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PubMed1997

[Evaluation of Federal Health Insurance process data as instrument for structural and quality analysis of inpatient care].

Statistically based quality assurance, despite its advantages also has a few marked disadvantages. In particular, it is not proven that it promotes measures of internal quality assurance. Instead, processing data of the statutory health insurance bodies are shown as flexible and easily available data covering a defined population and region. Hence, these processing data may be the starting point for internal quality management in hospitals. As examples, from an analysis of hospitalised cases some questions were derived concerning the structure and quality of hospital care. These questions should be answered by common efforts of hospitals, health insurance bodies, and public institutions. This may guarantee good and efficient inpatient care.

Adult↗
PubMedDate not supplied

[Indication, genotyping and phylogenetic analysis of bovine diarrhea virus obtained in the territory of the Russian Federation ].

Bovine diarrhea virus (BDV) is widespread throughout the European part of the Russian Federation. The BDV genome is detected in around 40% of animals (aged up to 18 months) with lesions in the gastrointestinal tract and respiratory system. It can be found in all intestinal sections, including its contents and feces, in lymphoid and respiratory organs as well as in nasal washings and discharges and in vaginal tunic discharges of cows. Primary structure analysis of 5'-untransalted region of the genome of the detected isolates revealed that all of them belonged to genotype 1. Phylogenetic analysis confirmed that a part of isolates belonged to subgenotype 1a, while most isolates make up a separate group. No geographic differences were reported in the circulation of the BDV genetic variants within Russia's territory.

5' Untranslated Regions↗
PubMed1993

Is health care different? Popular support of federal health and social policies.

Over the past several years there has been a striking increase in policy-makers' attention to health care reform. This paper explores whether there has been a corresponding shift in popular attitudes and identifies factors that may have changed these attitudes. The first part of the analysis relies on survey data collected between 1975 and 1989 to estimate a set of regression models, relating support for federal involvement in health care, antipoverty programs, and general domestic policies to a set of sociodemographic characteristics.... The second part of this study explores motivations that might account for these patterns. We identify a half dozen ways in which health care may be viewed as "different," that is, more or less appropriate for federal action. Analysis of survey data from 1987 suggests that there are relatively small differences in the attitudes and perceptions that motivate support for federal health initiatives, relative to federal domestic policies in general. However, there are more striking differences between health programs and more overtly redistributive policies.... We suggest that the growing support for federal intervention in health care, relative to other social policies, is in part an inadvertent by-product of ideological positions popularized during the Reagan and Bush administrations. We draw from these results some predictions about the course of the ongoing debate over federal health policies.

Altruism↗
PubMed1985

Failures of the hospital financing system of the Federal Republic of Germany and reform proposals.

This paper deals with an economic analysis of the present hospital financing system of the Federal Republic of Germany. In the first section normative criteria for the evaluation of hospital systems are established. The most important objectives are: a medically appropriate hospital care, an efficient production of services and adequate hospital care for everyone. The imminent conflicts between individual and social value systems on the one hand and between allocative and distributive objectives on the other hand are pointed out. The second section contains a short description of the most important elements of a hospital financing system: first the method of coordination of supply and demand. Since pure market systems are rejected as the only mechanism for the coordination of hospital care, other coordination systems must be applied. There are in principle two alternative systems at one's disposal: regulation of the hospital care by public authorities or negotiations between hospitals and financiers. Second, it is analysed how the financial burden can be shared amongst the patient and the various third party financing institutions such as statutory health funds, private insurance companies and public budgets. Third, the modes of reimbursement are discussed. It is pointed out, that besides the problem of how the hospital performance should be measured and how the level of prices of the services should be determined, the distribution of the production risks is the central matter in hospital reimbursement. The more hospitals have to undetake financial risks, the greater the incentives are for an efficient production of services. The third section contains a description of the main failures of the German hospital financing system. It is argued that the central public planning of capacities, which is dominated by political interests, causes excess capacities and structural disequilibria in particular sectors of hospital care. The next important failure is the division of the financial burden amongst public households and statutory health funds in spite of exclusive public planning authority. In the area of reimbursement the total cost reimbursement is criticized. The cost based public investment grants and cost based lump sum per-diem rates per patient in the area of operating cost imply incentives for an inefficient (and ineffective) production of services. The last section deals with some reform proposals which at present are being discussed. All proposals claim a regionalization of the hospital planning and a stronger participation of the hospitals and health funds concerned in the planning process.(ABSTRACT TRUNCATED AT 400 WORDS)

Facility Regulation and Control↗
PubMed1983

The epidemiology of stomach cancer in Bavaria.

