Changing healthcare: stakeholder perceptions of the burden of chronic disease and the value of teams, measurements and communication.

Canadian healthcare is changing. Over the course of the past decade, the Health Care in Canada Survey (HCIC) has annually measured the reactions of the public and professional stakeholders to many of these change forces. In HCIC 2008, for the first time, the public's perception of their health status and all stakeholders' views of the burden and effective management of chronic diseases were sought. Overall, Canadians perceive themselves as healthy, with 84% of adults reporting good-to-excellent health. However, good health decreased with age as the occurrence of chronic illness rose, from 12% in the age group 18-24 to 65% for the population =65 years. More than 70% of all stakeholders were strongly or somewhat supportive of the implementation of coordinated care, or disease management programs, to improve the care of patients with chronic illnesses. Concordant support was also expressed for key disease management components, including coordinated interventions to improve home, community and self-care; increased wellness promotion; and increased use of clinical measurements and feedback to all stakeholders. However, there were also important areas of non-concordance. For example, the public and doctors consistently expressed less support than other stakeholders for the value of team care, including the use of non-physician professionals to provide patient care; increased patient involvement in decision-making; and the use of electronic health records to facilitate communication. The actual participation in disease management programs averaged 34% for professionals and 25% for the public. We conclude that chronic diseases are common, age-related and burdensome in Canada. Disease management or coordinated intervention often delivered by teams is also relatively common, despite its less-than-universal acceptance by all stakeholders. Further insights are needed, particularly into the variable perceptions of the value and efficacy of team-delivered healthcare and its important components.

Microvascular burden and Alzheimer-type lesions across the age spectrum.

The occurrence of microvascular and small macrovascular lesions and Alzheimer's disease (AD)-related pathology in the aging human brain is a well-described phenomenon. Although there is a wide consensus about the relationship between macroscopic vascular lesions and incident dementia, the cognitive consequences of the progressive accumulation of these small vascular lesions in the human brain are still a matter of debate. Among the vast group of small vessel-related forms of ischemic brain injuries, the present review discusses the cognitive impact of cortical microinfarcts, subcortical gray matter and deep white matter lacunes, periventricular and diffuse white matter demyelinations, and focal or diffuse gliosis in old age. A special focus will be on the sub-types of microvascular lesions not detected by currently available neuroimaging studies in routine clinical settings. After providing a critical overview of in vivo data on white matter demyelinations and lacunes, we summarize the clinicopathological studies performed by our center in large cohorts of individuals with microvascular lesions and concomitant AD-related pathology across two age ranges (the younger old, 65-85 years old, versus the oldest old, nonagenarians and centenarians). In conjunction with other autopsy datasets, these observations fully support the idea that cortical microinfarcts are the only consistent determinant of cognitive decline across the entire spectrum from pure vascular cases to cases with combined vascular and AD lesion burden.

Audit report on the Cedar County Economic Development Commission for the years ended June 30, 2009, 2008 and 2007

Audit report on the Cedar County Economic Development Commission for the years ended June 30, 2009, 2008 and 2007

Report on the Iowa Department of Economic Development for the year ended June 30, 2009

Report on the Iowa Department of Economic Development for the year ended June 30, 2009

Special investigation of the Iowa Department of Economic Development Film Office and the Film, Television and Video Production Promotion Program for the period May 17, 2007 through September 21, 2009

Special investigation of the Iowa Department of Economic Development Film Office and the Film, Television and Video Production Promotion Program for the period May 17, 2007 through September 21, 2009

Summary of Real Estate Assessment, 2009

The most important aspect of property taxation is the concept that all property should be valued for tax purposes on a uniform basis so that the actual property tax burden can be distributed equitably among individual property owners. One of the most widely used and accepted methods of determining relative levels and uniformity of assessments is the assessment/sales ratio study. Such a study, in its most fundamental analysis, is the comparison of the assessed value of an individual property to its sale price. For example, a property assessed at $12,000 which sold for $26,000 would have an assessment/sales ratio of 46% ($12,000 ÷ $26,000). The purpose of this study is to provide assessment/sales ratio information that may be utilized by property tax administrators, local assessing officials, and interested taxpayers in examining the relative levels and uniformity of assessments throughout the State of Iowa. After further refinement, the study is one factor considered by the Director of Revenue in the biennial equalization of assessments.

