Delivery of health care at the end of life in cancer patients of four swiss cantons a retrospective database study (SAKK 89/09)

Background The use of cancer related therapy in cancer patients at the end-of-life has increased over time in many countries. Given a lack of published Swiss data, the objective of this study was to describe delivery of health care during the last month before death of cancer patients. Methods Claims data were used to assess health care utilization of cancer patients (identified by cancer registry data of four participating cantons), deceased between 2006-2008. Primary endpoints were hospitalization rate and delivery of cancer related therapies during the last 30 days before death. Multivariate logistic regression assessed the explanatory value of patient and geographic characteristics. Results 3809 identified cancer patients were included. Hospitalization rate (mean 68.5%, 95%CI 67.0-69.9) and percentage of patients receiving anti-cancer drug therapies (ACDT, mean 14.5%, 95%CI 13.4-15.6) and radiotherapy (mean 7.7%, 95%CI 6.7-8.4) decreased with age. Canton of residence and insurance type status most significantly influenced the odds for hospitalization or receiving ACDT. Conclusions The intensity of cancer specific care showed substantial variation by age, cancer type, place of residence and insurance type status. This may be partially driven by cultural differences within Switzerland and the cantonal organization of the Swiss health care system.

The impact of Medicare, Medicaid and Schip Extension Act of 2007 (MMSEA) on the long term acute care hospitals

The Long Term Acute Care Hospitals (LTACH), which serve medically complex patients, have grown tremendously in recent years, by expanding the number of Medicare patient admissions and thus increasing Medicare expenditures (Stark 2004). In an attempt to mitigate the rapid growth of the LTACHs and reduce related Medicare expenditures, Congress enacted Section 114 of P.L. 110-173 (§114) of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) in December 29, 2007 to regulate the LTCAHs industry. MMSEA increased the medical necessity reviews for Medicare admissions, imposed a moratorium on new LTCAHs, and allowed the Centers for Medicare and Medicaid Services (CMS) to recoup Medicare overpayments for unnecessary admissions. ^ This study examines whether MMSEA impacted LTACH admissions, operating margins and efficiency. These objectives were analyzed by comparing LTACH data for 2008 (post MMSEA) and data for 2006-2007 (pre-MMSEA). Secondary data were utilized from the American Hospital Association (AHA) database and the American Hospital Directory (AHD).^ This is a longitudinal retrospective study with a total sample of 55 LTACHs, selected from 396 LTACHs facilities that were fully operational during the study period of 2006-2008. The results of the research found no statistically significant change in total Medicare admissions; instead there was a small but not statistically significant reduction of 5% in Medicare admissions for 2008 in comparison to those for 2006. A statistically significant decrease in mean operating margins was confirmed between the years 2006 and 2008. The LTACHs' Technical Efficiency (TE), as computed by Data Envelopment Analysis (DEA), showed significant decrease in efficiency over the same period. Thirteen of the 55 LTACHs in the sample (24%) in 2006 were calculated as “efficient” utilizing the DEA analysis. This dropped to 13% (7/55) in 2008. Longitudinally, the decrease in efficiency using the DEA extension technique (Malmquist Index or MI) indicated a deterioration of 10% in efficiency over the same period. Interestingly, however, when the sample was stratified into high efficient versus low efficient subgroups (approximately 25% in each group), a comparison of the MIs suggested a significant improvement in Efficiency Change (EC) for the least efficient (MI 0.92022) and reduction in efficiency for the most efficient LTACHs (MI = 1.38761) over same period. While a reduction in efficiency for the most efficient is unexpected, it is not particularly surprising, since efficiency measure can vary over time. An improvement in efficiency, however, for the least efficient should be expected as those LTACHs begin to manage expenses (and controllable resources) more carefully to offset the payment/reimbursement pressures on their margins from MMSEA.^

Effect of parental weight status on the food packed in preschool children's lunches

