. However, the more typical rehabilitation model suggests a negotiated process in which the active patient utilizes not only the formal service system of support (secondary group resources) but other resources that may be available to him, including his personal assets and those sources derived from his informal social network (primary group resources). This study examines the influence of primary and secondary group resources on need levels, i.e., severity of disability, among adult disabled males using data obtained from a national survey in the U.S.A. The availability and use of primary social resources will likely have a positive effect on the disabled's status--on the assumption that these resources mitigate the adverse effects of chronic health conditions. Use of secondary social resources will tend to reflect need and thus more likely be associated with increased severity of disability. The findings are suggestive in that selective personal and social resources of the individual continue to play a role; however, family and kin ties as part of the socially supportive network are less clearly identified from this study. Secondary social resources as formal service supports tend to play a limited role in disability. The implications of these findings are discussed in terms of effective utilization of primary social resources that are supportive of an individual's need, and appear to enhance recovery.

Adult↗

PubMed2002

Utilitarianism and the disabled: distribution of resources.

Utilitarianism is more convincing than resource egalitarianism or welfare egalitarianism as a theory of how resources should be distributed between disabled people and nondisabled people. Unlike resource egalitarianism, utilitarianism can redistribute resources to the disabled when they would benefit more from those resources than nondisabled people. Unlike welfare egalitarianism, utilitarianism can halt redistribution when the disabled would no longer benefit more than the nondisabled from additional resources. The author considers one objection to this view: it has been argued, by Sen and others, that there are circumstances under which utilitarianism would unfairly distribute fewer resources to the physically disabled than to nondisabled people, on the ground that the disabled would derive less benefit from those resources. In response, the author claims that critics of utilitarianism have fallaciously exaggerated the circumstances under which the disabled would benefit less than the nondisabled from additional resources. In those limited circumstances in which the disabled really would benefit less from resources, the author argues, it does not seem unfair to distribute fewer resources to them.

Cost-Benefit Analysis↗

PubMed2003

Knowledge, gender, and resources in small-scale fishing: the case of Honda Bay, Palawan, Philippines.

The coastal zone is a place of intense activity where resources, users, and resource-use practices interact. This case study of small-scale fisheries in Honda Bay, Palawan, Philippines shows that resources, space, and gender are intertwined. The study was conducted between June 1997 and July 1998. The data were gathered using free listing, pile sort, ranking, resource mapping, and key informant interviews. The results showed that women's knowledge about fishery resources and their fishing activities are associated with the intertidal zone whereas men's knowledge is associated with coral reefs. In classifying fishery resources, appearance is the main consideration for women whereas a combination of appearance, habitat, and type of fishing gear is the consideration used by men. Market price is very important because of its dependence on the demand of the export market as well as the local market. Women dominate the buying of fishery products. Many women market their husband's catch, process fish, or gather shells and sea cucumber for sale. Among the fishing households, type of fishing gear provides an indication of socioeconomic standing. This paper concludes that access to resources is shaped by gender and age. The differences in resource knowledge possessed by men and women lead to differential access to fishery resources. In addition, the differences in socioeconomic status also influence resource access. The socialization of children into fishing reinforces the gender division of labor and space in the coastal zone.

Adult↗

PubMed2006

Integrating long-term stewardship goals into the remediation process: natural resource damages and the Department of Energy.

The United States and other developed countries are faced with restoring and managing degraded ecosystems. Evaluations of the degradation of ecological resources can be used for determining ecological risk, making remediation or restoration decisions, aiding stakeholders with future land use decisions, and assessing natural resource damages. Department of Energy (DOE) lands provide a useful case study for examining degradation of ecological resources in light of past or present land uses and natural resource damage assessment (NRDA). We suggest that past site history should be incorporated into the cleanup and restoration phase to reduce the ultimate NRDA costs, and hasten resource recovery. The lands that DOE purchased over 50 years ago ranged from relatively undisturbed to heavily impacted farmland, and the impact that occurred from DOE occupation varies from regeneration of natural ecosystems (benefits) to increased exposure to several stressors (negative effects). During the time of the DOE releases, other changes occurred on the lands, including recovery from the disturbance effects of farming, grazing, and residential occupation, and the cessation of human disturbance. Thus, the injury to natural resources that occurred as a result of chemical and radiological releases occurred on top of recovery of already degraded systems. Both spatial (size and dispersion of patch types) and temporal (past/present/future land use and ecological condition) components are critical aspects of resource evaluation, restoration, and NRDA. For many DOE sites, integrating natural resource restoration with remediation to reduce or eliminate the need for NRDA could be a win-win situation for both responsible parties and natural resource trustees by eliminating costly NRDAs by both sides, and by restoring natural resources to a level that satisfies the trustees, while being cost-effective for the responsible parties. It requires integration of remediation, restoration, and end-state planning to a greater degree than is currently done at most DOE sites.

Conservation of Natural Resources↗

PubMedDate not supplied

Overview of breast health care guidelines for countries with limited resources.

Among women around the globe, breast cancer is both the most common cancer and the leading cause of cancer-related death. Women in economically disadvantaged countries have a lower incidence of breast cancer, but poorer survival rates for the disease relative to women in affluent countries. Evidence suggests that breast cancer mortality can be reduced if resources are applied to the problem in a systematic way. The purpose of the Global Summit Consensus Conference was to begin a process to develop guidelines for improving breast health care in countries with limited resources-those with either low- or medium-level resources based on World Health Organization (WHO) criteria. Breast cancer experts and patient advocates representing 17 countries and 9 world regions participated in the conference. They reviewed the existing breast health guidelines, which generally assume unlimited resources. Individual panels then discussed and debated how limited resources can best be applied to improve three areas of breast health care--early detection, diagnosis, and treatment--and how to integrate these areas in building a breast health care program. The panelists unanimously agreed on the guiding principle that all women have the right to access to health care. They also agreed that collecting data on breast cancer is imperative for deciding how best to apply resources and for measuring progress. The panelists acknowledged the considerable challenges in implementing breast health care programs when resources are limited, as well as the need to build a program that is specific to each country's unique situation. The panelists noted that the development of centralized, specialized cancer centers may be a cost-effective way to deliver breast cancer care to some women when it is not possible to deliver such care to women nationwide. In countries with limited resources, at least half of the women have advanced or metastatic breast cancer at the time of diagnosis. Because advanced breast cancer has the poorest survival rate and is the most resource intensive to treat, measures to reduce the stage at diagnosis are likely to have the greatest overall benefit in terms of both survival and costs. Women should have access to diagnosis and treatment if efforts are undertaken to improve early detection of breast cancer. The panels' findings outline specific steps for prioritizing the use of limited resources to decrease the impact of breast cancer around the globe.

Breast Neoplasms↗