Just love in live organ donation

Emotionally-related live organ donation is different from almost all other medical treatments in that a family member or, in some countries, a friend contributes with an organ or parts of an organ to the recipient. Furthermore, there is a long-acknowledged but not well-understood gender-imbalance in emotionally-related live kidney donation. This article argues for the benefit of the concept of just love as an analytic tool in the analysis of emotionally-related live organ donation where the potential donor(s) and the recipient are engaged in a love relation. The concept of just love is helpful in the analysis of these live organ donations even if no statistical gender-imbalance prevails. It is particularly helpful, however, in the analysis of the gender-imbalance in live kidney donations if these donations are seen as a specific kind of care-work, if care-work is experienced as a labour one should perform out of love and if women still experience stronger pressures to engage in care-work than do men. The aim of the article is to present arguments for the need of just love as an analytic tool in the analysis of emotionally-related live organ donation where the potential donor(s) and the recipient are engaged in a love relation. The aim is also to elaborate two criteria that need to be met in order for love to qualify as just and to highlight certain clinical implications.

ADHD treatment in a behavioral health care carve-out: Medications, providers, and service utilization

Children's mental health services are increasingly being managed by managed behavioral health organizations (MBHOs) through carve-outs. Little information is available, however, about services and interventions being received by children whose mental health benefits are carved out. Using claims data, this study explores the treatment of children with a common child psychiatric disorder, attention deficit hyperactivity disorder (ADHD). Children being treated for ADHD see a variety of provider combinations. Children diagnosed with comorbid mood or anxiety disorders are more likely to see a psychiatrist than a primary care physician or therapist, and they are more likely to be in treatment with both a psychiatrist and a therapist than with just one mental health professional. After controlling for severity indicators, costs were significantly lower for patients being treated by just a psychiatrist than for patients seeing both a psychiatrist and therapist. This finding raises the possibility that attempts to save money by splitting treatment may not be cost-effective.     

Austerity program: States keep an eye on Mass. legislation limiting annual healthcare expenditures

Massachusetts' landmark bill to contain healthcare spending has the attention of policymakers nationwide, as they wait to see which approaches in the law work. "This is a broad bill that uses a lot of different levers to make progress on healthcare affordability," says Sarah Iselin, left, of the Blue Cross and Blue Shield of Massachusetts Foundation. "It's a complex challenge, and if there were one silver-bullet solution, we'd all be doing it."     

Beyond access: extending our thinking on health policy

Expanding access is often seen as a panacea for health problems. Although access is a necessary step, it is also important that policy analysts do not fail to consider postaccess issues. Increased access to health is often assumed to be synonymous with improved health outcomes; however, just because access exists does not mean (1) that everyone will take advantage of access to resources or (2) that those taking advantage of access will necessarily see improved outcomes. This article focuses on three aspects of health policy, (1) the types of postaccess issues that exist, (2) the "if you build it, they will come" syndrome, and (3) updating the Anderson/Aday model of health care access to better theoretically understand postaccess issues.     

Seven reasons why you should not categorize continuous data

I have shown that there are a variety of logical, philosophical, measurement, and statistical reasons why every attempt should be made to measure continuous attributes using measures which reflect that continuity and that following statistical analyses should also retain that continuity. I encourage you to look back at some of the research articles which you have read and see if any of these issues is pertinent. Check out the conclusions and see if they are warranted by the data.     

When should a urine specimen be examined after removal of a urinary catheter?

Catheter urine specimens (CSUs) were taken from 72 patients with short term urinary catheters just before the catheter was removed. The patients were assessed to see whether this specimen influenced their management. Their subsequent urinary symptoms were followed, and daily mid stream urines (MSUs) compared with the initial CSU to see if the initial CSU gave an accurate indication of the likelihood of infection when the catheter was removed. Only one patient was given antimicrobial therapy as a consequence of the initial CSU, and 18 patients (25 per cent) showed significant growth on the CSU but no growth or a non-significant growth on subsequent MSUs. It would appear that CSUs taken prior to the removal of urinary catheters are of limited value.     

Reform: round two

Powered by recapturing the House of Representatives, newly re-energized Republicans were full of talk of repealing the new healthcare reform law. That's making providers nervous, even if there are some parts of the law they don't like, such as the Independent Payment Advisory Board. "Everyone in the provider community, not just physicians, wants the IPAB repealed," said Patrick Smith, of the MGMA.     

