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Financial Burden (financial + burden)
Selected AbstractsLong-term efficacy of biologics in dermatologyDERMATOLOGIC THERAPY, Issue 1 2009Leslie Castelo-Soccio ABSTRACT Chronic dermatologic diseases affect millions of people. The long-term nature of these diseases creates psychological and financial burden as well as substantially impacts patients' quality of life. Biologics, including adalimumab, etanercept, alefacept, efalizumab, and infliximab, are the newest therapeutic agents in the treatment of moderate-to-severe psoriasis and psoriatic arthritis and have been used in a variety of other dermatologic diseases. These agents act relatively quickly and effectively in 12-week clinical trials. Because these agents are used to treat patients for longer than 12 weeks, there is a need to review the safety and efficacy of these agents over longer periods of time. Many levels of evidence are available for biologics including high level of evidence from large, randomized, double-blind, placebo-controlled clinical studies. This review focuses on the available data for efficacy and safety for greater than 24 weeks of therapy. The studies supporting the use of rituximab and intravenous immunoglobulin in autoimmune blistering diseases are also presented in this review. [source] Cigarettes and social differentiation in France: is tobacco use increasingly concentrated among the poor?ADDICTION, Issue 10 2009Patrick Peretti-Watel ABSTRACT Aims This paper aimed to assess whether the increase of social differentiation of smoking is observed in France. Design and setting Five cross-sectional telephone surveys conducted in France between 2000 and 2007. Participants The surveys were conducted among national representative samples of French subjects aged 18,75 years (n = 12 256, n = 2906, n = 27 499, n = 2887, n = 6007 in 2000, 2003, 2005, 2006 and 2007, respectively). We focused on three groups: executives, manual workers and the unemployed. Measurements Time trends of smoking prevalence were assessed, and socio-economic factors (especially occupation and job status) associated with smoking were identified and compared in 2000 and 2005. We also computed respondents' equivalized household consumption (EHI) and their cigarette budget to assess the financial burden of smoking. Findings Between 2000 and 2007, smoking prevalence decreased by 22% among executive managers and professionals and by 11% among manual workers, and did not decrease among the unemployed. Indicators of an underprivileged social situation were associated more markedly with smoking in 2005 than in 2000. In addition, the falling-off of smoking initiation occurred later and was less marked among manual workers than it was among executive managers and professionals. Finally, in 2005 15% of French smokers devoted at least 20% of their EHI to the purchase of cigarettes, versus only 5% in 2000, and smoking weighted increasingly heavily on the poorest smokers' budgets. Conclusions While these results point out an increased social differentiation in tobacco use, they underline the need to design and implement other forms of action to encourage people to quit, in particular targeting individuals belonging to underprivileged groups. [source] An environmental evaluation of household garbage processorsELECTRONICS & COMMUNICATIONS IN JAPAN, Issue 7 2010Kazuhito Haruki Abstract The amount of garbage emitted from households and industries has been constantly increasing in recent years, and its treatment cost has been a financial burden to municipal governments in Japan. Many municipal governments recommend that their citizens purchase household garbage processors in order to reduce the volume of garbage transferred to and incinerated at their facilities. Actually, 1535 municipal governments subsidize their citizens' purchase of electrical garbage processors and/or compost containers. These subsidies should be assessed from various points of view, such as the costs and benefits to municipal governments and citizens, and also global or local environmental loads. An environmental planning department of a city office sent questionnaires to its residents to investigate the utilization of the subsidized devices. An environmental organization of citizens supported the department with design of the questionnaire form and analysis of the collected questionnaire data. In this paper, the processes of designing the form and analyzing the data are explained, and then an evaluation of the subsidy is presented. The conclusions are as follows: Electrical garbage processors would be beneficial for dealing with local environmental problems such as lack of a final landfill site. However, the processors will increase CO2 emissions unless their electrical consumption efficiency can be improved. © 2010 Wiley Periodicals, Inc. Electron Comm Jpn, 93(7): 42,52, 2010; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ecj.10285 [source] Costs and determinants of privately financed home-based health care in Ontario, CanadaHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2008Denise N. Guerriere PhD Abstract The Canadian context in which home-based healthcare services are delivered is characterised by limited resources and escalating healthcare costs. As a result, a financing shift has occurred, whereby care recipients receive a mixture of publicly and privately financed home-based services. Although ensuring that care recipients receive efficient and equitable care is crucial, a limited understanding of the economic outcomes and determinants of privately financed services exists. The purposes of this study were (i) to determine costs incurred by families and the healthcare system; (ii) to assess the determinants of privately financed home-based care; and (iii) to identify whether public and private expenditures are complements or substitutes. Two