How Many Regional Medical Centers Can Maine Sustain? How Patient Hospital Utilization Can Help Define Structure

Making thoughtful decisions about where various levels of hospital care are to be provided is an important part of controlling overall healthcare costs. Efficient utilization of healthcare resources requires that high-cost and less frequently used high-tech equipment and specialized personnel should be limited to a few tertiary regional medical centers. Lars Rydell uses patient discharge data from the Maine Health Data Organization to suggest that Maine currently has only two hospitals that function as tertiary regional medical centers—Maine Medical Center in Portland and Eastern Maine Medical Center in Bangor. Policymakers need to think about whether Maine’s population base warrants more than two such centers

Overview of Accomplishments and Strategic Direction in Information and Telecommunications Policy, 2001

https://digitalmaine.com/oit_docs/1019/thumbnail.jp

Overview of Accomplishments and Strategic Direction in Information and Telecommunications Policy, 2001

https://digitalmaine.com/oit_docs/1019/thumbnail.jp

Outline of geotechnical research in the fourth framework programme of the European Community. Information technologies. Industrial and materials technologies. Standards, measurement and testing. Environment and climate. Marine science and technology. Non-nuclear energy. Transport

(1) The fourth framework programme; (2) Industrial technologies; (3) Environment; (4) Energy; (5) Transport; Appendix: (1) Geotechnical European Network for Information transfer – GENI; (2) Call for proposals lis

Ensamheten i Sverige 1985-2008

Ensamheten inte mer utbredd 2008 jämför med 1985 År 2008 upprepades vid sociologiska institutionen, Uppsala universitet en ensamhetsstudie som tidigare gjorts år 1985. År 1985 var det 49 procent av den vuxna befolkningen i åldrarna 25-79 år som ofta eller ibland kände ensamhet. År 2008 hade den siffran sjunkit till 42 procent. Oftast och star­kast ensamhet känner man då som nu bland de unga, inte bland de äldre som vi ofta är be­nägna att tro. Kvinnor kände 1985 också aningen  mer ensamhet jämfört med männen, vilket också gäller den nya undersökningen 2008, som innefattar 1 742 svenskar i åldrarna 20-90 år. Ensamhet är en mix av olika känslor I studien skiljs mellan olika sorters ensamhet, varav också en är självvald och positiv. Den negativa känslan av ensamheten är egentligen mix av delkänslor där bl.a. sådant som nedvärdering, alie­nation, självömkan och desperation utgör ingredienser. Känslomixen ser olika ut för olika kategorier människor, där kvinnor under 50 avviker genom att i sin ensamhetskänsla ha hög inblandning av just de nämnda känsloingredienserna. Män 50+ har å andra sidan en låg in­blandning av dessa känsloingredienser, men istället mer av det som kallas ”skamset undfly­ende”. Många olika orsaker till ensamhet Åtta distinkt åtskilda grupper av självupplevda orsaker till ensamhet kan särskiljas: man är utan närrelation, är alienerad, är avvikande, har otillräckliga vänskapsband, befinner sig där man inte vill vara, inte är intresserad av andra, saknar transportmedel, har påtvingat umgänge. De yngre re­spondenterna tenderar att framhäva orsaker som att vara alienerad, avvikande och ha otill­räckliga vänskapsband, medan de äldre respondenterna istället framhåller att vara utan närre­lation, att inte vara intresserad av andra, samt att sakna transportmedel. Otrygg barndom sammanhänger med ensamhet i vuxen ålder – hela livet De respondenter som beskriver att barndomen var mindre trygg, eller att man hade svårt att få vänner som barn, eller att man hade svårt etablera kontakt med det motsatta könet, rapporterar också mer och intensivare ensamhetskänslor i vuxen ålder. Åtgärderna mot ensamhet ofta mindre funktionella Det allra vanligaste är att man tittar på TV – som inte hjälper. Det finns dock en hel repertoar av åtgärder som klassificerats i sju olika kategorier. Hit hör fokuserad aktivitet, som bl.a. in­nebär att man ringer eller besöker någon; tröstkonsumtion, inåtvändhet, förströelse, bedöv­ning, eskapism och arbete.  Den fokuserade aktiviteten, som också är mest effektiv mot en­samhetskänslorna, används i högre grad av kvinnor, som dock samtidigt mer än männen ägnar sig åt tröstkonsumtion och inåtvändhet. Män, å andra sidan, ägnar sig i högre grad åt eskapism (musicerande, drickande), som inte hjälper, samt och åt arbete

