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PubMed2006

Purchaser strategies to influence quality of care: from rhetoric to global applications.

The potential of purchasers to influence the quality and safety of care has captured the attention of health sector leaders worldwide. Quality based purchasing explicitly seeks to hold providers accountable for the quality and safety of care. Three strategies are available to purchasers: (1) selective contracting based on quality; (2) payment differentials based on quality; and (3) sponsorship of comparative provider report cards. Examples are given to illustrate each of the three strategies. Governments, employers, social insurance funds, community based insurance organizations, health plans, donors, and other buyers of health services are encouraged to explore and debate these purchaser strategies within the context of an overarching national or local quality framework. Public and private funders of operations research are encouraged to support and disseminate evaluations of purchaser efforts to improve quality. This paper is designed to highlight and frame purchasers' strategies explicitly crafted to enhance the quality and safety of care. The ultimate aim is to encourage thoughtful discussion about whether or not one or more purchaser strategy might support a particular country's goals to improve care. Experiences from both developed and developing countries are included to facilitate the exchange of ideas and provide the broadest of perspectives.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2000

Pest management strategies in traditional agriculture: an African perspective.

African agriculture is largely traditional--characterized by a large number of smallholdings of no more than one ha per household. Crop production takes place under extremely variable agro-ecological conditions, with annual rainfall ranging from 250 to 750 mm in the Sahel in the northwest and in the semi-arid east and south, to 1500 to 4000 mm in the forest zones in the central west. Farmers often select well-adapted, stable crop varieties, and cropping systems are such that two or more crops are grown in the same field at the same time. These diverse traditional systems enhance natural enemy abundance and generally keep pest numbers at low levels. Pest management practice in traditional agriculture is a built-in process in the overall crop production system rather than a separate well-defined activity. Increased population pressure and the resulting demand for increased crop production in Africa have necessitated agricultural expansion with the concomitant decline in the overall biodiversity. Increases in plant material movement in turn facilitated the accidental introduction of foreign pests. At present about two dozen arthropod pests, both introduced and native, are recognized as one of the major constraints to agricultural production and productivity in Africa. Although yield losses of 0% to 100% have been observed on-station, the economic significance of the majority of pests under farmers' production conditions is not adequately understood. Economic and social constraints have kept pesticide use in Africa the lowest among all the world regions. The bulk of pesticides are applied mostly against pests of commercial crops such as cotton, vegetables, coffee, and cocoa, and to some extent for combating outbreaks of migratory pests such as the locusts. The majority of African farmers still rely on indigenous pest management approaches to manage pest problems, although many government extension programs encourage the use of pesticides. The current pest management research activities carried out by national or international agricultural research programs in Africa focus on classical biological control and host plant resistance breeding. With the exception of classical biological control of the cassava mealybug, research results have not been widely adopted. This could be due to African farmers facing heterogeneous conditions, not needing fixed prescriptions or one ideal variety but a number of options and genotypes to choose from. Indigenous pest management knowledge is site-specific and should be the basis for developing integrated pest management (IPM) techniques. Farmers often lack the biological and ecological information necessary to develop better pest management through experimentation. Formal research should be instrumental in providing the input necessary to facilitate participatory technology development such as that done by Farmer Field Schools, an approach now emerging in different parts of Africa.

Africa↗
PubMed1996

Developmental regulation of cytochrome oxidase subunit VIa isoforms in cardiac and skeletal muscle.

Physiological requirements for mitochondrial respiration change during fetal and postnatal development of cardiac and skeletal muscle, particularly after the abrupt transition from the hypoxic fetal environment to the oxygen-rich milieu of the neonate. This study defines the pattern of expression of nuclear genes encoding the muscle-specific (H) and non-muscle-specific (L) isoforms of cytochrome oxidase (COX) subunit VIa during pre- and postnatal development of striated muscles in the mouse. In the early embryo, COX VIa-L was the predominant isoform expressed in all tissues. COX VIa-H mRNA was detectable as early as day 8 postcoitum (pc) in the heart, but not until gestational day 14 in skeletal myofibers of the tongue, diaphragm, and other skeletal muscles. At late fetal stages up until birth (days 16-18 pc), COX VIa-L and COX VIa-H were both expressed in striated myocytes, although the L form remained the dominant isoform. In postnatal animals, however, expression of COX VIa-H increased whereas COX VIa-L decreased in a reciprocal manner. Activation of the COX VIa-H gene also was observed during differentiation of nurine myogenic cells in culture and was followed by diminished expression of the COX VIa-L isoform in maturing myotubes, as in the intact animal. We conclude that regulation of nuclear genes encoding subunits of COX is a component of the developmental programs that govern cardiac and skeletal muscle differentiation and maturation in the mammalian fetus and neonate. COX VIa-L, the predominant isoform in all fetal tissues, is gradually replaced by the muscle-specific H isoform in both cardiac and skeletal muscles, although this transition is not complete until after birth.

Aging↗
PubMed2006

[Public school programme for fissure sealants and its effect on the private demand for restorative dentistry for temporary teeth].

OBJECTIVE: To analyse the effect of a public school odontological programme of fissure sealants on the private demand for restorative dentistry for temporary teeth. DESIGN: A longitudinal, comparative study was conducted. It had 2 groups, control and sealant, with 3 years monitoring. SETTING: Santa Fe Health Area, concretely in the local districts (LD) of Santa Fe and Pinos Puente, Granada, Spain, starting in the school year 1996/1997. PARTICIPANTS: The sealant group was selected from the Santa Fe LD (which had a public programme of fissure sealants) (n=129); and the control group (n=120), from Pinos Puente LD. INTERVENTIONS: All the school students were examined (+ report issued) in the schools every 6 months for 3 years. The sealant group children received at the health centre fissure sealants in their first permanent molars. MAIN MEASUREMENTS: The restorations performed in temporary teeth for both groups were analysed (x+/-EE) during the study at 12, 24, and 36 month follow-up. RESULTS. The sealant group had a significantly greater increase in restorative treatment for temporary teeth (P< .05) than the Control group at all monitoring points. CONCLUSIONS: A public programme of fissure sealants raised private restorative treatment for temporary teeth.

Child↗
PubMed2003

The Cancer Genetics Network: recruitment results and pilot studies.

OBJECTIVE: The National Cancer Institute established the Cancer Genetics Network (CGN) to support collaborative investigations into the genetic basis of cancer susceptibility, explore mechanisms to integrate this new knowledge into medical practice, and identify ways of addressing the associated psychosocial, ethical, legal, and public health issues. SUBJECTS AND METHODS: The CGN has developed the complex infrastructure required to support the projects, including the establishment of guidelines and policies, uniform methods, standard questionnaires to be used by all of the centers, and a standard format for submission of data to the Informatics Center. Cancer patients and their family members have been invited to enroll and be included in a pool of potential study participants. The Information Technology Group is responsible for support of the design, implementation, and maintenance of the multicenter Network-wide research protocols. RESULTS: As of January 2004, the CGN contained data on 23,995 probands (participants) and 425,798 family members. As a resource for cancer genetic studies, the CGN has a large number of probands and first-degree relatives with and without cancer and with multiple ethnicities. Different study designs can be used including case-control, case-case, and family studies. CONCLUSIONS: The unique resources of the CGN are available for studies on cancer genetic susceptibility, translational research, and behavioral research. The CGN is now at a point where approved collaborators may have access to enrolled patients and their families for special studies, as well as to the clinical, environmental and family cancer history data banked in the Informatics Center.

Female↗