bluuebunny/crossref_metadata_2025_split huggingface dataset:
What Predicts Patients' Interest in the Internet as a Health Resource in Primary Care in England?
Authors: Mead Nicola , Varnam Robert , Rogers Anne , Roland Martin 
Published: January 2017

Objectives: To identify what factors predict patients' interest in using Internet health information in the light of poor uptake of a free, guided Internet service in one inner-city general practice. Methods: Questionnaires were administered over a five-day period to consecutive adult patients attending two Manchester general practices: An inner-city practice serving a relatively deprived patient population where the free Internet service had previously been available, and a suburban practice serving a relatively affluent population. Data were analysed using multiple regression to identify predictors of self-reported interest in using the Internet for health information. Results: A total of 753 (74%) patients completed the questionnaire although analyses were restricted to 660 (65%) cases. Independent predictors of patient-reported interest in getting health information from the Internet were (in order of relative ‘importance’): Positive outcome expectancy (i.e. the patient's strength of belief that it would enable them to deal better with their health); previous use of health websites; positive ‘self-efficacy’ (i.e. patients' confidence in their ability to use the technology); higher education; a positive attitude to getting health information from alternative sources; social deprivation; and having school-age children living at home. Level of Internet access was an important determinant of self-efficacy, but home access was the key predictor of outcome expectancy and past use of ‘e-health’. Conclusions: Access, demographics and, particularly, motivational factors all influence patients' interest in the Internet as a health resource. Proposals to encourage more widespread use of digital health information need to take account of this complexity and not deal with access issues alone.
Micro-Level Analysis of Distributional Changes in Health Care Financing in Finland
Authors: Klavus Jan , Häkkinen Unto 
Published: January 2017

Objectives: In the early 1990s the Finnish economy suffered a severe recession at the same time as health care reforms were taking place. This study examines the effects of these changes on the distribution of contributions to health care financing in relation to household income. Explanations for changes in various indicators of health care expenditure and use during that time are offered. Method: The analysis is based partly on actual income data and partly on simulated data from the base year (1990). It employs methods that allow the estimation of confidence intervals for inequality indices (the Gini coefficient and Kakwani's progressivity index). Results: In spite of the substantial decrease in real incomes during the recession, the distribution of income remained almost unaltered. The share of total health care funding derived from poorer households increased somewhat, due purely to structural changes. The financial plight of the public sector led to the share of total funding from progressive income taxes to decrease, while regressive indirect taxes and direct payments by households contributed more. Conclusions: It seems that, aside from an increased financing burden on poorer households, Finland's health care system has withstood the tremendous changes of the early 1990s fairly well. This is largely attributable to the features of the tax-financed health care system, which apportions the effects of financial and functional disturbances equitably.
League Tables for Performance Improvement in Health Care
Authors: Nutley Sandra , Smith Peter C. 
Published: January 2017

Objectives: Increasingly health care performance data are being disseminated in the form of ‘league tables' of health care providers, with the implication that such publication helps purchasers select the better providers, and spurs providers into improvements. This paper examines progress to date. Methods: Three stages of the league table process are considered: measurement, analysis and action. Results: A wide range of measurement schemes are now in place, although the emphasis has been on process variables and mortality as a measure of outcome. Several analytical techniques have been deployed to help users make sense of league tables, and to help determine the causes of variations in reported performance. The weakest aspect of current methods relates to the use to which such analysis is put. Conclusions: A haphazard approach to using league table data exists, with few reports on the impact of publication. A variety of directions for future research into the use of performance data are needed.
Determinants of Ambulatory Physician Utilization among Adults with Chronic Diseases in Quebec
Authors: Bads Enis , Champagne François , Rivard Michéle 
Published: January 2017

