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PubMed2002

[The state and perspectives of medical support for Armed forces of Russian Federation].

Critical analysis of the state of medical support of military district and navy staff allowed the specialists from Military Medical Headquarters to reveal 6 main problems of military medicine and to determine the ways of their solution. The models of territorial military medical infrastructure taking into account the prognosis of possible development of local wars and armed conflicts are worked out. The attempts to form the face of field hospital of the future became more effective. Constant attention is given to development of army and front complexes of medical service that could be used in conditions of regional (large-scale) war. The hospital bases continue to reduce and transfer to the new organizational structure. Owing to it part of the resources becomes free and is used for improvement of battle readiness of new units. The new time of effective planning and complex development based on introduction into the practice of the new forms and methods of control has come.

Delivery of Health Care↗
PubMed1994

Outcomes research, analysis, and dissemination: the federal government's role.

The Agency for Health Care Policy and Research (AHCPR) is responsible for medical outcomes research, analysis, and dissemination of results. The AHCPR's largest funded studies are the Patient Outcome Research Teams (PORTs). The results of the prostatic disease PORT show wide variations in practice patterns and provide insights into the reasons for and solutions to these variations. Managed care plans are using this information to educate patients and providers about the risks and outcomes associated with various treatment options. Early findings indicate positive results in terms of patient satisfaction and reduced treatment costs.

Health Services Research↗
PubMed2005

Cochlear implant complications: utility of federal database in systematic analysis.

OBJECTIVES: To explore the suitability of the Manufacturer User Facility and Distributor Experience (MAUDE) database (which is maintained by the Food and Drug Administration and has a mandatory reporting requirement) for systemic analysis of cochlear implant complications and treatments and, in so doing, analyze trends in cochlear implant complications for 2 periods, 2002 and pre-1998. DATA SOURCES: All events from 2002 and from before 1998 were considered. Events and action taken were categorized and tabulated. DATA SYNTHESIS: Because there was no null hypothesis, statistical analysis (chi2) was only used in comparing the 2 time frames. CONCLUSIONS: Structural limitations of the database, in addition to disparate reporting quality, made systematic analysis difficult. It was noted that spontaneous device failure accounted for the greatest single number of adverse events for both 2002 and the pre-1998 period (267/654 [41%] and 74/129 [57%], respectively), confirming earlier studies. A statistically significant decrease in spontaneous device failure and a significant increase in infections from the pre-1998 period to 2002 was observed. Flap problems ranging from extrusion to infection that required explantation were less frequently reimplanted than other problems requiring explantation, such as device failure or trauma. We considered new directions, including close collaboration with the new MedSun reporting system and conclude that while a valuable resource for narrative data, the current structure of the MAUDE database is only modestly useful for analyzing trends in complications and cannot answer several crucial questions, including device type comparisons. We suggest changing the current report format to include patient age, duration of implant, presence of anatomical abnormalities, and details on spontaneous device failures.

Cochlear Implantation↗
PubMed1993

[Unemployment and your health: long-term analysis for the German Federal Republic].

Findings from a study based on the longitudinal data of the German Socio-Economic panel (annual data, 1984-1988, N = 5516 individuals, 18-64 years) confirmed differences in health between unemployed and employed persons. The health satisfaction of unemployed persons is on a lower level as well as health impairments. This was only partially due to socio-demographic characteristics. The differences by employment status were stable in all years between 1984 and 1988. However, there were no indications for a causal influence of unemployment on health impairments. A constant health-satisfaction of persons loosing their job and of the re-employed, compared to their initial ratings, supported the selection hypotheses. This means that during the study period persons in poorer health are more likely to loose their job and persons in better health are more likely to be re-employed.

Adolescent↗
PubMed2003

[Social inequality and noise pollution by traffic in the living environment--an analysis by the German Federal Health Survey (Bundesgesundheitssurvey)].

AIM OF THE STUDY: The study deals with the relationship between socioeconomic status and the uneven distribution of noise pollution in residential areas. Based on the social indicators education, occupation, income and an index of socioeconomic status, the study investigates whether people of lower socioeconomic status are more likely to live in busier streets and to be more affected by traffic and noise pollution than others. MATERIAL: The German Federal Health Survey (Bundesgesundheitssurvey, BGS) is a representative survey of the health status of the adult population in Germany. The representative sample in question reflects the opinions of 6,644 individuals aged between 18 and 79 years who were asked to fill in a standardised questionnaire between autumn 1997 and spring 1999. RESULTS: People of lower socioeconomic status are more likely to live in busy to extremely busy main roads and through roads. They feel significantly more often affected by traffic noise pollution. People of higher socioeconomic status are more likely to live in quiet environments. Essentially, all four social indicators reflect the social gradient of noise pollution, but their impact is differently weighted. CONCLUSION: Noise pollution in environments is unevenly distributed, with people of lower socioeconomic status suffering more than others. In view of the increased social burden and assumed vulnerability experienced by lower socioeconomic groups, environmental objectives for protection from noise pollution should be developed which ensure a socially just distribution of environmental noise pollution in addition to avoiding danger to health.

Adult↗
PubMed1990

Primary prevention of coronary heart disease in the Federal Republic of Germany. Analysis of cost-effectiveness.

