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At least 19 recordsLinked to original sources
PubMed1991

Optimal pension funding with demographic instability and endogenous returns on investment.

"This paper tries to explore some optimal funding policies for pension systems in a general equilibrium setting where funding affects returns on investment and wages through its impact on capital formation. This is done in the context of irregular demographic evolutions such as those expected in developed countries for the next century. Particular attention is given to the intergenerational welfare criterion which is used for designing optimal policies.... We will first present the model for the pension system and the economy and discuss a general one-parameter form for the intergenerational utility function. We will then present the simulated optimal paths for different numerical specifications of the model and the utility function. The last section will show by how much a simpler policy with fixed transfers and purely individual funding can depart from optimal paths...."

Developed Countries↗
PubMed2025

A decentralized future for the open-science databases.

The continuous and reliable open access to curated biological data repositories is indispensable for accelerating rigorous scientific inquiry and fostering reproducible research outcomes. However, the current paradigm, which relies heavily on centralized infrastructure for the storage and distribution of foundational biomedical datasets, inherently introduces significant vulnerabilities. This centralized model is susceptible to single points of failure, including cyberattacks, technical malfunctions, natural disasters, and even political or funding uncertainties. Such disruptions can lead to widespread data unavailability, data loss, integrity compromises, and substantial delays in critical research, ultimately impeding scientific progress. The downstream effect of such interruptions can be the widespread paralysis of diverse research activities, including computational, clinical, molecular, and climate studies. This scenario vividly illustrates the inherent dangers of consolidating essential scientific resources within a single geopolitical or institutional locus. As data generation is accelerating and the global landscape continues to fluctuate, the sustainability of centralized models must be critically re-evaluated. A shift toward federated and decentralized architectures may offer a robust and forward-looking approach to enhancing the resilience of scientific data infrastructures by reducing exposure to governance instability, infrastructural fragility, and funding volatility, while also promoting equity and global accessibility. Inspired by established models such as ELIXIR's federated infrastructure and the policy and funding frameworks developed by CODATA and the Global Biodata Coalition (GBC), emerging Decentralized Science (DeSci) initiatives can contribute to building more resilient, fair, and incentive-aligned data ecosystems. The future of open science depends on integrating these complementary approaches to establish a globally distributed, economically sustainable, and institutionally robust infrastructure that safeguards scientific data as a public good, further ensuring continued accessibility, interoperability, and preservation for generations to come. Here, we examine the structural limitations of centralized repositories, evaluate federated and decentralized models, and propose a hybrid framework for resilient, fair, and sustainable scientific data stewardship.

data accessibility↗
PubMed1994

The implementation of casemix in Victoria--a clinician's view.

Although a number of concerns remain, casemix-based funding is seen by clinicians in Victoria to be a more equitable way of determining public hospital inpatient budgets than historical allocation, and will provide a valuable source of data for service provision planning. The concerns in particular are the inadequacy of the current Australian national diagnosis-related groups 2 system to classify modern clinical practice and describe complex patients; the absence of adequate baseline data to allow an accurate assessment of the impact of casemix-based funding on quality of care; the lack of direct recognition within diagnosis-related groups of the training, research and development roles of public hospitals; and the instability of a funding system which is in evolution.

Attitude of Health Personnel↗
PubMed1988

The demise of free care. The Visiting Nurse Association of Chicago.

This article discusses the decision by the Visiting Nurse Association (VNA) of Chicago to severely limit uncompensated care as of May 1986. Pressured by increasing market forces, the VNA unsuccessfully struggled to maintain its historical mission of service to indigent clients. As VNAs throughout the entire U.S. face financial instability, public sector agencies must be funded to assume responsibility for the care of the medically indigent.

Chicago↗
PubMedDate not supplied

Organizing health care within political turmoil: the Palestinian case.

Palestinians were given control over their own health services in late 1994. Since then they have been facing the challenge of reorganizing disordered health services into a cohesive, regulated and sustainable health care system. This paper focuses on the experience of organizing health care during political instability. It considers the ways that health care is currently provided and funded in the Palestinian Territories. The patterns of accessibility to health care services in terms of insurance coverage and provision (physical allocation) of services are discussed. Finally, the major health care policy changes in this transitional period are examined.

Arabs↗
PubMed1989

Worldwide trends and developments in social security, 1985-87.

