PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Nationality--changes”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1991

Cross-national changes in the effects of peptic ulcer disease.

OBJECTIVE: To describe and to analyze the changing effects of peptic ulcer disease over time. DESIGN: Variables relating to peptic ulcer disease from 1970-1986 were compared. The variables included rates of mortality, hospitalizations, operations, physician visits, and endoscopies, and the amount of disability-related loss of work and early retirement in six countries (Belgium, England and Wales, the Federal Republic of Germany, The Netherlands, Sweden, and the United States). MEASUREMENTS: Nonparametric epidemiologic time-trend analysis. MAIN RESULTS: The historic, slow, declining trend in mortality and hospitalization rates continued. The rate of operations for peptic ulcer disease exhibited a large, one-time reduction, then returned to a parallel declining trend, but at a lower level. The rate of physician visits declined by 50%. The greatest changes were found in the rate of endoscopy use and in disability-related loss of work and early retirement, where increasing trends were quickly followed by decreasing trends. The elderly, especially women, generally did not share many of these benefits. CONCLUSIONS: The effects of new interventions can be understood more fully by examining several variables in many countries over a long time. Contrary to expectations, the effects of the widespread use of histamine H2 antagonists have been more indirect (affecting work loss and disability retirement more) than direct (affecting high-cost medical service use and mortality less).

Absenteeism↗
PubMed1998

Issues in accommodating national changes and local variation in a computer-based guideline for childhood immunization and in related knowledge maintenance tools.

As clinical practice guidelines are increasingly implemented in computer-based form, a major challenge will be to maintain their domain knowledge as new national recommendations are developed and as local customization is required. This maintenance may also need to be performed for any computer-based tools developed to help in the guideline knowledge maintenance process itself. This paper uses the domain of childhood immunization to explore certain issues involved. It describes 1) two recent changes to the national recommendations dealing with the DTP and Polio vaccine series, and 2) several customizations requested by the immunization registries of the State of Oregon and the US Indian Health Service. It then describes how these guideline practice variations are currently handled in three computer-based tools, IMM/Serve, IMM/Def, and IMM/Test. Finally, it discusses how the use of these tools can provide one approach to characterizing the complexity of guideline variations.

Artificial Intelligence↗
PubMed1987

Testing local level labor force and unemployment projections.

The labor force projections perform well, even for small areas, which suggests that changes in local labor force participation rates can be approximated by national changes. In fact, the mean absolute percent errors are low even when the previously calculated population projections are used. The unemployment projections do not do as well, and using 1980 census labor force data instead of previously calculated labor force projections offers no improvement in the results. A two-step study is needed to determine why the errors are so large. First, the state level changes from 1970 to 1980 should be compared with national changes to determine the difference in unemployment rate changes by race and sex. Second, state level data on the occupational mix should be examined for the relationship between this and the changes in state level unemployment rates by race and sex. It is hypothesized that the first step will show that even state level changes in unemployment rates by race and sex cannot be well approximated by the national changes and the second step will show that some of the variation can be explained by state differences in occupational mix. Further studies should be made to determine how the calculation of national changes affects the results. Changes in labor force participation rates seem to follow trends, and therefore extrapolation may not have much effect on the results. Although using the actual changes in unemployment from 1970 to the latest year available as a proxy for the changes from 1970 to the target year may have a serious detrimental effect on the unemployment projections, if some of the variation in the national changes in race and sex can be explained and some adjustments made, the actual changes may be the best proxy to use.

Black or African American↗
PubMed1994

Community intervention and trends in dietary fat consumption among black and white adults.

