bluuebunny/crossref_metadata_2025_split huggingface dataset:
Routine Reporting or Sentinel Surveys for HIV/AIDS Surveillance in Resource-Poor Settings: Experience in South Africa, 1991-97
Authors: Stuart James M , Irlam James H , Wilkinson David 
Published: October 2002

Information from routine and sentinel surveillance was used to monitor the HIV/AIDS epidemic in KwaZulu-Natal, South Africa between 1991 and 1997. Comparisons were made between data obtained from (1) sentinel surveillance for antenatal HIV infection, pulmonary tuberculosis (PTB), and AIDS in a single health district and (2) province-wide sentinel surveillance for antenatal HIV infection, legally required notification of cases of PTB, and voluntary notification of AIDS cases. HIV prevalence among antenatal clinic attenders in the sentinel district rose rapidly and at similar rates to provincial figures: 4.2% vs 4.8% in 1992 to 25.9% vs 26.9% in 1997. PTB incidence increased four-fold in the sentinel district over the study period, whereas provincial PTB figures from passive surveillance fluctuated widely and showed no clear increase (Chi-square for trend 425.5, P ≤ 0.00001). AIDS incidence in the sentinel district increased dramatically while provincial data from the voluntary reporting system showed a less consistent and much slower rise (Chi-square for trend 9.07, P=0.003). Incidence of AIDS in 1997 was estimated as 437/105 in the sentinel district compared to 32/105 in the provincial figures. Routine disease notification and voluntary reporting systems are likely to underestimate the impact of the HIV/AIDS epidemic in resource-poor settings. Sentinel surveillance at representative sites should be developed to validate or replace passive surveillance systems.
Inequality in the geographical distribution of general practitioners in England and Wales 1974-1995
Authors: Gravelle Hugh , Sutton Matthew 
Published: October 2002

Objectives: To compare geographical inequality in the distribution of general practitioners (GPs), other resources and mortality around 1995 in England and Wales; to measure trends between 1974 and 1995 in inequality of GP distribution; to examine the implications of different need adjustments and inequality measures on the degree of geographic inequality; and to analyse the impact of policies (increased supply, area inducements and entry regulation) on inequality. Methods: Measurement of relative inequality (decile ratio, Gini coefficient, Atkinson index) and absolute inequality (standard deviation) in the ratio of GPs to need-adjusted population in former Family Practitioner Committee/Family Health Services Authority areas each year from 1974 to 1995; and relative inequality across areas in the distributions of income, other resources and standardised mortality ratios (SMRs) around 1995. Regression of 1995 GP/population ratios on 1974 ratios. Application of equalising net advantages location model to GP distribution. Results: Inequality in the distribution of GPs in 1995 was less than inequality in other primary care resources, but greater than inequalities in disposable income, SMRs, primary school expenditure, and hospital and community health services expenditure. The decile ratio shows little change between 1974 and 1995. Gini and Atkinson inequality indices indicate some reduction in inequality between 1974 and 1980, but little change thereafter. The standard deviation of need-adjusted provision increased over the period. Areas that had the lowest GP provision in 1974 tended to have the lowest in 1995. Conclusions: The choice between relative and absolute inequality measures and, to a lesser extent, the method of adjusting for need affect conclusions about the trend in inequality. Both types of measure and most need adjustments suggest that the policies adopted did not lead to a reduction in inequality over the period. Interactions between policies may reduce their overall effectiveness.
What makes British general practitioners take part in a quality improvement scheme?
Authors: Spooner Andrew , Chapple Alison , Roland Martin 
Published: October 2002

Objectives: To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care. Methods: Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) had enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness - PRICCE). Results: Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change. Conclusions: When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.
Motives for seeking a second opinion in orthopaedic surgery
Authors: van Dalen Isabelle , Groothoff Johan , Stewart Roy , Spreeuwenberg Peter , Groenewegen Peter , van Horn Jim 
Published: October 2002

