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At least 721 records · Page 40Linked to original sources
PubMed2005

[Does migration from high and intermediate endemic regions increase the prevalence of hepatitis B infection in Germany?].

BACKGROUND AND OBJECTIVE: Germany is one of the low endemic areas for hepatitis B. There are 7,3 million foreign citizens and 3,2 million migrants from the former USSR and Eastern Europe with German roots, the "Resettlers" (Aussiedler), who migrated to Germany mostly from countries with moderate or high HBsAg prevalence. The aim of this study was to determine the HBsAg prevalence in adult foreign citizens and resettlers compared with that among the adult German population. METHODS: Adult foreign citizens and resettlers were categorized according to their country of origin into groups with low, intermediate or high HBsAg prevalence, using data from the WHO. Statistics of the Federal Office for Statistics, the Federal Office for Administration and the Federal Ministry of the Interior were used for the demographic analysis. The number of chronic HBsAg carriers for the different population groups and the whole population was then calculated. RESULTS: 84% of the adult migrant population in Germany migrated from countries with intermediate and high HBsAg endemicity. For 2003 we calculated 503 040 HBsAg carriers in Germany. 42% of these have a migratory background, even though migrants represent only 12.7% of the whole population. The risk for chronic infection with HBsAg is 7.1 (4.8-13.2) for the resettlers and is 4.3 (3.0-8.1) times higher for foreign citizens than for the German population. CONCLUSIONS: These remarkable differences in prevalence make it important that migrants and their close contacts be vaccinated properly, pregnant women be included in screening programs and cases of chronic hepatitis B be treated adequately.

Adult↗
PubMed2006

Systemic collapse: Medical care in the aftermath of Hurricane Katrina.

This article describes and analyzes key aspects of the medical response to Hurricane Katrina in New Orleans. It is based on interviews with individuals involved in the response and on analysis of published reports and news articles. Findings include: (1) federal, state, and local disaster plans did not include provisions for keeping hospitals functioning during a large-scale emergency; (2) the National Disaster Medical System (NDMS) was ill-prepared for providing medical care to patients who needed it; (3) there was no coordinated system for recruiting, deploying, and managing volunteers; and (4) many Gulf Coast residents were separated from their medical records. The article makes recommendations for improvement.

Delivery of Health Care↗
PubMedDate not supplied

Quantitative determination of sildenafil (Viagra) and its metabolite (UK-103,320) in fluid and tissue specimens obtained from six aviation fatalities.

During the investigation of aviation accidents, postmortem samples from victims are submitted to the Federal Aviation Administration's Civil Aerospace Medical Institute for toxicological analysis. This report presents a rapid and reliable method for the identification and quantitation of sildenafil (Viagra) and its active metabolite, UK-103,320. This procedure utilizes sildenafil-d(8) as an internal standard for more accurate and reliable quantitation. The quantitation of sildenafil and UK-103,320 in postmortem fluid and tissue specimens obtained from victims from six separate aviation fatalities is described. The method incorporates solid-phase extraction and liquid chromatography-tandem mass spectrometry (LC-MS-MS) and MS-MS-MS utilizing an atmospheric pressure chemical ionization ion trap MS in the positive chemical ionization mode. Solid-phase extraction provided an efficient sample extraction yielding recoveries ranging from 79 to 88%. The limits of detection for sildenafil and UK-103,320 were 0.39 and 0.19 ng/mL, respectively. The linear dynamic range for both compounds was 0.78-800 ng/mL. The current method proved to be simple, accurate, and robust for the identification and quantitation of sildenafil and UK-103,320 in postmortem fluids and tissues.

Accidents, Aviation↗
PubMed2000

Incident monitoring in emergency departments: an Australian model.

The specialty-based study of incidents, adverse events, and errors in medicine has largely occurred in anesthesia and to a lesser extent in intensive care and psychiatry. Few studies have specifically addressed the problem in emergency medicine (EM). Because of the significant risks, the resulting adverse outcome, and the high degree of preventability of errors occurring in the emergency department (ED), it is essential that an incident monitoring system be part of the ED's risk management program. The combination of time pressure, uncertainty, complexity, and workload means the ED is a high-risk environment. The delivery of high-quality emergency care is dependent on having an effective patient processing system in place and, because EM is a "systems-dependent" specialty, the environment lends itself to improvements to the system (re-engineering) to improve the safety of the environment given that the majority of errors in the ED are probably the result of failures of the system. This paper describes an existing incident monitoring system that has recently been adopted by six EDs in Australia. It was developed as a result of a similar successful program in anesthesia, and funded by the Federal Department of Health of Australia. Incorporating incident monitoring and analysis to identify causative factors of incidents and the subsequent implementation of corrective strategies as part of the ED risk management program may result in improvement in the quality of care through a reduction in the frequency of incidents.

Australia↗
PubMed1997

Economic and medical significance of sleep-related breathing disorders.

The improvement in outpatient sleep medical care in the Federal Republic of Germany over the last 10 years has been associated with an increase in the costs for diagnosis and therapy of sleep-related breathing disorders. The medical importance of these sleep-related problems consists in their high prevalence, especially in middle-aged men and risk groups, e.g. in patients with cardiovascular conditions. The effect on the performability of patients, which is manifested in the excessive daytime sleepiness at the workplace and in everyday life, are likewise significant. For social insurance agencies, immense costs arise from the sequelae and concomitant illnesses of untreated sleep-related breathing disorders. A comparison of the costs and the benefits of diagnosis, therapy and follow-up of patients with sleep-related breathing disorders over a period of 10 years shows that a mean annual monetary net benefit of DEM 2.3 billion in the Federal Republic of Germany can be assumed. The health economics analysis shows that an appropriate provision of sleep-medical care for the population is of great benefit for the health of the nation and thus for the entire economy.

