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Post-traumatic stress disorder and the care of persons living with HIV/AIDS 创伤后应激障碍和对艾滋病毒/艾滋病感染者的护理
Pub Date : 2011-11-04 DOI: 10.2174/1874924001104010039
S. Coughlin
In conjunction with medical and scientific advances that have improved the survival and quality of life of persons living with HIV/AIDS, there has been increasing interest in examining post-traumatic stress disorder (PTSD) in HIV positive persons. Studies of comorbid HIV/AIDS and PTSD have focused on a wide variety of demographic, cultural, and socioeconomic subgroups of diverse populations including women [1-3], socioeconomically disadvantaged persons [4, 5], gay men [6], and adolescents and young adults in developed countries such as the U.S. and Great Britain [7]. Other studies have focused on adults or children in African countries impacted by the AIDS pandemic [8, 9]. In the U.S., PTSD rates have been reported to be 10.4% to 42.2% in treatment seeking and convenience samples of patients with HIV/AIDS [2, 10]. Several factors may account for the cooccurrence of HIV/AIDS and PTSD and other anxiety and mood disorders such as major depression. These include the potentially traumatic nature of being diagnosed with a diagnosis that is often perceived as life-threatening; the relatively high rates of traumatic exposures (physical assault, sexual trauma, or the sudden, unexpected death of a close family member or friend) that have been reported in studies of persons with HIV/AIDS; and patient perceptions of AIDS-related stigma [2, 11].
随着医学和科学进步改善了艾滋病毒/艾滋病感染者的生存和生活质量,人们对检查艾滋病毒阳性患者的创伤后应激障碍(PTSD)越来越感兴趣。对合并HIV/AIDS和PTSD的研究主要集中在不同人群的各种人口统计学、文化和社会经济亚群体上,包括女性[1-3]、社会经济弱势群体[4,5]、男同性恋者[1-3]以及美国和英国等发达国家的青少年和年轻人[1- 5]。其他研究集中在受艾滋病流行影响的非洲国家的成人或儿童身上[8,9]。在美国,据报道,在寻求治疗和便利的HIV/AIDS患者样本中,PTSD发病率为10.4%至42.2%[2,10]。有几个因素可以解释艾滋病毒/艾滋病和创伤后应激障碍以及其他焦虑和情绪障碍(如重度抑郁症)的同时发生。其中包括被诊断出通常被视为危及生命的诊断的潜在创伤性;在对艾滋病毒/艾滋病患者的研究中报告的相对较高的创伤性暴露率(身体攻击、性创伤或亲密家庭成员或朋友的突然、意外死亡);以及患者对艾滋病相关污名的认知[2,11]。
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引用次数: 4
How do Vested Interests Maintain Outdated Policy? The Case of Food Marketing to New Zealand Children 既得利益集团如何维持过时的政策?新西兰儿童食品营销案例
Pub Date : 2011-11-01 DOI: 10.2174/1874924001104010030
P. Field, R. Gauld
This paper examines the role of powerful vested interest groups in determining public health nutrition policy. With childhood obesity now being classified as an epidemic, television food advertising to children is a relevant case study, which is reported on in this article. The study consisted of qualitative interviews with members of the New Zealand food advertising policy community and documentary analysis of relevant submissions to two government inquiries, websites and policy documents related to food advertising to children. The findings categorised the positions of three identifiable interest groups. Each group's use of evidence and other influence strategies was examined in relation to their impact on government policy. We found the food industry to be tightly coordinated in their influence activities, public relations, partnership agreements and the creation of scientific uncertainty. Non government organisations were less coordinated in their advocacy for regulation, relying heavily on the use of scientific evidence to support their position. As a result industry groups dominated the processes to produce a policy outcome where the government was not acting in its own best economic interest, in terms of reducing the longer-term costs of obesity, or that of the public. The evidence from this study supports international recommendations for new approaches to health policymaking. Government needs to lead a collaborative process between vested interest groups to ensure industry groups do not have the upper hand. Such approaches would enable policy with positive public health outcomes.