This article highlights major trends and developments in social security programs featured in the publication Social Security Programs Throughout the World, 1987. Certain developments observable in industrialized countries, especially in Europe--continuing high unemployment levels, particularly among the young; growing numbers of long-term unemployed; and aging populations--tend to create financial instability in social security programs. Thus, as program costs continue to rise, the emphasis on cost-effective use of social security funds becomes more pronounced. In the period under review, this concern is reflected in the widening interest in mandated private pension supplementation of social security, as well as in measures to encourage employment. In developing countries, a strengthening of programs for families and, in some instances, a lowering of the retirement age are noted, in addition to a general expansion in the benefit structure of the work-injury program.

Cost-Benefit Analysis↗
PubMed2005

HIV/AIDS: global trends, global funds and delivery bottlenecks.

Globalization affects all facets of human life, including health and well being. The HIV/AIDS epidemic has highlighted the global nature of human health and welfare and globalization has given rise to a trend toward finding common solutions to global health challenges. Numerous international funds have been set up in recent times to address global health challenges such as HIV. However, despite increasingly large amounts of funding for health initiatives being made available to poorer regions of the world, HIV infection rates and prevalence continue to increase world wide. As a result, the AIDS epidemic is expanding and intensifying globally. Worst affected are undoubtedly the poorer regions of the world as combinations of poverty, disease, famine, political and economic instability and weak health infrastructure exacerbate the severe and far-reaching impacts of the epidemic. One of the major reasons for the apparent ineffectiveness of global interventions is historical weaknesses in the health systems of underdeveloped countries, which contribute to bottlenecks in the distribution and utilisation of funds. Strengthening these health systems, although a vital component in addressing the global epidemic, must however be accompanied by mitigation of other determinants as well. These are intrinsically complex and include social and environmental factors, sexual behaviour, issues of human rights and biological factors, all of which contribute to HIV transmission, progression and mortality. An equally important factor is ensuring an equitable balance between prevention and treatment programmes in order to holistically address the challenges presented by the epidemic.

Journal Article↗
PubMed1997

Population control I: Birth of an ideology.

Population control, as a major international development strategy, is a relatively recent phenomenon. However, its origins reach back to social currents in the 19th and early 20th centuries, culminating in an organized birth control movement in Europe and the United States. The conflicts and contradictions in that movement's history presage many of today's debates over population policy and women's rights. Eugenics had a deep influence on the U.S. birth control movement in the first half of the 20th century. After World War II private agencies and foundations played an important role in legitimizing population control as a way to secure Western control over Third World resources and stem political instability. In the late 1960s the U.S. government became a major funder of population control programs overseas and built multilateral support through establishment of the U.N. Fund for Population Activities. At the 1974 World Population Conference, Third World governments challenged the primacy of population control. While their critique led population agencies to change their strategies, population control remained a central component of international development and national security policies in the United States.

Eugenics↗
PubMed1978

Proceedings of the Annual Scientific Meeting of the International Medical Society of Paraplegia held at Stoke Mandeville from 28-30 July 1977 (Part II). Fracture dislocation of the cervical spine: a critique of current management in the United States.

The author has been asked to review the hospital records and X-rays of 12 patients from various regions of the United States who have sustained fracture dislocations of the cervical spine. In no instance was the initial care considered to be appropriate. No patient was significantly improved by treatment although only 17% had apparent complete transverse cord syndromes on admission. Sixty-seven per cent of the patients became worse. In the latter group there were three patients who were admitted with either no neurological deficit or only minimal pyramidal signs. All of these three patients became tetraplegic as a consequence of their not being immobilised or placed in traction during periods of many hours to several days after admission. There is little evidence that the treating physicians understood the need for immediate immobilisation, proper examination, steroid therapy, adequate safe radiological examination, expedited traction, postural adjustments, or follow-up examination. After-care was poor, leading to excessive complication. Two patients were transferred in deteriorating condition to other hospitals without safeguards and with adverse result. The availability and the performance of neurological surgeons during the first critical hours after injury was generally suboptimal. Although all of the patients were admitted within an hour of injury only three were seen by a neurosurgeon within 2 hours of admission. Three patients were seen between 36 hours and 8 days. The remaining six patients were examined between 4 and 36 hours and at an average of 12 hours. Skeletal traction was instituted on an average of 11 hours after admission excluding one case of delay for 9 days. Only two patients had adequate reduction within 28 hours. Steroids were given to eight patients at an average of 6 1/2 hours following admission but usually in inadequate dosage. Five laminectomies and six anterior fusions were eventually performed. Two patients had both operations. One patient subsequently expired. No patient had a surgically remedial lesion or showed postoperative favourable change in cord function. Five operated patients developed spine deformity, persistent dislocation, spinal canal stenosis or instability. This care was generally attested to meet proper standards and to represent the treatment ordinarily rendered when academic and qualified neurosurgeons gave testimony regarding it. Neither the funding of care and research, nor the adopted codes governing treatment in accredited hospitals, nor accepted teaching would appear to have influenced the substandard of care provided these patients. Other statistics confirm this to be a prevailing circumstance.

