Relationship between medical expenditures and government-sponsored medical check-ups for the aged

Japanese law provides for regular medical examinations for the aged. A simulation study to determine the relationship between medical expenditures of cardiovascular disease patients and government-sponsored health check-ups for the aged was conducted in a small community town in Kanagawa Prefecture. The results showed that medical expenditures decreased in accordance with an increase in health screening. However, medical expenditure for out-patients increased slightly with an increase in screening for those cardiovascular disease patients who had not received treatment prior to the government health checkup.     

Impact of expenditures for veterinary services and medical supplies on dairy farm productivity and profitability

OBJECTIVES: This study was undertaken to explore smoking patterns and attitudes that influence smoking cessation and relapse among African Americans. METHODS: Baseline data from eight Community Intervention Trial for Smoking Cessation (COMMIT) sites were analyzed. RESULTS: Compared with Whites, African Americans who smoke less than 25 cigarettes per day were 1.6 times more likely to smoke within 10 minutes of awakening (a behavioral indicator of nicotine dependence), adjusting for education, age, and gender (OR = 1.2 for heavier smokers). African Americans reported a stronger desire to quit smoking and reported serious quit attempts in the past year. African Americans favored tobacco restrictions (they were 1.8 times more likely than Whites to view smoking as a serious community problem, 1.7 times more likely to favor restrictions on cigarette vending machines, and 2.1 times more likely to prohibit smoking in their car). African Americans were lighter/moderate, menthol smokers. CONCLUSIONS: African Americans find smoking socially unacceptable and are strongly motivated to quit, but their "wake-up" smoking may indicate high nicotine dependence, making abstinence difficult even for lighter smokers.     

The impact of payor/provider type on health care use and expenditures among the frail elderly

OBJECTIVES: This study examined whether health care expenditures and usage by the frail elderly differ under three payor/provider types: Medicare fee for service, Medicare health maintenance organization (HMO), and dual Medicare-Medicaid enrollment. METHODS: In-home interviews were conducted among 450 frail elderly patients of a San Diego, Calif, health care system. Cost and use data were collected from providers. RESULTS: Analyses revealed no difference in total expenditures between fee-for-service and HMO enrollees, but Medicare-Medicaid beneficiaries' expenditures were 46.8% higher than those for HMO enrollees and 52.2% higher than those for the fee-for-service group. Fee-for-service participants were less than half as likely as HMO enrollees to have two or more hospital admissions, but hospital usage rates between those two payor/provider groups did not differ. Not were there payor/provider differences in access to home health care, but HMO home health care users received significantly fewer services than the others. CONCLUSIONS: The care provided to these HMO beneficiaries resulted in a combination of restricted home health use and higher multiple hospitalizations. This raises compelling questions for future research. For the dually enrolled, stronger cost containment may be required.     

The medical device directives and their impact on the development and manufacturing of medical implants

For flexible peptides, nuclear Overhauser Effects (NOE) experiments do not provide enough information to ensure a correct definition of their solution structure. The use of distance constraints, derived from the knowledge of proton chemical shifts, is developed to restrict the number of possible conformations. In the case of flexible molecules, randomization appears as an important factor of the correct estimation of the chemical shifts from the 3D structure. The refinement of the solution structure of the highly flexible AVP-like parallel dimer is described to illustrate this process.     

Discrepancies between patient recall and the medical record. Potential impact on diagnosis and clinical assessment of chronic disease

BACKGROUND: During a case-control study, data necessary for fulfilling diagnostic and classification criteria for spondyloarthropathy were collected from 121 patients. OBJECTIVE: To study the potential impact of differences between patient recall and the medical record on diagnosis and clinical characterization of spondyloarthropathy as a model of chronic disease. METHODS: The study was conducted among four Alaskan Eskimo populations served by the Alaska Native Health Service. Two sets of historical data were compiled for each subject, one acquired during the interview and the other derived from the medical record. Paired items from the interview and the medical record were analyzed to determine discrepancies and consequent effects on diagnosis, classification, and disease characterization. RESULTS: Significant differences were observed in the reporting of genitourinary or diarrheal illnesses preceding or associated with arthritis, the occurrence of eye inflammation in association with joint pain, the occurrence of joint pain and back pain together, and the age at onset of back pain all of which are important to the diagnosis and classification of spondyloarthropathy. In contrast, for information needed to establish the probable inflammatory nature of back pain, patient interview was more helpful than the medical records, which did not provide adequate details to differentiate inflammatory from mechanical back pain. CONCLUSIONS: Patient recall bias can substantially affect diagnosis and clinical assessment of chronic disease, as exemplified by spondyloarthropathy. Reliance on records alone, however, may lead to underestimation of features that require subjective appraisal by the patient.     

