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PubMed2004

[Comparative analysis of the non-profit, for-profit and public hospital providers: American experiences].

BACKGROUND AND OBJECTIVES: The new legislation allowed hospitals and other health care facilities to be converted into for-profit status. The detailed regulatory framework is under development in Hungary. This article reviews the literature of studies comparing hospital financial performance and the quality of care before and after conversion from public or non-profit status to for-profit. METHODS: Studies were identified through electronic search of Medline (Pubmed), EconLit, Cochrane Library, Economic Evaluation Database (EED), az Health Technology Assessment (HTA) databases, library files and reference lists. The literature search was extended to the Internet, World Bank, International Labor Office (ILO), Organization for Economic Cooperation and Development (OECD), and WHO websites as well as government, academic institutions and large insurance companies web pages for unpublished online information. Time series and before-after studies and systematic literature reviews were included. RESULTS: The conversion from non-profit to for-profit status improved the profitability of the hospitals. However the quality of care (measures in mortality, frequency of side effects, complications) might suffer in the first couple years of the conversion. The conversion may increase the total health care expenditures per capita. Trustful relationship between patients and physicians may also be threatened. CONCLUSION: The generalisability of the American experiences into the Hungarian single payer system may be limited. From societal point of view, for-profit providers could provide socially beneficial care in areas where it is possible to define, monitor and evaluate the nature and quality characteristics of the services, as well as market competition can be ensured. However most of the healthcare services are too complex to fall into this category.

Australia↗

PubMed1999

Trading trash: why the U.S. won't sign on to the Basel convention.

Environmentalists worry that hazardous wastes produced in industrialized nations are being dumped in cash-starved developing countries--the countries with the least political or economic clout to resist and the fewest resources for managing these toxic imports. Imported waste can pose a serious threat to the health of human populations and ecosystems if not managed appropriately. In 1989, the international community initiated efforts to reduce the flow of hazardous wastes from industrialized countries to developing countries by drafting a treaty known as the Basel Convention on the Control of Transboundary Wastes and their Disposal. The convention's mission is to strictly regulate the international transfer of hazardous wastes and to ensure that wastes are managed and disposed of in an environmentally sound manner. Although the United States supports the convention in theory, it remains the only industrialized country within the Organization for Economic Cooperation and Development yet to ratify it. However, legislation drafted by the Clinton administration that is soon to go before the 106th Congress could make the United States a party to the convention.

Developing Countries↗

PubMedDate not supplied

Healthcare system performance indicators: a new beginning for a reformed Canadian healthcare system.

Canada's healthcare system is the envy of many other countries and their citizens around the world. And like other members of the Organization for Economic Cooperation and Development, Canada is under pressure to reduce healthcare expenditures. One strategy being explored by Canadian provincial governments is to regionalize or decentralize the delivery of healthcare services. To ensure achievement of its goals for each region, the Ministry of Health requires each regional health authority to submit a business plan and annual report, including performance information and underlying performance indicators. Performance indicators are used to measure process and outcome as well; they are useful for generating questions about the behavior or the performance of a provider or organization. A system for defining systemic performance measures for a publicly funded healthcare system does not exist. However, the performance indicators described in this article provide a sampling of provider-based healthcare performance.

Annual Reports as Topic↗

PubMed2000

Economic development and traffic accident mortality in the industrialized world, 1962-1990.

BACKGROUND: We examined the association between prosperity and traffic accident mortality in the industrialized world in a long-term perspective. METHODS: We calculated traffic accident mortality, traffic mobility and the fatal injury rate of 21 industrialized countries from 1962 until 1990. We used mortality and population data of the World Health Organization (WHO), and figures on motor vehicle ownership of the International Road Federation (IRF). We examined cross-sectional and longitudinal associations of these traffic-related variables with the prosperity level per country, derived from data of the Organization for Economic Cooperation and Development (OECD). RESULTS: We found a reversal from a positive relation between prosperity and traffic accident mortality in the 1960s to a negative association currently. At a certain level of prosperity, the growth rate of traffic mobility decelerates and the fatal injury rate continues to decline at a similar rate to earlier phases. CONCLUSIONS: In a long-term perspective, the relation between prosperity and traffic accident mortality appears to be non-linear: economic development first leads to a growing number of traffic-related deaths, but later becomes protective. Prosperity growth is not only associated with growing numbers of motor vehicles in the population, but also seems to stimulate adaptation mechanisms, such as improvements in the traffic infrastructure and trauma care.