Carpal tunnel syndrome. It's not just with keyboards

CTS is often preventable. Take care of your hands when at work or at play when performing repetitive tasks, especially if there is also force, vibration, or awkward postures. Try to keep your wrists in a neutral posture, use tools and techniques that minimize required force, have a proper working surface height, design and arrange your work space to minimize the CTS risk factors, and make sure to have enough breaks to have sufficient recovery time. Avoid being overweight. If you experience pain similar to that described with CTS, see your medical doctor. He or she can help differentiate CTS from other upper extremity disorders and can help identify the most appropriate treatment approach. Remember, CTS is not just with keyboards.     

Marketing best practices in alternative medicine

Healthcare organizations throughout the country are endeavoring to select the best strategy to pursue in the area of alternative medicine. In an effort to define and clarify choices, the Alliance for Healthcare Strategy and Marketing has just released the second in its series of Marketing Best Practices research reports. This report documents the marketing "best practices" of 15 organizations or alternative medicine consultants throughout the country (see figure 1). The study revealed some distinct trends and practices that can be a predictor of success for other programs.     

Is statistical significance always significant?

One way in which we learn new information is to read the medical literature. Whether or not we do primary research, it is important to be able to read literature in a critical fashion. A seemingly simple concept in reading is to interpret p values. For most of us, if we find a p value that is <.05, we take the conclusion to heart and quote it at every opportunity. If the p value is >.05, we discard the paper and look elsewhere for useful information. Unfortunately, this is too simplistic an approach. The real utility of p values is to consider them within the context of the experiment being performed. Defects in study design can make an interpretation of a p value useless. One has to be wary of type I (seeing a "statistically significant" difference just because of chance) and type II (failing to see a difference that really exists) errors. Examples of the former are publication bias and the performance of multiple analyses; the latter refers to a trial that is too small to demonstrate the difference. Finding significant differences in surrogate or intermediate endpoints may not help us. We need to know if those endpoints reflect the behavior of clinical endpoints. Selectively citing significant differences and disregarding studies that do not find them is inappropriate. Small differences, even if they are statistically significant, may require too much resource expenditure to be clinically useful. This article explores these problems in depth and attempts to put p values in the context of studies.     

Consumer understanding and use of health claims for foods

Health claims for foods are permitted in an increasing number of countries, but there are very few studies evaluating their effect on purchase behavior and consumer health. There are significant differences between countries but, in general, consumers see health claims as useful; they prefer short, succinct wording rather than long and complex claims; and they believe that claims should be approved by the government. Consumers view a food as healthier if it carries a health claim and this "halo" effect may discourage them from seeking further nutrition information. Consumers do not clearly distinguish between nutrient content, structure-function, and health claims. There is some evidence that the use of health claims improves the quality of dietary choices and knowledge of diet-disease relationships.     

对青年志愿者开展农村卫生扶贫的思考

探讨农村卫生扶贫问题.通过总结分析安徽省青年志愿者卫生扶贫的作用及意义,认为青年志愿者开展卫生扶贫缓解了群众"看病难,看病贵"的问题.帮助改进了乡镇卫生院管理,提高了当地的医疗水平,宣传了健康文明的生活方式.卫生扶贫弘扬了社会正气,同时也对青年志愿者自身成长起到了积极作用.     

Family counselling

The principles of counselling are the same in the Eastern and Western world, but their application may vary considerably because of cultural differences. Western society is characterized by being more open and frank than Eastern society. Nevertheless, knowledge of family dynamics is needed just as much in the East, and family counselling is therefore just as if not more important there.     

Interaction between medicines and medicinal plants

In recent years there has been a notable increase in the consumption of medicinal plants in Spanish society. This might be due to the fact that in some cases they have shown themselves to be efficient in treating certain pathologies and to the erroneous perception that these products are innocuous. Medicinal plants behave as authentic medicines since the chemical substances of which they are formed can have a biological activity in humans. For this reason, their joint administration with "conventional medicines" can produce variations in the magnitude of the effect. This type of interaction, just like those produced between two or more medicines, can produce pharmacokinetic mechanisms if they affect the processes of absorption, distribution, metabolism and excretion, or pharmacodynamic mechanisms if they affect the result of the pharmacological action. In the medical literature there are few articles and notifications of cases concerning the adverse effects and interactions that affect medicinal plants, which probably reflects an under-notification of these phenomena. If we add to this the lack of experimental data and controlled studies, perception of their prevalence is difficult or nearly impossible. This article sets out, in an order that will be explained later, the findings of an exhaustive review of the medical literature with the aim of making its existence known to the reader, without going into other considerations, such as the degree of evidence for example, which will be the subject of forthcoming articles.     

