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PubMed1977

Impact of federal regulations at a university.

Last year the University of Iowa conducted an in-house study of how federal regulations, executive orders, and agency administrative policies affected the day-to-day operations of the university on all levels. This article is an analysis and reassessment of the federal impact issue based on the information uncovered in the University of Iowa survey.

Costs and Cost Analysis↗
PubMed1991

[Global cost analysis of radiological procedures].

In the Federal Republic of Germany, the amount spent on investments in electromedical equipment and systems has remained constant at 0.7% of total health expenditure over the last 15 years. One-fifth of this sum is used for large medico-technical systems such as CT scanners, cardioangiography systems or shock-wave lithotriptors. Expenditure on this category of equipment, including investments and total application costs, amounts to 2 billion DM. This sum also amounts to 0.7% of total health expenditure, or 1.5% of the volume of the statutory health insurance schemes. This paper contains evaluation from various countries showing that the correct implementation of such high-performance units in diagnosis and therapy results in considerable savings. The cost-reducing effects can nevertheless be over-compensated by additional applications carried out due to the specific advantages of these technologies. However, the growing utilisation indicates improved and more economic medical care of the population.

Costs and Cost Analysis↗
PubMed1997

Dietary analysis of meals served in the breakfast and lunch programs of Puerto Rican schools.

BACKGROUND: Nutritional analysis of meals in the Federally-sponsored Breakfast and Lunch Programs in Stateside Schools has recently been completed. However due to ethnic and cultural differences, the findings may not be directly applicable to similar nutrition programs in Puerto Rico. It is our aim to carry out an analysis of meals served in Federal programs in Puerto Rico and to compare results to the stateside study. METHODS: Twenty eight different breakfast meals and 96 different lunch meals being cycled in elementary, middle and secondary schools throughout the entire island of Puerto Rico were analyzed for content using the Minnesota Nutrition Data System 32 and compared with: 1) compliance to meal pattern requirements of federal programs, 2) dietary guidelines for Americans (DG) and 3) recommended dietary allowances (RDA's). RESULTS: Breakfasts and lunches served in Puerto Rican Schools satisfy federal meal pattern requirements however most frequently offered foods different from programs in the mainland, reflecting ethnic and cultural food preferences. In terms of DG's adequate protein was present, cholesterol content was satisfactory but meals had excess percent energy from fat as well as excess energy from saturated fat, high sodium and a lower than recommended level of energy from carbohydrate. In terms of RDA's meals had prescribed levels of vitamin A, vitamin B12, vitamin C, calcium, folacin, magnesium, phosphorus and potassium. Below prescribed levels included vitamin B6, copper, vitamin E, energy, fiber, iron, niacin and zinc. CONCLUSIONS: While differences in food preferences exist between foods available in the Breakfast and Lunch Programs in Puerto Rican and U.S., schools, they have similar strengths and weaknesses when compared to compliance with U.S. Dietary Guidelines and with recommended dietary allowances.

Adolescent↗
PubMed1996

Prognostic role of immunosuppressive acidic protein in advanced ovarian cancer.

OBJECTIVE: Our purpose was to investigate immunosuppressive acidic protein in the prognostic characterization of advanced ovarian cancer. STUDY DESIGN: Serum levels of immunosuppressive protein were prospectively measured in 80 patients with untreated ovarian carcinoma. To evaluate the prognostic significance of immunosuppressive acidic protein levels, cutoff points were studied every 50 micrograms/ml between 450 and 1350 micrograms/ml. RESULTS: Pretreatment immunosuppressive acidic protein levels were not significantly associated with stage, histotype, grade of differentiation, postoperative residual tumor, and response to chemotherapy. The most significant association with survival was observed at a cutoff value of 1100 micrograms/ml (p = 0.0089). In the univariate analysis for overall survival, International Federation of Gynecology and Obstetrics stage and immunosuppressive acidic protein status were found to have a role in predicting ovarian cancer prognosis. In the multivariate analysis only immunosuppressive acidic protein status was significantly associated with survival. A statistical correlation was found between serum levels and overall survival (p = 0.0104, chi 2 6.56), including immunosuppressive acidic protein as a continuous variable. CONCLUSION: Our data suggest that immunosuppressive acidic protein assay is a potentially useful tool in the prognostic characterization of advanced ovarian cancer.

CA-125 Antigen↗
PubMed1997

[Suicides in the Russian Federation as a sociopsychiatric problem].

The analysis of suicide situation in Russia in 1989-1993 is presented. Unfavourable trends have been identified: growth of suicides prevalence and younger age of their committing. The differentiation of Russian regions according to suicide rates is also presented. While suicide prevalence was 37.9 per 100,000 among general Russian population it was more than twice as high among mentally ill, in outpatient clinic, that is 78.2. 1738 mentally ill suicide cases have been considered. Most of these suicides have been committed by patients at the age of 30-59 years. Schizophrenic patients prevailed--55.6% of cases. It was found that unlike general population age-sex structure of the population considered was more stable and wasn't changed under the influence of social factors. The changes in the nosological structure of the above population depended on the changes of the psychiatric registration procedure.

Adolescent↗
PubMed2005

A modeled economic analysis of a digital tele-ophthalmology system as used by three federal health care agencies for detecting proliferative diabetic retinopathy.