Objectives: The number of second opinions in orthopaedic surgery is increasing rapidly, yet the grounds on which patients and their doctors decide to seek a second opinion have been little studied. The goal of the study was to identify patient and consultant factors that appeared to contribute to a second opinion being sought. Methods: Two thousand and seventy-nine consecutive new patients visiting an orthopaedic surgical outpatient clinic in 1996-1997 participated in the study. Patients were self-defined as seeking a second opinion if they had visited at least one other consultant for the same condition within the previous two years. Each of these patients completed a questionnaire before seeing the orthopaedic surgeon; this included details about the physician-patient relationship, reasons for seeking a second opinion and perceived health status. The first-opinion consultants were contacted by mail; their practice characteristics and the motives for seeking a second opinion were also obtained. Results: Thirty per cent of the study population ( n = 625) had sought a second opinion. Patients sought a second opinion because of disappointment concerning their original treatment, or because they wanted more information about their condition and/or its treatment. First-opinion consultants were usually unaware of these communication issues. Patients' inclination to initiate a second opinion was best predicted by their evaluation of their relationship with their first-opinion consultant. The propensity to initiate referrals for a second opinion varied widely among the first-opinion consultants (10-70%) and was inversely proportional to the size of the group they worked in and their distance from the referral centre. Conclusions: Patients did not seek a second opinion because they had doubts about the competence of their treating consultant, but because they were dissatisfied about the level of communication or about the results of their treatment. Medical educators should continue to increase their efforts to improve specialists' communication and relationship skills since these seem to generate referrals for second opinions, which occupy clinic space that could be used by other patients.
Guidelines and educational outreach visits from community pharmacists to improve prescribing in general practice: a randomised controlled trial
Authors: Watson Margaret , Gunnell David , Peters Tim , Brookes Sara , Sharp Deborah 
Published: October 2002

Objectives: To evaluate the effectiveness of guidelines with or without one-to-one educational outreach visits by community pharmacists in improving general practice prescribing for non-steroidal anti-inflammatory drugs (NSAIDs). Methods: Cluster randomised trial of 20 general practices within Avon, England. Practices were randomised to three groups: control; mailed guidelines; mailed guidelines plus educational outreach visits. General practitioners (GPs) in the latter group received two one-to-one outreach visits from community pharmacists. Changes in prescribing were measured using outcomes derived from prescribing analysis and cost (PACT) data. The primary outcome measure was change in the volume of prescribing for ibuprofen, diclofenac and naproxen as a percentage of total NSAID prescribing. Six secondary outcomes included other measures of prescribing quality and volume. A cost-benefit analysis was performed. Results: No significant differences were observed for the primary outcome measure: practices receiving outreach visits prescribed only 2.1% [95% confidence interval (CI): -0.8 to 5.0] more of the three recommended NSAIDs than the control practices did and 1.6% (95% CI: -1.4 to 4.7) more than practices that received guidelines only. Following adjustment for multiple comparisons, only one secondary outcome showed a statistically significant difference between the groups: the proportion of prescribing of the five most frequently used drugs was 2.2% (95% CI: 0.9 to 3.6) higher in the educational outreach group compared with the control group. A net increase in costs was shown with both interventions. Conclusions: Although good prescribing at baseline in the participating practices limited the capacity for improvement, this trial provides no evidence that guidelines with or without educational outreach visits from community pharmacists lead to substantial improvements in prescribing behaviour.
Factors influencing physicians' assessment of urgency for inpatient surgery
Authors: Arnesen Kjell Erik , Erikssen Jan , Stavem Knut 
Published: October 2002

Objectives: To assess to what extent patient, disease and referral characteristics influenced physicians' assessment of urgency of inpatient surgery. Methods: In total, 452 patients, mean age 50 years, were examined in surgical or gynaecological outpatient clinics in one hospital and referred for inpatient surgery. Data were collected by the examining physician, and the patients were either given a maximal waiting time or the waiting time was not specified. A stepwise logistic regression, with urgency for surgery within four weeks or less as the dependent variable, was used. The results are presented as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results: Of 452 patients, 181 (40%) were deemed urgent (four weeks or less). In multivariate logistic regression analysis, suspected or verified malignant disease (OR 3.45, 95% CI 2.11 to 5.64), risk of serious deterioration (OR 4.53, 95% CI 2.17 to 9.46), being on sick leave from work (OR 3.97, 95% CI 1.82 to 8.64) and being assessed by a physician undergoing specialist training (OR 1.99, 95% CI 1.24 to 3.21) were significant predictors of being assessed as needing inpatient surgery urgently. Conclusions: Physicians' judgements, in an informal way, internalize many of the public's concerns for fairness, such as the severity of a condition, the potential for improvement and aversion to inequalities in health. More research is needed to understand the difference in urgency ratings between junior and more experienced physicians.
The effects of case-based pricing on length of stay for common surgical procedures
Authors: Mikkola Hennamari , Häkkinen Unto 
Published: October 2002

