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PubMed2004

Addressing tobacco in managed care: results of the 2002 survey.

INTRODUCTION: In the United States, tobacco use is the leading preventable cause of death and disease. The health and cost consequences of tobacco dependence have made treatment and prevention of tobacco use a key priority among multiple stakeholders, including health plans, insurers, providers, employers, and policymakers. In 2002, the third survey of tobacco control practices and policies in health plans was conducted by America's Health Insurance Plans' technical assistance office as part of the Addressing Tobacco in Managed Care (ATMC) program. METHODS: The ATMC survey was conducted in the spring of 2002 via mail, e-mail, and fax. A 19-item survey instrument was developed and pilot-tested. Of the 19 items, 12 were the same as in previous years, four were modified to collect more detailed data on areas of key interest, and three were added to gain information about strategies to promote smoking cessation. The sample for the survey was drawn from the 687 plans listed in the national directory of member and nonmember health plans in America's Health Insurance Plans. RESULTS: Of the 246 plans in the sample, 152 plans (62%) representing more than 43.5 million health maintenance organization members completed the survey. Results show that health plans are using evidence-based programs and clinical guidelines to address tobacco use. Compared to ATMC survey data collected in 1997 and 2000, the 2002 ATMC survey results indicate that more health plans are providing full coverage for first-line pharmacotherapies and telephone counseling for smoking cessation. Plans have also shown improvement in their ability to identify at least some members who smoke. Similarly, a greater percentage of plans are employing strategies to address smoking cessation during the postpartum period to prevent smoking relapse and during pediatric visits to reduce or eliminate children's exposure to environmental tobacco smoke. CONCLUSION: The results of the 2002 ATMC survey reflect both tremendous accomplishments and important opportunities for health plans to collaborate in tobacco control efforts. With appropriate support, analytical tools, and resources, it is likely that health plans, clinicians, providers, and consumers will continue to evolve in their efforts to reduce the negative consequences of tobacco use.

Adult↗

PubMed2005

The role of state public health agencies in addressing less prevalent chronic conditions.

INTRODUCTION: State-based chronic disease programs typically focus on the most prevalent chronic conditions, such as cancer, diabetes, and cardiovascular disease, but interest in less prevalent chronic conditions (LPCCs), such as epilepsy, is growing. In our study, we examined the perceived roles of state health departments in addressing LPCCs and used this information to develop recommendations for state health departments that are considering developing LPCCs programs. We also compared the identified state health department roles for LPCCs with roles related to healthy aging, as well as to the essential elements of existing state-based chronic disease programs, to determine whether future LPCCs programs would have any unique requirements. METHODS: Participants used concept-mapping techniques to generate a set of 100 statements on steps that state health departments could take to address LPCCs. The participants sorted and rated each statement according to importance and feasibility. We used a sequence of multivariate statistical analyses to generate a series of maps, or clusters, and rating graphics. We reviewed the findings and produced recommendations for state health departments. We used a similar process to examine roles of state health departments in addressing healthy aging. RESULTS: The participants grouped the LPCCs statements into nine clusters, which they rated as moderately feasible and important. The healthy aging statements were grouped into eight clusters. Clusters for LPCCs and healthy aging were similar. We also compared LPCCs clusters and the essential elements of existing state-based chronic disease programs and found that they were similar. CONCLUSION: The similarities between LPCCs clusters and essential elements of existing state-based chronic disease programs highlight an important point. State health departments that are considering establishing LPCCs programs should use strategies that have already been used by other public health agencies to develop chronic disease prevention and control programs.

Chronic Disease↗

PubMedDate not supplied

Addressing health disparities through promoting equity for individuals with intellectual disability.