OBJECTIVE: This study assessed whether a state public health department could effectively implement an affordable nutrition intervention program at the community level. DESIGN: Cross-sectional data were collected via telephone surveys of 9,839 adults, aged 18 years or older, in 1987, 1989, and 1991 in two South Carolina communities. Nutrition education programs began in 1988 in one community. The other community served as a comparison site. We assessed and compared changes in community levels of dietary fat and weekly meat consumption, salt use, and nutrition promotion awareness with analysis of covariance regression techniques that included race, sex, and age as covariates. RESULTS: We observed favorable changes in most eating behaviors and levels of awareness in both communities. The intervention community experienced greater absolute changes that the comparison community in use of animal fats (-8.9% vs -4.0%; P = .02) and liquid or soft vegetable fats (+8.4% vs +3.6%; P = .04), and in awareness of restaurant nutrition information (+33.0% vs +19.4%; P = .0001). Although the primary type of dietary fat used differed between black and white respondents, we observed significant change among both groups. CONCLUSIONS: These results suggest that community-wide nutrition education programs may have augmented regional or national changes in dietary behavior among white and black adults in the intervention community.

Adult↗
PubMed1998

Innovation in the assessment of nursing theory and its evaluation: a team approach.

In response to recent national changes in United Kingdom (UK) nurse education (e.g. devolution of assessment, moves to higher education, revision of the aims) and to local concerns (e.g. fairness to students, validity and reliability of written assessments, helping staff with less experience of assessment, student learning) an initiative has been developed at Southampton based on a team approach to marking and moderating. A five-stage evaluation was designed to accompany implementation of the initiative. The evaluation, carried out by a lecturer and an independent educational evaluator, involved both tutors/lecturers and students. Interviews, questionnaires and observation methods were used. Benefits of the initiative and of the particular model of evaluation included: increased knowledge and confidence in the validity and reliability of the marking and moderating process undertaken by tutor-teams; increased fairness to students; in-service tutor training related to student assessment; knowledge that assessment-promoted learning was taking place. A review of the total assessment programme was an unexpected outcome, including a review of the frequency and timing of assessments and of the written guidelines. The five-stage evaluation developed a feeling of involvement and heightened self-knowledge. Curricular understanding also increased; this helped to achieve the initiative as designed and intended. We recommend this model of evaluation; it promotes involvement of all concerned, students as well as staff, and generates valuable process-knowledge. It can be used in pre- and post-registration nurse education.

Attitude of Health Personnel↗
PubMed1990

Food-consumption trends between adolescent and adult years and subsequent risk of prostate cancer.

A population-based, case-control study of prostate cancer in Utah was used to assess reported food-consumption patterns for the adolescent and adult years. Men reported eating eggs, whole milk, butter, white bread, cereals, and candy less frequently and red meat, fish, low-fat milk, cheese, yogurt, ice cream, margarine, fruits and vegetables, and whole-wheat bread more frequently as adults, indicating that diets changed in the hypothesized direction to correspond to national changes in food-consumption practices. Men who consumed a diet high in saturated fatty acids as adults were at a slightly increased risk of developing aggressive prostate cancer after adjusting for adolescent diet (odds ratio 1.8 comparing high with low intakes), whereas men who consumed a diet high in saturated fatty acids as adolescents were not at increased risk of developing these tumors after controlling for a diet high in saturated fatty acids as adults (odds ratio 1.1).

Adolescent↗
PubMed1992

Developments in occupational health and safety qualifications.

Standards of competence for health and safety practitioners are being developed by the Occupational Health and Safety Lead Body (OHSLB) within the overall context of the national changes in vocational training. These changes focus on the development of National Vocational Qualifications (NVQs) and Scottish Vocational Qualifications (SVQs).

Occupational Health↗
PubMed1989

National trends in educational differentials in mortality.

The authors examined national changes in socioeconomic differentials in mortality for middle-aged and older white men and women in the United States with the use of 1960 data from the Matched Records Study and 1971-1984 data from the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study (NHEFS). In 1960, there was little difference in mortality by educational level among middle-aged and older men. Since 1960, death rates among men declined more rapidly for the more educated than the less educated, which resulted in substantial educational differentials in mortality in 1971-1984. In contrast, among women, death rates declined at about the same rate regardless of educational attainment, so that a strong inverse relation between education and mortality in 1960 remained about the same magnitude during 1971-1984. Trends in educational differentials for heart disease mortality are responsible for much of the change for all causes of death. Relative risk estimates based on the NHEFS indicate that after taking into account selected baseline risk factors the least educated are still at substantially elevated risk of death from heart disease, ranging from a relative risk of 1.38 for men aged 65-74 years at baseline to 2.27 for men aged 45-64 years. Reasons for the observed educational differentials and their changes over time are not easily explained and are likely to be multifactorial.