Accidents, Traffic↗
PubMed2026

Implementation factors shaping British Columbia's drug decriminalization pilot: A systematic review with narrative synthesis.

BACKGROUND: In January 2023, British Columbia (BC) became the first Canadian province to implement a legally sanctioned drug decriminalization policy, removing criminal penalties for adults possessing 2.5 g or less of opioids, cocaine, methamphetamine, and MDMA. Introduced as a three-year pilot, it aimed to reframe substance use as a public health issue, reduce stigma, and improve health and social service engagement. Criminal penalties were reintroduced for drug possession in most public spaces in May 2024, and the pilot ended in January 2026. Its termination has been interpreted as policy failure; this review aimed to examine how the pilot was implemented in practice and to identify factors that shaped its operationalization and early implementation-relevant outcomes. METHODS: We conducted a systematic review with narrative synthesis of peer-reviewed literature examining implementation-relevant aspects of BC's decriminalization pilot. Six databases were searched (January-February 2026) for studies published May 31, 2022-February 1, 2026. The protocol was registered in PROSPERO (CRD420251271694). RESULTS: Twenty-seven studies were included. Four cross-cutting implementation barriers were identified: pilot design features, public and cross-sector communication gaps, limited frontline training, and insufficient funding and infrastructure. Design features included the 2.5 g possession threshold, misalignment with real-world drug use patterns; the three-year timeframe, which constrained system-level effects; and the May 2024 amendment, which introduced additional instability. The pilot was implemented without commensurate investment in harm reduction, treatment, or housing infrastructure, within already constrained systems. CONCLUSION: BC's decriminalization pilot suggests the effects of legal reform are shaped by implementation context. Early outcomes may reflect design features, institutional readiness, and system capacity rather than legal change alone; longer-term impacts remain uncertain. Future reforms should align legal change with coordinated implementation, operational guidance, public communication, and adequate service infrastructure.

British Columbia↗
PubMed1996

Current situation and control strategies for resurgence of diphtheria in newly independent states of the former Soviet Union.

Since 1990, an epidemic of diphtheria has spread throughout the newly independent states of the former Soviet Union, and by 1995 a total of 47 808 cases were reported. During the early stages of the epidemic, adequate control measures were not taken and vaccine was in short supply; possible contributing factors to the spread of the epidemic are the presence of highly susceptible child and adult populations, socioeconomic instability, population movement, and a deteriorating health infrastructure. Although WHO views the epidemic as an International public-health emergency and, together with UNICEF and the International Red Cross, has formulated a strategy to combat the epidemic, the necessary funds have not been made fully available. Current vaccination recommendations also need to be reviewed to ensure that population immunity will be adequate to prevent any resurgence of diphtheria in Europe and North America.

Age Distribution↗
PubMedDate not supplied

Globalisation, complex humanitarian emergencies and health.

A new political economy of conflict has emerged in the aftermath of colonialism and the Cold War. Complex political emergencies have been simmering in the post-colonial world for more than three decades. Intra-country armed conflict, often combined with natural disasters, at present contributes to the displacement of over 20 million people world-wide. The international community remains profoundly uncomfortable with the complex political emergencies of the new era, torn between the respect for national sovereignty upon which the international political system of the United Nations and other agencies is built, and the growth of concern with human rights and a burgeoning International Humanitarian Law. Globalisation may have brought many benefits to some but there are also many losers. The Word Bank and the International Monetary Fund imposed structural adjustment policies to ensure debt repayment and economic restructuring that have resulted in a net reduction in expenditure on health, education and development. A downward spiral has been created of debt, disease, malnutrition, missed education, economic entrapment, poverty, powerlessness, marginalization, migration and instability. Africa's complex political emergencies are particularly virulent and tenacious. Three examples that are among the most serious humanitarian emergencies to have faced the world in recent times--those in Angola, the Democratic Republic of Congo and Sudan--are reviewed here in detail. The political evolution of these emergencies and their impact on the health of the affected populations are also explored.

Angola↗
PubMed2004

[Molecular pathology in hereditary colorectal cancer. Recommendations of the Collaborative German Study Group on hereditary colorectal cancer funded by the German Cancer Aid (Deutsche Krebshilfe)].