Objectives: Finland's state subsidy reform of 1993 encouraged hospital districts to adopt case-based pricing of their services. The revenues of most hospitals have since depended on the volume and price of services produced. Information on the incentive effects of this method of funding is needed to further develop pricing systems in public hospitals. This study focuses on identifying the effects of case-based prices on length of stay (LOS) for lumbar discectomies and hip and knee replacements. Method: The effects of case-based pricing were estimated using count data models. Data from 1994-1998 on 17 767 lumbar disc patients and 19 039 hip and 15 174 knee replacement patients treated in public hospitals were used. Patient characteristics and hospital and hospital district characteristics, as well as accessibility of care and the time trend were taken into account in the modelling. Results: Use of case-based pricing shortened the LOS by 0.49 days for hip replacements and 0.55 days for knee replacements, but did not shorten LOS for lumbar discectomies. Conclusions: The use of case-based prices would make possible about 400 extra knee and hip replacements yearly, resources (e.g. orthopaedists) permitting. The effects of hospital pricing reform on LOS in Finland compared with countries such as the USA and Sweden have been relatively modest. Overall, measures to reduce differences in clinical practice would probably have a greater impact on LOS or the number of cases treated than case-based pricing.
Policy and profession: Elite perspectives on redefining general practice in Australia and England
Authors: Lewis Jenny 
Published: October 2002

Objectives To understand how general (family) practice is being redefined and is redefining itself, from the perspective of policy elites, and to build an analytical framework. Methods Politicians, senior bureaucrats and executives of professional organisations were interviewed (1998-2000) about the impact of general practice reforms on the profession. The information gathered was thematically coded and used to advance an understanding of profession from an elite perspective. Results Four main aspects of profession were discussed by interviewees. These were cultural authority, profession&s authority, social authority and professional autonomy. The elites interviewed reported a potential challenge to the cultural authority of general practice in both countries through moves to redefine it as something broader. The profession&s authority was seen as having shifted, especially in Australia where new forms of representation for the profession have been established. Medicine was viewed variously as having its social authority challenged, maintained, or extended in the granting of expertise in health, and professional autonomy was regarded as having been restructured through policy change. Conclusions Policy elites perceive that the authority and autonomy of general practitioners has changed but reform has not resulted in generalised losses for the profession. The framework developedhere, which employed aspects of profession that arose as major themes, proved useful for examining the redefinition of profession and for generating policy insights in regard to possibilities for change and likely impacts.
Reform and counter reform: How sustainable is New Zealand&s latest health system restructuring?
Authors: Cumming Jackie , Mays Nicholas 
Published: October 2002

New Zealand's health care sector has undergone almost continual restructuring since the early 1980s. In the latest set of reforms, 21 district health boards (DHBs) have been established with responsibility for promoting health, purchasing services for their populations and delivering publicly owned health services. Boards will be governed by a mix of elected and appointed members, will be responsible for arranging the delivery of primary and community health services, and will own and run public hospitals and related facilities. We clarify the differences and continuities between earlier reforms and the 2000/01 structures, as well as the current reforms’ potential strengths and weaknesses. The paper discusses whether the DHB model was the only feasible option for restructuring and whether the dynamics of the new system may lead to further changes, particularly on the purchaser side of the system. Given that DHBs face potential conflict between their purchasing and provision roles, and given the potential advantages that primary care organisations may have as purchasers, we conclude that it is possible that all or part of the purchasing function of DHBs might eventually shift to primary care organisations, leaving the DHBs as hospital-based provider organisations.
Variations in practice admission rates: the policy relevance of regression standardisation
Authors: Ferguson Brian , Gravelle Hugh , Dusheiko Mark , Sutton Matthew , Johns Rachel 
Published: October 2002

Objectives: To explore variations in general practice admission rates, comparing standardisation by regression with direct standardisation of the data to identify explained and unexplained variation. Methods: Data from hospital episode statistics and the attribution dataset on 8048 cataract admissions from 109 practices in an English health district (North Yorkshire) between 1995 and 1998. Multiple regression was used to estimate the effect of practice characteristics, socio-economic factors, waiting times and distance on practice admission rates. Rankings of practices by the residuals from the regression were compared with rankings by directly standardised admission rates. Results: The regression model yielded intuitively plausible results and explained 35% of the cross-practice variation in directly standardised admission rates. Standardisation by regression, compared with direct standardisation, made as least as much difference to the ranking of practices as direct standardisation compared with crude admission rates. Regression standardisation suggested that 10 practices not identified as 'unusual' by comparison of their rates to the district mean were in fact 'unusual', and that six practices identified as unusual by comparison with the district mean were not unusual once allowing for the explanatory factors used in the regression model. Conclusions: Given the increasing importance of systematic performance assessment to support quality improvement, care must be taken when interpreting variations in health care activity even after conventional standardisation of the data. If significant variations are detected, regression analysis can assist in explaining some of it, which is the starting point in informing discussions about whether variations are justified or unjustified.
Pneumoconiosis among workers in a Vietnamese refractory brick facility
Authors: Chinh Chien Vien , Kim Chai Sanders , Ngoc Hai Doan , Takaro Tim , Checkoway Harvey , Keifer Matthew , Hong Son Phan , Van Trung Le , Barnhart Scott 
Published: October 2002

