SEARCH · PubMed Health

Results for “Federated analysis”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 271 records · Page 15Linked to original sources

PubMed2001

[Allocation of health care resources in the state of Santa Catarina, Brazil: a contribution to a discussion on health financing].

OBJECTIVE: To describe the health situation in municipalities in the state of Santa Catarina, Brazil, in 1996, and to investigate how that correlated with federal health spending in 1997. METHODS: Multiple regression analysis was used to investigate the association between federal health care funding and proportional mortality, supply of health services (hospitals and outpatient clinics), and the municipality's population (number of inhabitants). Also investigated was the association between mortality from broad groups of causes and socioeconomic structure, supply of health services, and the municipality's population. RESULTS: The multiple regression analysis showed an association between proportional mortality due to: 1) infectious diseases and: infant mortality, number of non-doctor medical professionals per 10,000 inhabitants, and number of physicians per 10,000 inhabitants (negative association); 2) chronic degenerative diseases and: percentage of individuals 60 years and older, infant mortality (negative association), and number of non-doctor medical professionals per 10,000 inhabitants (negative association); and 3) external causes of death and: the municipality's population, number of hospitals per 10,000 inhabitants (negative association), and percentage of children younger than 1 year. Health spending per inhabitant in 1997 was mainly associated with the municipality's population, number of outpatient clinics per 10,000 inhabitants, Swaroop and Uemura mortality rate, and deaths due to chronic degenerative diseases in 1996. CONCLUSIONS: Municipalities with a better morbidity and mortality profile and a better health services structure received more federal health care resources. To improve this situation, special strategies should be considered in order to ensure additional resources for municipalities that have poorer health indicators.

Brazil↗

PubMed1995

Malpractice reform in the 1990s: past disappointments, future success?

State governments, the federal government, interest groups, and researchers have proposed various approaches to reform the malpractice system. Malpractice reforms fall into two generations. First-generation reforms are those adopted by states beginning in the 1970s chiefly to reduce claim frequency and severity and thereby improve the malpractice system primarily from the perspective of providers and insurers. Scholars and interested constituencies developed second-generation reforms, such as use of medical practice guidelines to set the standard of care, various no-fault approaches, enterprise liability, mandated alternative dispute resolution, and scheduling damages, to streamline the adjudication and compensation system from the perspective of claimants and providers. Research indicates that first-generation reforms have not been very effective in achieving the compensation and deterrence goals of tort, whereas second-generation reforms hold greater promise of doing so. This analysis of state and federal legislation indicates that states, and more recently Congress, have been reluctant to adopt second-generation reforms but continue to promote and/or adopt first-generation reforms. The strength of the provider lobby, concerns of health care reformers about the relationship between defensive medicine and health system costs, and lack of an organized consumer force for second-generation malpractice reform are important explanations of why the states and Congress have not embraced second-generation reforms. Furthermore, federal and state legislative interest in second-generation reforms, although never high, is waning in the current health care reform debate.

Consumer Advocacy↗

PubMed2001

Object-oriented modeling of patients in a medical federation.

This research explores the development of an object-oriented model to support inter-operation of simulations within a federation for the purpose of conducting medical analysis and training over a distributed infrastructure. The medical federation is referred to as the combat trauma patient simulation system and is composed using high level architecture. The infrastructure contains components that were separately developed and are heterogeneous in nature. This includes a general anatomical computer database capable of generating human injuries, referred to as operational requirements-based casualty assessment, an animated mannequin called the human patient simulator, and other components. The research develops an object model that enables bodily injury data to be shared across the simulation, conducts analysis on that data, and considers possible applications of the technique in expanded medical infrastructures.

Computer Communication Networks↗

PubMed2001

The regulation of outpatient services: an analysis of the interaction between HCFA and Medicare providers.

The Federal Register is used as a historical record documenting the interaction between the Health Care Financing Administration (HCFA) and health care providers in the regulation of outpatient surgery services to Medicare patients. A content analysis of the Federal Register reveals that HCFA is more likely to accommodate requests for clarification, for shifting services among payment levels, and for adding or deleting services from coverage than for altering payment methods. These findings can be used by health care providers to develop strategies for coping with the expansion of prospective payment to all outpatient services.

Ambulatory Care↗

PubMedDate not supplied

[Revisiting the Spanish flu: the 1918 influenza pandemic in Rio de Janeiro].

