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Biomedical subjects

D McIntyre

Publications and source records attributed to D McIntyre.

At least 37 records · Page 2Linked to original sources
PubMed1996

Value for money in South African health care: findings of a review of health expenditure and finance.

This article highlights the most striking findings of a review of health expenditure and finance in South Africa in 1992/3. The level of national expenditure on health care, and the distribution of resources between the public and private sectors, are discussed first. Then the article highlights the maldistribution of financial, physical and human resources on a geographic basis, racially and between levels of care. The cost of redressing inequities, at least at the primary care level, is mentioned in the context of seeking options for additional sources of finance. The article concludes by examining the planning prerequisites for successful reform.

Financial Support↗
PubMed1995

The metabolic costs of different types of contractile activity of the human adductor pollicis muscle.

1. The metabolic costs and physiological consequences of shortening contractions of a human muscle working in situ have been compared with those of the muscle maintaining a continuous isometric contraction and when performing repeated brief isometric contractions. 2. After a total of 10 s stimulation, the shortening and intermittent brief isometric protocols had very similar effects, causing a 30% loss of force and a threefold increase in the half-time of relaxation. This was in contrast to the continuous isometric contraction protocol where there was less than 10% loss of force or slowing of relaxation. 3. The ATP cost over the first 5 s of the continuous isometric protocol was 27 mmol (l intracellular water)-1 while for the shortening and repeated brief isometric protocols the costs were 48 and 46 mmol (l intracellular water)-1, respectively. 4. The results show that shortening and repeated brief isometric contractions are considerably more energetically demanding, and hence more fatiguing, than sustained isometric contractions.

Adenosine Triphosphate↗
PubMed1995

Expenditure on health research in South Africa, 1991/1992.

OBJECTIVE: To determine expenditure on health research in South Africa in 1991/1992. DESIGN: Data from the financial statements of large statutory councils conducting research in South Africa, as well as other relevant reports, particularly the Department of National Education's (NATED) survey of research institutions, were analysed. RESULTS: A total of R198.7 million was spent on health research in 1991/1992, 56.1% by the tertiary education sector and 20.7% by the Medical Research Council. Only 1.1% of expenditure on health was spent on research. Less than 9% of health research expenditure by tertiary educational institutions is classified within the category of 'comprehensive medicine' (which includes community health, epidemiology and nutrition), whereas 82% of expenditure by autonomous government institutions is so classified. CONCLUSIONS: Given that expenditure on health research in South Africa is relatively low by international standards, an increase in expenditure by both the public and private sectors should be considered. Given the scarcity of research resources, there should be adequate planning, co-ordination, and particularly prioritisation of resource allocations, so that research can be directed towards addressing the country's health needs.

Health Expenditures↗
PubMed1995

Acceptability to general practitioners of national health insurance and capitation as a reimbursement mechanism.

OBJECTIVE: To determine general practitioners' attitudes to national health insurance (NHI) and to capitation as a mechanism of reimbursement. To explore determinants of these attitudes. DESIGN: Cross-sectional survey by means of telephone interviews; four focus group discussions. SETTING: Cape Peninsula. PARTICIPANTS: 174 GPs randomly sampled from a total population of 874. MAIN OUTCOME MEASURES: Acceptance of NHI, acceptance of capitation. MAIN RESULTS: 63.3% approved of NHI. More than 81% approved of NHI if GPs would be able to maintain their independent status, e.g. own premises and working hours; 82.3% said NHI would be a more equitable system of health care, 88% approved of the fact that NHI would make care by GPs more accessible, and 73% said they would have the capacity to treat more patients. However, 61.3% of GPs disapproved of capitation as a form of reimbursement. CONCLUSIONS: Most GPs in the Cape Peninsula were amenable to some form of NHI. However, the proportion of GPs who approved the introduction of NHI varied depending on details of the NHI system such as payment mechanisms, workload, income and effects on professional autonomy. A national survey of medical practitioners is recommended. The implications of GPs' preferences concerning the reimbursement mechanism for the feasibility of implementing a NHI system in South Africa require serious consideration by policy-makers.

Adult↗
PubMed1982

Factors influencing salvage cystectomy results.

Analysis of 86 patients who underwent salvage cystectomy following a radical course of radiotherapy for bladder cancer and 37 patients who underwent primary cystectomy has shown a greater survival for women than men. The following factors were associated with a significant deterioration in survival: 1. Age at time of cystectomy: post-operative mortality and tumour recurrence are greater over the age of 70. 2. Non-function of one kidney on IVU. 3. Grade 3 tumour on cystectomy specimen. 4. pT3 or pT4 tumour on cystectomy specimen.

Age Factors↗
PubMed1981

Characterization of macrophage subpopulations responsive to activation by endotoxin and lymphokines.

The subpopulations of murine macrophages (M phi) that can be activated by endotoxin (LPS) and lymphokines to produce lymphocyte-activating factor, or interleukin 1 (IL-1), and to express cytostatic and cytolytic activities against tumor cells were characterized in 3 cell populations with immature and mature M phi in various proportions, namely, normal peritoneal cells, glycogen-induced peritoneal cells, and cultured bone marrow M phi. There is disagreement in the literature as to whether tumor cytotoxicity can be elicited from all M phi or from a subset of small, newly formed peroxidase-positive (p+) monocytes. Using the technique of cell size fractionation, which separates p+ and p- M phi to various extents, we have found that the magnitude of te response to LPS and lymphokines increases with cell size (and hence maturity or the degree of prior stimulation) and is not exclusive to p+ M phi. Our results are consistent with the concept that all M phi, irrespective of developmental stage, can exist in a continuum of activated states, depending on the nature of the activation signals.

Animals↗
PubMed1979

Selective superior mesenteric embolization for small intestinal hemorrhage.

A 25-year-old white woman who had previously undergone two operations for peptic ulcer disease, and was addicted to drugs and alcohol, had massive hemorrhage from the small intestine. Angiography pinpointed the jejunum as the source of bleeding. Because the patient had a coagulopathy she was considered a poor risk for surgery. Bleeding was controlled by embolization with sterile, commercially available Gelfoam (Upjohn) which was injected into the offending branch of the superior mesenteric artery. This is believed to be only the third documented case of embolization of small intestinal vessels. A review of the available literature is presented and the value of Gelfoam embolization as an adjunct in the control of hemorrhage in selected patients is stressed.

Adult↗