Intellectual disabilities (ID) are conditions originating before the age of 18 that result in significant limitations in intellectual functioning and conceptual, social and practical adaptive skills. IDs affect 1 to 3% of the population. Persons with ID are more likely to have physical disabilities, mental health problems, hearing impairments, vision impairments and communication disorders. These co-existing disabilities, combined with the limitations in intellectual functioning and in adaptive behaviours, make this group of Canadians particularly vulnerable to health disparities. The purpose of this synthesis article is to explore potential contributory factors to health vulnerabilities faced by persons with ID, reveal the extent and nature of health disparities in this population, and examine initiatives to address such differences. The review indicates that persons with ID fare worse than the general population on a number of key health indicators. The factors leading to vulnerability are numerous and complex. They include the way society has viewed ID, the etiology of ID, health damaging behaviours, exposure to unhealthy environments, health-related mobility and inadequate access to essential health and other basic services. For persons with ID there are important disparities in access to care that are difficult to disentangle from discriminatory values and practice. Policy-makers in the United States, England and Scotland have recently begun to address these issues. It is recommended that a clear vision for health policy and strategies be created to address health disparities faced by persons with ID in Canada.

Adult↗

PubMed2006

Addressing tobacco in managed care: results of the 2003 survey.

INTRODUCTION: Although tobacco control activity in the United States during the past several years has increased dramatically, tobacco use continues to have devastating consequences among all age cohorts. METHODS: In November 2003, a survey of tobacco control practices and policies in health insurance plans was conducted by America's Health Insurance Plans' national technical assistance office. The survey was the fourth and final survey conducted as part of the Addressing Tobacco in Managed Care program. Of the 215 plans in the sample, 160 (74%) completed the survey. Collectively, these plans represent more than 60 million members of health maintenance organizations. RESULTS: From 1997 to 2003, health insurance plans have demonstrated increasing use of evidence-based programs and clinical guidelines to address tobacco use. The number of plans providing full coverage for any type of pharmacotherapy for tobacco cessation has more than tripled since 1997. Plans have also shown substantial improvement in their ability to identify all or some of their members who smoke. Similarly, a greater percentage of plans are using strategies to address smoking cessation during treatment for other chronic diseases and after acute events such as a myocardial infarction. CONCLUSION: Despite improvements, important opportunities remain for health insurance plans and other stakeholders to expand their tobacco control activities and transfer the lessons learned to other health problems.

Data Collection↗

PubMedDate not supplied

Local health department effectiveness in addressing the core functions of public health.

Objective 8.14 of the Year 2000 National Health Objectives calls for 90 percent of the population to be served by a local health department effectively carrying out the three core functions of public health--assessment, policy development, and assurance. To provide a benchmark of local health department effectiveness in addressing the core functions and to assess implications for achieving the year 2000 target, a random national sample (stratified by jurisdiction and population base) of local health departments was surveyed to determine self-reported compliance with 10 public health practice performance measures that operationalize the core functions. Overall compliance with the 10 performance measures was 50 percent, based on weighted responses of 208 responding health departments. Compliance was highest for the practices related to the assurance function and least for practices related to the policy development function. Compliance was also high for departments serving a population of 50,000 or more and those smaller departments organized at the city and city-county levels. Using two different definitions developed by the investigators, 19 and 31 percent of the health departments were judged to be effective in addressing the core functions of public health. These data suggest that less than 40 percent of the U.S. population was served by a health department effectively addressing the core functions of public health in 1993. It appears that considerable capacity building within the public health system will be needed to achieve the year 2000 target of 90 percent.

Community Health Services↗

PubMed1993

Do elderly patients mind how doctors address them?

A survey was carried out in the Geriatric Unit at Cork Regional Hospital to determine how elderly patients would like to be addressed by their doctor. Two hundred patients over the age of 65 were given a Questionnaire asking them to state their preference. Only a minority (4.5%) expressed a definite preference for the formal mode of address. The remainder either did not mind (38%) or preferred to be addressed by their first name (57.5%). We concluded that most elderly patients do have a preference and this should be established on admission.

Aged↗

PubMedDate not supplied

[Study of kinetic parameters of glucose oxidase and alpha-chymotrypsin, immobilized in polymeric matrices, using a light-addressable sensor].