The article analyzes the political and social impacts of the 1918 Spanish flu epidemic in the city of Rio de Janeiro, then Brazil's federal capital. Based on an analysis of Rio de Janeiro press reports and of other documentation (including annals, reports, and bulletins from a federal ministry, the Mayor's Office, and the Chamber of Deputies, along with studies from the Brazilian National Academy of Medicine and dissertations from Rio de Janeiro's Faculdade de Medicina), we explore use of the epidemic as a means of political engineering. Our focus is on how the epidemic impacted not only the representation of certain political and social actors but also the reaffirmation of a group of sanitarians as an intelligentsia with a vocation for political leadership who played a key role in the process of modernizing Brazilian society.

Brazil↗

PubMed2005

Determining the modern carbon content of biobased products using radiocarbon analysis.

In support of the USDA Federal Biobased Products Preferred Procurement Program (FB4P), Iowa State University is coordinating testing to determine the "biobased content" of manufactured products. These tests are part of a process to "designate" items that qualify for preferential procurement status with federal agencies. Biobased content determinations are being performed using three radiocarbon dating procedures specified in ASTM D 6866-05. Test results obtained thus far indicate that the AMS and benzene synthesis methods provide comparable results. Data from the CO(2) cocktail method did not agree as well with the data from the other two methods, but were still in reasonably good agreement with those data. Radiocarbon analysis is shown to be a reliable and valuable tool for verifying the biobased content of a wide variety of biobased products. Based on inter- and intra-laboratory comparisons, a reasonable uncertainty to associate with the analyses would be +/-3% (absolute) for the AMS and benzene synthesis methods. Because of limited data availability, additional work is needed to establish the uncertainty of the CO(2) cocktail method for analyzing biobased products.

Carbon Radioisotopes↗

PubMed1991

Liberal benefits, conservative spending. The Physicians for a National Health Program proposal.

The Physicians for a National Health Program proposes to cover all Americans under a single, comprehensive public insurance program without copayments or deductibles and with free choice of provider. Such a national health program could reap tens of billions dollars in administrative savings in the initial years, enough to fund generous increases in health care services not only for the uninsured, but for the underinsured as well. We delineate a transitional national health program budget that would hold overall health spending at current levels while accommodating increases in hospital and physician utilization. Future national health program spending would be indexed to the growth in gross national product adjusted for demographic, epidemiologic, and technologic shifts. Financing for the national health program would transfer funds into the public program without disrupting the general pattern of current revenue sources. We suggest a funding package that would augment existing government health spending with earmarked health care taxes. Because these new taxes would replace employer-employee insurance premiums and substantial portions of current out-of-pocket expenditures, they would not increase health costs for the average American.

Budgets↗

PubMed2007

Survival and toxicity differences between 5-day and weekly cisplatin in patients with locally advanced cervical cancer.

BACKGROUND: Cisplatin (CDDP) administration concomitant with radiotherapy (RT) for the treatment of locally advanced cervical cancer has evolved from an inpatient 5-day every 21-day regimen to a weekly outpatient regimen. This study was designed to test for differences in progression-free survival (PFS) and toxicity between the 2 regimens. METHODS: In all, 77 consecutive patients at a single institution with stage IB2-IV cervical cancer were included in this analysis (using the International Federation of Gynecologists and Obstetricians staging system). All patients were treated with CDDP, external beam RT, and 2 9-Gy high-dose-rate brachytherapy treatments. Two cohorts were compared: 1) 5-day, patients treated from 1995 to 2001 with CDDP 20 mg/m(2) x 5 days every 21 days concomitant with RT; 2) weekly, treated after May 2001 with CDDP 40 mg/m(2) weekly concomitant with RT. RESULTS: In all, 50 patients were treated with the 5-day regimen and 27 patients with the weekly regimen. There were no significant demographic differences between the groups. Overall 3-year PFS, controlling for stage, was 90% and 76% for 5-day and weekly groups, respectively (P = .01). Adjusting for stage, age, and completion of treatment, the risk of treatment failure among the weekly group was 3.46 times higher than the 5-day group (P = .02). The weekly group had a 3.43 times higher risk of developing acute toxicities than the 5-day group (P = .02) in advanced-stage patients. CONCLUSIONS: Patients who received weekly CDDP have a shorter 3-year PFS. Patients with advanced-stage cervical cancer who received weekly CDDP had significantly more acute toxicities. These data should be confirmed in a multi-institutional, randomized, controlled study.