State of Iowa Long-Term Economic Recovery Strategy

The "State of Iowa Long-Term Economic Recovery Strategy" was prepared for the Economic Development Administration, U.S. Department of Commerce. In July, 2008 Iowa received a $3 million grant from the Economic Development Administration to create an Economic Recovery Strategy for recovering from the devastating floods and tornadoes that impacted the state earlier that summer. This report outlines the final version of that strategy. It includes the methods, goals, objectives, measures and key projects that the state has undertaken and will continue into the future to ensure the state‘s complete recovery.

Evaluating Direct and Indirect Economic Outcomes of the 2008 Iowa Weather‐Related Disasters

This research seeks to fill some of the gaps in understanding the local, regional, and statewide economic consequences of the disasters of 2008. This report evaluates sets of population, unemployment, employment, business firms, and trade patterns over time in an attempt to discern the household consumption and business productivity disruptions caused by the weather disasters of 2008.

Comparative socio-economic evaluation of IBD patients with and without infliximab maintenance therapy

Background: The anti-TNFα agent Infliximab (IFX) is used for the treatment of moderate to severe inflammatory bowel disease (IBD) with insufficient response to conventional immunomodulator therapy. IFX maintenance therapy is expensive and it is unknown if indirect costs (eg. by loss of work productivity) can be reduced by this therapy. Goal: to evaluate the direct and indirect costs of an IBD patient cohort under maintenance IFX compared to a cohort under "conventional" immunomodulator therapy. Methods: Direct and indirect costs of an IBD cohort under IFX and a reference cohort (similar disease activity and location) under conventional immunomodulator therapy (Azathioprine, or 6-MP, or MTX) were retrospectively evaluated over 12 months (January to December 2008). Results: 54 IFX-patients (24f/30m, 37 CD, 10 UC, 7 IC) and 71 non-IFX-patients (38f/33m, 56 CD, 12 UC, 3 IC) were included. IFX patients were younger than non-IFX patients (36 vs. 47 years, P = 0.0003). The mean duration of inpatient stay in hospital (23 in IFX vs. 21 days for non-IFX, P = 0.909) and the hospitalization costs (7,692 in IFX vs. 4,179 SFr for non-IFX, P = 0.4540) did not differ. IFX-patients had significantly more frequently specialist outpatient consultations (8 vs. 4, P < 0.001) and outpatient-related costs (3,633 vs. 2,186 SFr, P <0.001). Total costs for all diagnostic procedures (blood work, endoscopies, radiology) were higher in the IFXcohort (2,265 vs. 1,164 SFr, P < 0.001). Sixty-five percent of IFX-patients had a 100% job employment compared to 80% in the non-IFX cohort (P = 0.001). Conclusions: The direct and indirect costs of maintenance IFX-treated IBD patients are higher compared to IBD patients under conventional immunomodulators. Care should be taken not only to judge the costs as the IFX treated population may represent a cohort with more aggressive disease phenotype, furthermore, quality of life aspects were not assessed.

Summary of Real Estate Assessment, 2008

The most important aspect of property taxation is the concept that all property should be valued for tax purposes on a uniform basis so that the actual property tax burden can be distributed equitably among individual property owners. One of the most widely used and accepted methods of determining relative levels and uniformity of assessments is the assessment/sales ratio study. Such a study, in its most fundamental analysis, is the comparison of the assessed value of an individual property to its sale price. For example, a property assessed at $12,000 which sold for $26,000 would have an assessment/sales ratio of 46% ($12,000 ÷ $26,000). The purpose of this study is to provide assessment/sales ratio information that may be utilized by property tax administrators, local assessing officials, and interested taxpayers in examining the relative levels and uniformity of assessments throughout the State of Iowa. After further refinement, the study is one factor considered by the Director of Revenue in the biennial equalization of assessments.

Supplement Information to the August 2008 Economic and Workforce Development Task Force Report, August 2008

The 2008 disasters devastated businesses, farms, homes, schools, non-profit institutions, entire communities, and people’s lives across the state of Iowa. The Rebuild Iowa Advisory Commission (RIAC) is charged by the Governor to guide the state’s recovery and reconstruction process. The Economic and Workforce Development Task Force is respectfully submitting this report to be included and considered in the deliberations of the RIAC. While economic and workforce development are two issues that are inextricably linked and critical to Iowa’s rebuilding strategies, each also requires extraordinary attention in determining what needs to be considered in the very immediate and longer-term recovery. Supplement Information to the August 2008 Economic and Workforce Development Task Force Report