本文考察了强大的既得利益集团在确定公共卫生营养政策中的作用。随着儿童肥胖被列为一种流行病,电视食品广告对儿童是一个相关的案例研究,这篇文章报道。该研究包括对新西兰食品广告政策社区成员的定性访谈,以及对两项政府调查、网站和与儿童食品广告有关的政策文件的相关意见书的文献分析。调查结果对三个可识别的利益集团的立场进行了分类。审查了每个群体使用证据和其他影响战略的情况,以及它们对政府政策的影响。我们发现,食品行业在影响活动、公共关系、伙伴关系协议和科学不确定性的创造方面是紧密协调的。非政府组织在倡导监管方面缺乏协调,它们严重依赖使用科学证据来支持自己的立场。因此,行业集团主导了制定政策结果的过程,而政府并没有按照自己的最佳经济利益行事,就减少肥胖或公众的长期成本而言。这项研究的证据支持国际上关于卫生政策制定新方法的建议。政府需要领导既得利益集团之间的合作过程,以确保工业集团不会占上风。这种做法将使政策能够产生积极的公共卫生成果。
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引用次数: 9
How Healthcare Studies Use Claims Data 医疗保健研究如何使用索赔数据
Pub Date : 2011-08-27 DOI: 10.2174/1874924001104010026
Bryan Burton, P. Jesilow
Claims data have become common during the past two decades. The electronic records include information entered on bills (claims) submitted by healthcare providers to third-party payers. They are an attractive data source; however, they contain limitations that threaten the validity of studies that use them. We reviewed 168 studies that employed claims data, published during 2000-2005 in five healthcare journals, to investigate how claims data are being used and whether their use is appropriate. Healthcare studies in our sample used claims data to select a sample, to establish healthcare costs, to determine whether specific treatments or procedures had been provided, to ascertain the cost- effectiveness of services, and to establish their accuracy as a stand-in for other measures. Most studies appropriately used claims data; however, there was a sizable percentage that used claims data in an inappropriate or questionable fashion.
在过去的二十年里,索赔数据变得很常见。电子记录包括医疗保健提供者提交给第三方支付者的账单(索赔)中输入的信息。它们是一个有吸引力的数据来源;然而,它们也有局限性,威胁到使用它们的研究的有效性。我们回顾了168项研究,这些研究采用了2000-2005年间发表在5份医疗保健期刊上的索赔数据,以调查索赔数据是如何被使用的,以及它们的使用是否恰当。我们样本中的医疗保健研究使用索赔数据来选择样本,确定医疗保健成本,确定是否提供了特定的治疗或程序,确定服务的成本效益,并确定其作为其他措施替代的准确性。大多数研究恰当地使用了索赔数据;然而,有相当大的比例以不适当或可疑的方式使用索赔数据。
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引用次数: 7
Patient Centered Care - A Conceptual Model and Review of the State of the Art 以病人为中心的护理-一个概念模型和艺术状态的回顾
Pub Date : 2011-04-27 DOI: 10.2174/1874924001104010015
R. Jayadevappa, S. Chhatre
Background: Patient-centered care that encompasses informed decision making can improve treatment choice, quality of care and outcomes. Patient-centered care recognizes the need for major changes in the process of care that arranges health care system around the patient. Objective: Study objective was to evaluate and discuss the interplay of components of patient- centered care by developing a conceptual model of patient-centered care. Methods: Comprehensive literature review was conducted using Medline, CINAHL, and Cochrane databases. Included were English language studies addressing issues related to patient-centered-care and patient reported outcomes. Results: Though the concept of patient-centered care emerged in the early 50s, it exploded in the health care research policy arena exponentially in the late nineties. The conceptual model described here can aid objective and subjective evaluation of patient-centered care. As we strive to improve the quality of care, patient-centered care can play a pivotal role in this process. This however requires changes in our healthcare system so as to improve overall quality of care by minimizing wasteful health resource consumption. Conclusions: With healthcare costs projected to continue their rapid increase, the current paradigm of healthcare is unsustainable. More research is needed to explore the various attributes of patient-centered care, its acceptability, and comparative effectiveness in the healthcare arena.