hundred and fifty-eight short-term clients (< 90 days of service utilisation) and 256 continuing care clients (> 90 days of utilisation) were recruited from six regions across the province of Ontario, Canada, from November 2003 to August 2004. Participants were interviewed by telephone once a week for 4 weeks and asked to provide information about time and monetary costs of care, activities of daily living (ADL), and chronic conditions. The mean total cost of care for a 4-week period was $7670.67 (in 2004 Canadian dollars), with the overwhelming majority of these costs (75%) associated with private expenditures. Higher age, ADL impairment, being female, and a having four or more chronic conditions predicted higher private expenditures. While private and public expenditures were complementary, private expenditures were somewhat inelastic to changes in public expenditures. A 10% increase in public expenditures was associated with a 6% increase in private expenditures. A greater appreciation of the financing of home-based care is necessary for practitioners, health managers and policy decision-makers to ensure that critical issues such as inequalities in access to care and financial burden on care recipients and families are addressed. [source] Progressive segmented health insurance: Colombian health reform and access to health servicesHEALTH ECONOMICS, Issue 1 2007Fernando Ruiz Abstract Equal access for poor populations to health services is a comprehensive objective for any health reform. The Colombian health reform addressed this issue through a segmented progressive social health insurance approach. The strategy was to assure universal coverage expanding the population covered through payroll linked insurance, and implementing a subsidized insurance program for the poorest populations, those not affiliated through formal employment. A prospective study was performed to follow-up health service utilization and out-of-pocket expenses using a cohort design. It was representative of four Colombian cities (Cendex Health Services Use and Expenditure Study, 2001). A four part econometric model was applied. The model related medical service utilization and medication with different socioeconomic, geographic, and risk associated variables. Results showed that subsidized health insurance improves health service utilization and reduces the financial burden for the poorest, as compared to those non-insured. Other social health insurance schemes preserved high utilization with variable out-of-pocket expenditures. Family and age conditions have significant effect on medical service utilization. Geographic variables play a significant role in hospital inpatient service utilization. Both, geographic and income variables also have significant impact on out-of-pocket expenses. Projected utilization rates and a simulation favor a dual policy for two-stage income segmented insurance to progress towards the universal insurance goal. Copyright © 2006 John Wiley & Sons, Ltd. [source] Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insuranceHEALTH ECONOMICS, Issue 3 2001Winnie Yip Abstract Governments are constantly faced with competing demands for public funds, thereby necessitating careful use of scarce resources. In Egypt, the School Health Insurance Programme (SHIP) is a government subsidized health insurance system that targets school children. The primary goals of the SHIP include improving access and equity in access to health care for children while, at the same time, ensuring programme sustainability. Using the Egyptian Household Health Utilization and Expenditure Survey (1995), this paper empirically assesses the extent to which the SHIP achieves its stated goals. Our findings show that the SHIP significantly improved access by increasing visit rates and reducing financial burden of use (out-of-pocket expenditures). With regard to the success of targeting the poor, conditional upon being covered, the SHIP reduced the differentials in visit rates between the highest and lowest income children. However, only the middle-income children benefitted from reduced financial burden (within group equity). Moreover, by targeting the children through school enrollment, the SHIP increased the differentials in the average level of access between school-going children and those not attending school (overall equity). Children not attending school tend to be poor and living in rural areas. Our results also indicate that original calculations may underestimate the SHIP financial outlays, thereby threatening the long run financial sustainability of the programme. Copyright © 2001 John Wiley & Sons, Ltd. [source] Australian Universities 1939-1999: How Different Now?HIGHER EDUCATION QUARTERLY, Issue 2 2000Bruce Williams Between 1939 and 1999, when the Australian population increased from 7 to 19 million, university enrolments rose from 14,236 to 681,870. Until 1974 the most notable changes were the increases in the size of universities and of departments (which encouraged greater specialization), continued increases in research expenditures, in the percentage of postgraduate students, and a gradual decline in collegiality. In 1974 the Commonwealth Government assumed full responsibility for government grants to universities and abolished fees at just that time when growth rates in the economy fell sharply. Government influence on the universities increased, and there were some departures from the no-fees policy for international and postgraduate course-work masters and diploma students. Then in 1988 the Government decided to abolish the distinction between universities and colleges of advanced education, to create through amalgamations a smaller number of much larger universities and to set a specific mission for each university in the interest of economic growth. The Tertiary Education Commission was abolished and the universities