Objectives: To test the explanatory power of a model of ambulatory service use and to determine the relative roles of the main determinants of physician utilization for two chronic medical conditions in adults in Quebec. Methods: A behavioral model based on Andersen's model was developed and tested by linking two databases: the Quebec health survey as regards patient characteristics, and the Quebec health insurance board data on physician characteristics and service use. Path analysis was used for data analysis. Results: The model explained a little less than 20% of the variation in service use. The number of hospitalizations, physician's specialty and perceived health were the most important predictors of the volume of visits. Conclusion: Further specification of utilization, relating it to a particular medical condition, does not necessarily lead to an increase in the explanatory power of the model. We recommend that future research should put more emphasis on provider-related determinants rather than focusing on the type and purpose of utilization.
The Limits of Leadership: Opinion Leaders in General Practice
Authors: Flottorp Signe , Oxman Andrew , Bjørndal Arild 
Published: January 2017

Objective: To explore the importance and characteristics of opinion leaders in general practice, particularly in relationship to the use of laboratory tests. Design: Focus group discussions and a mailed survey. Subjects: Five focus groups ( n = 29 participants) in four different municipalities and a random sample of 85 general practitioners (GPs) in Norway. Results: While Norwegian GPs recognised colleagues who were influential in determining how they practised, they found it difficult to identify opinion leaders specifically with respect to the use of laboratory tests. Opinion leaders were thought to be less important in influencing the use of laboratory tests than continuing medical education activities and practice guidelines, but more important than industry, patients or personal financial interests. Norwegian GPs recognised and characterised opinion leaders in much the same way as physicians in the USA. Influential colleagues were characterised as being good conveyers of information and willing to take time, as well as being up-to-date and having a high level of clinical expertise. GPs expressed a negative attitude towards ‘superspecialists’ who give advice without knowing the epidemiology of general practice, people who are arrogant and people who do not show respect towards GPs. Conclusions: The potential to identify and use opinion leaders to improve the use of laboratory tests by GPs in Norway appears to be limited.
Shifting Services from Secondary to Primary Care: Stakeholders' Views of the Barriers
Authors: O'Cathain Alicia , Musson Gill , Munro James 
Published: January 2017

Objectives: To identify the barriers to shifting services from secondary to primary care perceived by the involved stakeholders. Methods: Forty-five semi-structured interviews with stakeholders from primary care, acute and community hospitals, purchasers (health authorities) and other agencies involved in two contrasting initiatives to shift services. Results: Stakeholders perceived similar barriers in the two initiatives: disinvesting from existing providers; lack of information on activity and costs; uncertainty over the quality of the proposed alternative service; concern about an increasing workload in primary care; diversity of views within primary care; difficulties in communication between the many agencies involved; and lack of leadership by purchasers. Conclusions: Service shifts which involve disinvestment from existing providers and collaboration between agencies with different views and interests will inevitably face a range of barriers. Attempts to shift services by disinvesting from secondary care are likely to encounter the greatest difficulties. Attempts to shift without concomitant disinvestment may also be slow because of the difficulties of multi-agency collaboration. Frustration will be reduced if those involved have a realistic understanding of the difficulties rather than being surprised and overwhelmed by them.
The Impact of Angiotensin Converting Enzyme Inhibitors on the Arterial Wall
Authors: Lee Alison FC , Struthers Allan D 
Published: January 2017

There is recent interest in the possibility that angiotensin converting enzyme inhibitors (ACE inhibitors) may reduce the damage inflicted on the arterial wall by common cardiovascular risk factors such as hypertension, hyperlipidaemia and ageing. The efficacy of these drugs in blood pressure reduction is accepted, but whether there is an excess benefit on arterial structure and function, conferred by use of ACE inhibitors over more traditional antihypertensives, is still under debate. There is also evidence in animal models to suggest that ACE inhibition is effective in reduction of arterial damage due to experimental hyperlipidaemia. ACE inhibitors not only reduce the conversion of angiotensin I and angiotensin II, which can interact with the sympathetic nervous system, but also prevent the degradation of bradykinin. This means that ACE inhibitors have several potential mechanisms through which they could suppress intimai hypertrophy and prevent endothelial dysfunction, which is believed to precede arteriosclerosis in man. Although much further work is needed to clarify the mechanism underlying the beneficial effects on the arterial wall of this group of drugs, they do appear to have significant potential in the effort to reduce cardiovascular mortality and morbidity, especially in high risk groups.
The PACK Trial: Morbidity and Mortality Effects of Ketanserin
Authors: Verstraete Marc 
Published: January 2017