Light-addressable potentiometric sensors were prepared by immobilizing glucose oxidase or alpha-chymotrypsin on the surface of a pH-sensitive electrode. Two methods of immobilization were used: incorporation into a hydrophilic matrix of bovine serum albumin and incorporation into a hydrophobic matrix of modified polyethylenimine. The glucose oxidase and alpha-chymotrypsin preparations immobilized in the polyethylenimine matrix were characterized by the Michaelis constant values of 6.0 and 3.1. mM, respectively, and by pH optimums at 6.0-7.2 and 7.0-8.0, respectively. These values are consistent with results obtained by other methods. Therefore, light-addressable potentiometric sensors can be used in combination with both hydrophilic and hydrophobic matrices. The ability to combine light-addressable potentiometric sensors with hydrophobic matrices provides an opportunity for the development of potentiometric biosensors for detecting substances poorly soluble in water.

Biosensing Techniques↗

PubMedDate not supplied

Evolutionary adaptations of gene structure and expression in natural populations in relation to a changing environment: a multidisciplinary approach to address the million-year saga of a small fish.

We have used an experimentally based strategy to address molecular mechanisms underlying adaptation in Fundulus heteroclitus. In an attempt to falsify the hypothesis that selection is a major driving force in the maintenance of genetic diversity, we employed a multidisciplinary approach including allelic isozyme and mtDNA phylogeography, kinetic analyses of allelic isozymes, analysis of variation in coding and regulatory DNA sequences, metabolic biochemistry, organismal physiology, and selection experiments. Observed differences in gene structure and expression led us to make testable predictions about differences in metabolic flux, whole organism performance, and differential survival between allotypes. We have shown that variation in the lactate dehydrogenase-B (Ldh-B) protein results in differences in physiological function and is correlated with differences in survival at high temperatures. Recent work has investigated the role of variation in Ldh-B expression. There are differences in the levels of Ldh-B protein, mRNA, and transcription rate. We have addressed the mechanisms responsible for differences in transcription rate by a combination of sequence comparison, DNase I footprinting, and functional analyses both in vitro and in vivo. We have shown that variation in the regulatory sequence of Ldh-B is responsible for the differences in transcription rate between populations and that the patterns of variation are inconsistent with a neutral model of molecular evolution. This functional differentiation, coupled with departures from neutral expectations, suggests that natural selection has acted on the regulation of Ldh-B. This article illustrates the value of a multidisciplinary approach in addressing problems in gene structure, expression, and evolutionary adaptation.

Adaptation, Physiological↗

PubMed2004

Music, musicians, and the brain: an exploration of musical genius. The 2004 presidential address.

The concept of musical genius used to frame a discussion of the "art" practiced by neurosurgeons is the focus of the 2004 Presidential Address to the American Association of Neurological Surgeons (AANS). The musical genius, in contrast to the musically talented individual, is profiled and placed in the pantheon of those who have demonstrated extraordinary creativity. Observations and speculations about the specialization and elaboration of brain structures in musicians evolve into a discussion of artificial intelligence as a foil to what constitutes the essence of humanity. Taking an inductive approach, the author juxtaposes the conclusion about "music, musicians, and the brain" with the theme of the 2004 annual meeting of the AANS, "Advancing Patient Care Through Technology and Creativity," to elaborate on the characteristics of the consummate neurosurgeon. (Note: Musical vignettes used in the address can be found in the accompanying article posted on Neurosurgical Focus http://www.aans.org/education/journal/neurosurgical).

Brain↗

PubMed2002

Presidential address, 2001. Roots and relevance.

The infrastructure, focus and modus operandi of the Canadian Orthopaedic Association (COA) has been changed to effectively address the needs of the Association in this new century, as well as the possibility of a diminished interest in orthopedic surgery as a career choice. These issues are dealt with in this COA presidential address given at the COA annual general meeting in June 2001.

Canada↗

PubMedDate not supplied

Issues for covariance analysis of dichotomous and ordered categorical data from randomized clinical trials and non-parametric strategies for addressing them.