dealt directly with the Minister and his Department. The Universities became distinctly more managerial, less collegial, and the range of courses and degrees was greatly expanded. There are now legitimate doubts about the quality of some degrees. Student fees came back, but in a way that reduced the financial burden on the government without giving the universities greater freedom. The government sponsored collective bargaining for university staff but as universities were not given the capacity to earn much additional income, increases in salaries increased student/staff ratios and induced a decline in morale. [source] A review of gastrointestinal foreign bodiesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2006A. A. Ayantunde Summary Gastrointestinal tract (GIT) foreign bodies represent a significant clinical problem in the Emergency Department, causing a high degree of financial burden, morbidity and mortality. A large variety of foreign bodies are accidentally ingested or inserted into the GIT in different age groups. This a retrospective review of 38 patients who presented to the Emergency Department with GIT foreign bodies between January 2001 and December 2004. Computer database and case note search of patients' personal data, nature of the foreign objects and mode of entry to the GIT were recorded. There were 30 males and eight females (M : F ratio of 3.75:1) with an age range of 10 months to 87 years (median age 25.5 years). Foreign body ingestion/insertion was accidental in 14 patients, deliberate in 11, for anal erotism in 11 and as a result of assault in two cases. The median time before presentation was 12 h, and the mean length of hospital stay was 1.7 days. Treatment was conservative in 15 patients; five patients had gastroscopic retrieval; 15 patients underwent examination under anaesthetic, retrieval and proctosigmoidoscopy and three patients underwent laparotomy for impacted foreign bodies. GIT foreign body ingestion or insertion is common; however, majority of cases can be successfully managed conservatively. [source] Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, ChinaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2004Qingyue Meng Abstract Both challenges and opportunities have been created by health sector reforms for TB control programmes in developing countries. China has initiated radical economic and health reforms since the late 1970s and is among the highest TB endemic countries in the world. This paper examines the operation of TB control programmes in a decentralized financial system. A case study was conducted in four counties of Shandong Province and data were collected from document reviews, and key informant and TB patient interviews. The main findings include: direct government support to TB control weakened in poorer counties after its decentralization to township and county governments; DOTS programmes in poorer counties was not implemented as well as in more affluent ones; and TB patients, especially the low-income patients, suffered heavy financial burdens. Financial decentralization negatively affects the public health programmes and may have contributed to the more rapid increase in the number of TB cases seen over the past decade in the poorer areas of China compared with the richer ones. Establishing a financial transfer system at central and provincial levels, correcting financial incentives for health providers, and initiating pro-poor projects for the TB patients, are recommended. Copyright © 2004 John Wiley & Sons, Ltd. [source] The effectiveness of silver-releasing dressings in the management of non-healing chronic wounds: a meta-analysisJOURNAL OF CLINICAL NURSING, Issue 5 2009Shu-Fen Lo Aim., The purpose of this study was to examine the efficacy of silver-releasing dressings in the management of non-healing chronic wounds. Background., Non-healing chronic wounds often have a negative physical impact on patients and place a financial burden on healthcare systems. Silver dressings are wound products designed to control infection and provide a wound environment conducive to healing. However, validation of the clinical efficacy of these dressings is lacking. Design., Systematic review and meta-analysis. Methods., A systematic search of the major electronic databases PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO, OCLC and Proquest between 1950,June 2007 was conducted. Hand searches of selected periodicals, textbooks and checking reference lists and contacting experts was also performed. Results., Eight studies were selected from a potentially relevant 1957 references screened. Analysis incorporated data from 1399 participants in the eight randomised control trials. We found that silver dressings significantly improved wound healing (CI95: 0·16,0·39, p < 0·001), reduced odour (CI95: 0·24,0·52, p < 0·001) and pain-related symptoms (CI95: 0·18,0·47, p < 0·001), decreased wound exudates (CI95: 0·17,0·44, p < 0·001) and had a prolonged dressing wear time (CI95: 0·19,0·48, p = 0·028) when compared with alternative wound management approaches. An analysis of sensitivity in these studies by subgroup analysis generally supported these associations. Furthermore, studies indicated an improvement in quality of life (CI95: 0·04,0·33, p = 0·013) using silver dressings in wound management with no associated severe adverse events. Conclusion., This meta-analysis confirms the effectiveness of silver dressings in wound healing and improving patients' quality of life. However, it also highlights the need for additional well-designed randomised controlled trials to evaluate the effectiveness of silver-related dressings further. Relevance to clinical practice., The results of this study provide objective data on the effectiveness of silver-related dressing when applied to non-healing chronic wounds. [source] A systematic review of wound cleansing for pressure