Assessment of observer variation in measuring the Radiographic Vertebral Index in patients with multiple myeloma

The Radiographic Vertebral Index (RVI) was assessed as a possible outcome measure for bone disease in myeloma by evaluating within and between reader reproducibility. Four readers (2 radiologists and 2 clinical hematologists) independently scored, on two separate occasions, the RVI on 40 radiographs from patients with myeloma. Each vertebra from third thoracic (T3) to fifth lumbar (L5) received a score of "1" if normal, "2" if biconcave and "4" if crushed or fractured. RVI global scores, therefore, could vary from a minimum of 15, for no damage, to a potential maximum of 60 in which all vertebrae are collapsed. Agreement was determined for each vertebra using crude percentage agreement and the kappa statistic (which corrects for chance-expected agreement) for categorical data, and for global score using analysis of variance and calculating intra-class correlation. With increasing mean abnormality score on individual vertebrae there was a corresponding increase in kappa and reduction in crude percentage agreement. Within readers, the mean percentage agreement across all vertebrae varied from 85.6 to 90.3% and the observed differences just reach statistical significance (p = 0.048). Mean kappa values ranged from 0.48 to 0.63 and were similar across readers. Differences in intra-reader agreement were not related to subspecialty. When between reader percentage agreement and kappa scores were assessed for radiologists and non-radiologist clinicians, no difference could be detected. Agreement with respect to intra-reader mean global RVI scores was excellent as illustrated by the intra-class correlation coefficient which varied from 0.89 to 0.94. The mean intra-class correlation for radiologists was 0.92, compared with 0.91 for non-radiologists.(ABSTRACT TRUNCATED AT 250 WORDS)     

Medicare physician payment reform: its effect on access to care

This study analyzed a specific indicator condition, congestive heart failure (CHF), to see if there is evidence that physician payment reform (PPR) has had an effect on access to care for Medicare beneficiaries. If there was a decrease in access to ambulatory care services associated with PPR, one would expect to see an increase in hospitalizations for CHF in the period after PPR was implemented This analysis examined the trend in rates of hospitalization for CHF for the overall Medicare population and for selected vulnerable subgroups. No significant discontinuity was found in hospitalizations for CHF with the implementation of PPR.     

Increase in interleukin-6 and fibrinogen after exposure to dust in tunnel construction workers

Objectives: To see if there is any change in blood concentrations of interleukin-6 (IL-6) and fibrinogen during a working shift in tunnel construction workers.     

Condom promotion in women attending inner city general practices for cervical smears: a randomized controlled trial

BACKGROUND: Although condom promotion schemes have been widely piloted in UK general practices, there have been no rigorous evaluations of their effectiveness. OBJECTIVES: To see if a practice-based sexual health education intervention increases the number of women having smears who are given condoms and advice on avoiding STDs. To see if this low cost intervention affects subsequent condom use. METHOD: We conducted a cluster randomized trial of condom promotion in 1382 women aged <35 years attending 28 South London general practices for cervical smear tests. RESULTS: More women in intervention than control practices reported receiving advice on avoiding sexually transmitted infections (27% versus 10%) and being given condoms (28% versus 1%, P < 0.05). However, there was no difference in subsequent condom use, even in the 22% of women reporting >/=2 sexual partners in the previous year. CONCLUSIONS: To provide evidence of effectiveness, future interventions may need to be more intensive or focus on higher risk groups.     

Creative playgrounds for the pre-school children

Why are there easels for painting on the playground? Children will just make a mess if they are allowed to play in water and sand! Those crates and boards are such an “eye-sore” and aren't they dangerous for young children? Why do they need all of those old dishes and pots to put dirt in?     

Direct contracting: a recipe for savings

Hospitals, anxious to maximize patient revenues, and purchasers, just as anxious to contain soaring healthcare costs, are getting together through direct contracting. But the arrangements aren't the answer for all providers. Such efforts are fruitless without adequate financial commitment, cooperation from the medical staff and a reputation for quality. However, if the key ingredients are there, the deals can be sweet indeed.