Analysis of covariance is an effective method for addressing two considerations for randomized clinical trials. One is reduction of variance for estimates of treatment effects and thereby the production of narrower confidence intervals and more powerful statistical tests. The other is the clarification of the magnitude of treatment effects through adjustment of corresponding estimates for any random imbalances between the treatment groups with respect to the covariables. The statistical basis of covariance analysis can be either non-parametric, with reliance only on the randomization in the study design, or parametric through a statistical model for a postulated sampling process. For non-parametric methods, there are no formal assumptions for how a response variable is related to the covariables, but strong correlation between response and covariables is necessary for variance reduction. Computations for these methods are straightforward through the application of weighted least squares to fit linear models to the differences between treatment groups for the means of the response variable and the covariables jointly with a specification that has null values for the differences that correspond to the covariables. Moreover, such analysis is similarly applicable to dichotomous indicators, ranks or integers for ordered categories, and continuous measurements. Since non-parametric covariance analysis can have many forms, the ones which are planned for a clinical trial need careful specification in its protocol. A limitation of non-parametric analysis is that it does not directly address the magnitude of treatment effects within subgroups based on the covariables or the homogeneity of such effects. For this purpose, a statistical model is needed. When the response criterion is dichotomous or has ordered categories, such a model may have a non-linear nature which determines how covariance adjustment modifies results for treatment effects. Insight concerning such modifications can be gained through their evaluation relative to non-parametric counterparts. Such evaluation usually indicates that alternative ways to compare treatments for a response criterion with adjustment for a set of covariables mutually support the same conclusion about the strength of treatment effects. This robustness is noteworthy since the alternative methods for covariance analysis have substantially different rationales and assumptions. Since findings can differ in important ways across alternative choices for covariables (as opposed to methods for covariance adjustment), the critical consideration for studies with covariance analyses planned as the primary method for comparing treatments is the specification of the covariables in the protocol (or in an amendment or formal plan prior to any unmasking of the study.

Analysis of Variance↗

PubMed2005

New York AANCART: using participatory research to address the health needs of South Asian and Korean Americans in New York City.

Since its inception in April 2000, the New York Asian American Network for Cancer Awareness, Research, and Training (NY AANCART) has conducted cancer control education, research, and infrastructure-building activities in collaboration with the agenda of the national AANCART project, one of the Special Population Networks funded by the National Cancer Institute. In New York, the AANCART program was developed based on the principles of community-based participatory research (CBPR), a research approach that is centered on community strengths and issues and that engages the community in the research process. NY AANCART has been dedicated to developing leadership within and collaboration with community-based organizations (CBOs) to address the needs of medically underserved New York Asian-American populations. In particular, NY AANCART has worked with CBOs to develop and implement a diverse public health agenda that addresses the concerns of the communities that are served by these organizations. Using case studies from two community-based partnerships that were developed by NY AANCART, the current report describes how the principles of CBPR were applied in two rapidly growing Asian-American communities in New York City.

Asian↗

PubMed1992

Addressing national and regional health needs: a framework for health planning.

Completion of the first decade since the Alma-Ata Declaration of 'health for all' (1978) has led to numerous appraisals, in international forums, of progress achieved by the current primary health care strategy. Although this strategy appears to have contributed to improvements in selected health outcomes, changing circumstances in many developing countries may now require a more flexible and country-specific approach to health care programming. This article argues for the development of a pragmatic framework: to articulate problems which should be addressed in the development of national health programs; and, to organize concepts and methodologies to address these problems. Such a framework should enable an assessment of currently implicit value judgments, and enable strategies to be considered that assess several input and output variables simultaneously. Moreover, this framework would, we believe, further the goal of improved health delivery at a national level, and serve as a guide for further methodologic and conceptual development.

Developing Countries↗

PubMed1999

Addressing human variability in risk assessment--the robustness of the intraspecies uncertainty factor.

Addressing human variability and sensitive subpopulations is one of the challenges of risk assessment and is an important aspect of the Food Quality Protection Act, the law passed in 1996 that regulates food use pesticides in the United States. The intraspecies uncertainty factor is intended to address differences in susceptibility within the human population. This paper examines the history and scientific basis for the intraspecies uncertainty factor. Our best source of knowledge about human variability in the response to chemicals comes from clinical trials of pharmaceuticals. This large body of data allows both qualitative and quantitative characterization of variability in pharmacokinetic and pharmacodynamic parameters in the general population and in subgroups such as children. The preponderance of evidence in the areas of pharmacodynamics and pharmacokinetics supports the routine use of an intraspecies uncertainty factor in the range of 1-10 as being protective of greater than 99% of the human population. The intraspecies uncertainty factor is highly protective of various subpopulations, including infants and children.

