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PubMed1996

Tobacco industry efforts hindering enforcement of the ban on tobacco sales to minors: actions speak louder than words.

OBJECTIVE: The tobacco manufacturers state that they want to see laws that prohibit the sale of tobacco to minors enacted and enforced. Our purpose was to compare these public statements with the US tobacco industry's legislative agenda at the federal and state levels. DESIGN: A review of the industry's comments to the US Department of Health and Human Services (DHHS) regarding proposed federal regulations, and an analysis of pro-tobacco state legislation concerning tobacco sales to minors. RESULTS: The industry is strongly opposed to federal regulations requiring states to effectively enforce their laws prohibiting the sale of tobacco to minors. A food industry newsletter reports that the Tobacco Institute has circulated a model state bill concerning underage tobacco sales. Striking similarities between bills from several states would seem to confirm this report. These bills strip communities of enforcement authority while making effective enforcement by state officials virtually impossible. CONCLUSION: The evidence strongly suggests an industry strategy to undermine efforts to enforce laws prohibiting the sale of tobacco to minors. As has been the case in the past, the tobacco industry is publicly endorsing a socially responsible goal while apparently taking action behind the scenes to ensure that the goal is not achieved.

Adolescent↗
PubMed1982

[Developmental tendencies of gastrointestinal tumors relative to frequency and mortality with special reference to the special situation in Bavaria].

The time trends from 1952-1978 show a decreasing mortality from stomach cancer and increasing rates of cancers of the colon, rectum and pancreas in the Federal Republic of Germany. An analysis of regional trends shows that the stomach cancer rates are highest in the Federal State of Bavaria during the last 30 years. The analysis by age and birth cohorts shows a decrease of mortality rates with increasing year of birth. The effect is most pronounced in persons born after 1910 and in the age groups above 60 years. Since the regional pattern shows higher than average rates in Northeastern Bavaria and the lowest rates in the adjacent region of the Federal State of Hessen, a case control study was launched to investigate the possible reasons. This study will include hitherto considered risk factors, which are discussed, and additional information on dietary and traditional habits.

Adult↗
PubMed1991

Economic analysis in health care antitrust.

The Federal Trade Commission (FTC or Commission) has been very active in enforcing antitrust laws in the health care field for the past two decades. The staff has investigated a wide variety of cases covering a broad range of restrictions on competition. These cases can be divided into three basic types of cases in health care: (1) mergers and acquisitions, (2) horizontal restraints cases or agreements among competitors, and (3) input market monopolization cases, such as hospital privileges cases. The Commission relies on both legal and economic analysis in all of these cases. As Chairman Steiger of the Federal Trade Commission has stated, antitrust policy has been "increasingly reshaped by analysis based on economic theory." This article attempts to explain the economic analysis used in antitrust enforcement as applied to the first two of the three types of health care cases. Section I presents the basic economic framework that is used to assess the competitive implications of health care mergers and acquisitions. Section II describes the analysis applied to other agreements among competitors in the health care field and briefly explains how this analysis differs in other health care cases.

Antitrust Laws↗
PubMed1996

[Quality management from the viewpoint of the Federal Public Health Ministry].

A recent analysis of quality assurance measures used by German health care providers, which was conducted by order of the German Federal Ministry of Health, documented a large heterogeneity of methods, a missing validation for most measures, and the lack of a unifying framework. The "Total Quality Management" strategy, which originally was developed for industrial purposes, may provide such a unifying framework if adapted to the health care setting. Therefore, the German Federal Ministry of Health encourages the introduction of the "Total Quality Management" philosophy into the German health care system and will support this process by providing educational material. Since in Germany economic factors have an increasing impact on health care providers, which absolutely is intended by the legislative power, the application of "Total Quality Management" strategies will not only become a major competitive factor for providers, but may also improve patient outcome and satisfaction and reduce resource consumption.

Cost Control↗
PubMedDate not supplied

[Factors for ambulant care--first results of a small area comparison of assessment data in the Federal States of Schleswig-Holstein and Mecklenburg-Vorpommern].

This paper shows possible opportunities and analysis potentials to contrast between Federal States--in this case Schleswig-Holstein and Mecklenburg-Vorpommern--with regard to application for and demands on benefits granted by statutory long-term care insurance. It is a further development of an early study. Under the assumption of an equal behaviour as to application for, demands on and distinction of ADL (activities of daily life) variances for defined areas of a Federal State are pointed out. Within a Federal State, definite differences between rural and urban areas are exemplified. Applications for and demands on benefits follow the same trend, but there are differences in profile. Self-assessment of each of the the States concerned, differs surprisingly and is in itself often contradictory. On comparing these States, it was possible to verify individual factors of influence such as infrastructure, housing property conditions and individual self-assessment. Moreover the paper shows the influence of the process of transition taking place in East Germany, e. g. by selective migration and fast suburbanization.

Activities of Daily Living↗
PubMed1992

Transcultural nursing considerations of child abuse/maltreatment in American Samoa and the Federated States of Micronesia.