Antineoplastic Agents↗

PubMed2006

Public finance policy strategies to increase access to preconception care.

Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15-44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.

Adolescent↗

PubMed1983

Analysis of 120 shift systems of the police in the Federal Republic of Germany.

120 shift rotas of the police were collected and analysed. The frequency distribution of the shift cycles, the duration of shifts, the start and end of shifts, the maximal number of consecutive night shifts, as well as the frequency of different kinds of free weekends, were determined. The shift systems are compared with recommendations for the design of shift rotas which are based on physiological, psychological and social criteria.

Journal Article↗

PubMed2005

Anticipated socio-environmental impacts of the proposed Little Darby National Wildlife Refuge in Ohio.

Data were collected during the summer of 2000 from 146 residents living in a rural area located in central Ohio that had been identified as a possible site for a national wildlife refuge. The purpose of the study was to assess anticipated socio-economic and environmental impacts of the proposed refuge on local people and natural ecosystems. A 'vested interests' theoretical model was developed to guide the investigation. The theoretical model posits that attitudes of local people toward externally induced projects are a function of costs and benefits individuals expect to receive as a result of the development action. The theory posits that individuals who expect to receive greater benefits from the refuge will exhibit more favorable attitudes toward the proposed project. Anticipated impacts of the proposed refuge were assessed with a Likert-type attitude scale that was shown to be highly reliable. Variables measuring specific costs and benefits associated with the proposed project were used as predictive variables. Descriptive statistics demonstrated that respondents believed the proposed wildlife refuge would generate more costs than benefits for local residents. Multiple linear regression findings demonstrated that six variables were significant in explaining 65.1% of the variance in the attitudes toward the proposed project. The significant variables were as follows: perceived costs and benefits associated with the proposed project, perceived water quality within the Little Darby Creek at the time of the data collection, age of primary income earner, expected future water quality within the Little Darby Creek, expected impact of farmland transition on the household, and attitude toward private property rights. Study findings consistently support research hypotheses.

Adult↗

PubMed2004

Phenprocoumon-induced liver disease ranges from mild acute hepatitis to (sub-) acute liver failure.

BACKGROUND/AIMS: Except for bleeding complications, other serious adverse reactions of coumarin anticoagulants such as hepatotoxicity or skin necrosis are comparatively rare. Nonetheless, a small number of coumarin-induced (sub-) acute liver failures has been published. METHODS: A retrospective analysis was performed of patients treated for liver disease between 1992 and 2002 at our department to evaluate the incidence, clinical findings and histopathology of coumarin-induced hepatotoxicity. RESULTS: The retrospective analysis revealed eight cases of phenprocoumon-induced hepatotoxicity, including three cases of (sub-) acute liver failure which resulted in two orthotopic liver transplantations and one fatal outcome. Five patients with phenprocoumon-induced hepatitis recovered well after anticoagulation was switched to another coumarin derivate or subcutaneous low molecular weight heparin. In all patients liver injury was predominantly of an hepatitic type. In the cases of (sub-) acute liver failure massive confluent liver cell necroses were histologically present, whereas among patients without liver failure mild portal to moderate active lobular hepatitis were observed. A retrospective analysis by BfArM (German Federal Institute for Drugs and Medical Devices) revealed 4390 cases of possible phenprocoumon-related adverse reactions since 1990, 2% of which had presented with hepatitis and 0.2% with liver failure. CONCLUSIONS: Phenprocoumon-induced liver disease is an uncommon complication, which can, however, cause (sub-) acute liver failure.

Acute Disease↗

PubMed2005

Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes?