ulcersJOURNAL OF CLINICAL NURSING, Issue 15 2008FFNMRCSI, Zena Moore MSc Aim., The aim of this study was to use a Cochrane systematic review process to explore the effect of wound cleansing solutions and techniques on pressure ulcer healing. Background., Pressure ulcers impose a significant financial burden on health care systems and negatively affect the quality of life. Wound cleansing is an important component of pressure ulcer care; however, there is uncertainty regarding best practice. Design., Systematic review. Methods., The Specialised Trials Register of the Cochrane Wounds Group, the Cochrane Central Register of Controlled Trials and bibliographies of relevant publications were searched. Drug companies and experts in the field were also contacted. Randomized controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion. For dichotomous outcomes, relative risk (RR) plus 95% confidence intervals (CI) were calculated; for continuous outcomes, weighted mean difference plus 95% CI were calculated. Meta analysis was not conducted because of the small number of diverse RCTs identified. Results., No studies compared cleansing with no cleansing. A statistically significant improvement in healing occurred for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared with isotonic saline (p = 0·025). No statistically significant change in healing was seen when water was compared with saline (RR 3·00, 95% CI 0·21, 41·89). No statistically significant change in healing was seen for ulcers cleansed with, or without, a whirlpool (RR 2·10, 95% CI 0·93,4·76). Conclusion., There is little trial evidence to support the use of any particular wound cleansing solution or technique for pressure ulcers. Relevance to clinical practice., No firm recommendations for ways of cleansing pressure ulcers in clinical practice can be made, the lack of RCT evidence should be a concern for health care providers. [source] Reducing patient financial liability for hospitalizations: The physician role,JOURNAL OF HOSPITAL MEDICINE, Issue 3 2010Edward A. Ross MD Abstract With increasingly strict guidelines for insurance coverage, hospitals have adopted meticulous resource utilization review and management processes. It is important for physicians to appreciate that careful documentation of certain patient parameters may not only optimize the facility's reimbursement but have profound impact on the patient's out-of-pocket expenses. Hospital utilization teams have access to the frequently changing national payor guidelines for policy benefits, usually revolving around whether the patient meets medical necessity criteria for being classified as an "inpatient" vs. an "observation" outpatient. Those statuses are not merely time-based, and lead to marked differences in patient deductibles and coverage for medication, room, procedure, laboratory, and ancillary charges. There are nationally-recognized guidelines for classification, based on severity of illness and intensity of services provided. By participating in case management activities, physicians can have an important patient advocate role, and thereby minimize the financial burden to these individuals and their families. Journal of Hospital Medicine 2010;5:160,162. © 2010 Society of Hospital Medicine. [source] Laboratory Models Available to Study Alcohol-Induced Organ Damage and Immune Variations: Choosing the Appropriate ModelALCOHOLISM, Issue 9 2010Nympha B. D'Souza El-Guindy The morbidity and mortality resulting from alcohol-related diseases globally impose a substantive cost to society. To minimize the financial burden on society and improve the quality of life for individuals suffering from the ill effects of alcohol abuse, substantial research in the alcohol field is focused on understanding the mechanisms by which alcohol-related diseases develop and progress. Since ethical concerns and inherent difficulties limit the amount of alcohol abuse research that can be performed in humans, most studies are performed in laboratory animals. This article summarizes the various laboratory models of alcohol abuse that are currently available and are used to study the mechanisms by which alcohol abuse induces organ damage and immune defects. The strengths and weaknesses of each of the models are discussed. Integrated into the review are the presentations that were made in the symposium "Methods of Ethanol Application in Alcohol Model,How Long is Long Enough" at the joint 2008 Research Society on Alcoholism (RSA) and International Society for Biomedical Research on Alcoholism (ISBRA) meeting, Washington, DC, emphasizing the importance not only of selecting the most appropriate laboratory alcohol model to address the specific goals of a project but also of ensuring that the findings can be extrapolated to alcohol-induced diseases in humans. [source] Predisposing factors to phlebitis in patients with peripheral intravenous catheters: A descriptive studyJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 4 2008Esin Uslusoy BSN, MS (Research Assistant) Abstract Purpose: The purpose of this study was to investigate the predisposing factors in the development of phlebitis in peripheral intravenous (IV) catheterization sites in patients treated with a variety of IV infusion solutions and drugs. Data sources: Systematic observation of 568 IV sites inserted for fluid infusion and drug administration in 355 patients in the Department of General Surgery of a University Hospital in Turkey. A data collection tool was based on standards established by the Infusion Nurses Society. Patients' infusion sites were monitored every 24 h during treatment and for 48 h after discontinuation of the IV. Conclusions: In contrast to the usual findings in the literature, the authors found that infusion through an infusion pump and insertion of catheters in the veins around the elbow increased the risk of phlebitis. Also, the