Problem. Recent statistics show that over a fifth of children aged 2-5 years in 2006-2008 were overweight, with 7% above the 97 th percentile of the BMI-for-age growth charts (extreme obesity). Because poor diet is an important environmental determinant of obesity and the preschool years are crucial developmentally, examination of factors related to diet in the pre-school years is important for obesity prevention efforts. ^ Objective. The goals of this study were to determine the association between BMI of the parents and the number of servings of fruits, vegetables, and whole grains (FVWG) packed; the nutrient content of preschool children’s lunches; and norms and expectations about FVWG intake.^ Methods. This study was a cross sectional analysis of parents enrolled in the Lunch is in the Bag program at baseline. The independent measure was weight status of the parents/caregivers, which was determined using body mass index (BMI) calculated from self-reported height and weight. BMI was classified as healthy weight (BMI <25) or overweight/obese (BMI ≥25). Outcomes for the study included the number of servings of fruits, vegetables and whole grains (FVWG) in sack lunches, as well as the nutrient content of the lunches, and psychosocial constructs related to FVWG consumption. Linear regression analysis was conducted and adjusted for confounders to examine the associations of these outcomes with parental weight status, the main predictor. ^ Results. A total of 132 parent/child dyads were enrolled in the study; 59.09% (n=78) of the parents/caregivers were healthy weight and 39.01% (n=54) of the parents/caregivers were overweight/obese. Parents/caregivers in the study were predominantly white (68%, n=87) and had at least some college education (98%, n=128). No significant associations were found between the weight status of the parents and the servings of fruits, vegetables and whole grain packed in preschool children’s lunchboxes. The results were similar for the association of parental weight status and the nutrient contents of the packed lunches. Both healthy weight and overweight/obese parents packed less than the recommended amounts of vegetables (mean servings = 0.49 and 0.534, respectively) and whole grains (mean servings = 0.58 and 0.511, respectively). However, the intentions of the obese/overweight parents were higher compare to the healthy for vegetables and whole grains.^ Conclusion. Results from this study indicate that there are few differences in the servings of fruits, vegetables and whole grains packed by healthy weight parents/caregivers compared to overweight/obese parents/caregivers in a high income, well-educated population, although neither group met the recommended number of servings of vegetables or whole grains. Thus, results indicate the need for behaviorally-based health promotion programs for parents, regardless of their weight status; however, this study should be replicated with larger and more diverse populations to determine if these results are similar with less homogenous populations.^

Gender disparities in utilization, unmet need and expenditure for mental health care

Objectives: To compare mental health care utilization regarding the source, types, and intensity of mental health services received, unmet need for services, and out of pocket cost among non-institutionalized psychologically distressed women and men. ^ Method: Cross-sectional data for 19,325 non-institutionalized mentally distressed adult respondents to the “The National Survey on Drug Use and Health” (NSDUH), for the years 2006 -2008, representing over twenty-nine millions U.S. adults was analyzed. To assess the relative odds for women compared to men, logistic regression analysis was used for source of service, for types of barriers, for unmet need and cost; zero inflated negative binomial regression for intensity of utilization; and ordinal logistic regression analysis for quantifying out-of-pocket expenditure. ^ Results: Overall, 43% of mentally distressed adults utilized a form of mental health treatment; representing 12.6 million U.S psychologically distressed adults. Females utilized more mental health care compared to males in the previous 12 months (OR: 1. 70; 95% CI: 1.54, 1.83). Similarly, females were 54% more likely to get help for psychological distress in an outpatient setting and females were associated with an increased probability of using medication for mental distress (OR: 1.72; 95% CI: 1.63, 1.98). Women were 1.25 times likelier to visit a mental health center (specialty care) than men. ^ Females were positively associated with unmet needs (OR: 1.50; 95% CI: 1.29, 1.75) after taking into account predisposing, enabling, and need (PEN) characteristics. Women with perceived unmet needs were 23% (OR: 0.77; 95% CI: 0.59, 0.99) less likely than men to report societal accommodation (stigma) as a barrier to mental health care. At any given cutoff point, women were 1.74 times likelier to be in the higher payment categories for inpatient out of pocket cost when other variables in the model are held constant. Conclusions: Women utilize more specialty mental healthcare, report more unmet need, and pay more inpatient out of pocket costs than men. These gender disparities exist even after controlling for predisposing, enabling, and need variables. Creating policies that not only provide mental health care access but also de-stigmatize mental illness will bring us one step closer to eliminating gender disparities in mental health care.^