Stomach cancer represents an important cause of death in the Federal Republic of Germany, the regional analysis of mortality rates showing that the rates in Bavaria lay significantly above the national average during the years 1952 till 1978. Within this Federal State the mortality again is not uniform but regions in the Northeast with high rates are distinguishable from low mortality in the Southwest. Furthermore, the analysis by age and birth cohorts shows a decrease of mortality from stomach cancer with later years of birth. The considerable differences in consecutive birth cohorts, given the regional patterns, may indicate a varying exposure to etiological factors, most likely to be sought in the early life of the later cancer victims. In an attempt to clarify the reasons for these regional particularities a case-control study is designed to investigate, among other factors, the etiological relevance of nutritional habits. The possible influence of competing causes of death is discussed.

Adult↗
PubMed2003

The significance of medico-legal findings for behavioural analysis in unsolved homicide cases.

In recent years, behavioural analysis in unsolved homicide cases is playing a more and more important role in the field of police work in Germany. The method of behavioural analysis was developed in the USA and first carried out in Germany at the end of the 80s by the Federal Criminal Police Office (BKA). Since 1998 each Federal State has set up behavioural analysis units. In Germany, behavioural analysis is defined as complex information processing system for the purpose of enabling an overall view of a case and of supporting the case work in ongoing investigations. The procedure of behavioural analysis is based on empirically and scientifically proven knowledge, on case information (e.g. crime scene characteristics, medico-legal findings) and on methods of combining the existing knowledge on statements relevant to the case. To assess the role of legal medicine in the process of behavioural analysis, a retrospective examination of more than 40 case analyses in unsolved homicide cases was performed. It turned out that medico-legal findings played a major role in the process of case analysis because the results were of central importance for the case reconstruction and further deductions (e.g. offender aims, organized/disorganized components, escalation). In a vast majority of cases though, the autopsy reports did not provide sufficiently detailed information, explanations and/or interpretations of injuries, wound patterns and sequence of events. Various examples are presented to elucidate the significance of medico-legal findings for the process of behavioural analysis. As a basic principle, the role of the forensic scientist as independent, unbiased, unprejudiced expert for the court should not be influenced by speculative interpretations within the process of behavioural analysis. This can be established by a very precise and comprehensive autopsy protocol on the one hand and - separately - an interpretation by another experienced specialist who works for the behavioural analysis unit but not for the court.

Adolescent↗
PubMed1993

Is health care different? Popular support of federal health and social policies.

Over the past several years there has been a striking increase in policymakers' attention to health care reform. This paper explores whether there has been a corresponding shift in popular attitudes and identifies factors that may have changed these attitudes. The first part of the analysis relies on survey data collected between 1975 and 1989 to estimate a set of regression models, relating support for federal involvement in health care, antipoverty programs, and general domestic policies to a set of sociodemographic characteristics. Relative to other federal policies, support for health initiatives grew over this period. During the same period, long-standing differences in support between rich and poor, old and young, educated and uneducated, all narrowed for health care, though they did not for other types of federal policies. The second part of this study explores motivations that might account for these patterns. We identify a half dozen ways in which health care may be viewed as "different," that is, more or less appropriate for federal action. Analysis of survey data from 1987 suggests that there are relatively small differences in the attitudes and perceptions that motivate support for federal health initiatives, relative to federal domestic policies in general. However, there are more striking differences between health programs and more overtly redistributive policies. Compared to redistributive federal programs, support for federal health initiatives are (a) less identified with racial minorities or economically disadvantaged groups, (b) less constrained by notions of individual responsibility, (c) more closely associated with concerns about equal opportunity in American society, and (d) somewhat more constrained by choices between federal and local government. These patterns persist whether or not respondents are politically active and whether they report themselves to be liberal or conservative. We suggest that the growing support for federal intervention in health care, relative to other social policies, is in part an inadvertent by-product of ideological positions popularized during the Reagan and Bush administrations. We draw from these results some predictions about the course of the ongoing debate over federal health policies.

Adult↗
PubMed2003

Dermatofibrosarcoma protuberans, giant cell fibroblastoma, and hybrid lesions in children: clinicopathologic comparative analysis of 28 cases with molecular data--a study from the French Federation of Cancer Centers Sarcoma Group.