Animals↗

PubMed1996

Application of the message-address concept to the docking of naltrexone and selective naltrexone-derived opioid antagonists into opioid receptor models.

A binding site model for the opioid family of G-protein coupled receptors (GPCRs) is proposed based on the message-address concept of ligand recognition. Using ligand docking studies of the universal opioid antagonist, naltrexone, the structural basis for "message' recognition is explored across all three receptor types, mu, delta, and kappa. The binding mode proposed and basis for selectivity are also rationalized using the naltrexone-derived ligands, naltrindole (NTI) and norbinaltorphimine (nor BNI). These ligands are docked to the receptor according to the common naltrexone core or message. The resulting orientation places key "address' elements in close proximity to amino acid residues critical to selectivity among receptors types. Selectivity is explained by sequence differences in the mu, delta, and kappa receptors at these recognition points. Support for the model is derived from site directed mutagenesis studies and ligand binding data for the opioid receptors and other related GPCRs.

Amino Acid Sequence↗

PubMed2006

[PROWESS, ENHANCE and ADDRESS: clinical implications for the treatment with drotrecogin alfa (activated)].

Drotrecogin alfa (activated) (DrotAA) represents a therapeutic advance in the treatment of severe sepsis. In the pivotal PROWESS trial DrotAA had demonstrated a significant decrease in 28-day mortality, most evident in the subgroup of patients at higher risk of death. Thus, DrotAA was licensed throughout Europe for treatment of adult patients with severe sepsis with multiple organ failure when added to best standard care. The ADDRESS trial was mandated by the FDA to investigate prospectively the treatment effect of DrotAA in patients at low risk of death, e.g. single organ failure. The trial was prematurely stopped due to futility, because no reduction in mortality was observed in this non-indicated patient population. The ENHANCE open-label trial enrolled similar patients to the PROWESS trial and the observed 28-day mortality was consistent with the results seen in the PROWESS trial. Survival rates for patients receiving DrotAA early within 24 h from the first sepsis-induced organ dysfunction were significantly higher than in patients treated later. In this overview we will discuss the results of the ENHANCE and ADDRESS trials in the context of the PROWESS study and clinical implications for the treatment with DrotAA.

Antifibrinolytic Agents↗

PubMed2007

How do medical teachers address the problem of transfer?

Clinical teachers often complain that medical students have forgotten or somehow "lost" knowledge that has been taught at pre-clinical levels at the time of entering the clinical part of education. The purpose of this qualitative study was to explore, whether transfer of knowledge was identified as a problem by the teaching staff of anatomy and surgery, and if so, what strategies they used to overcome it. Semi-structured interviews were conducted with ten medical teachers in anatomy and surgery. Most teachers recognised that there was a problem of transfer and some individuals had adopted strategies to address this. However, there was no formal educational strategy suggested to overcome the problem of transfer. The conclusion is that transfer needs to be addressed both by basic science teachers and clinical teachers. There is a need for a mutual educational discourse of the contexts students will face.

Anatomy↗

PubMed1988

Data compression: 8-dimensional flow cytometric data processing with 28K addressable computer memory.

A method of data analysis for flow cytometry is presented which enables up to eight-dimensional data to be handled by a microcomputer with 28K addressable plus a further 32K non-addressable memory. The multi-parameter coordinates are coded into single numbers using a minimal modification of the array vector mapping equation. These code numbers, each of which corresponds to a given set of coordinates, and then ranked in ascending order according to magnitude and the frequency of each code number is found. Following this step the code is then decoded by integer arithmetic into its original coordinates which are then packed, together with the frequency, into two, three or four 16-bit words depending on the dimensionality of the data set. A five-dimensional data set is used as the illustration. Three regions were set on one two-dimensional data space and the five mono-dimensional histograms, plus a different bivariate distribution, were extracted in a single pass through the processed data file. In addition to considerable space saving the technique has two further attributes, namely, increased speed with which the user can appreciate multiparameter data and the ability to analyse such data sets with a microcomputer.

Algorithms↗