背景:以患者为中心的护理包括知情决策可以改善治疗选择,护理质量和结果。以患者为中心的护理认识到需要在护理过程中进行重大改变,以安排围绕患者的医疗保健系统。目的:通过建立以病人为中心的护理概念模型,评估和讨论以病人为中心的护理各组成部分之间的相互作用。方法:采用Medline、CINAHL、Cochrane数据库进行综合文献复习。其中包括与以患者为中心的护理和患者报告的结果相关的英语研究。结果:虽然以病人为中心的护理概念在50年代初就出现了,但在90年代后期,它在卫生保健研究政策领域呈指数级增长。这里描述的概念模型可以帮助客观和主观评价以病人为中心的护理。当我们努力提高护理质量时,以患者为中心的护理可以在这一过程中发挥关键作用。然而,这需要改变我们的医疗保健系统,通过减少浪费的卫生资源消耗来提高整体医疗质量。结论:随着医疗成本预计将继续快速增长,目前的医疗模式是不可持续的。需要更多的研究来探索以患者为中心的护理的各种属性,其可接受性和在医疗保健领域的相对有效性。
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引用次数: 136
Erosion in the Healthcare Safety Net: Impacts on Different Population Groups. 医疗安全网的侵蚀:对不同人口群体的影响。
Pub Date : 2011-03-30 DOI: 10.2174/1874924001104010001
Lee Mobley, Tzy-Mey Kuo, Gloria J Bazzoli

Safety net hospitals (SNHs) have played a critical role in the U.S. health system providing access to health care for vulnerable populations, in particular the Medicaid and uninsured populations. However, little research has examined how access for these populations changes when contraction of the safety net occurs. Institutional policies, such as hospital closure or ownership conversion, could affect the supply of minority health care providers, thus exacerbating disparities in outcomes. We use multilevel logistic modeling of person-level hospital discharge data to examine the effects of contractions in the California safety net over the period of 1990-2000 on access to care as measured by changes in ambulatory care sensitive condition (ACSC) admissions, using geographic methods to characterize proximity to a contraction event. We found that presence of a contraction event was associated with a statistically significant increase in the predicted probability of impeded access, with an increase of about 1% for Medicaid-insured populations and about 4-5% for the uninsured. The Medicaid-insured group also maintained the highest rates of ACSC admissions over time, suggesting persistent access problems for this vulnerable group. This research is timely given continued budget problems in many states, where rising unemployment has increased the number of Medicaid enrollees by 6 million and uninsured individuals by 1.5 million, increasing pressure on remaining SNHs.

安全网医院(SNHs)在美国卫生系统中发挥了关键作用,为弱势群体提供医疗保健,特别是医疗补助和无保险人群。然而,很少有研究审查当安全网收缩时这些人口的获取如何变化。机构政策,如医院关闭或所有权转换,可能会影响少数族裔卫生保健提供者的供应,从而加剧结果的差异。我们使用多层次logistic模型对个人水平的医院出院数据进行建模,以考察1990-2000年期间加州安全网的收缩对获得护理的影响,通过门诊护理敏感条件(ACSC)入院的变化来衡量,使用地理方法来表征收缩事件的接近性。我们发现,在统计上,收缩事件的存在与阻碍获取的预测概率显著增加有关,有医疗保险的人群增加了约1%,没有医疗保险的人群增加了约4-5%。随着时间的推移,有医疗补助的群体也保持着最高的ACSC入学率,这表明这个弱势群体持续存在准入问题。鉴于许多州持续存在的预算问题,这项研究是及时的。在这些州,不断上升的失业率使医疗补助计划的参保人数增加了600万,未参保的人数增加了150万,增加了对剩余snh的压力。
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引用次数: 17
Quantitative Models for Causal Analysis in the Era of Genome Wide Association Studies. 全基因组关联研究时代因果分析的定量模型。
Pub Date : 2011-01-01 DOI: 10.2174/1874924001003010118
Steven S Coughlin
Causal inference in health research is a complex endeavor partly because the biomedical enterprise involves researchers from many disciplines including clinical medicine, epidemiology, genetics, basic sciences such as pathology and cell biology, and the behavioral sciences. A multidisciplinary approach is often needed to study health concerns and interpret findings, drawing upon expertise from epidemiologists, statisticians, physicians, nurses, geneticists, psychologists, and other practicing clinicians and researchers. In addition to the diversity of scientific disciplines and professions that are represented in many study groups, the range of health topics that can be studied is large and can include physical injuries such as traumatic brain injury; pain syndromes and other neurological conditions; chronic health conditions such as obesity, cancer, respiratory illnesses, and cardiovascular disease, gastrointestinal illnesses such as irritable bowel syndrome, infectious diseases such as H1N1 influenza and hepatitis C, psychiatric conditions such as post traumatic stress syndrome, depression, and suicide, adverse reproductive outcomes, and other health problems and concerns. Another feature of health research is that a range of study designs are employed by researchers including surveillance systems, observational studies with a case-control or cohort design, cross-sectional surveys, and randomized controlled trials. In recent years, observational studies include the large platforms of cases and controls that are identified for genome-wide association studies [1, 2]. In addition to statistical geneticists, the researchers who analyze data from genome-wide association studies and proteomics research often include persons with expertise in bioinformatics or machine learning techniques. These three features of health research (diversity of scientific disciplines, wide variety of health topics of interest, and alternative study designs) create both challenges and opportunities for researchers attempting to identify causal associations with possible etiologic agents and new therapeutic targets, so that research findings can be translated into targeted clinical interventions and evidence-based therapies. For example, in studies with an observational design, where assignment of exposures is not under control of the investigators, assessments of causality can be more challenging than in randomized trials [3, 4]. Investigations into the distribution and determinants of health conditions attempt to gain new knowledge through observation and inductive logic. Causal criteria commonly cited in epidemiology include temporal order of exposure and disease, biologic gradient or dose-response curve, biologic plausibility, biologic coherence, and consistency of findings, although some authors have recommended subsets of the criteria or refined definitions [5-7]. The strength of the observed association is also important in some assessments of causality. Crite
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引用次数: 1
Support to Primary Health Care in Transitional Situations: Lessons Learned from the Field 在过渡局势中支持初级保健:从实地吸取的经验教训
Pub Date : 2010-11-30 DOI: 10.2174/1874924001003010123
S. D. Mortier, Ruth C Bullen, Hervé le Guillouzic
In a war context, a transition period begins when the guns fall silent following a ceasefire or a peace agreement is signed. In a natural disaster context, it starts as soon as the search and rescue activities are over. Progression from the emergency to the transition phase is often a tedious process, involving a complex emergency context, unforeseen additional and emerging needs and the presence/withdrawal of stakeholders. Humanitarian aid commonly described in most emergencies often persists during the transition phase. It requires them to make a complete shift in its approach, planning, financing, performance monitoring and evaluation. In transition situations, the key is to develop national and international partnership in respect to primary health centres, with a clearly-defined, realistic and participative public health methodology. This paper, a review of some key humanitarian guidelines and peer reviewed studies, is presented with a methodological approach with a succession of practical questions, answers, and documented case examples and targets central, provincial and district health facilities and national and international public health workers facing the challenges of a fragmented and fragile post-emergency health service network.