The clinicopathologic and immunohistochemical features of 28 dermatofibrosarcoma protuberans (DFSP), giant cell fibroblastomas (GCFs), and hybrid lesions occurring in children are presented, including molecular data for seven of them. There were 19 pure adult-type DFSP (9 male and 10 female patients aged between a few days [neonate] and 13 years, median 7 years), 5 pure GCF (all males aged from 2 to 8 years, median 4 years), and 4 hybrid tumors (all males aged from 1 to 4 years, median 2.5 years). Tumor locations in pure adult-type DFSP included the trunk (6) and lower (11) and upper (2) limbs. Pure GCFs were observed on the trunk (4) and knee (1), and hybrid lesions on the trunk (2) and lower (1) and upper (1) extremities. Tumor size (n = 20) ranged from 0.6 to 5 cm (median 2 cm). Histologically, pure DFSP presented as monotonous and infiltrative, low-grade, dermal/hypodermal storiform spindle cell proliferations, sparing adnexal structures. GCF showed a dense fibrous to myxoid matrix containing slender wavy spindle cells and multinucleated giant stromal cells often lining angiectoid spaces. Hybrid lesions showed varying combinations of DFSP and GCF areas. Mitotic activity ranged from 1 to 3 mitoses per 10 high power fields. All tumors were diffusely positive for vimentin and CD34 but negative for smooth muscle actin, desmin, epithelial membrane antigen, and cytokeratins; one pure adult-type DFSP was also S-100 protein positive; <1% of nuclei were Ki67 (Mib-1) positive. One karyotyped adult-type DFSP showed an unbalanced t(17;22) (q22;q13) translocation. Multiplex RT-PCR analysis and sequencing of PCR products in seven cases showed gene fusion transcripts in two pure DFSP, two pure GCFs, and one hybrid lesion. Results were uncertain in one pure GCF; one adult-type DFSP was negative. Treatment procedures were known for 27 patients, consisting of 16 wide excisions and 11 marginal excisions. Follow-up information on 15 widely excised tumors (median 24 months; range 5-144 months) showed no recurrence. Five of six marginally excised lesions with available follow up recurred 2 months to 6 years (median 2 years) after initial surgery; all but one were cured by wide reexcision. None of the tumors metastasized. In conclusion, this study emphasizes 1) the occurrence of adult-type DFSP in children, 2) the close relationship between DFSP and GCF clinically, histologically, and molecularly, 3) the excellent prognostic of these lesions if widely excised, and 4) the diagnostic usefulness of RT-PCR analyses in detecting the gene fusion transcripts resulting from the t(17;22) (q22;q13) in paraffin-embedded tissues.

Adolescent↗
PubMed2004

[Prevention by vaccination of children and young people. Obstacles and examples of effective measures in the Federal State of Brandenburg].

This article identifies successful vaccination strategies, obstacles to such strategies and the role that schools can play in terms of health education by analysing vaccination rates among children in the Federal State of Brandenburg. The analysis is based on the vaccination status of Brandenburg's children at day care centres and schools in relation to the social status of their parents, the extent to which preventive examinations (U up to J1) is taken advantage of and regional location. Furthermore, an evaluation is rendered of the vaccination awareness campaign which has been carried out in sixth grade students since 2002 to assess the impact of health promotion at schools. In the Federal State of Brandenburg vaccination coverage among infants and toddlers is good, with approximately 94% having received complete basic vaccination in 2003. By contrast, there are marked deficits among tenth grade schoolchildren in terms of refresher vaccinations, basic hepatitis B vaccinations and the second measles, mumps and rubella (MMR) vaccinations. Vaccination status is strongly dependent on the social status of parents and the extent to which preventive medical examinations and regional medical health-care provision are utilized. Systematic checking of vaccination documents by the public health services promotes vaccination awareness. Prevention by vaccination is most effective when combined with preventive medical examinations, effective local vaccination management and interdisciplinary interventions: education at schools, systematic tracking of vaccination documents combined with the provision of vaccinations in doctors' surgeries and additionally by the public health services.

Adolescent↗
PubMed1998

Psychometric characteristics of the minimum data set I: confirmatory factor analysis.