Although twin studies indicate that inherited genetic factors contribute to about 35% of colorectal cancers (CRC), the exact genetic background has currently been elucidated in only 5-10% of cases. These comprise several hereditary cancer predisposition syndromes that present with a high number of syn- or metachronous neoplasms within an affected person and/or family. Many of these tumors exhibit typical histopathological changes. In general, one should discriminate between cancer syndromes associated with adenomatous and non-adenomatous (i.e., hamartomatous) polyps, the latter being quite rare. The patient's age often serves as a substantial hint to hereditary cancer. The next step of diagnostic work-up includes analysis of microsatellite instability (MSI) together with immunohistochemical detection of a loss of expression in one of the most frequently affected mismatch repair genes (MSH2, MSH6; MLH1, PMS2). Finally, the molecular demonstration of a gene mutation in the blood or germline is the most expensive and tedious procedure. This requires a signed informed consent from the patient after appropriate genetic counseling.

Colonic Neoplasms↗
PubMed1991

Increasing the number of competing awards at the National Heart, Lung, and Blood Institute: projections of a model.

In the mid 1980s, the National Heart, Lung, and Blood Institute (NHLBI) sought to extend the benefits of longer award terms to the research community by supporting requests for longer award terms that were scientifically justified. Although investigators welcomed the resultant increase in support stability, concerns were raised about the institute's ability to fund competing awards. A model was developed to assess alternative policies that might result in increased numbers of competing awards. Assuming that the NHLBI receives budget increases sufficient only to keep pace with inflation, the transitory effects of moving to the current policy of longer award terms should largely have passed by 1993. In the long term, the annual number of competing awards will exceed the average number funded between 1980 and 1983. To increase the annual number of competing awards over the long term would require either a reduction in the current percentage of five-year awards or an increase in the total number of active grants. A reduction in the current percentage of five-year awards would subject productive scientists to greater instability in their research support (that is, they would have to apply more frequently for grants) and would introduce greater variability in the number of competing awards available each year. A substantial increase in the total number of active NHLBI awards would be necessary to return the institute's competing awards to the levels of 1984 to 1988.

Financing, Government↗
PubMedDate not supplied

[Functional changes in the bladder of children with primary bladder diverticulum].

OBJECTIVE: Primary vesical diverticulum is generally diagnosed during urological evaluation for recurrent urinary tract infection that are frequently associated with the symptoms of urinary dysfunction. A urodynamic study was performed in children with primary vesical diverticulum to confirm or discard the presence of vesicourethal dysfunction, its relationship with vesicoureteral reflux, which is associated with diverticulum, and the results achieved by surgical versus medical treatment. METHODS/RESULTS: A urodynamic study was carried out in 11 children (7 boys and 4 girls), aged 6 to 13 years, with primary vesical diverticulum. The diverticulum was parameatal in 7 cases (4 with reflux), posterolateral in 2 cases (1 with reflux), anterolateral in 1 patient and 1 patient had multiple bladder diverticula without neurological disorder. Surgery was indicated in 8 cases and 3 were managed conservatively. Vesicourethral function, at the time the diverticulum was diagnosed, was normal in 3 (27%) and pathological in 8 (73%) patients. The urodynamic study disclosed uncoordinated vesicosphincteric function (4 pts), vesical instability (3 pts) and vesical hypotony (1 pt). Of these 4 cases with urodynamic disorders, diverticulum was associated with vesicoureteral reflux. Of the 8 children submitted to surgery, 6 had a functional pathology preoperatively; following surgical treatment of the diverticulum, vesicourethral function returned to normal in all cases. Of the 3 cases managed conservatively, 2 had persistent urodynamic disorders despite drug therapy; one of them had clinical features of urinary incontinence. CONCLUSIONS: These fundings suggest that alterations of bladder function might arise from the anatomic changes in the detrusor muscle causing the diverticulum and contribute to the onset or persistence of reflux, and should be considered an additional criterion for indicating surgery. It is therefore suggested that a urodynamic study for its diagnosis be included in the protocol for evaluation of children with primary vesical diverticulum.

Adolescent↗
PubMed2001

The future fertility of mankind: effects on world population growth and migration.