A conceptual analysis focuses on defining child maltreatment from the perspective of two Island nations in the Pacific Basin, American Samoa and the Federated States of Micronesia. Based on a review of the literature on child maltreatment laws and cultural factors in each region, a range definition is proposed. The range definition is comprised of defining features and borderline features for child maltreatment as it exists across these cultures in the Pacific Basin. Defining features were derived from evaluation of child abuse and neglect laws in each specified population. Borderline features were derived from cultural factors in American Samoa and the Federated States of Micronesia. While these Island nations already have child abuse and neglect laws, they are adapted from the United States. The degree at which unreasonable harm becomes abuse is culturally dictated, hence, these territories of the Pacific Basin are seeking culturally specific terminology when defining child maltreatment. The findings of this analysis indicate the significance of transcultural knowledge in nursing practice and the legal accountability nurses hold on the issue of child maltreatment.

Child↗
PubMed2001

A seat at the table: membership in federal advisory committees evaluating public policy in genetics.

OBJECTIVES: This study examined who participates in federal government advisory committees regarding public policy in human and medical genetics, what parties they represent, and to what extent the general public is meaningfully represented. METHODS: Analysis focused on 7 federal government documents published from January 1990 to February 1995. Advisors were categorized into 4 groups based on the professional affiliations that were listed in the publications. After a search of several references and data-bases, the study examined whether these individuals also had other affiliations not listed in the government publications. RESULTS: Individuals whose principal affiliations were with academia (n = 32; 44%) or industry (n = 19; 26%) represented nearly three fourths of the sample, followed by government employees (n = 13; 18%) and consumer advocates (n = 8; 11%). At least 16% of the advisors serving on the federal committees, mostly members of academia, had a dual affiliation. CONCLUSIONS: These data indicate that the public has modest representation on key federal advisory committees making policy recommendations regarding human genetics technology and clinical practice and that there is ample room for additional public participation.

Committee Membership↗
PubMed1984

Recent legal decisions and the implications for governance.

What major legal precedents were considered in the past year that affect hospital governance? The assistant general counsel of the American Hospital Association examines three particular areas of concern: the composition of hospital boards, trustee liability for federal taxes, and antitrust analysis of exclusive contracts.

Contract Services↗
PubMed2004

[Development of guidelines for rehabilitation of patients with stroke: analysis of therapeutic procedures].

The Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte) in Berlin took the initiative to develop evidence-based guidelines for rehabilitation including stroke rehabilitation. In the present study we performed a systematic survey of the scientific literature on stroke rehabilitation and deduced 8 evidence-based therapeutic modules. They were supplemented by 5 practice-based modules to cover the full range of interventions currently applied in stroke rehabilitation. Modules are clusters of various interventions which were aggregated according to the rehabilitative goal they have in common. Data were analysed from 8,876 BfA patients, the total population of "neuro"-patients in 2001 and 2002 with 142,951 interventions and 1,071,885 appointments. Stroke diagnoses covered ICD-10 codes I60, I61, I62, I63, I64 or were coded by G45, G81 and one of these I-codes. Stroke rehabilitation as provided in daily practice was found to be a complex multimodal treatment programme in all hospitals which were studied. On average, patients receive treatments from 7.3 therapeutic modules. A dominating role is played by "motor modules". Obviously, they play a major role in acute stroke rehabilitation in all hospitals compared to cognitive retraining, language therapy and especially improvement of psychic functions, which were significantly less applied. A dramatic variation could be shown to exist between the rehabilitation hospitals (1) with respect to the number of patients who were treated with a given module (e. g., some modules showed variations between 18 % and 100 %), and (2) with respect to treatment intensity and treatment duration per week. Several factors can be taken into account for interpretation of this high variance. Intrinsically, the high variation in symptomatology after stroke can play a major role, as both the deficit profile and the level of severity of a given deficit and the combined severity level can vary from patient to patient. On the other hand, extrinsic factors such as lack of staff may also account for some of the differences. In any case, the results show the necessity to optimize stroke rehabilitation by development and implementation of guidelines. Yet, they also point to a need for further research into rehabilitation interventions and procedures to yield evidence for the approximately 30 % of "only" practice-based interventions.

Adult↗
PubMedDate not supplied

[Infectious diseases in natural reservoirs: epidemic situation and morbidity in the Russian Federation and prophylactic measures].

The analysis of morbidity in infections with natural foci in Russia for the period of 1999-2000 indicates that a rise in the number of cases of hemorrhagic fever with the renal syndrome, tick-borne encephalitis, Crimean hemorrhagic fever and West Nile fever with a high proportion of urban population among the patients is registered annually. An increase in the epizootic activity of the natural foci of plague is noted in the absence of morbidity among humans. The appearance of the outbreaks of tularemia is linked nor only with the increased activity of the natural foci, but also with the reduced coverage of the population with prophylactic immunization in endemic regions. This analysis infers that morbidity prognosis in infections with natural foci for 2001 remains unfavorable. The growth of morbidity in these infections is mainly due to the reduction of measures for controlling their vectors both is open nature and in settlements, as well as to low coverage with prophylactic immunization. Urgent complex measures which may ensure effective antiepidemic and prophylactic work for controlling infections with natural foci are presented.