A total of 3899 patients over 40 years old who had documented intermittent claudication for at least 2 months and in whom the ratio of systolic blood pressure in the ankle to that in the arm was <0.85 in both arteries of at least one foot were recruited in a double-blind, randomized, placebo-controlled trial after a single-blind run-in period of placebo treatment for 1 month. Trial drug was ketanserin 40 mg three times daily. The first primary event after randomization was the endpoint. Primary events were definite myocardial infarction, major stroke, amputation above the ankle, excision of ischaemic viscera, and death due to other vascular causes. There were 136 study endpoints in the 1930 patients treated with ketanserin, who were followed up for 2063 patient-years, and 132 study endpoints in the 1969 patients treated with placebo, who were followed up for 2129 patient-years. A harmful interaction of ketanserin and potassium-losing diuretics resulted in an increase in the number of deaths. After patients taking potassium-losing diuretics or antiarrhythmic agents were excluded, a secondary analysis showed that there were 65 endpoints in 1514 patients taking ketanserin and 87 in 1577 patients taking placebo, a reduction of 23% in the number of study endpoints in those taking ketanserin. The treadmill walking distance and ankle systolic pressure were measured in a predetermined subset of 594 patients. Complete datasets at the beginning and end of 1 year's treatment with ketanserin or placebo were available in 436 patients. There was no difference between the groups in the improvement in pain-free treadmill walking distance. The placebo effect on treadmill walking distance increased continuously for at least 1 year at the rate of about 15% every 6 months. There was no significant change in either group in the ankle systolic pressure at the end of the treatment period, but, in the group given ketanserin, brachial systolic pressure was decreased and the ankle/arm systolic pressure ratio therefore increased.
The roots of neo-liberal resilience: Explaining continuity and change in background ideas in Europe’s political economy
Authors: Schmidt Vivien A 
Published: January 2017

Defines and elucidates the concept of ‘background ideas’; Defines and elucidates neo-liberalism and its relationship to background ideas; Uses discursive institutionalism as framework for analysis of background ideas and neo-liberalism; Explores different levels of neo-liberal ideas in terms of philosophy, program, and policy; Considers how different levels of ideas may be transformed over time through revolutionary or evolutionary change; Examines different forms of ideas, especially as philosophies, ideologies, and discourse, and different types of ideas, both cognitive and normative; Considers the different ways in which ideas are constructed and communicated by policy or political entrepreneurs and/or act in discursive policy communities; Discusses political entrepreneurs as ideological, pragmatic, or opportunistic. Neo-liberalism has come to constitute the core background idea of European political economies, as the unquestioned set of beliefs, understandings, or core philosophy exercising a seemingly incontrovertible hold since the 1980s in Europe. Using a discursive institutionalist framework, this article defines background ideas; describes their different forms, levels, and types; theorizes about the nature of continuity and change in such ideas; and considers the agents and discursive processes through which such ideas are constructed and disseminated. It illustrates throughout with examples of neo-liberalism, from the philosophical origins through its many different permutations in different institutional contexts over time. This article concludes that although ‘background ideas’ as a concept remains somewhat elusive, it is nonetheless useful as a way of understanding how neo-liberalism has managed to infuse people’s deepest assumptions about the possible and thereby to set the limits of the imaginable with regard to political economic action.
Building Resilient Finance? Uncertainty, complexity, and resistance
Authors: Brassett James , Holmes Christopher 
Published: January 2017