number of times infusions were started led to an increased rate of phlebitis. However, conflicting results were obtained about the relation between phlebitis, gender, and catheter size. Implications for practice: Phlebitis causes sepsis, pain, additional diagnostic investigations, and treatments, and may lead to increased duration of hospitalization, patient's stress level, and financial burden, as well as increasing staff workload. Advanced practice nurses need to be aware of the factors that increase the likelihood of phlebitis and take appropriate measures to prevent it. [source] Money matters: students' perceptions of the costs associated with placementsMEDICAL EDUCATION, Issue 10 2007Natalie Wray Context, Placements are an integral component of the medical, nursing and allied health curricula. However, apart from the relocation costs associated with placements, little research on students' understandings and experiences of the financial implications of placements has been carried out. Objectives, We report on students' financial concerns associated with placements, which emerged as a main theme in a broader study we conducted on the impact of undergraduate student placement experiences on graduate practice. Methods, We conducted a qualitative study which included focus group discussions (n = 17), individual interviews (n = 48) and written responses (n = 2) with undergraduate students (n = 103) and graduates (n = 27) from a tertiary institution in Victoria, Australia. Results, Students identified that income generation and the costs associated with transport and placement location contributed to the financial burden of placements. Students also spoke of the implications of high financial strain impacting on their accumulation of debt as well as on their health and wellbeing. Discussion, Our study advances our understanding of the implications of financial hardship experienced by medical, nursing and allied health students. In our study, students, regardless of their placement location, experienced increased demands and associated stress as a result of managing placements, paid employment and limited financial resources. We recommend that further quantitative research be conducted to measure the variables identified as emerging themes in this study. [source] Annual Direct and Indirect Health Costs of the Congenital IchthyosesPEDIATRIC DERMATOLOGY, Issue 4 2010Andrew R. Styperek M.B.A. We conducted a cost analysis through an online survey posted on the Foundation for Ichthyosis and Related Skin Types Website. We assessed cutaneous disease severity, via the previously validated Congenital Ichthyosis Severity Index (CISIÔ), demographics, and CI type. We estimated direct health care costs: prescription and over-the-counter medications, outpatient visits, and emergency department and hospital visit costs; and indirect costs: earnings lost owing to absences from work because of CI-related illness. The CI subjects of our study (n = 224) consumed a mean (SD) of $3,192 ($7,915) annually. Direct costs accounted for 90%, whereas indirect costs accounted for 10%. These costs resulted in an estimated annual cost of $37MM/year (excluding ichthyosis vulgaris) of which $17MM is borne out-of-pocket by patients. Depending on the CI diagnosis, patients were responsible for 30,51 cents of every dollar of mean annual medical care costs. Our estimated annual CI costs are comparable to cutaneous lymphoma. More effective treatments for CI would help minimize this burden. Traditional insurance products do not appear to substantially alleviate the financial burden of disease, as a significant amount is from out-of-pocket expenses. [source] Zur nachhaltigen Finanzierung der GRV: Der Beitrag der Altersgrenzenanhebung im RentenreformprozessPERSPEKTIVEN DER WIRTSCHAFTSPOLITIK, Issue 4 2008Oliver Ehrentraut In this article we analyze the effects of the latest reforms on the future development of the contribution rate as well as the public pension level. Furthermore, we quantify the extent of an increase of the average retirement age on the funding of the pension scheme, as the increase can temporarily dilute the financial burden due to demographic transition. [source] Life is sweet in Fiji: the availability of diabetes healthcare and health education, and diabetes awareness amongst diabetic patients in FijiPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 6 2002Jay Kuruvatti BSc, MB ChB Pre-registration House Officer Abstract During an elective visit to Fiji we assessed the knowledge of diabetes possessed by patients who attended the hospital Diabetic Clinic in Lautoka. All the patients interviewed had type 2 diabetes and 15.4% were treated with insulin, 80.8% with oral therapy and 3.8% with diet alone. Blindness was the commonest complication known to patients but almost a quarter could not describe any diabetic complication. All patients had seen a hospital doctor regarding their diabetes; 17.9% also saw a private general practitioner, 80.8% had seen the diabetes nurse, 60.8% a dietician, and 57.7% a chiropodist. When asked about causative factors 12.8% thought diabetes was caused by overeating, 12.8% thought it was due to too much sugar in the diet, and the remaining 60.3% did not know. The methods by which the ever-increasing financial burden of diabetes in Fiji can be reduced are discussed. We feel that the prevention of diabetes and the early detection of complications would be the most cost-effective methods to improve overall diabetes care in Fiji. However, the whole diabetes care service in Fiji is constrained by the poor economic state of the country and the low profile of diabetes in the healthcare plans of the country. Copyright © 2002 John Wiley & Sons, Ltd. [source] Resource Utilization of Living Donor Versus Deceased Donor Liver Transplantation Is Similar at an Experienced Transplant CenterAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2009J. C. Lai Although living donor liver transplantation (LDLT) has been shown to decrease waiting-list mortality, little is known of its financial impact relative to deceased donor liver transplantation (DDLT). We performed a retrospective cohort study of the comprehensive resource utilization, using financial charges as a surrogate measure,from the pretransplant through the posttransplant periods,of 489 adult liver transplants (LDLT n = 86; DDLT n = 403) between January 1, 2000, through December 31, 2006, at a single center with substantial experience in LDLT. Baseline characteristics differed between LDLT versus DDLT with regards to age at transplantation (p = 0.02), male gender (p < 0.01), percentage Caucasians (p < 0.01) and transplant model for end-stage liver disease (MELD) score (p < 0.01). In univariate analysis, there was a trend toward decreased total transplant charges with LDLT (p = 0.06), despite increased surgical charges associated with LDLT (p < 0.01). After adjustment for the covariates that were associated with financial charges, there was no significant difference in total transplant charges (p = 0.82). MELD score at transplant was the strongest driver of resource utilization. We conclude that at an experienced transplant center, LDLT imposes a similar overall financial burden than DDLT, despite the increased complexity of living donor surgery and the addition of the costs of the living donor. We speculate that LDLT optimizes transplantation by transplanting healthier and younger recipients. [source] Refined candidate region specified by haplotype sharing for Escherichia coli F4ab/F4ac susceptibility alleles in pigsANIMAL GENETICS, Issue 1 2010M. Jacobsen Summary Infection of the small intestine by enterotoxigenic Escherichia coli F4ab/ac is a major welfare problem and financial burden for the pig industry. Natural resistance to this infection is inherited as a Mendelian recessive trait, and a polymorphism in the MUC4 gene segregating for susceptibility/resistance is presently used in a selection programme by the Danish pig breeding industry. To elucidate the genetic background involved in E. coli F4ab/ac susceptibility in pigs, a detailed haplotype map of the porcine candidate region was established. This region covers approximately 3.7 Mb. The material used for the study is a three generation family, where the founders are two Wild boars and eight Large White sows. All pigs have been phenotyped for susceptibility to F4ab/ac using an adhesion assay. Their haplotypes are known from segregation analysis using flanking markers. By a targeted approach, the candidate region was subjected to screening for polymorphisms, mainly focusing on intronic sequences. A total of 18 genes were partially sequenced, and polymorphisms were identified in GP5, CENTB2, APOD, PCYT1A, OSTalpha, ZDHHC19, TFRC, ACK1, MUC4, MUC20, KIAA0226, LRCH3 and MUC13. Overall, 227 polymorphisms were discovered in the founder generation. The analysis revealed a large haplotype block, spanning at least 1.5 Mb around MUC4, to be associated with F4ab/ac susceptibility. [source] Alternative cervical cancer prevention in low-resource settings: Experiences of visual inspection by acetic acid with single-visit approach in the first five provinces of ThailandAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2007Buncha PALANUWONG Abstract Background:, After the confirmation of its safety, acceptability and feasibility in a cervical cancer prevention demonstration project in 2002, a visual inspection by acetic acid (VIA) followed by an effective treatment using cryotherapy as a single-visit approach (SVA) was recently introduced in five provinces having low Pap smear screening rates, in Thailand. The effectiveness of a screening program is usually associated with a high level of coverage; however, in low-resource settings such a high coverage is still hard to attain by the conventional Pap smear approach. Aims:, To evaluate whether VIA/SVA can increase women's access to the prevention services in low-resource provinces of Thailand. Methods:, A cross-sectional study was conducted by analysing electronic screening records of the provinces. A ,2 test was used in the comparisons of screening coverage between the year before and the first year of VIA/SVA implementation during 1998,2005. Results:, This comparative study, which included 88 554 screening visits totally, shows a significant increase in the screening coverage of five provinces after the VIA/SVA implementation (P < 0.001). As a result of the large substitution of VIA/SVA for Pap smears, the costs of screening were lowered by as much as $US362 300 (66.8%) in the first year. Conclusion:, VIA/SVA has provided good screening coverage and lowered the financial burden in five low-resource provinces of Thailand. Therefore, it is promisingly competitive as a potential alternative means of cervical cancer prevention in low-resource areas. [source] Loss of income and levels of scholarship support for students on rural clinical placements: A survey of medical, nursing and allied health studentsAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2009Deborah Schofield Abstract Objective:,To quantify the financial impact of rural clinical placements on medical, nursing and allied health students in rural Australia. Design:,The Careers in Health Tracking Survey provided data on whether students were employed, usual weekly hours of employment and a range of covariates, such as age, sex, course of study, marital status, dependants and rural or urban origin. Participants:,A total of 121 students from a range of health professions completed the Careers in Health Tracking Survey while on rural placement at the Northern Rivers University Department of Rural Health. Outcome measures:,Survey data. Results:,Forty-one per cent of respondents were working immediately