A mulher na política do Brasil

O artigo discute a desigualdade de gênero entre homens e mulheres no Brasil na ocupaçao de cargos políticos eletivos. Trata-se de uma pesquisa bibliográfica e documental que utiliza os dados estatísticos do Tribunal Superior Eleitoral (TSE) das eleiçoes de 2006, 2008, 2010 e 2012 para avaliar se houve um aumento real de mulheres ocupando cargos políticos eletivos com a criaçao da lei No 12.034/2009 que obrigou partidos/coligaçoes a reservar, no mínimo, 30 das vagas para candidatura femininas. Os resultados mostram apesar do Brasil em 2010 ter eleito a primeira mulher Presidenta do país, das mulheres serem a maioria da populaçao segundo o IBGE (2010) e representarem 52 do eleitorado do país conforme o TSE (2010), elas ainda sao "subrepresentadas" nos cargos políticos eletivos, ocupados por maioria masculina. Visto que a média de mulheres eleitas no Brasil é, em torno, de 10 do total, mesmo com o maior número de candidaturas femininas em decorrência da exigência Legal

Políticas de sentimiento y políticas de muerte en un corpus latinoamericano : Estéticas de la violencia y del guerrero

Textos como Angosta (2004) de Héctor Abad Faciolince, La escuela del dolor humano de Sechuán (2005) de Mario Bellatin, o la narrativa cucurtiana (2003, 2005, 2006, 2008) gesticulan experiencias estéticas atravesadas por formas de la violencia que se constituyen en un entre-lugar habitado por la ruina, pero también por la posibilidad de futuro. Por un lado las políticas de muerte que han llevado al cuerpo migrante al riesgo de vida, y por otro el rescate de esas formas de vida (trans, migrantes) como políticas del sentimiento que, al profanar dispositivos clasificatorios, producen nuevas lógicas estéticas/estésicas que nos permiten leer el presente: tecnologías narrativas y tecnologías del "yo" condensadas en determinadas figuras/políticas. Por ende, propongo recorrer estos tópicos en relación con la temática del goce/estetización de la violencia en torno a la figura del guerrero y la agencia de la muerte. Sostengo la hipótesis de una politización en un sentido benjaminiano donde lo artístico es atravesado por lo tecnológico. No obstante, en los casos que aquí se trabajan las técnicas que se ponen a funcionar son las del "yo"

Inclusión escolar : Reflexiones desde las concepciones y opiniones de los docentes

En este trabajo presentamos los resultados de una investigación (período 2006-2008) destinada a indagar las concepciones y opiniones sobre la inclusión de niños con discapacidades, proporcionadas por dos tipos de actores técnico-docentes. Se trata, en el primer caso, de directivos y docentes procedentes de Institutos Superiores de Formación Docente. En el segundo, de directivos, docentes y personal de los Equipos de Orientación Escolar de escuelas destinadas a niños con necesidades educativas derivadas de las discapacidades (NEDD) y de escuelas de Educación Primaria Básica (EPB). La información fue recabada a través de la realización de entrevistas en profundidad con los participantes seleccionados. Las dimensiones incluidas contemplaron: tipo y calidad de la formación recibida en distintas instancias (grado, en ejercicio, posgrado); conocimientos de los problemas de las personas con discapacidades (tipos y determinantes causales); actitudes frente a la integración e inclusión escolar y sus condiciones de posibilidad; valoraciones sobre los derechos de los niños con discapacidad a ser incluidos en la EPB; y posibilidades de reflexionar sobre la problemática. El objetivo final se orientó a obtener información relevante que colabore en el diseño de estrategias destinadas a propiciar las condiciones para un aprendizaje escolar cooperativo y colaborativo, que contemple la problemática de la diversidad y de las diferencias individuales

Inclusión escolar : Reflexiones desde las concepciones y opiniones de los docentes

En este trabajo presentamos los resultados de una investigación (período 2006-2008) destinada a indagar las concepciones y opiniones sobre la inclusión de niños con discapacidades, proporcionadas por dos tipos de actores técnico-docentes. Se trata, en el primer caso, de directivos y docentes procedentes de Institutos Superiores de Formación Docente. En el segundo, de directivos, docentes y personal de los Equipos de Orientación Escolar de escuelas destinadas a niños con necesidades educativas derivadas de las discapacidades (NEDD) y de escuelas de Educación Primaria Básica (EPB). La información fue recabada a través de la realización de entrevistas en profundidad con los participantes seleccionados. Las dimensiones incluidas contemplaron: tipo y calidad de la formación recibida en distintas instancias (grado, en ejercicio, posgrado); conocimientos de los problemas de las personas con discapacidades (tipos y determinantes causales); actitudes frente a la integración e inclusión escolar y sus condiciones de posibilidad; valoraciones sobre los derechos de los niños con discapacidad a ser incluidos en la EPB; y posibilidades de reflexionar sobre la problemática. El objetivo final se orientó a obtener información relevante que colabore en el diseño de estrategias destinadas a propiciar las condiciones para un aprendizaje escolar cooperativo y colaborativo, que contemple la problemática de la diversidad y de las diferencias individuales