OBJECTIVES: Quality assessment of coronary artery bypass grafting has traditionally been performed with data from clinical databases. Administrative databases that rely primarily on information collected for billing purposes increasingly have been used as tools for public reporting of outcomes quality. The correlation of administrative data with clinical data for clinical quality assessment has not been confirmed. METHODS: With data from a clinical database, we analyzed the outcomes of all patients who underwent coronary artery bypass grafting surgery in 1 hospital between 1999 and 2001. This information was collected before, during, and after the surgery and hospitalization by designated clinical individuals involved with the patient's care and then entered into an audited clinical database (The Society of Thoracic Surgeons National Cardiac Database). These data were then compared with administrative data collected on the same cohort of patients for the number of procedures performed and mortality rate as reported by the federal government (Medical Provider Analysis and Review), state government (Texas Health Care Information Council), hospital system (HCA, Inc, Casemix Database), and an internet Web site (healthgrades.com). Data were analyzed on the basis of the population reported, definitions used, risk assessment algorithms, and case volumes. RESULTS: By using the audited The Society of Thoracic Surgeons database as the standard and aggregating the reporting of case volumes by the inclusion criteria of various sources of administrative data, we found variances in the reported procedure volumes and mortality. Case volumes were overreported by as much as 21% in all patients and underreported by up to 16% or more in Medicare patients. Mortality in administrative data exceeded that reported in clinical data by 21%. Reasons for variances included time period reported (calendar vs fiscal year), population reported (all patients, Medicare patients, Medicare patients aged >/= 65 years), date used for the patient record captured (date of surgery, discharge), and the definition of mortality. Different proprietary risk-adjusting algorithms used magnified variances with risk-adjusted mortality exceeding the Society of Thoracic Surgeons data by as much as 61%. CONCLUSIONS: Substantial variability of reported outcomes is seen in administrative data sets compared with an audited clinical database in the end points of the number of procedures performed and mortality. This variability makes it challenging for the nonclinician unfamiliar with outcomes analysis to make an informed decision.

Aged↗

PubMed2006

Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication.

UNLABELLED: The presence of the metabolic syndrome is an important risk factor for cardiovascular disease and diabetes. There are limited data on the prevalence of the metabolic syndrome in European patients suffering from schizophrenia. METHODS: All consecutive patients with schizophrenia at our university psychiatric hospital and affiliate services were entered in an extensive prospective metabolic study including an oral glucose tolerance test. The prevalence of the metabolic syndrome was assessed based on the National Cholesterol Education Program criteria (NCEP, Adult Treatment Protocol, ATP-III), adapted ATP-III criteria using a fasting glucose threshold of 100 mg/dl (AHA) and on the recently proposed criteria from the International Diabetes Federation (IDF). RESULTS: The analysis of 430 patients showed a prevalence of the metabolic syndrome of 28.4% (ATP-III), 32.3% (ATP-III A) and 36% (IDF), respectively. The prevalence of the metabolic syndrome in our sample of patients with schizophrenia is at least twice as high compared to an age-adjusted community sample in Belgium. CONCLUSION: The metabolic syndrome is highly prevalent among treated patients with schizophrenia. It represents an important risk for cardiovascular and metabolic disorders. Assessment of the presence and monitoring of the associated risks of the metabolic syndrome should be part of the clinical management of patients treated with antipsychotics.

Adult↗

PubMed1998

Literacy and body fatness are associated with underreporting of energy intake in US low-income women using the multiple-pass 24-hour recall: a doubly labeled water study.

OBJECTIVE: The accuracy of the multiple-pass 24-hour recall method for estimating energy intake in low-income women in the United States was ascertained by comparing the method with measurements of total energy expenditure. The multiple-pass 24-hour recall is designed to provide respondents with multiple cues and opportunities to report their food intake. It consists of 3 distinct passes: the quick list, detailed description, and review. Predictors of energy intake misreporting (energy intake--total energy expenditure) in the sample were determined. DESIGN: Four multiple-pass 24-hour recalls (2 in person, 2 by telephone) were obtained over a 14-day period to estimate energy intake. Total energy expenditure was measured over the same 14-day period using the doubly labeled water method. Body composition was measured using dual energy x-ray absorptiometry, and literacy was measured by the Wide Range Achievement Test (WRAT) for reading and spelling. SUBJECTS/SETTINGS: Thirty-five low-income women between the ages of 19 and 46 years were tested at the General Clinical Research Center at the University of Vermont, Burlington. Low income was defined as a household income at or below 130% of the federal poverty level. STATISTICAL ANALYSIS: Pearson product moment correlation coefficients, t tests, paired t tests, and stepwise multiple regression analysis were used to test the relationships among study variables. RESULTS: Mean energy intake was significantly lower than mean total energy expenditure (2,197 +/- 607 vs 2,644 +/- 503 kcal, P = .001) and the correlation between the 2 measures was poor (r = .22, P = .20). Percentage body fat and the combined age-adjusted reading and spelling WRAT scores were the best predictors of misreporting of energy intake (R = .52, P = .006). CONCLUSIONS: The multiple-pass 24-hour recall did not generate a group measure of energy intake that was accurate or unbiased in this sample. Underreporting was strongly associated with increased body fatness. The ability to read and spell as measured by the WRAT improved the accuracy of the women's recall of their food intake. APPLICATIONS: Dietetics professionals should take into consideration the problem of underreporting whenever conclusions are made about associations between diet and health and/or when evaluating the impact of food assistance programs on dietary intake.