Activities of Daily Living↗
PubMed1997

The resurgence of selective contracting restrictions.

As managed care has spread, so has legislation to force plans to contract with any willing provider (AWP) and give patients freedom of choice (FOC). Managed care organizations' selective networks and provider integration reduce patient access to providers, along with provider access to paying patients, so many providers have lobbied for AWP-FOC laws. In opposition are managed care organizations (MCOs), which want full freedom to contract selectively to control prices and utilization. This article comprehensively describes laws in all fifty-one jurisdictions, classifies their relative strength, and assesses the implications of the laws. Most are relatively weak forms and all are limited in application by ERISA and the federal HMO Act. The article also uses an associative multivariate analysis to relate the selective contracting environments to HMO penetration rates, rural population, physician density, and other variables. States with weak laws also have higher HMO penetration and higher physician density, but smaller rural populations. We conclude that the strongest laws overly restrict the management of care, to the likely detriment of cost control. But where market power is rapidly concentrating, not restricting selective contracting could diminish long-term competition and patient access to care. In the face of uncertainty about the impact of these laws, an intermediate approach may be better than all or nothing. States should consider mandating that plans offer point-of-service options, for a separate premium. This option expands patient choice of plans at the time of enrollment and of providers at the time of care, yet maintains plans' ability to control core providers.

Community Participation↗
PubMed1995

The development of the Hill-Burton legislation: interests, issues and compromises.

The Hill-Burton Hospital Survey and Construction Act has its roots in the social health and welfare programs of the New Deal. This paper traces its development and the positions of three groups-the hospital industry, the U.S. Public Health Service, and the Senate Subcommittee on Wartime Health and Education-on four issues: the nature of federal funding to states, the use of public funds by private hospitals, the oversight powers of a Federal Hospital Council, and health services for the poor. The analysis involves two lines of thought: the political strategy of incrementalism and the roles of the three interest groups in reaching compromises to quickly pass an "unsponsored" bill. Relevance to the current effort to pass a single payer national health insurance is explored.

Financing, Government↗
PubMed1996

The Catholic church and U.S. health care reform.

The Catholic Church is the largest (and arguably the best organized) single denomination in the United States, and it has extensive holdings in the health care field. It therefore has a material stake in the current debate over health care reform, as well as a moral interest in a question touching on the ethics of resource distribution. The position of the church on health care is analyzed as a case study of how organized religion interacts with and attempts to influence social policy in a pluralistic society.

Capitalism↗
PubMed2003

Endometrial cancer of the uterus in a patient with spinal cord injury.

Spinal cord injury occurs predominantly in males, and endometrial cancer in a patient with spinal cord injury is very rare. A 71-year-old woman, gravida 7, para 4, who had incomplete quadriplegia due to a spinal cord injury, was admitted with a complaint of genital bleeding. Biopsies of the cervix and the endometrium revealed endometrioid adenocarcinoma. Total abdominal hysterectomy was performed under general anesthesia. Pathohistological analysis revealed endometrial adenocarcinoma (G1) with squamous metaplasia and International Federation of Gynecology and Obstetrics (FIGO) surgical stage 2b. Local recurrence was not obvious after the surgery. However, lung metastasis appeared on postoperative day 225, and she died from dyspnea on day 277. Uterine cancer screening is more necessary in long-term bedridden women.

Aged↗
PubMed2003

Income inequality, illiteracy rate, and life expectancy in Brazil.

OBJECTIVES: The link between income disparities and health has been studied mostly in developed nations. This study assesses the relationship between income disparities and life expectancy in Brazil and measures the impact of illiteracy rates on the association. METHODS: The units of analysis (n = 27) are all the Brazilian states and the federal capital. Simple and multiple linear regressions were performed to measure the association between income disparity, measured by the Gini coefficient, gross domestic product (GDP) per capita, and illiteracy rate. Data came from publicly available sources at the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics. RESULTS: Income disparities and illiteracy rates were negatively associated with life expectancy in Brazil. GDP per capita was positively associated with life expectancy. The inclusion of illiteracy rates in the regression model removed the effect of income disparities. CONCLUSIONS: Illiteracy rate is strongly associated with life expectancy in Brazil. This finding is in accord with reports from the United States and has implications for health policy and planning for both developed and developing countries.

Aged↗
PubMed1977

National health insurance policy in the United States: a case of non-decision-making.

Despite the vast range of commentaries and research on the current health care crisis, little research attention has been focused specifically on the lack of federal response to this crisis. As a way of focusing analysis on the specifics of Congressional inaction, it is suggested that both the range of health care proposals and the current debates in Congress may be seen as part of an ongoing bargaining process over legitimate alternatives for modication of health care delivery. It is argued that the lack of any new health care legislation may be seen as the result of a series of non-decision by conservative Congressional representatives of the dominant medical interest groups. These non-decisions have successfully excluded any challenges to those interests by reliance upon a predominant "mobilization of bias" to effectively define and/or divert these challenges as illegitimate attempts at change. The changes which eventually evolve from Congressional compromise may represent a modification of the prevailing bias concerning legitimate alternatives, but are unlikely to modify the relation of the controlling interests involved.

American Medical Association↗
PubMed1990

An ethnographic view: positive consequences of the War on Poverty.

Life history data from Coast Salish tribes of Washington state reveal that federal War on Poverty programs produced important results that routine analysis has failed to uncover. The Comprehensive Training and Employment Act and the Indian Community Action Project provided income that enabled family networks to serve as centers of moral and financial support for members engaged in therapeutic work and provided training opportunities for a generation of leaders who are now instrumental in attracting funding for mental health programs.

Cultural Characteristics↗