在战争背景下,当停火或和平协议签署后枪声停止时,过渡期就开始了。在自然灾害的情况下,一旦搜救活动结束,它就会开始。从紧急情况进入过渡阶段往往是一个冗长乏味的过程,涉及复杂的紧急情况、无法预见的额外需求和新出现的需求以及利益攸关方的出席/退出。在大多数紧急情况中通常描述的人道主义援助往往在过渡阶段继续进行。它要求它们在方法、规划、筹资、执行情况监测和评价方面彻底改变。在过渡局势中,关键是在初级保健中心方面发展国家和国际伙伴关系,采用明确界定、现实和参与性的公共保健方法。本文回顾了一些关键的人道主义准则和同行评议研究,并采用方法学方法提出了一系列实际问题、答案和记录的案例示例和目标,这些案例和目标是中央、省和地区卫生设施以及面临支离破碎和脆弱的应急后卫生服务网络挑战的国家和国际公共卫生工作者。
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引用次数: 1
Health Expenditure Comparisons: Low, Middle and High Income Countries 卫生支出比较:低收入、中等收入和高收入国家
Pub Date : 2010-08-31 DOI: 10.2174/1874924001003010111
S. Hopkins
Cross-sectional health expenditure data are used to compare health expenditure aggregates and the contribution of the public and private sectors in a selection of 31 low, middle and high income countries. The comparative data illustrate the diversity of outcomes in terms of total health expenditure and its components even amongst countries with similar GDP per capita. Low and middle income countries on the whole, rely more heavily on private funding especially household out-of-pocket payments. Public funding is more prevalent for funding of curative care than for funding of pharmaceuticals in high, middle and low income countries. The results illustrate the usefulness of internationally comparable health expenditure data to undertake cross country comparisons. Such comparisons are crucial for contributing to evidence based policy.
横断面卫生支出数据用于比较选定的31个低收入、中等收入和高收入国家的卫生支出总额以及公共和私营部门的贡献。比较数据表明,即使在人均国内生产总值相似的国家之间,在卫生总支出及其组成部分方面的结果也存在差异。低收入和中等收入国家总体上更依赖私人资金,特别是家庭自付费用。在高、中、低收入国家,公共资金用于资助治疗保健的情况比用于资助药品的情况更为普遍。结果表明,国际上可比较的卫生支出数据对进行跨国比较是有用的。这种比较对于促进基于证据的政策至关重要。
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引用次数: 34
Editorial: The Struggle to End Homelessness in Canada: How we Created the Crisis, and How We Can End it~!2009-08-20~!2009-09-28~!2010-03-22~! 社论:结束加拿大无家可归者的斗争:我们如何制造危机,以及我们如何结束危机~!2009-08-20~!2009-09-28~!2010-03-22~!
Pub Date : 2010-04-07 DOI: 10.2174/1874924001003020021
S. Gaetz
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引用次数: 43
The Future of Homeless Services: An Introduction~!2009-08-18~!2009-09-28~!2010-03-22~! 无家可归者服务的未来:导论~!2009-08-18~!2009-09-28~!2010-03-22~!
Pub Date : 2010-04-07 DOI: 10.2174/1874924001003020030
J. Olivet, Kristen Paquette, J. Hanson, E. Bassuk
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引用次数: 2
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The open health services and policy journal
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