OBJECTIVE: To determine the structure and statistical reliability of the federally mandated Minimum Data Set (MDS). DESIGN: Confirmatory, hypothesis-testing factor analysis was performed on MDS protocols of 733 nursing home residents. SETTING: All participants were residents of the Philadelphia Geriatric Center. PARTICIPANTS: Participants represented consecutively admitted skilled and intermediate care residents and another pool of residents with probable dementia. MEASUREMENTS: MDS protocols were completed by nurse care coordinators. Item composites hypothesized represented the domains of cognition, activities of daily living, time use, social quality, depression, and problem behaviors. RESULTS: For higher functioning residents (n = 336) and for all residents together, all domain clusters except social quality were confirmed. None of the domain clusters were confirmed within the more impaired (n = 391) group. CONCLUSIONS: The MDS does provide usable indicators of five areas of basic competence of nursing home residents. Lack of reliability in rating many aspects of the behavior and states of cognitively impaired residents is evident, however. Improvement of such measures and rating procedures constitutes a major research priority.

Activities of Daily Living↗
PubMed1991

Forty years of litigation involving medical students and their education: II. Issues of finance.

An analysis of reported state and federal adjudication from 1950 through 1989 was undertaken to identify trends in litigation involving medical students and undergraduate medical education. Of the 110 cited judicial decisions during that time, 59 (54%) involved disputes over financing medical education; 43 (73%) were litigated since 1985. This dramatic increase arises primarily from challenges to National Health Service Corps obligations and from attempts to discharge or reorganize debt under the Bankruptcy Code. Medical school graduates enjoyed very little success in these cases. Analysis of court decisions points to a need for informed counseling for medical students, particularly as to the consequences of timing in default on service obligations and of incurring loans under the Health Education Assistance Loan (HEAL) program as opposed to other loan sources. The growing educational debt of today's medical students foreshadows continued litigation in this area.

Education, Medical, Undergraduate↗
PubMedDate not supplied

[On the epidemiological situation in quarantine, natural focal and other infections on the territory of the Southern Federal District].

The data on the sanitary and epidemiological situation in the Southern Federal District are presented. The analysis of morbidity in tuberculosis, measles, HIV infection, viral hepatitis A, typhoid fever, cholera and quarantine infections, Crimean hemorrhagic fever, West Nile fever, rabies, malaria has been carried out. Special attention has been given to "new and newly returning infections", and among them to the spread of SARS ("atypical pneumonia"). The role of regional epidemiological safety programs, in particular such program as "The prophylaxis of quarantine and natural focal infections and the sanitary protection of the territory of the Southern Federal District of the Russian Federation from the import and spread infectious diseases in 2003-2005", has been substantiated.

Animals↗
PubMed2004

[Exudative pleurisy of tuberculosis etiology in Russia's children and adolescents by the data of the new tuberculosis cases registry].

The paper analyzes the incidence of tuberculous exudative pleurisy (TEP) in children and adolescents in 30 administrative subjects of 7 Russian Federal Okrugs in 1992-2000. TEP was detected in 957 individuals, including 451 (5.3%) children and 506 (11.8%) adolescents. TEP was detected mainly on referral. Control examinations (tuberculin diagnosis, fluorography, contact examination) identified 163 patients with TEP. Analyzing the sex-age-specific structure in patients with TEP established that the boys (n = 572 (59.8%)) were ill more frequently than the girls (386 (40.2%)). Analyses of age-related changes in TEP revealed a gradual increase in its incidence from to 1 to 17 years of age. The analysis made in 5 Russian Federal Okrugs indicated that in children and adolescents, TEP was not recorded in all cases. In adults, the incidence of TEP corresponded to the total morbidity. The authors have established that this mismatch is due to the misinterpretation of the disease when TEP was not notified as an individual nosological entity, but it was interpreted as a concomitant process in different tuberculous lesions in the lung tissue, intrathoracic lymph nodes, and other organs.

Adolescent↗
PubMed2005

From Medicaid to uninsured: drop-out among children in public insurance programs.