AbstractBackgroundVietnam is a rapidly industrializing country with increasing needs for building materials, including refractory bricks. The manufacture of refractory bricks results in high levels of free silica, a recognized occupational hazard.MethodsA cross‐sectional survey was conducted among 158 employees using a respiratory symptom questionnaire and ILO classification of radiographs for pneumoconiosis.ResultsThe prevalence of radiographic silicosis (ILO category 1/0 and greater) was 10% in all workers with evidence of a dose–response gradient. Pneumoconiosis prevalence increased from 0% in workers employed < 10 years at the plant to 18% for workers employed > 20 years (trend test P = 0.01 for each year increment after adjusting for gender and tobacco use).ConclusionsWorkers in this plant demonstrate a consistent pattern of radiographic evidence of pneumoconiosis, which appears to be related to duration of work. Future studies should assess exposure control measures that are appropriate to countries undergoing rapid industrialization such as Vietnam. Am. J. Ind. Med. 42:397–402, 2002. Published 2002 Wiley‐Liss, Inc.
Monocyte CD14 response following endotoxin exposure in cotton spinners and office workers
Authors: Fishwick D. , Raza S.N. , Beckett P. , Swan J.R.M. , Pickering C.A.C. , Fletcher A.M. , Niven R.McL. , Francis H. , Rawbone R. , Curran A.D. 
Published: October 2002

AbstractBackgroundMonocyte cell surface CD14 acts as the major lipopolysaccharide (LPS) binding structure, and as such is of interest in the etiology of LPS induced disease.MethodsThe objective was to assess change in monocyte cell surface CD14 and CD4 + CD25 + lymphocytes in a group of cotton workers exposed to LPS over a working week, and to compare this to changes in office workers. Twenty‐five cotton workers and nine office workers were studied. Monocyte CD14 fluorescence was measured by flow cytometry, on samples taken pre‐shift on a Monday morning (baseline/pre‐exposure), and subsequently after 6 and 72 hr. The majority of cotton workers were exposed to at least 1 EU/m3 of endotoxin over a working shift, and some highly exposed (between 100 and 400 EU/m3).ResultsAfter 6 hr of work in the mill, cotton workers developed a significant upregulation in CD14 in comparison to office workers (P = 0.016), whereas CD14 expression had returned to levels not significantly differing from the office workers at 72 hr after first work exposure (P = 0.426).ConclusionsWe propose that CD14 expression on monocytes may help to determine the mechanism of action of lipopolysaccharide in producing respiratory ill health, and may ultimately play a role in monitoring the health effect associated with LPS exposure in the workplace. Am. J. Ind. Med. 42:437–442, 2002. Published 2002 Wiley‐Liss, Inc.
Chemical markers for bacteria in extraterrestrial samples
Authors: Fox Alvin 
Published: October 2002

AbstractInterplanetary missions to collect pristine Martian surface samples for analysis of organic molecules, and to search for evidence of life, are in the planning phases. The only extraterrestrial samples currently on Earth are lunar dust and rocks, brought back by the Apollo (U.S.) and Luna (Soviet Union) missions to the moon, and meteorites. Meteorites are contaminated when they pass through the Earth's atmosphere, and during environmental exposure on Earth. Lunar fines have been stored on Earth for over 30 years under conditions designed to avoid chemical but not microbiological contamination. It has been extremely difficult to draw firm conclusions about the origin of chemicals (including amino acids) in extraterrestrial samples. Of particular concern has been the possibility of bacterial contamination. Recent work using state‐of‐the‐art gas chromatography tandem mass spectrometry (GC‐MS/MS) has dramatically lowered the chemical background, allowing a clear demonstration that lunar fines are remarkably different from terrestrial dust in that they generally lack certain chemical markers (muramic acid and 3‐hydroxy fatty acids) characteristic of Earth's bacteria. Thus, lunar dust might be used as a negative control, in conjunction with GC‐MS/MS analyses, in future analytical studies of lunar dust and meteorites. Such analyses may also be important in studies designed to search for the presence of life on Mars. Anat Rec 268:180–185, 2002. © 2002 Wiley‐Liss, Inc.