A mulher na política do Brasil

O artigo discute a desigualdade de gênero entre homens e mulheres no Brasil na ocupaçao de cargos políticos eletivos. Trata-se de uma pesquisa bibliográfica e documental que utiliza os dados estatísticos do Tribunal Superior Eleitoral (TSE) das eleiçoes de 2006, 2008, 2010 e 2012 para avaliar se houve um aumento real de mulheres ocupando cargos políticos eletivos com a criaçao da lei No 12.034/2009 que obrigou partidos/coligaçoes a reservar, no mínimo, 30 das vagas para candidatura femininas. Os resultados mostram apesar do Brasil em 2010 ter eleito a primeira mulher Presidenta do país, das mulheres serem a maioria da populaçao segundo o IBGE (2010) e representarem 52 do eleitorado do país conforme o TSE (2010), elas ainda sao "subrepresentadas" nos cargos políticos eletivos, ocupados por maioria masculina. Visto que a média de mulheres eleitas no Brasil é, em torno, de 10 do total, mesmo com o maior número de candidaturas femininas em decorrência da exigência Legal

Políticas de sentimiento y políticas de muerte en un corpus latinoamericano : Estéticas de la violencia y del guerrero

Textos como Angosta (2004) de Héctor Abad Faciolince, La escuela del dolor humano de Sechuán (2005) de Mario Bellatin, o la narrativa cucurtiana (2003, 2005, 2006, 2008) gesticulan experiencias estéticas atravesadas por formas de la violencia que se constituyen en un entre-lugar habitado por la ruina, pero también por la posibilidad de futuro. Por un lado las políticas de muerte que han llevado al cuerpo migrante al riesgo de vida, y por otro el rescate de esas formas de vida (trans, migrantes) como políticas del sentimiento que, al profanar dispositivos clasificatorios, producen nuevas lógicas estéticas/estésicas que nos permiten leer el presente: tecnologías narrativas y tecnologías del "yo" condensadas en determinadas figuras/políticas. Por ende, propongo recorrer estos tópicos en relación con la temática del goce/estetización de la violencia en torno a la figura del guerrero y la agencia de la muerte. Sostengo la hipótesis de una politización en un sentido benjaminiano donde lo artístico es atravesado por lo tecnológico. No obstante, en los casos que aquí se trabajan las técnicas que se ponen a funcionar son las del "yo"

A mulher na política do Brasil

O artigo discute a desigualdade de gênero entre homens e mulheres no Brasil na ocupaçao de cargos políticos eletivos. Trata-se de uma pesquisa bibliográfica e documental que utiliza os dados estatísticos do Tribunal Superior Eleitoral (TSE) das eleiçoes de 2006, 2008, 2010 e 2012 para avaliar se houve um aumento real de mulheres ocupando cargos políticos eletivos com a criaçao da lei No 12.034/2009 que obrigou partidos/coligaçoes a reservar, no mínimo, 30 das vagas para candidatura femininas. Os resultados mostram apesar do Brasil em 2010 ter eleito a primeira mulher Presidenta do país, das mulheres serem a maioria da populaçao segundo o IBGE (2010) e representarem 52 do eleitorado do país conforme o TSE (2010), elas ainda sao "subrepresentadas" nos cargos políticos eletivos, ocupados por maioria masculina. Visto que a média de mulheres eleitas no Brasil é, em torno, de 10 do total, mesmo com o maior número de candidaturas femininas em decorrência da exigência Legal

Políticas de sentimiento y políticas de muerte en un corpus latinoamericano : Estéticas de la violencia y del guerrero

Textos como Angosta (2004) de Héctor Abad Faciolince, La escuela del dolor humano de Sechuán (2005) de Mario Bellatin, o la narrativa cucurtiana (2003, 2005, 2006, 2008) gesticulan experiencias estéticas atravesadas por formas de la violencia que se constituyen en un entre-lugar habitado por la ruina, pero también por la posibilidad de futuro. Por un lado las políticas de muerte que han llevado al cuerpo migrante al riesgo de vida, y por otro el rescate de esas formas de vida (trans, migrantes) como políticas del sentimiento que, al profanar dispositivos clasificatorios, producen nuevas lógicas estéticas/estésicas que nos permiten leer el presente: tecnologías narrativas y tecnologías del "yo" condensadas en determinadas figuras/políticas. Por ende, propongo recorrer estos tópicos en relación con la temática del goce/estetización de la violencia en torno a la figura del guerrero y la agencia de la muerte. Sostengo la hipótesis de una politización en un sentido benjaminiano donde lo artístico es atravesado por lo tecnológico. No obstante, en los casos que aquí se trabajan las técnicas que se ponen a funcionar son las del "yo"