The cost-effectiveness of a primary prevention strategy for coronary heart disease is reviewed in this paper. Five subgroups were identified, depending on the degree of medical intervention required to achieve a target low density lipoprotein (LDL)-cholesterol level of less than 4.15 mmol/L. One group required no intervention and, apart from initial screening costs, no further treatment costs were incurred. The cost-effectiveness of medical intervention in the other groups was calculated by use of mathematical models to predict the incidence of coronary heart disease. According to this analysis, life-years saved per 1000 individuals and cost per life-years saved increased as the intensity of intervention increased. In individuals in whom a reduction in total cholesterol was required, life expectancy did not improve substantially, but the onset of coronary heart disease was deferred until an older age. Cholesterol-lowering interventions are unlikely to result in important savings to the health care system, as the benefit of treatment is rather reflected in terms of reduced mortality and improved quality of life. Total costs (in Deutschmarks [DM]) per life-year saved in this analysis were DM30,000-40,000 in men and DM86,000-110,000 in women.

Coronary Disease↗
PubMed2005

Analysis of how the health systems context shapes responses to the control of human immunodeficiency virus: case-studies from the Russian Federation.

OBJECTIVE: To develop a methodology and an instrument that allow the simultaneous rapid and systematic examination of the broad public health context, the health care systems, and the features of disease-specific programmes. METHODS: Drawing on methodologies used for rapid situational assessments of vertical programmes for tackling communicable disease, we analysed programmes for the control human of immunodeficiency virus (HIV) and their health systems context in three regions in the Russian Federation. The analysis was conducted in three phases: first, analysis of published literature, documents and routine data from the regions; second, interviews with key informants, and third, further data collection and analysis. Synthesis of findings through exploration of emergent themes, with iteration, resulted in the identification of the key systems issues that influenced programme delivery. FINDINGS: We observed a complex political economy within which efforts to control HIV sit, an intricate legal environment, and a high degree of decentralization of financing and operational responsibility. Although each region displays some commonalities arising from the Soviet traditions of public health control, there are considerable variations in the epidemiological trajectories, cultural responses, the political environment, financing, organization and service delivery, and the extent of multisectoral work in response to HIV epidemics. CONCLUSION: Within a centralized, post-Soviet health system, centrally directed measures to enhance HIV control may have varying degrees of impact at the regional level. Although the central tenets of effective vertical HIV programmes may be present, local imperatives substantially influence their interpretation, operationalization and effectiveness. Systematic analysis of the context within which vertical programmes are embedded is necessary to enhance understanding of how the relevant policies are prioritized and translated to action.

Delivery of Health Care↗
PubMed2005

Health policy roundtable--policy by numbers: the role of budget estimates and scoring in health care reform.

The purpose of this roundtable is to explore the imperfect art of estimating the budget costs of health insurance proposals-called scoring when done by government agencies. The panel addresses the complexities involved in generating these estimates, which usually depend on many untested and untestable assumptions. For example, the Medicare prescription drug "donut hole" was invented so that policymakers could achieve budget targets. These budget scores play a critical role in the design of health policies, as well as in the reform proposals put forth by candidates in an election. The roundtable discusses how policymakers can and do use health policy estimates and budget scores.

Actuarial Analysis↗
PubMed1997

Activities of an Environmental Analysis Van in the German Federal State Schleswig-Holstein.

A cooperation was started between the Union of Physicians of Schleswig-Holstein (Bad Segeberg, Germany) and an environmental engineer in 1992. A mobile unit for environmental analysis was set up, the Environmental analysis Van (EAV) or mobile umweltambulanz. Inspection of sites and collection of air and dust/material samples for analysis of xenobiotics were performed on request. The results of this cooperation were evaluated to show which sources of indoor pollutants could be particularly relevant to human health impairment. During a 30-month period form July 1993 to December 1995, 1793 site inspections wer conducted. Xenobiotic analysis and subsequent advising was performed in 1318 cases; enhanced concentrations of one or more toxic substances (mainly biocides such a pentachlorophenol, permethrin, and/or hexachlorocyclohexane) were found in 71% of the sites analyzed. Formaldehyde, volatile organic compounds, and contamination by molds were also documented. A follow-up was done on 80 clients of the Environmental Analysis Van, which had detected elevated concentrations of permethrin because of pyrethroid-treated carpeting. The effect of removing all contaminated carpeting on health improvement in comparison with nonremoval was statistically significant (p<0.0001). Pyrethroid-treated carpeting, which was already 5, 7 and 10 years old, revealed permethrin concentrations of 115, 100, and 150 mg/kg dust. This result indicates that indoor contamination of permethrin is highly persistent and may be the cause of adverse health effects.

Air Pollution, Indoor↗
PubMed2005

Increased risk of tuberculosis among health care workers in Samara Oblast, Russia: analysis of notification data.

SETTING: Samara Oblast, Russia. OBJECTIVE: To compare the rates of tuberculosis (TB) in health care workers (HCWs) working in TB services, general health services (GHS) and the general population in a region of the Russian Federation. DESIGN: Analysis of notification rates of TB among HCWs, GHS workers and the general population during the 9-year period from 1994 to 2002. RESULTS: During 1994-2002, TB incidence among staff employed at the TB services in Samara Oblast was ten times higher than among the general population, reaching 741.6/100 000 person years at risk. Staff working at in-patient TB facilities were found to be at highest risk, with an incidence rate ratio of 17.7 (95% CI 11.6-27.0) compared to HCWs at the GHS. CONCLUSIONS: HCWs at TB services in the Russian Federation are at substantially increased risk for TB, suggesting significant risks from nosocomial transmission. Control of institutional spread of TB in the Russian Federation is an area that requires urgent attention, especially given the epidemic of human immunodeficiency virus that Russia is currently witnessing.

Adult↗