Aged↗
PubMed1978

Ivan Basilevich: a gerontologist in transit.

Chance often determines the names that are recorded in history. Among an earlier generation's gerontologists, Ivan Basilevich was distinguished by the promise of his career and recognition in the USSR by his peers. The military invasion of his nation changed the pattern of his life. From a professional level in his native land, at the age of 50, he became a resident in psychiatry in Rhode Island where he continued his work on aging. He became a citizen in 1954 and by 1962 was the senior psychiatrist of his hospital's staff. His contributions to gerontology included his participation in the Kiev Congress of Aging in 1938 and a monograph in English (unpublished) on the medical aspects of natural old age. He wrote some 70 articles. In his papers on the subject of aging he heralded the transition of gerontology to its modern stage.

Geriatrics↗
PubMed1995

Waiting list dynamics and the impact of earmarked funding.

OBJECTIVE: To determine how changes in the number of admissions from waiting lists and changes in the number of additions to the lists are related to list size and waiting times, in the context of local waiting list initiatives. DESIGN: Review of national and Körner statistics. SETTING: England (1987-94) and districts of the former Oxford region (1987-91). MAIN OUTCOME MEASURES: Correlation of quarterly changes in the number of admissions from waiting lists in England with changes in total list size, numbers of patients waiting one to two, or over two years, and number of additions to the lists; examination of changes in waiting list statistics for individual district specialties in one region in relation to funding for waiting list initiatives. RESULTS: Nationally, changes in the number of admissions to hospital from lists closely correlated with changes in the number of additions to lists (r = 0.84; P < 0.01). After adjusting for changes in the number of additions to lists, changes in the number of admissions correlated inversely with changes in list size (r = -0.62; P < 0.001). Decreases in the number of patients waiting from one to two years were significantly associated with increases in the number of admissions (r = -0.52; P < 0.01); locally, only six of 44 waiting list initiatives were followed by an increase in admissions and a fall in list size, although a further 11 were followed by a fall in list size without a corresponding increase in admissions. CONCLUSIONS: An increase in admissions improved waiting times but did not reduce list size because additions to the list tended to increase at the same time. The appropriateness of waiting list initiatives as a method of funding elective surgery should be reviewed.

England↗
PubMed1994

Comprehensive periodic health examination: impact on health care utilisation and costs in a working population in Japan.

STUDY OBJECTIVE: To examine the impact of a comprehensive periodic health examination programme on health care utilisation and costs in a working population. DESIGN: A cohort method was used to observe the trends in health care utilisation and costs for a group of local government employees from 1 February 1986 until 31 January 1992, during which time (in 1988) a comprehensive periodic health examination programme had been introduced. Health care utilisation was measured by a claim rate per employee (number of claims in a year divided by number of employees) and a utilisation rate per 100 employees (number of employees who submitted at least one claim in a year divided by number of employees x 100). Health care costs were measured by claim costs per employee (total cost of claims divided by number of employees). National and prefectural changes in per capita health care costs were used for the adjustment of claim costs. Internal comparisons were made in relation to the intensiveness of the periodic health examinations administered before the introduction of the comprehensive programme. SETTING: Fukuoka Prefecture, Japan. PARTICIPANTS: A total of 19,146 local government employees (12,455 men, 6691 women) who worked in small cities, towns, and villages in Fukuoka Prefecture throughout the study period participated. MAIN RESULTS: Both the claim and utilisation rates showed an increase in 1988 when the comprehensive programme was introduced. After adjustment for the national changes in per capita health care costs and the aging effect of the study participants, substantial increases in claim costs were noted after introduction of the comprehensive programme. The programme had a greater but short term effect of increasing the health care utilisation of those who had received less intensive periodic health examinations before 1988, but no similar effect on claim costs was noted. CONCLUSIONS: The comprehensive programme had some role in increasing health care utilisation and costs. Its effect on costs was confirmed when the general population or another population was used as a reference. When comparisons were made internally, the comprehensive programme was seen to have had a greater but short term effect of increasing the utilisation of those who had previously received less intensive health examinations to equalise the health care utilisation and costs within the study population.