The effect of inflation on expenditures by mental health organization between 1969 and 1990

At first glance, the rise in current dollar expenditures for all mental health organizations from $3.3 billion in 1969 to $28.4 billion in 1990 seems enormous. However, if the annual expenditures are adjusted for inflation and expressed in constant dollars, the rise in expenditures is only from $3.3 billion in 1969 to $5.6 billion in 1990. Thus, most of the increase in expenditures by mental health organizations over the past two decades is due to inflation, with less than 10 percent due to increases in real purchasing power. Since both the number of private psychiatric hospitals and the expenditures they incurred increased dramatically between 1969 and 1990, these hospitals showed gains in absolute dollar amounts and in dollar amounts per capita, even if the expenditures are expressed in constant dollars. To a lesser extent, the same was true of RTCs. Although both VA medical centers and State mental hospitals showed increases in expenditures as measured in current dollars, if expenditures are expressed in constant dollars, these organizations showed net decreases. Their inpatient populations also decreased during this period. However, if expenditures per inpatient under care are examined, the reverse is true. The per patient expenditures for State mental hospitals increased between 1969 and 1990, even if the results are stated in constant dollars.(ABSTRACT TRUNCATED AT 250 WORDS)     

Environmental skin diseases and the impact of common dermatoses on medical readiness

The environmental extremes in which soldiers exercise and fight, like the environmental extremes in which many civilians encounter occupationally and recreationally, can prove to be a significant cause for morbidity and decreased effectiveness. A variety of skin diseases are related to occupational exposure to dusts and ultraviolet radiation as a well known cause of cutaneous damage. As more is understood about the biochemical factors involved in frostbite injury, treatment recommendations have changed. Too much water, hot or cold, is a continued source of cutaneous misery to the soldier in the field. Finally, even common minor skin ailments can incapacitate the sufferer when confronted with unfavorable environments.     

Health policy reforms and their impact on the practice of tropical medicine

This paper addresses the consequences of reforming health policies on the practice of tropical medicine. It briefly reviews the historical development of health systems in poor, tropical countries before summarising current trends in the reform of financing and management. Reforms considered include decentralising management, broadening choices in health financing, particularly introducing user fees, introducing 'managed competition' principles, and working with the private sector. Experiences in different countries are used to highlight some of the dangers inherent in current reform trends. It is suggested that while monopolistic and centralised systems of public provision are unlikely to come back into fashion, much can be done to build on the more positive aspects of current reforms and to minimise their undesirable side effects. Key issues are developing mechanisms that ensure that services are responsive to users, avoiding polarisation of services between rich and poor, and improving systems of regulation, supervision and monitoring.     

Lifetime risk of dementia and Alzheimer's disease. The impact of mortality on risk estimates in the Framingham Study

We estimated the remaining lifetime risks of developing Alzheimer's disease (AD) and dementia from all causes, based on data from longitudinal population studies. The risk of developing AD during one's lifetime depends on both disease incidence and life expectancy. Conventional estimates of cumulative incidence overestimate the risk when there is a substantial probability of mortality due to competing causes. A total of 2,611 cognitively intact subjects (1,061 men, 1,550 women; mean age, 66 +/- 7 years) were prospectively evaluated for the development of AD or other dementia. A modified survival analysis was used to estimate both cumulative incidence and the sex-specific remaining lifetime risk estimates for quinquennial age groups above age 65 years. Over a 20-year follow-up period, 198 subjects developed dementia (120 with AD). The remaining lifetime risk of AD or other dementia depended on sex, being higher in women, but varied little with age between 65 and 80 years. In a 65-year-old man, the remaining lifetime risk of AD was 6.3% (95% CI, 3.9 to 8.7) and the remaining lifetime risk of developing any dementing illness was 10.9% (95% CI, 8.0 to 13.8); corresponding risks for a 65-year-old woman were 12% (95% CI, 9.2 to 14.8) and 19% (95% CI, 17.2 to 22.5). The cumulative incidence between age 65 and 100 years was much higher: for AD, 25.5% in men and 28.1% in women; for dementia, 32.8% in men and 45% in women. The actual remaining lifetime risk of AD or dementia varies with age, sex, and life expectancy and is lower than the hypothetical risk estimated by a cumulative incidence in the same population.     