before their clinical placements. Nursing students worked the longest hours by far and were significantly more financially disadvantaged than both medical and allied health students (P < 0.01). Scholarship support was unevenly distributed, with nursing and allied health students being relatively under-supported in relation to lost earnings. Conclusion:,Recruitment of students can be an effective strategy to address the rural health workforce shortage throughout Australia. However, there are a number of financial disincentives for students to undertake rural clinical placements. Additional support for some disciplines is needed to provide equitable distribution of scholarship support to offset this financial burden. Establishing an employment scheme for students on rural clinical placements and a scholarship for income replacement where employment is not available would also alleviate income loss. [source] Breast pathology guideline implementation in low- and middle-income countries,CANCER, Issue S8 2008Shahla Masood MD Abstract The quality of breast healthcare delivery and the ultimate clinical outcome for patients with breast cancer are directly related to the quality of breast pathology practices within the healthcare system. The Breast Health Global Initiative (BHGI) held its third Global Summit in Budapest, Hungary from October 1 to 4, 2007, bringing together internationally recognized experts to address the implementation of breast healthcare guidelines for the early detection, diagnosis, and treatment in low-income and middle-income countries (LMCs). From this group, a subgroup of experts met to address the specific needs and concerns related to breast pathology program implementation in LMCs. Specific recommendations were made by the group and process indicators identified in the areas of personnel and training, cytology and histopathology interpretation, accuracy of pathology interpretation, pathology reporting, tumor staging, causes of diagnostic errors, use of immunohistochemical markers, and special requirements to facilitate breast conservation therapy. The group agreed that the financial burden of establishing and maintaining breast pathology services is counterbalanced by the cost savings from decreased adverse effects and excessive use of treatment resources that result from incorrect or incomplete pathologic diagnosis. Proper training in breast pathology for pathologists and laboratory technicians is critical and provides the underpinnings of programmatic success for any country at any level of economic wealth. Cancer 2008;113(8 suppl):2297,304. © 2008 American Cancer Society. [source] 4245: Non-surgical strategies for PCO preventionACTA OPHTHALMOLOGICA, Issue 2010IM WORMSTONE Purpose Surgical approaches and IOL design have gone some way to reduce the rate of PCO progression. Despite these efforts PCO remains a common and important problem which diminishes the visual quality of patients and is a major financial burden on healthcare providers. If we are to effectively respond to the problem of PCO then a biological solution has to be adopted to reduce/prevent formation of light scattering changes. Methods Methods have been employed to investigate PCO development, which include in vitro cell culture and capsular bag models; in vivo animal models and post-mortem analysis. These have greatly aided our understanding of PCO. Results A number of basic approaches have been identified to prevent PCO. 1) To kill the entire lens epithelial population. This will require a pharmacological agent, therefore delivery of this drug needs to be localised to the target cells, but have limited access to non-target cells; closed capsular bag systems such as perfect capsule provides opportunity to achieve this aim. 2) Maintenance of a cell monolayer on the posterior capsule. In particular the role of TGF, has been investigated, which is known to cause matrix deformation. Disruption of TGF, signalling pathways can suppress matrix deformation and thus reduce light scatter. 3) Recreation of a lens is the ultimate solution. While it has been shown that lens fibre differentiation can be promoted in animal systems, perfect formation of the lens is not achieved and the protein density is typically low relative to the native lens. Conclusion Strategies to prevent PCO are being actively developed, which will are greatly aided by improved drug delivery systems. The development of biological/pharmacological approaches in concert with improved surgical methods and IOL designs should yield benefit to patients. Commercial interest [source] Fixed Mandibular Restorations on Three Early-Loaded Regular Platform Brånemark ImplantsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2001Hugo De Bruyn DDS ABSTRACT Background: Originally, the Brånemark System was used as a two-stage surgical procedure. Comparable clinical results have made one-stage and early-loading concepts possible alternatives in the edentulous mandible. From the patient's point of view, the financial aspect of implant treatment is important. In an attempt to decrease financial burden, the reduction of surgical interventions and reduction of the number of implants could be considered. Purpose: This prospective multicenter study evaluated (1) the 1-and 3-year success rates of implants loaded within 1 month after one-stage surgery with a fixed 10- to 12-unit bridge on three regular platform Brånemark System implants in the mandible, (2) the outcome of the prosthetic treatment, and (3) the opinion of patients regarding the treatment procedure. Materials and Methods: Of 20 patients, 19 received five implants in the mandible, of which three were functionally loaded with the one-stage technique (group 1). The loaded implants were inserted in a tripodal position, one implant in the symphysis and two located anterior of the mental foramen in the bicuspid area. Two