Adult↗
PubMed1982

Food and drug interactions.

A significant contribution could be made to patient care if nutritional biochemists, basic and clinical toxicologists, and pharmacologists in the various fields were to mount the studies needed to understand the nature of food-drug interactions. If only a small fraction of the 120 billion dollars per year spent for food or the 10 billion dollars expended for drugs were allocated for research in this area, advances might be made for the health of the nation. Changes in man's diet produce marked effects on drug metabolism. We know that changing a customary diet to one high in protein and low in carbohydrate increases the rates of metabolism of antipyrine and theophylline, and shifting to an isocaloric diet of low protein-high carbohydrate slows the rates of metabolism of these drugs. Presumably, high-protein-low carbohydrate diets in man resemble the animal studies with high protein diets that show enhanced hepatic drug metabolism. However, numerous studies emphasize the considerable individual variability to changes in human diets; some people have dramatic changes, whereas others exhibit little or no response. Similar individuality has been found in the response to enzyme induction by smoking. Numerous foods and food ingredients affect drug metabolism in human beings and apparently follow the same patterns as found in experimental animal studies with changes in the levels of cytochrome P-450 dependent monooxygenases in the liver and intestine. These changes presumably exert some protective action against environmental carcinogens, cocarcinogens, or promoters. Dietary modifications are brought about by use of weight-reducing diets, vegetarian diets, hospitalization, or post-operative regimens. These diets are often continued for long periods of time and it is likely they result in changes in the metabolism by the body of subsequently administered drugs or exposure to environmental chemicals. Methods are needed to measure inter-individual and inter-group differences in metabolism of foreign compounds in order to accurately assess dietary influences on drug metabolism and vice versa. Epidemiologic studies of rigorously selected human populations, coupled with the newer sensitive chemical analytical methods, will provide the necessary data base for these investigations.

Animals↗
PubMed1994

The beliefs and values shaping today's health reform debate.

Survey results show that the American public comes to the health care reform debate with ambivalent feelings and a relatively low base of specific knowledge. But Americans also hold a set of core values that will shape their response to various proposals for national change. These include (1) a moral commitment to the uninsured; (2) a desire to achieve personal peace of mind; (3) a lack of self-blame; (4) a limited willingness to sacrifice; (5) reasoned self-interest in what changes are enacted; (6) a distrust of government; and (7) a healthy cynicism about the behavior of our major institutions.

Adult↗
PubMed1989

National trends in the use of preventive health care by women.

This study investigates national changes between 1973-74 and 1985 in women's use of three preventive health services based on data from the National Health Interview Survey. Smoothed proportions of women with recent preventive care were estimated using weighted least squares for subgroups categorized by age (20-39, 40-59, 60-79), race (White, Black), income (poor, nonpoor), and year of interview. Older women and Black women experienced the largest increases in recent use of clinical breast examinations and Pap tests. Between 1973 and 1985 changes in recent breast examination ranged from zero for White women ages 20-39 years to a 23 percentage point increase (95% CI = 17,30) for Black women ages 60-79 years. A similar pattern was found for Pap testing. Changes between 1974 and 1985 in recent blood pressure testing ranged from zero for women ages 20-39 years to an 8 percentage point increase (95% CI = 6, 10) for women ages 60-79 years. Despite the increases among older women, in 1985 recent use of breast exams and Pap tests remained lower among older women. Further, the poor remained less likely than the nonpoor to have recent preventive care (except blood pressure testing among older women). Most women without recent cancer screening tests had a recent physician contact, highlighting the need for greater emphasis on cancer prevention by health care providers.