Accidents, Traffic↗

PubMed2006

Biodegradability of imidazolium and pyridinium ionic liquids by an activated sludge microbial community.

Ionic liquids (ILs) are novel organic salts that have enormous potential for industrial use as green replacements for harmful volatile organic solvents. Varying the cationic components can alter the chemical and physical properties of ILs, including solubility, to suit a variety of industrial processes. However, to complement designer engineering, it is crucial to proactively characterize the biological impacts of new chemicals, in order to fully define them as environmentally friendly. Before introduction of ILs into the environment, we performed an analysis of the biodegradability of six ILs by activated sludge microorganisms collected from the South Bend, Indiana wastewater treatment plant. We examined biodegradability of 1-butyl, 1-hexyl and 1-octyl derivatives of 3-methyl-imidazolium and 3-methyl-pyridinium bromide compounds using the standard Organisation for Economic Cooperation and Development dissolved organic carbon Die-Away Test, changes in total dissolved nitrogen concentrations, and 1H-nuclear magnetic resonance analysis of initial and final chemical structures. Further, we examined microbial community profiles throughout the incubation period using denaturing gradient gel electrophoresis (DNA-PCR-DGGE). Our results suggest that hexyl and octyl substituted pyridinium-based ILs can be fully mineralized, but that imidazolium-based ILs are only partially mineralized. Butyl substituted ILs with either cation, were not biodegradable. Biodegradation rates also increase with longer alkyl chain length, which may be related to enhanced selection of a microbial community. Finally, DGGE analysis suggests that certain microorganisms are enriched by ILs used as a carbon source. Based on these results, we suggest that further IL design and synthesis include pyridinium cations and longer alkyl substitutions for rapid biodegradability.

Electrophoresis↗

PubMedDate not supplied

Changes in serum alpha2u-globulin levels in castrated male rats treated with testosterone propionate in a Hershberger assay.

The Hershberger assay has been proposed as a candidate screening test method for the detection of androgenic and anti-androgenic chemicals and is being validated presently under the test guideline programme of the Organization for Economic Cooperation and Development (OECD). Rat alpha2u-globulin is male rat-specific protein appearing in their serum and urine, and the protein is known to be induced by androgens. We investigated the usefulness of measuring serum alpha2u-globulin levels as a parameter for the androgenic activity of chemicals tested in the Hershberger assay. The serum alpha2u-globulin level was measured after the administration of testosterone propionate at dosages of 0, 20, 100 or 500 microg kg(-1) day(-1) for ten consecutive days in the castrated male rats. The ventral prostate, balbocavernosus/levator ani muscles, glans penis and Cowper's gland were collected and weighed. Although all the androgen-responsive organ weights were increased significantly at dosages of 100 and 500 microg kg(-1) day(-1), the serum alpha2u-globulin level was increased significantly only at a dosage of 500 microg kg(-1) day(-1). These results show that the serum alpha2u-globulin level may be a useful biomarker for detecting androgenic activity caused by test chemicals, but it is less sensitive than the organ weights of androgen-responsive tissues in the Hershberger assay.

Alpha-Globulins↗

PubMed2004

Biodegradation of all stereoisomers of the EDTA substitute iminodisuccinate by Agrobacterium tumefaciens BY6 requires an epimerase and a stereoselective C-N lyase.

Biodegradation tests according to Organization for Economic Cooperation and Development standard 301F (manometric respirometry test) with technical iminodisuccinate (IDS) revealed ready biodegradability for all stereoisomers of IDS. The IDS-degrading strain Agrobacterium tumefaciens BY6 was isolated from activated sludge. The strain was able to grow on each IDS isomer as well as on Fe(2+)-, Mg(2+)-, and Ca(2+)-IDS complexes as the sole carbon, nitrogen, and energy source. In contrast, biodegradation of and growth on Mn(2+)-IDS were rather scant and very slow on Cu(2+)-IDS. Growth and turnover experiments with A. tumefaciens BY6 indicated that the isomer R,S-IDS is the preferred substrate. The IDS-degrading enzyme system isolated from this organism consists of an IDS-epimerase and a C-N lyase. The C-N lyase is stereospecific for the cleavage of R,S-IDS, generating d-aspartic acid and fumaric acid. The decisive enzyme for S,S-IDS and R,R-IDS degradation is the epimerase. It transforms S,S-IDS and R,R-IDS into R,S-IDS. Both enzymes do not require any cofactors. The two enzymes were purified and characterized, and the N-termini were sequenced. The purified lyase and also the epimerase catalyzed the transformation of alkaline earth metal-IDS complexes, while heavy metal-IDS complexes were transformed rather slowly or not at all. The observed mechanism for the complete mineralization of all IDS isomers involving an epimerase offers an interesting possibility of funneling all stereoisomers into a catabolic pathway initiated by a stereoselective lyase.