The objective of this study was to compare, using a 12-month time frame, the cost-effectiveness of a non-mydriatic digital tele-ophthalmology system (Joslin Vision Network) versus traditional clinic-based ophthalmoscopy examinations with pupil dilation to detect proliferative diabetic retinopathy and its consequences. Decision analysis techniques, including Monte Carlo simulation, were used to model the use of the Joslin Vision Network versus conventional clinic-based ophthalmoscopy among the entire diabetic populations served by the Indian Health Service, the Department of Veterans Affairs, and the active duty Department of Defense. The economic perspective analyzed was that of each federal agency. Data sources for costs and outcomes included the published literature, epidemiologic data, administrative data, market prices, and expert opinion. Outcome measures included the number of true positive cases of proliferative diabetic retinopathy detected, the number of patients treated with panretinal laser photocoagulation, and the number of cases of severe vision loss averted. In the base-case analyses, the Joslin Vision Network was the dominant strategy in all but two of the nine modeled scenarios, meaning that it was both less costly and more effective. In the active duty Department of Defense population, the Joslin Vision Network would be more effective but cost an extra 1,618 dollars per additional patient treated with panretinal laser photo-coagulation and an additional 13,748 dollars per severe vision loss event averted. Based on our economic model, the Joslin Vision Network has the potential to be more effective than clinic-based ophthalmoscopy for detecting proliferative diabetic retinopathy and averting cases of severe vision loss, and may do so at lower cost.

Cost-Benefit Analysis↗
PubMed1992

[Estimation of the incidence of diabetes in the Federal Republic of Germany based on insurance data. A secondary data analysis of a representative random sample of locally insured persons in the city of Dortmund].

All records relating to medical prescriptions and services relating to diabetes for a representative sample (n = 6478) of inhabitants of Dortmund in 1988, who were members of the Local Health Insurance in Dortmund, were analysed. 264 patients (4.08%) were receiving antidiabetic drugs during that year, 198 (3.06%) oral ones, 42 (0.65%) insulin and 24 (0.37%) both. 12.41% of all those insured over the age of 60 were on antidiabetic drugs, more women than men (5.08 vs 2.94%; P less than 0.001). The most frequently used oral antidiabetics were sulphonylurea ones (95.1%), while the proportion of biguanides was only 4.4%. On the basis of established diagnosis, regular blood sugar and HbA1 tests, as well as optic fundi examination, a further 104 persons (1.60%) are assumed to have diabetes but not treated by drugs. This sample indicates an overall prevalence of diabetes of 5.68% among the population. Relating it to the age and sex pattern of the population of the Federal Republic of Germany this corresponds to a prevalence of diagnosed diabetes of 4.82%. Thus there are probably a little less than 4 million diabetic citizens of the Federal Republic of Germany.

Age Factors↗
PubMed1986

Prospective pricing system for tertiary neonatal intensive care.

This study assessed the potential impact of the federal neonatal diagnosis-related group (DRG) pricing system upon reimbursement to a state neonatal intensive care program. Data for length of intensive care unit stay, procedures, hospital charges, and audited cost reports from the state of Florida's ten regional neonatal intensive care centers were analyzed for 8,492 neonates whose charges totaled $118 million. Mean lengths of stay in these tertiary care centers were substantially longer than those reported for the federal DRGs, which were based on community hospital data. If federal DRG-based reimbursement to hospitals were implemented in Florida's perinatal intensive care program, compensation would range from 9% to 56% of actual hospital care charges. Federal DRG price rates were not predictive of hospital charges. Only 16% of the total variation in hospital charges was explained by differences among federal DRG rates (R2 = .16). Analysis of data by major determinants of resource consumption provided groups more homogeneous with respect to hospital charges and, hence, cost. Therefore, we developed a prospective pricing system that used modifications of federal newborn DRG system. These modifications resulted in a threefold increase in R2 (.52). Our proposed system permits prediction of cost and reimbursement for infants by three criteria: birth weight, need for mechanical ventilation and/or major surgery, and survival status and length of survival for those who die.

Analysis of Variance↗
PubMed1992

[Estimate of the total number of HIV-infected subjects in the Federal Republic of Germany based on data from the AIDS Center].

On the basis of an analysis of the data from the mandatory reporting of detected HIV infections and the reports to the central AIDS case registry an attempt is made to determine the total number of HIV infected individuals in the FRG. Results of surveys of testing behaviour in different risk groups were included in the calculations. For the calculation different estimates were used as to the total number of detected HIV infections, distribution of infections and percentage of detected infections in different risk groups. Depending on the estimates chosen a "best case" calculation yields 29,515 and the "worst case" calculation 81,949 HIV infected persons at the end of 1990. A synoptic analysis by the AIDS Center of the Federal Health Office resulted in an estimate of 50,000 to 60,000 HIV infected individuals in the FRG which is well between the "best" and "worst case" estimates.

Germany↗
PubMed1999

[The Federal Health Survey: response, composition of participants and non-responder analysis].

The first German Health Survey was carried out from October 1997 to March 1999. In the survey, 7,124 subjects of a representative sample of the residential population aged between 18 and 79 years were interviewed and medically examined. The response rate was 61.4%; 0.4% of the sample participated only partly in the study. Moreover, 16.0% of the non-respondents filled in a short questionnaire. This results in (although partly limited) information from 77.8% of the sample. The sample also comprises aliens living in Germany. More than 15% of the non-respondents could not be addressed to participate in the study because they were never reached personally. According to the statements in the short questionnaire, non-respondents and respondents differ in particular items such as e.g. education. The differences between the individual answers concerning the important question of the general health status can be classified as negligible. Weighting factors were calculated to arrive at representative information on the 18 to 79 year-old population.

Adolescent↗