Research Highlights and Abstract The article develops a critical analysis of the politics of financial resilience as an increasingly prevalent discourse of economic policy and practice. Against existing critiques of resilience which focus on the neoliberal rationalities and subjectivities that it (apparently) perpetuates, we argue that resilience per se does not—of necessity—infer any particular form of governance or subjectivity. Instead, resilience can be thought of as a sphere of political engagement. An emphasis on system, structure, and the relations between actors over time gives financial resilience a productive ambiguity: neither structure nor subject is ever fully defined and thus remains open. To this end, we engage the Bank of England’s recent turn to complexity modeling and its correlative, somewhat metaphorical, ethos of ‘clear thinking’ in ‘complex times’. This idea of complexity foregrounds the ‘unknown’ through positing the unpredictability of system-wide events; however, ensuing attempts to ‘model complexity’ entail a closure, rendering uncertainty ‘known’ in particular (and limited) ways. Indeed, we identify a general disconnect between the radical rhetoric of resilience agendas that emphasize complexity and the relative banality of resulting policy advice: self-regulation, capital ratios, and so on. We then explore how a focus on the ‘unknown’ can also give financial resilience an open quality, emphasizing the role of imagination and the diversity of agency. Put simply, if financial governance must be imagined, then it can be imagined differently. We therefore examine a set of everyday attempts to use the openness of resilience/complexity, in order to imagine finance in more democratic or communitarian terms. In particular, market formations such as local banking, peer lending, and wider attempts to politicize financial regulation through documentaries like Bank of Dave play on the productive ambiguities of financial resilience in critical ways. Such agendas do not exhaust or solve the dilemmas identified, but do represent a creative set of attempts to engage the politics of finance in inclusive, participatory, and reciprocal terms.
Quality of Life and Pain in Patients with Acute Cholecystitis
Authors: Vetrhus M. , Søreide O. , Eide G. E. , Nesvik I. , Søndenaa K. 
Published: January 2017

Background: Acute cholecystitis carries a higher risk of subsequent gallstone related events than symptomatic, non-complicated disease. However, it is largely unknown to what extent non-operative treatment will affect the patient's well-being as no trial has studied the possible consequences on pain and quality of life. Our aim was to study in a randomized trial how observational treatment (watchful waiting) compared to cholecystectomy. Methods: Sixty-four patients with acute cholecystitis were randomized to observation or cholecystectomy. All gallstone related events were registered and patients answered questionnaires on quality of life (PGWB and NHP) and pain (Pain score and VAPS) at randomization and at 6, 12 and 60 months later. Results: Patients were followed-up for a median of 67 months. Ten of 33 patients (30 %, 95 % CI 15 %−46 %) patients randomized to observation and 27 of 31 (87 %, 95 % CI 75 %−99 %) of patients randomized to operation had a cholecystectomy. Twelve of 33 (36 %, 95 % CI 20 %−53 %) patients in the observation group had a gallstone related event compared to 6 of 31 (19 %, 95 % CI 5%−33 %) patients in the operation group, but the difference was not significant. When patients were grouped according to randomization or actual operative outcome (+/− cholecystectomy), we did not find any significant differences in pain or quality of life measurements. Conclusion: Although conservative treatment of AC carried a certain but not significantly increased risk of subsequent gallstone related events, this did not influence the symptomatic outcome as assessed by quality of life and pain measurements. Thus, we argue that conservative (non-operative) treatment and observation of AC is an acceptable option and should at least be considered in elderly and frail patients.
Fate of the Rectum after Colectomy with Ileorectal Anastomosis in Ulcerative Colitis
Authors: Lepistö A. , Järvinen H. J. 
Published: January 2017