Agrobacterium tumefaciens↗

PubMedDate not supplied

[Health economic: the health systems and reforms in action].

Health Expenditure and Basic Models of Health Systems. The first part of this monographic study deals with the problems concerning health expenditure in industrialized countries (on average, 8% of home product in the countries belonging to Organization for Cooperation and Economic Development). The Author analyzes the structural factors causing the increase of health expenditure such as a population aging, scientific and technological progress, gap between consumption and expenditure, and demand for health service. The Author finally takes into consideration the two basic models of health systems, the solidarity model, born and widespread in Europe, and the individualistic model, mainly widespread in the U.S.A. The second part of the monographic studies deals with the evolution of the Italian Health System from the introduction of the National Health Service to the managerial reform. In particular, the authors analyze the mechanism of health planning, the financial support of the Italian Ministry of Health and the organization of health enterprises.

Age Factors↗

PubMed2001

TestSmart-high production volume chemicals: an approach to implementing alternatives into regulatory toxicology.

This article examines the status and application of alternatives defined as replacements, refinements, and reduction for screening high production volume (HPV) chemicals. It specifically focuses on the Screening Information Data Set (SIDS), a series of toxicological tests recommended by the Organization for Economic Cooperation and Development to screen such chemicals. Alternative tests associated with acute, repeat-dose, genetic, and reproductive and developmental toxicity were examined at 2 meetings of academic, industry, and regulatory scientists and their status determined. Tests were placed in 1 of 3 categories: ready for immediate use, in need of or currently undergoing validation, or needing research/developmental work. With respect to traditional acute toxicity testing, the basal cytotoxicity approach was placed in the category of research with the up-and-down, fixed-dose, limit test, and the acute toxic class categorized as available for immediate use and the neutral red assay under validation. Cell culture methods that could provide information on acute target organ toxicity were all categorized in the research stage. Studies of the Ah receptor were placed under validation. All alternative tests for repeat-dose toxicity were placed in the category of research. With regard to genetic toxicity, the Ames, mouse lymphoma, and Chinese hamster ovary methods were considered ready for immediate use, while the in vitro micronucleus and Syrian hamster ovary assays were placed in the validation category. All alternatives for developmental toxicity, with the exception of gene chip technology, were placed in the category of validation. Gene chip technology is considered to be in the research stage. For reproductive toxicity, sperm motility and morphology were considered as ready for immediate use, with the other assays categorized as needing validation or in the research stage. Follow-up to these results is obvious. Work needs to be conducted to move those tests from the research stage to the validation and use stage. This is one approach to the development of alternatives to SIDS. Progress along these lines would apply not only to SIDS but also to toxicology in general.

Animal Testing Alternatives↗

PubMed1994

Harmonization of good laboratory practice requirements and laboratory accreditation programs.

Efforts to harmonize Good Laboratory Practice (GLP) requirements have been underway through the Organization for Economic Cooperation and Development (OECD) since 1981. In 1985, a GLP panel was established to facilitate the practical implementation of the OECD/GLP program. Through the OECD/GLP program, Memoranda of Understanding (MOU) agreements which foster requirements for reciprocal data and study acceptance and unified GLP standards have been developed among member countries. Three OECD Consensus Workshops and three inspectors training workshops have been held. In concert with these efforts, several OECD countries have developed GLP accreditation programs, managed by local health and environmental ministries. In addition, Canada and the United States are investigating Laboratory Accreditation programs for environmental monitoring assessment and GLP-regulated studies. In the European Community (EC), the need for quality standards specifying requirements for production and international trade has promoted International Standards Organization (ISO) certification for certain products. ISO-9000 standards identify requirements for certification of quality systems. These certification programs may affect the trade and market of laboratories conducting GLP studies. Two goals identified by these efforts are common to both programs: first, harmonization and recognition of requirements, and second, confidence in the rigor of program components used to assess the integrity of data produced and study activities. This confidence can be promoted, in part, through laboratory inspection and screening processes. However, the question remains, will data produced by sanctioned laboratories be mutually accepted on an international basis?(ABSTRACT TRUNCATED AT 250 WORDS)

Accreditation↗

PubMed1993

Global budgeting in the OECD countries.