Adipose Tissue↗

PubMed2003

Access to health care for youth leaving foster care: Medicaid and SCHIP.

PURPOSE: To examine how Medicaid and the State Children's Health Insurance Program (SCHIP) could improve health care access for youth aging out of foster care, a vulnerable population with multiple health concerns. METHODS: On the basis of an analysis of state and federal laws, state plans and amendments, and a telephone survey of state officials, this article identifies options in Medicaid and SCHIP for states to provide health insurance coverage for these youth, examines states' use of available options, and highlights other relevant federal health care programs. RESULTS: Numerous Medicaid and SCHIP eligibility categories could provide coverage for older adolescents leaving foster care. The federal Foster Care Independence Act of 1999 (FCIA) created a new Medicaid expansion option for this group and other opportunities for states to address their health care needs. Numerous other federal programs also finance health care that could serve this population. CONCLUSIONS: The potential exists through Medicaid or SCHIP to ensure that nearly all former foster youth have health insurance as they leave state custody, but Medicaid and SCHIP cannot alone meet all health care needs of these youth. Financing available through other public programs is essential. A few states have adopted the new FCIA Medicaid expansion option for former foster youth, and a larger number have implemented other relevant Medicaid options. Additional states have used other innovative approaches to facilitate health care access. Most states could do much more. A major challenge is to find approaches that can be implemented during times of severe budgetary limitations.

Adolescent↗

PubMed2006

Mandibular fracture: analysis of 293 patients treated in the Hospital of Clinics, Federal University of Uberlândia.

UNLABELLED: Mandibular fracture is the second most common facial fracture and there has been a significant increase in number of cases in the last years. Misidentification and inadequate treatment can take to permanent aesthetic or functional deformity. AIM: Evaluate cases of mandibular fracture reduction in the Hospital of Clinics of the Federal University of Uberlândia, from January of 1974 to December of 2002. STUDY DESIGN: Historical cohort. PATIENT AND METHOD: Two hundred and ninety-three cases of reduction of mandibular fractures were retrospectively analyzed according to factors related to: patient, trauma, signs and symptoms, and surgical treatment. RESULTS: There has been a clear tendency of increase of the number of mandibular fractures along the years. There was higher prevalence in male (4:1), with occurrence peak between 20 to 29 years old. The principal causes of fracture in this study were traffic accidents and violence, representing 72.4%. One hundred and thirty-five patients presented only one fracture. The most injured sites were, in decreasing order, symphysis, condyle, angle, body, ramus, and coronoid. We performed closed reduction (28), open reduction (213) and association of the two (11 patients); 56.8% of the patients were treated within the first 3 days; and, 50.4% were discharged from the hospital until the first postoperative day. About 10% of the patients presented complications, being osteomyelitis the most frequent one. CONCLUSION: The incidence of mandibular fractures was remarkably larger in the male sex, during the third decade of life. The most common cause was traffic accident, and symphysis and condyle were the most injured sites. Isolated fractures occurred in over half of the cases. Most of the patients were treated in the first three days and were discharged until the first postoperative visit. Closed reduction was the treatment most commonly employed. The most frequent complication was osteomyelitis.

Accidents, Traffic↗

PubMed2004

Structural organization of the genome of SARS-associated coronavirus (Strain SoD) isolated on the territory of the Russian Federation.

Complete nucleotide cDNA sequence (29715 nucleotides) of SARS-associated coronavirus (strain SoD) isolated for the first time in the territory of the Russian Federation was determined. Phylogenetic analysis revealed maximum similarity between strain SoD genome and Frankfurt 1 strain genome. Three nucleotide substitutions determining two amino acid substitutions were detected.

Amino Acid Substitution↗