OBJECTIVES: To estimate a national disenrollment rate among children in Medicaid and the Children's Health Insurance Program (CHIP); to determine what share of disenrollment is due to acquiring other insurance or losing eligibility; and to examine what demographic and policy factors make disenrollment more likely. DATA SOURCES: Insurance status, income, and demographics from the Current Population Survey (CPS) March Supplement (1998-2001); eligibility data from the National Governors Association; and policy data from the former Health Care Financing Administration (HCFA), state welfare offices, and previous research. STUDY DESIGN: The study used a nationally representative sample of 5,551 children in Medicaid or CHIP. The key outcomes were the percentage of children still enrolled 1 year later, and the share of disenrollees who became uninsured despite remaining eligible. Multivariate logistic regression was used to explore demographics and policies predictive of disenrollment. DATA COLLECTION AND ANALYSIS: CPS data were extracted using the Census Bureau's Federal Electronic Research and Review Extraction Tool 1.0. Data analysis was performed using Stata 7 (Stata Corporation 2001). PRINCIPAL FINDINGS: Of the children enrolled in Medicaid or CHIP, 27.7 percent were no longer enrolled 12 months later. Of those, 45.4 percent dropped out despite apparently remaining eligible and having no other insurance--corresponding to 3.0 million children annually. Drop-out varied significantly across states. Children without siblings in public insurance were at a higher risk for drop-out. Children with more educated parents were more likely to leave Medicaid for private insurance or to lose Medicaid eligibility, while black children and infants were less likely to lose their eligibility. Decreased Medicaid provider reimbursement rates were strongly associated with drop-out, while Medicaid managed care increased the exodus to private insurance. CONCLUSIONS: Drop-out from Medicaid and CHIP is a significant policy concern and helps explain the persistence of uninsurance among millions of eligible children. Clinical encounters with providers appear to play a key role in preventing drop-out.

Adolescent↗
PubMed2000

Issues related to the use of genetic material and information.

PURPOSE/OBJECTIVES: To review issues regarding the use of genetic materials and information. DATA SOURCES: Professional literature, regional and federal legislation. DATA SYNTHESIS: An analysis is provided of the relationship among advances in genetic technology, use of genetic material and information, and the development of laws that protect the interests of donors, researchers, and insurers. Rapid technological achievements have generated complex questions that are difficult to answer. The Human Genome Project began and the scientific discoveries were put to use before adequate professional and public debate on the ethical, legal, social, and clinical issues. The term "proper use" of genetic material and information is not defined consistently. An incomplete patchwork of protective state and federal legislation exists. CONCLUSIONS: Many complicated issues surround the use and potential misuse of genetic material and information. Rapidly advancing technology in genetics makes it difficult for regulations that protect individuals and families to keep pace. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to recognize their role as change agents, understand genetic technology, and advocate for patients by participating in the debate on the proper use and prevention of misuse of genetic material and information.

Confidentiality↗
PubMed1985

[The economic evaluation of vaccination against infectious cough in horses using the cost-benefit analysis].

Approximately 40% of all horses in the Federal Republic of Germany had infectious respiratory disease in 1982. Although an expert vaccine prophylaxis confers a reliable protection, conventional therapy is preferred over vaccination because of the cost. The cost/effect analysis carried out in this investigation demonstrates that vaccination should be favoured also for economic reasons. Based on the individual animal immune prophylaxis saves the horse owner at least 415 DM per year. This analysis did not take into account the danger of a transmission to man and related infection chains of viruses primarily responsible for respiratory disease in horses.

Animals↗
PubMed1987

[Constraints imposed by political factors upon government intervention and health promotion].

In this article, Michel O'Neill, Ph. D., discusses the necessity of taking political factors into consideration when embarking on preventive programmes, regardless of the level in the community in which the intervention is to take place. When using the term, "political factors", the author is referring to the powers of influence which certain individuals or groups inevitably have over members of a community, regardless of its size. The influence is thus not necessarily linked to partisan politics but potentially has extensive implications for health promotion activities. After an introduction to the history of the development of a community health oriented system in Quebec, O'Neill presents four examples (at the local, regional, provincial, and federal levels) to introduce his analysis of political influence in community health and its implications in health promotion programmes. The marketing genius and tremendous budget of a multinational, American-based fast food corporation represents the political influence contrary of health promotion interests in two of the examples: competing with nutrition education efforts at a local level and "philanthropically" supporting curative efforts at a regional level. At a provincial level, the perpetual problem of tobacco corporations influencing elected officials in their social policies is presented while the aberration between rhetoric vis à vis policy and the reality of non-action is cited as political influence at a federal level. The examples cited are only four among "dozens and dozens" and serve as a reminder that health promotion professionals must take political influences into account if they wish to implement effective policies and programmes.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Health Services↗