Many of the Organization for Economic Cooperation and Development countries use global budgeting to control all or certain portions of their health care expenditures. Although the use of global budgets as a cost-containment tool has not been implemented in the United States in any comprehensive way, recent health care reform initiatives have increased the need for research into such tools. In general, the structure, process, and effectiveness of global budgets vary enormously from country to country, in part because the underlying social welfare system of each country is unique.

Budgets↗

PubMed1996

Reform the watchword as OECD countries struggle to contain health care costs.

Like other countries in the Organization for Economic Cooperation and Development, Canada is attempting to contain the overall costs of health care by concentrating on the reform of health care delivery, not health care financing. Systems like Canada's, with predominantly public financing and mainly private delivery, have become increasingly popular around the world. Like other nations, Canada has implemented reforms to make the most of the health care dollars we do have. In this article, Susan MacPhee examines common approaches to health care reform.

Budgets↗

PubMedDate not supplied

Developmental toxicity risk assessment: consensus building, hypothesis formulation, and focused research.

Risk assessment for developmental toxicity has become more defined over the last decade and the most recent EPA guidelines for developmental toxicity risk assessment were published in 1991. Development of approaches for risk assessment in this area have relied on building of consensus opinion among experts about the interpretation of developmental toxicity data. These discussions have aided in strengthening the scientific basis for risk assessment for developmental toxicity, including the default assumptions that must be used when more complete information on mechanisms of action and pharmacokinetics are unavailable. Such discussions continue on both a national and international basis. The EPA risk assessment guidelines outlined several major areas of research needed to strengthen risk assessment for developmental toxicity and led to the formulation of hypotheses to be tested in focused research projects. Several major research efforts have focused on dose-related mechanisms and biologically based modeling of specific agents, physiologically based pharmacokinetic models of pregnancy that can be scaled across species, and the influence of dose and duration of exposure on developmental outcomes, as well as the delineation of specific biomarkers of adverse developmental effects. Although such research initiatives will require a long-term effort, it is important that attention be focused now on those approaches that can improve the risk assessment process to avoid continued reliance on default approaches that have been used for the past 30 years or more. The impact of the EPA Guidelines for Developmental Toxicity Risk Assessment has been widespread. One of the main purposes for developing risk assessment guidelines by EPA was to communicate procedures to risk assessors inside the agency in an effort to promote consistency. In addition, the guidelines were to communicate to those outside the agency in private industry and other regulatory agencies how EPA would evaluate and interpret data. The developmental toxicity guidelines have standardized terminology used in developmental toxicity risk assessments. They also have influenced the revision of testing guidelines and the writing of new guidelines, such as the developmental neurotoxicity testing guidelines. More extensive use of developmental toxicity data within the RfD/RfC process was influenced by the guidelines, as well. More recently, the risk assessment guidelines have had a major impact on the harmonization of international testing and risk assessment guidelines through cooperative efforts with the World Health Organization under the auspices of the International Program on Chemical Safety (IPCS) and the Organization for Economic Cooperation and Development (OECD). We foresee these types of interagency and international cooperative efforts continuing as we attempt to make more efficient use of the limited resources available for testing, risk assessment, and research to better understand and prevent developmental toxicity.

Child↗

PubMed2006

Endocrine disruptors in the marine environment: mechanisms of toxicity and their influence on reproductive processes in fish.

Recent research demonstrated how endocrine-disrupting chemicals (EDCs) may disturb wildlife populations and possibly also represent a human health risk. Much of the focus has been on (anti-)estrogenic and (anti-)androgenic effects, and these effects are thought to be mediated through the estrogen (ER) and androgen (AR) receptors, respectively. The seriousness of the problem has led international bodies such as the Organization for Economic Cooperation and Development (OECD) and the European Union (EU) to initiate large research programs and developments toward new guidelines and regulations. EDCs have both synthetic and natural sources. The mechanisms of action of EDCs can be divided into: (1) agonistic/antagonistic effect ("hormone mimics"), (2) disruption of production, transport, metabolism, or secretion of natural hormones, and (3) disruption of production and/or function of hormone receptors. However, the number of nuclear hormone receptors being potential targets for EDCs has increased dramatically the last decade, opening up new avenues for possible endocrine disruptor effects. In studies with Atlantic salmon, data showed that 4-nonylphenol, a model xenoestrogen previously used in large volumes, for example, in paints and detergents, acts as an estrogen mimic, as a steroid metabolism disruptor, and by modulating estrogen receptor (ER) levels, indicating that one single compound exerts all of these three mechanisms, depending on the dose given to the organism. A hypothesis explaining this observation is that the nature of the effect of an EDC is determined by dose-dependent routing and cross-talk between different classes of nuclear receptors.