Age Factors↗
PubMedDate not supplied

Job satisfaction and morale of nurses in NHS trusts.

In April 1991 the Daphne Heald Research Unit at the Royal College of Nursing (RCN) started a three-year research project to assess the job satisfaction of nurses working in the community. This took place against a backdrop of considerable change in the organisation and funding of community health care. Initially four NHS Trusts participated, one withdrew after the first year. A measure of job satisfaction was administered to the entire community nursing and practice nursing workforce in each area. The response rate varied from 74% (year 1) to 54% (year 2). Differences in satisfaction were detected between trusts, different groups of nurse and over time. Some nurses added comments to their questionnaire, voicing concerns over uncertainty, paperwork and a perceived change in ethos within their organisations. Trust managers interviewed as part of the study spoke of their strategies for local implementation of the national changes.

Health Care Reform↗
PubMed1996

Why is health care reform faltering? Delaware's experience.

Many managed care plans propose short-term economics, without stressing quality, assuring universal access, supporting research, or caring for the poor. None provide much in the way of preventive services. In the absence of any major national changes to assure universal access to health services, local health care providers and state regulatory agencies need to be freed from many restrictive federal laws and regulations. Relief is needed from well-intended federal controls which have usually made the health care system more expensive 1) by applying federal anti-trust regulations to prevent physicians from self-regulation and working to improve the health care system, 2) by making it difficult for physicians to do office laboratory work for their patients' convenience, 3) by making "safe" drugs expensive because of FDA regulations, 4) by sequentially spawning PRO, PSRO, and now the Health Care Quality Improvement Program (HCQIP) to "assure quality control" (they probably have not paid for themselves), 5) by not using the RBRVS system (accepted by HCFA as a way to relate a physician's fees to the resources required to perform a service) to stimulate physicians to enter primary care practice, 6) by giving tax breaks for insurance costs to big corporations but not to small businesses, and 7) by protecting self-insured businesses from state regulations. States should be allowed to obtain waivers from ERISA (which incidentally would improve competition) so states could regulate health insurers, try such proposals as a single payer system, or at least restore community rating and equity. This should improve access to technological advances in prevention and health care for all. More commissions and studies and federal laws are not the answer. Health care providers should be able to work together freely to deliver efficient, cost-effective health care. States should be able to assure preventive services, clinical research, public health support, professional education and care for the poor.

Delaware↗
PubMed1997

Local population differences and the needs of people with cognitive impairment.

INTRODUCTION: Variations in local population age structure have attracted less attention than national population ageing. As moderate and severe cognitive impairment is a major cause of need for long-term care, population-based estimates of the numbers and characteristics of this group were calculated, to explore the effects of local differences. METHOD: The UK Office of Population Census and Surveys (OPCS) study of disability in adults (N > 14000) was reanalysed. A group with moderate or severe cognitive impairments was identified and age-specific estimators of sociodemographic characteristics, household types, disabilities and service use were combined with population estimates for district health authorities in England and Wales. RESULTS: The proportion of the 65 plus population who are 85 plus varies from 8% to 15% across districts, equivalent to national population projections for 1986 and 2031 respectively. The estimated prevalence of the study group varies from 53 to 70 per 1000 population aged 65 plus, with 34-48% of cases aged 85 plus. Curiously, the proportion with severe disabilities varies little across districts. If national norms applied, local rates of institutionalization would vary from 18 to 27 per 1000 aged 65 plus. CONCLUSION: Local differences in population age structure age large compared to national changes over decades. Local differences have substantial effects on overall prevalence and on the proportion of the cognitively impaired who would be institutionalized if national patterns applied. Service design should be influenced by these complex variations, with estimates modified by local surveys.

Activities of Daily Living↗