Inclusión escolar : Reflexiones desde las concepciones y opiniones de los docentes

En este trabajo presentamos los resultados de una investigación (período 2006-2008) destinada a indagar las concepciones y opiniones sobre la inclusión de niños con discapacidades, proporcionadas por dos tipos de actores técnico-docentes. Se trata, en el primer caso, de directivos y docentes procedentes de Institutos Superiores de Formación Docente. En el segundo, de directivos, docentes y personal de los Equipos de Orientación Escolar de escuelas destinadas a niños con necesidades educativas derivadas de las discapacidades (NEDD) y de escuelas de Educación Primaria Básica (EPB). La información fue recabada a través de la realización de entrevistas en profundidad con los participantes seleccionados. Las dimensiones incluidas contemplaron: tipo y calidad de la formación recibida en distintas instancias (grado, en ejercicio, posgrado); conocimientos de los problemas de las personas con discapacidades (tipos y determinantes causales); actitudes frente a la integración e inclusión escolar y sus condiciones de posibilidad; valoraciones sobre los derechos de los niños con discapacidad a ser incluidos en la EPB; y posibilidades de reflexionar sobre la problemática. El objetivo final se orientó a obtener información relevante que colabore en el diseño de estrategias destinadas a propiciar las condiciones para un aprendizaje escolar cooperativo y colaborativo, que contemple la problemática de la diversidad y de las diferencias individuales

Acoustic multi-frequency indicator of four major groups on a spatial grid in the Bay of Biscay

The first data set contains the mean and cofficient of variation (standard deviation divided by mean) of a multi-frequency indicator I derived from ER60 acoustic information collected at five frequencies (18, 38, 70, 120, and 200 kHz) in the Bay of Biscay in May of the years 2006, 2008, 2009 and 2010 (Pelgas surveys). The multi-frequency indicator was first calculated per voxel (20 m long × 5 m deep sampling unit) and then averaged on a spatial grid (approx. 20 nm × 20 nm) for five 5-m depth layers in the surface waters (10-15m, 15-20m, 20-25m, 25-30m below sea surface); there are missing values in particular in the shallowest layer. The second data set provides for each grid cell and depth layer the proportion of voxels for which the multi-frequency indicator I was indicative of a certain group of organisms. For this the following interpretation was used: I < 0.39 swim bladder fish or large gas bubbles, I = 0.39-0.58 small resonant bubbles present in gas bearing organisms such as larval fish and phytoplankton, I = 0.7-0.8 fluidlike zooplankton such as copepods and euphausiids, and I > 0.8 mackerel. These proportions can be interpreted as a relative abundance index for each of the four organism groups.

(Table 2) Seroprevalence against Trichinella spp. in Ursus maritimus from Svalbard and Barents Sea pack ice

Blood samples of live-caught polar bears (Ursus maritimus) from Svalbard collected 1991-2000 (Period 1) and 2006-2008 (Period 2) and from the pack ice of the Barents Sea collected in Period 1, were assayed for antibodies against Trichinella spp. by ELISA. Of 54 cubs-of-the-year included in the Period 1 sample, 53 were seronegative, indicating that exposure to Trichinella infected meat is uncommon during the first months of life for polar bears in the Svalbard region. Of 30 mother-offspring pairs, 18 mothers were seropositive with seronegative offspring (n = 27), suggesting (1) that maternal antibodies had dropped to levels below detection limit by the time of capture in April (offspring approximately 4 months old), and (2) supporting experimental studies in other animal models showing that vertical transmission of Trichinella spp. is uncommon. Bear 1 year and older had higher prevalence in Svalbard (78%) than in the Barents Sea (51%). There was no temporal change in prevalence for bears from Svalbard during the time between the two periods. The prevalence increased with age in both sexes. A positive correlation was found between anti-Toxoplasma gondii and anti-Trichinella spp. antibodies.