additional implants were inserted for safety reasons but were not intended to be included in the restoration. These two additional implants served as either an unloaded one-stage control implant (group 2) or an unloaded control implant installed with the submerged technique (group 3). Immediately after surgery, the implants were loaded with a relined denture. The patients received a 10- to 12-unit prosthetic reconstruction an average 31 days (range, 4-53 d) after surgery. Implant stability was clinically checked at 3, 12, and 36 months. Radiographs were taken at corresponding follow-up visits to calculate bone-to-implant level and marginal bone resorption. Results: Six of 60 functionally loaded implants (10%) and 3 of 20 prostheses (15%) failed within the first year. The cumulative implant failure rate in group 1, both after 1 and after 3 years, was 9.5%. No implant failure occurred in the control groups 2 and 3. The average marginal bone level measured at 1 and 3 years was 1.6 mm (SD = 0.8 mm) and 2.1 mm (SD = 0.2 mm), respectively, for group 1; 1.5 mm (SD = 1.3 mm) and 2.4 mm (SD = 0.6 mm), respectively, for group 2; 0.8 mm (SD = 1.4 mm) and 0.7 mm (SD = 0.9 mm), respectively, for group 3. Conclusions: The results of treatment using three regular platform Brånemark System implants supporting a fixed mandibular arch reconstruction were less favorable than the outcome that can be expected with a standard four- to six-implant with one-stage surgery. [source] Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, ChinaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2004Qingyue Meng Abstract Both challenges and opportunities have been created by health sector reforms for TB control programmes in developing countries. China has initiated radical economic and health reforms since the late 1970s and is among the highest TB endemic countries in the world. This paper examines the operation of TB control programmes in a decentralized financial system. A case study was conducted in four counties of Shandong Province and data were collected from document reviews, and key informant and TB patient interviews. The main findings include: direct government support to TB control weakened in poorer counties after its decentralization to township and county governments; DOTS programmes in poorer counties was not implemented as well as in more affluent ones; and TB patients, especially the low-income patients, suffered heavy financial burdens. Financial decentralization negatively affects the public health programmes and may have contributed to the more rapid increase in the number of TB cases seen over the past decade in the poorer areas of China compared with the richer ones. Establishing a financial transfer system at central and provincial levels, correcting financial incentives for health providers, and initiating pro-poor projects for the TB patients, are recommended. Copyright © 2004 John Wiley & Sons, Ltd. [source] Evaluating Oversight Systems for Emerging Technologies: A Case Study of Genetically Engineered OrganismsTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 4 2009Jennifer Kuzma The U.S. oversight system for genetically engineered organisms (GEOs) was evaluated to develop hypotheses and derive lessons for oversight of other emerging technologies, such as nanotechnology. Evaluation was based upon quantitative expert elicitation, semi-standardized interviews, and historical literature analysis. Through an interdisciplinary policy analysis approach, blending legal, ethical, risk analysis, and policy sciences viewpoints, criteria were used to identify strengths and weaknesses of GEOs oversight and explore correlations among its attributes and outcomes. From the three sources of data, hypotheses and broader conclusions for oversight were developed. Our analysis suggests several lessons for oversight of emerging technologies: the importance of reducing complexity and uncertainty in oversight for minimizing financial burdens on small product developers; consolidating multi-agency jurisdictions to avoid gaps and redundancies in safety reviews; consumer benefits for advancing acceptance of GEO products; rigorous and independent pre- and post-market assessment for environmental safety; early public input and transparency for ensuring public confidence; and the positive role of public input in system development, informed consent, capacity, compliance, incentives, and data requirements and stringency in promoting health and environmental safety outcomes, as well as the equitable distribution of health impacts. Our integrated approach is instructive for more comprehensive analyses of oversight systems, developing hypotheses for how features of oversight systems affect outcomes, and formulating policy options for oversight of future technological products, especially nanotechnology products. [source] Economics and quality of care for patients with acute coronary syndromes: The impending crisisCLINICAL CARDIOLOGY, Issue S1 2002Eric J. Topol M.D. Abstract Several factors are placing significant financial burdens on the health care system today. These include the growing older population, the obesity and type II diabetes epidemics, and the attendant increased prevalence of heart disease, which remains the leading cause of death in the United States. In response, cardiovascular medicine is undergoing sweeping change in the use of advanced technology and interventions. In addition, biomarkers, such as troponin, are emerging as critical predictors of responses to therapy, particularly for coronary stenting. Future trends in the treatment of acute coronary syndromes (ACS) will embrace the use of genomic solutions, such as gene expression profiling, to predict therapeutic outcomes. Careful consideration will need to be given to these innovative approaches to ensure they are cost effective. [source] | |||||||||||||||||||||||||