Animals↗
PubMed1984

[Divorces, 1982].

Explore the source record for details and available documents.

Cohort Studies↗
PubMed2001

Medical students exchange program organized by Croatian Medical Students International Committee, 1996-2000.

AIM: To assess the interest of Croatian medical students in going to foreign countries and foreign medical students' interest in coming to Croatia for one-month professional and research clerkship in the period from 1996 to 2000. METHOD: Data were obtained from contracts between Croatian Medical Students' International Committee and other National Member Organizations of the International Federation of Medical Students' Associations; from student Application forms; reports of the Local Committees of Croatian Medical Students' International Committee summed up in a Statistical form and used for statistical analysis in the International Federation of Medical Students' Associations; and from Cards of acceptance and Cards of confirmation. RESULTS: The number of available bilateral exchange places increased from 28 in 1996 to 66 in 1999. Croatian students going for clerkship abroad used 65.8% of available places and foreign students realized 59.3% of all places available in Croatia. Most of the exchange students chose clinical, whereas only a small number chose preclinical clerkship. The most visited were the departments of medicine and general surgery. All the students preferred doing their clerkships in August. Most foreign students came from Italy, Spain, Slovakia, and Hungary. Croatian students preferred to go to Italy, Spain, Egypt, and Finland. CONCLUSION: Political problems strongly affected students' interest in doing clerkship in a certain country. Croatia needs to attract more students from different countries and to increase the interest of Croatian students in doing clerkship in Eastern European countries.

Croatia↗
PubMed2003

Federal Trade Commission v. Tenet: a retrospective review and analysis.

Primarily through a series of interviews with a variety of interested persons, the author analyzes the controversial merger of two hospitals in Poplar Bluff, Missouri, in late 1999. A district court had stopped the merger in 1998; however, the Eighth Circuit overturned the decision the following year, therefore permitting the parties to execute the merger. The Article highlights the effects of, and the market's response to, the merger. Results reveal that in the two years following the merger, none of the parties interviewed believe the merger was favorable. Similarly, parties perceive that the price of care has increased, while the quality of care has not improved. Nonetheless, at the two-year mark, it remains too soon to determine whether the government's concerns in opposing the merger have been justified.

Antitrust Laws↗
PubMed2002

Pleomorphic liposarcoma: clinicopathologic, immunohistochemical, and follow-up analysis of 63 cases: a study from the French Federation of Cancer Centers Sarcoma Group.

The clinicopathologic and immunohistochemical features of 63 pleomorphic liposarcomas are presented. There were 35 men and 28 women (median age 63 years; range 18-93 years). Tumor size ranged from 2 to 23 cm (median 10 cm). Tumor locations included lower extremity (36.5%), especially the thigh (28.5%), limb girdles (17.5%), upper extremity (16%), thoracoabdominal wall (9.5%), and internal trunk (20.5%). A total of 75% were deep seated and/or extracompartmental. Histologically, lesions show a varying combination of lipogenic and nonlipogenic areas characterized by malignant fibrous histiocytoma-like, round cell liposarcoma-like, and/or epithelioid/carcinoma-like features. A pericytic pattern was focally present in 15 (24%) tumors. Eighteen (29%) lesions were grade 2, and 45 (71%) were grade 3 sarcomas. Tumor necrosis was observed in 51 (81%) cases, vascular invasion in three, and mitotic counts ranged from 3 to 124 per 10 high power fields (median 25). Lipogenic areas were S-100 protein immunoreactive, at least focally, in 20 of 42 (48%) cases. Nonlipogenic areas showed focal reactivity for smooth muscle actin (24 of 49; 49%), desmin (9 of 48; 19%), CD34 (18 of 45; 40%), S-100 protein (5 of 49, 10%), CD68 (6 of 46, 13%), and epithelial membrane antigen (13 of 49, 26.5%). Epithelioid areas showed epithelial membrane antigen (4 of 11; 36%) but not cytokeratin (0 of 11) reactivity. Treatment procedures in 51 patients consisted of simple tumorectomy (16) and wide excision (33). Five and 31 patients received neoadjuvant and adjuvant chemotherapy and/or radiation therapy, respectively. Follow-up (48 patients, range 7-276 months; median 38 months) showed a 45% local recurrence rate and a 42.5% metastasis rate, metastases occurring mostly in lungs and pleura. Seventeen patients (35%) died of disease, of whom none was metastatic at diagnosis. Five-year overall, metastasis-free, and local recurrence-free survivals were 57%, 50%, and 48%, respectively. Patient age > or =60 years, truncal tumor location, deep situation, tumor size >5 cm, vascular invasion, and incomplete tumor excision were significant adverse prognostic factors. Tumor grade and histology did not affect patient outcome. In conclusion, pleomorphic liposarcoma is a rare, often deep-seated and limb-based aggressive and metastasizing neoplasm of late adulthood. It shows a wide range of morphologic appearances, but tumor grade and histology have no effect on patient outcome.

Adolescent↗