Animals↗

PubMed1999

Classification criteria for skin-sensitizing chemicals: a commentary.

A formalized, standardized and effective mechanism for the identification of substances which possess significant skin sensitization potential is a necessary first step in the process of limiting the incidence of allergic contact dermatitis. Strategies to achieve such hazard identification are unified throughout the European Union and also have been publicised by the World Health Organization. Global harmonization of these and other approaches (e.g., in the USA) is being driven by the Organization for Economic Cooperation and Development. In this paper, the benefits and limitations of these classification systems are reviewed. A common element of all the systems is that they seek to distinguish important contact allergens from chemicals which are infrequent sensitizers. The European criteria are legal requirements in the EU member states and formal classification as a skin sensitizer leads to mandatory labelling. The most notable omission from current and proposed classification criteria relates to the relative potency of a classified skin sensitizer and the exposure dose. Such information is necessary for proper risk assessment and management measures to be implemented.

Allergens↗

PubMed2001

[Performance of the Dutch health care from an international perspective: background and implications for policy].

The 'World Health Report 2000' has stimulated discussions on the Netherlands' performance in health and healthcare from an international perspective. The only concrete result it provided was a world ranking in which the Netherlands stood in 17th place. The comparative data which have appeared in several other recent reports, are more useful to policy makers, a notable example being those from the Organization for Economic Cooperation and Development (OECD). One issue arising from these reports is that the increase in life expectancy in the Netherlands is lagging behind the European Union average. This is particularly the case for women and a major cause of this is smoking. Developments in Dutch perinatal mortality are also unfavourable and are associated with a strong increase in the age at which women bear children. International comparisons of public health data are valuable inputs for health policy development and it is therefore important to invest in the international harmonisation of such data collection.

Age Distribution↗

PubMed2006

Biodegradation of US premanufacture notice chemicals in OECD tests.

Biodegradation testing of commercial chemicals other than pesticides is generally performed using test guidelines of the Organization for Economic Cooperation and Development (OECD). We used test data submitted with US Premanufacture Notifications (PMNs) received from 1995 through 2005 to study performance of OECD biodegradation tests, as well as the overall testing strategy and guidance. Among the findings are that (1) ready biodegradation (RB) tests gave fairly consistent results relative to the pass/fail outcome, but not necessarily percent degradation; (2) the Zahn-Wellens test worked well in providing a quick measure of sorption potential, but aside from this, provided little useful information for the investigated chemicals beyond what was already available from RB tests; (3) the SCAS test sometimes gives lower % removal than continuous-feed simulation tests like OECD 303A; and (4) OECD 306 (marine biodegradation test) appeared less conservative than ordinary RB tests. Overall, the PMN data lend support to new OECD guidance that endorses the primary role of RB tests, but emphasizes simulation rather than inherent biodegradation tests as the next step.

Biodegradation, Environmental↗

PubMed2005

Effect of different soil types on the enchytraeids Enchytraeus albidus and Enchytraeus luxuriosus using the herbicide Phenmedipham.

Soil ecotoxicology studies are usually performed in standard soils, such as the OECD (Organization for Economic Cooperation and Development) artificial soil or the LUFA St. 2.2, a natural soil. When assessing the toxic effects in the environment, soil properties are often different from those in standard soils, which might lead to a different exposure situation for the test species and, therefore, to a different evaluation of the risk of the test substance. Selected to cover a broad range of properties and based on the Euro-Soils concept, 18 different soils were studied regarding their suitability to two test species: Enchytraeus albidus and Enchytraeus luxuriosus (Enchytraeidae). In reproduction tests, the test species reacted differently to the tested soils, but both enchytraeids did not survive in acid soils (i.e. pH<or=5). Results indicate that although a combined effect of soil properties seems to occur, certain soil properties are causing specific toxic effects. In the present study, EC50s in enchytraeids changed by a factor of 9 for juveniles and nearly 30 for the adults of E. luxuriosus (maximum values; slightly lower values were found for E. albidus), which shows how important the test soil can become for the environmental risk assessment of chemicals. More data using more soils and species are required to understand the effect of soil properties in soil toxicology. Nevertheless, it was clear that certain soil properties such as OM (Organic Matter) and WHC (Water Holding Capacity) or pH, CEC (Cation Exchange Capacity), C/N (Carbon/Nitrogen ratio) and clay content did interact with the chemical and the organisms.

Animals↗