The world's population, currently just over 6 billion, is projected to increase to 9-10 billion by the year 2050. Most of this growth will occur in the developing countries of Asia, where there is an enormous unmet demand for contraception, while an increasing number of developed countries will have declining populations. The human immunodeficiency virus (HIV) pandemic will target developing countries, with India destined to become its new epicenter. By 2050, there may be 1 billion HIV-infected people in the world. The significant protective effect of male circumcision may spare Islamic countries, such as Pakistan, Bangladesh, Iran and Indonesia, from the worst effects of the pandemic. Australia will be increasingly threatened by the high rates of population growth of her Asian neighbours. This, coupled with political instability and sea-level rises as a consequence of global warming, will turn the present trickle of refugees from a variety of Asian countries seeking safe haven on our sparsely populated northern coastline into a veritable flood. There will come a time when we have neither the manpower, nor the means, nor even the moral right to intercept, detain or repatriate the thousands who will come in peace, in search of a better life. However, if Australia is to stabilize its future population at around 23 million, which seems highly desirable on ecological grounds, then the net immigration rate must be limited to approximately 50000 people per year. Because the final point of departure for all these refugees is Indonesia, it is essential that Australia maintains good relations with Indonesia, so that together we can attempt to manage the refugee problem. However, Indonesia's own population is destined to increase by 100 million in the next 50 years, which will only exacerbate the situation. Australia would be well advised to make a major increase in its paltry financial assistance to Indonesia's excellent family planning programmes, which are currently starved of funds. Helping Indonesia to contain its population growth is Australia's best long-term investment for its own future.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Transitions from AFDC to SSI before welfare reform.

The Supplemental Security Income (SSI) and Aid to Families with Dependent Children (AFDC) programs serve populations with similar characteristics. SSI serves adults and children with disabilities who are in low-income families, and AFDC serves low-income families with children. Because of that overlap, policy changes in one program can affect the other. In 1996, Congress enacted the Personal Responsibility and Work Opportunity Reconciliation Act, which transformed AFDC into the Temporary Assistance for Needy Families (TANF) program. Many people have expected that implementing that welfare reform legislation would eventually increase SSI participation, for two reasons. First, TANF includes new work requirements and time limits that induce more AFDC/TANF recipients with disabilities to obtain SSI benefits. Second, the change in the funding mechanism--from open-ended funding on a matching basis for AFDC to cash assistance block grants for TANF--gives states a stronger incentive to shift welfare recipients to SSI. This article examines the interaction between the SSI and AFDC programs in the prereform period (1990 to 1996) and discusses the potential implications of welfare reform on that interaction. Using matched data from the Survey of Income and Program Participation and Social Security Administration (SSA) records, our analysis focuses on how the interaction of those programs affects young women (aged 18 to 40) and children (aged 0 to 17). We find a very strong link between AFDC and SSI for young women and children. Significant portions of young female and child SSI beneficiaries in the 1990-1993 period were in AFDC families or had received AFDC in the past. In addition, a substantial share of young women and children who received AFDC during that period eventually entered SSI. Because the SSI program is now serving a much larger population of families with young women and children than in the past, SSA might need to develop policies to better serve that group. The findings also suggest that the prereform period is a poor baseline against which to measure the impact of TANF, primarily because of the instability in programs and policies.

Adolescent↗
PubMed2003

Developing a scientific basis for radiation risk estimates: goal of the DOE Low Dose Research Program.

The U.S. Department of Energy's Low Dose Radiation Research Program is a 10 y activity currently funded at $21 million per year. It focuses on biological responses to low doses (<0.1 Gy) of low-LET ionizing radiation. The overall goal of this program is to provide a sound scientific basis for the radiation protection standards. The program supports basic research that combines modern genomic, molecular, and cellular techniques with recent advances in scientific instrumentation. These combinations make it possible to detect responses and test paradigms associated with the mechanisms of low dose radiation action not previously measurable or testable. Research to date is briefly reviewed and suggests the need for some major paradigm shifts. Exposure of the extracellular matrix can modify both the pattern of gene expression and the phenotype of the cells which result in cell transformation without direct mutation. Low dose radiation exposure results in a range of dose-response relationships for changes in the number, types, and patterns of gene expression. Such studies suggest an increased role for gene expression relative to single mutations for radiation induced cancer. Low dose research using microbeams demonstrated that cells do not require a direct "hit" to result in significant biological alterations. These "bystander effects" demonstrate that "non-hit" cells respond with changes in gene expression, DNA repair, chromosome aberrations, mutations, and cell killing. Research to link genomic instability with cancer is also being conducted and will be discussed. Detection of radiosensitivity genes as markers of genetic susceptibility in individuals and populations can be used in epidemiological studies to determine how molecular changes may impact risk. It is not possible to determine how this research will influence current radiation standards. However, the Low Dose Research Program will help ensure that radiation standards are set using the best scientific data available, and that they are adequate and appropriate for the protection of workers and the public.

DNA↗