Objective: Aim of the study was to evaluate the cumulative success of colectomy and ileorectal anastomosis in 20 patients with ulcerative colitis. Patients and Methods: Data were collected from patient histories and cumulative success was calculated by the Kaplan-Meier method. Results: Seven of 20 (35 %) ileorectal anastomoses were lost. Cumulative success rate was 84 % at 5 years, 69 % at 10 years and 56 % at 20 years. Most common indication for proctectomy was disabling proctitis. Other reasons for failure were postoperative ileal necrosis and persisting presacral infection. Patients with advanced colonic cancer managed relatively well with ileorectal anastomosis until death. No cases of rectal cancer were detected during postoperative follow-up but one moderate dysplasia was treated locally. Conclusion: Ileorectal anastomosis can be chosen for patients who are not suitable for ileoanal operation. Rectal endoscopies are mandatory postoperatively.
Surgery for Pilonidal Disease
Authors: Hølmebakk T. , Nesbakken A. 
Published: January 2017

Background and Aims: Surgery for pilonidal disease carries a considerable risk of complications, recurrence, and cosmetic sequelae. The present study evaluates the four procedures performed in our institution. Material and Methods: Operations from 1999 through 2002 were retrospectively assessed. Cosmetic result and overall satisfaction were reported on visual analogue scales. Results: Seventy-three procedures were performed in 71 patients: excision with open granulation in nine; excision and primary suture in 25; rhomboid plasty in 23; and lay-open in 16 patients. Infections were as frequent after rhomboid plasty (40 %) as after excision and primary suture (43 %). Nineteen recurrences (26 %) were observed during a median follow-up of 20 months, and the estimated five-year actuarial recurrence rate was 44 %. Recurrence occurred in 1/9 (11 %) after excision with granulation, in 4/23 (17 %) after excision and suture, in 5/25 (20 %) after rhomboid plasty, and in 9/16 patients (56 %) after lay-open. The cosmetic result was satisfactory only in 22/53 (42 %) patients; the result was poor in 16/53 (30 %) patients. Conclusion: Results after surgery for pilonidal disease are modest and should be compared to conservative management in a randomised trial.
The Profile of Leg Symptoms, Clinical Disability and Reflux in Legs with Previously Operated Varicose Disease
Authors: Saarinen J. , Suominen V. , Heikkinen M. , Saaristo R. , Zeitlin R. , Vainio J. , Nordback I. , Salenius J-P. 
Published: January 2017

Purpose: It is difficult to assess the severity and location of venous insufficiency in legs with recurrent varicose disease. This present purpose was to evaluate the distribution of reflux and the diagnostic role of current classifications in a consecutive series of legs with previously operated varicose disease. Methods: A total of 90 legs in a cohort of 66 patients were included. The examination comprised CEAP clinical class, clinical disability score (CDS) and leg symptoms. Colour-flow duplex imaging (CFDI) was used to observe reflux in deep and superficial veins. Details of prior surgery were assessed. Results: The site of superficial reflux was at the groin in 58 % (recurrent or residive vein trunk or unoperated great saphenous vein), and the rate in the popliteal fossa was 11 % (unoperated short saphenous vein). In 58 % of the legs presenting superficial reflux at groin level, previous surgery at the saphenofemoral junction was noted. A sensation of pain was observed in 74 % of the legs, sensation of oedema in 64 %, itching in 26 %, and night cramps in 8%, respectively. Only itching was significantly infrequent in uncomplicated (CEAP C 2–3) legs, and in legs with local reflux was restricted to vein tributaries. Higher CDS (classes 2–3) were significantly more frequent among complicated legs (CEAP clinical class C2–3: 22% versus CEAP clinical class C4–6: 77%; p < 0.005). A similar situation was noted when legs with only local reflux were compared to those with more severe reflux (local reflux: 7 % versus severe reflux: 48 %; p < 0.005). Conclusions: Superficial reflux is frequently detected at groin level despite prior surgery. Unstructured evaluation of leg symptoms is not beneficial. Clinical disability scores associate well with the severity of the venous disease.