中西文化差异对英语教学的影响

如果英语教学仅仅局限在英语词汇和语法上,那么在教学过程中很容易遇到瓶颈,所以西方国家的文化和历史背景的学习也是必不可少的.鉴于中西方巨大的语言文化差异,把一些日常细节如见面时的寒暄、社交礼仪、称谓等信息融入教学中,对于改善英语教学质量,掌握地道英语,有着巨大帮助.     

Differences between Native Americans and Whites on the California Psychological Inventory.

Minimal data exist regarding the performance of Native Americans on standardized self-report personality instruments. In this study, the California Psychological Inventory (CPI) was administered to a nonpsychiatric sample of 70 Native American adults and 100 White adults of equivalent age, educational background, and socioeconomic status. Native Americans scored significantly lower than the equivalent White sample on a number of CPI scales. These results appear to reflect primarily differences between Native American and White women, which may be a function of differences in acculturation and role expectations. Ethnicity appears to be an important factor in the production of differential response patterns on the CPI. The results suggest that Native Americans, particularly women, may be at a disadvantage when the CPI is used for selection purposes unless their responses are compared to cultural norms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health On the Net automated database of health and medical information

With the number of World Wide Web sites growing every day, the problem is not just to find information, but to locate the right piece of information. Current World Wide Web search engines have not resolved this problem as they most often return a long list of documents. The search result is then unusable because of the large number of answers from different domains and topics. Only complex queries may, in a given situation, produce a limited number of potentially relevant documents. To make searches more efficient and usable by common users, we now need intelligent and specialised search engines on the Net [1,2]. Health On the Net Foundation and the Molecular Imaging and Bioinformatics Laboratory at Geneva University Hospital have developed Multi-Agent Retrieval Vagabond on Information Networks (MARVIN), a robot that searches sites and documents specifically related to a given specialised field. One such robot has already been implemented and used for the medical and the 2D electrophoresis domains. Health On the Net Foundation has implemented the corresponding search engines, MedHunt (http://www.hon.ch/cgi-bin/find) for the medical field and 2DHunt (http://www.hon.ch/cgi-bin/2DHunt/find) for the 2D electrophoresis field.     

论佛教中国化与马克思主义中国化的若干异同

佛教中国化和马克思主义中国化在时代背景、国内背景、国际背景和发展历程上存在明显的异同,马克思主义要充分借鉴佛教中国化的经验,立足时代、放眼全球,进一步推动自身的中国化进程.同时,马克思主义要和其他中国文化要素结合,形成中国新文化体系,实现马克思主义中国化理论的指导地位与充分发挥非马克思主义理论形态的积极社会作用的"双赢",共同推动中国社会的快速健康发展.     

从身势语看中日文化差异

身势语是非语言交际的重要手段,了解这些知识对于顺利实现跨文化交际是十分重要的.以此对中国人与日本人身势语的异同点进行了对比分析,以求中日跨文化交际能够顺利地开展.     

Spreadsheet evaluation of computerized medical records: the impact on quality, time, and money

Information and communication technologies are presumed to play a critical role in improving effectiveness and efficiency of clinical care. Although the most promising directions of technological development are microcomputer-generated computerized medical record systems, documenting their value has been a major challenge for health care providers. This paper proposes a 15-item spreadsheet instrument for evaluating computerized medical records, and demonstrates how it was experimentally applied to a 6-year long experience at three sites. In conclusion, preliminary implications and guidelines are drawn with regard to practice and research in this area.     

论1949-1969年间英美对华政策分歧的主要原因

在1949到1969年中美全面对抗的20年里,英美之间在对华政策的诸多领域产生了广泛而深刻的分歧和矛盾,其主要原因可以归纳为以下四个方面:两国在华利益差异较大;两国对华认知以及对中苏关系的认知极为相左;两国决策过程中的国内、国际制约因素存在很大不同;两国外交理念和外交决策传统具有明显区别.