Swedish-Lithuanian telemedicine Litmed project in otolaryngology

Telemedicine is becoming a reality as a result of improvements in technology and telecommunications. The task of the otolaryngological part of the pilot international telemedicine Litmed project was devoted to the establishment of telemedicine training and demonstration facilities in cooperation between the Departments of Otolaryngology of the Kaunas University of Medicine (Lithuania) and the Lund University (Sweden). The main areas of action of the Litmed project in otolaryngology were: (1) remote rehabilitation of cochlear implant (CI) patients, and (2) phonosurgery and phoniatrics. The main results of the project were as follows: (a) establishment of telemedicine environment for remote on-line collaboration and planned off-line collaboration by use of recorded video laryngostroboscopic images, voice samples, and graphical and computed tomography (CT) data; (b) possibility to carry through telemedicine sessions for pedagogical and speech training support and for cooperative work of speech therapists from Lund and Kaunas with CI patients; (c) remote consultations and discussion of challenging laryngeal cases; and (d) establishment of a technical environment and practical routines for on-line consultations during laryngeal surgery at the Departments of Otolaryngology of Kaunas and Lund. The Litmed project served to assist medical education and research. Tele-otolaryngology helps to keep constant professional contacts with the specialists from abroad and supports an establishment of a center of reference in tele-otolaryngology in Lithuania

Plasma proteomics and lung function in four community-based cohorts

BACKGROUND: Underlying mechanism leading to impaired lung function are incompletely understood. OBJECTIVES: To investigate whether protein profiling can provide novel insights into mechanisms leading to impaired lung function. METHODS: We used four community-based studies (n = 2552) to investigate associations between 79 cardiovascular/inflammatory proteins and forced expiratory volume in 1 s percent predicted (FEV1%) assessed by spirometry. We divided the cohorts into discovery and replication samples and used risk factor-adjusted linear regression corrected for multiple comparison (false discovery rate of 5%). We performed Mendelian randomization analyses using genetic and spirometry data from the UK Biobank (n = 421,986) to assess causality. MEASUREMENTS AND MAIN RESULTS: In cross-sectional analysis, 22 proteins were associated with lower FEV1% in both the discovery and replication sample, regardless of stratification by smoking status. The combined proteomic data cumulatively explained 5% of the variation in FEV1%. In longitudinal analyses (n = 681), higher plasma levels of growth differentiation factor 15 (GDF-15) and interleukin 6 (IL-6) predicted a more rapid 5-year decline in lung function (change in FEV1% per standard deviation of protein level -1.4, (95% CI, -2.5 to -0.3) for GDF-15, and -0.8, (95% CI, -1.5 to -0.2) for IL-6. Mendelian randomization analysis in UK-biobank provided support for a causal effect of increased GDF-15 levels and reduced FEV1%. CONCLUSIONS: Our combined approach identified GDF-15 as a potential causal factor in the development of impaired lung function in the general population. These findings encourage additional studies evaluating the role of GDF-15 as a causal factor for impaired lung function

Cardiovascular disease-linked plasma proteins are mainly associated with lung volume

Background Epidemiological studies have shown that impaired lung function is common and associated with increased risk of cardiovascular disease. Increased levels of several inflammatory and cardiovascular disease-related plasma proteins have been associated with impaired lung function. The aim was to study the association between plasma proteomics and forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio. Methods We used a discovery and replication approach in two community-based cohorts, EpiHealth and the Malmö Offspring Study (total n=2874), to cross-sectionally study 242 cardiovascular disease- and metabolism-linked proteins in relation to FEV1, FVC (both % predicted) and FEV1/FVC ratio. A false discovery rate of 5% was used as the significance threshold in the discovery cohort. Results Plasma fatty acid-binding protein 4, interleukin-1 receptor antagonist, interleukin-6 and leptin were negatively associated with FEV1 and paraoxonase 3 was positively associated therewith. Fatty acid-binding protein 4, fibroblast growth factor 21, interleukin-1 receptor antagonist, interleukin-6 and leptin were negatively associated with FVC and agouti-related protein, insulin-like growth factor-binding protein 2, paraoxonase 3 and receptor for advanced glycation end products were positively associated therewith. No proteins were associated with FEV1/FVC ratio. A sensitivity analysis in EpiHealth revealed only minor changes after excluding individuals with known cardiovascular disease, diabetes or obesity. Conclusions Five proteins were associated with both FEV1 and FVC. Four proteins associated with only FVC and none with FEV1/FVC ratio, suggesting associations mainly through lung volume, not airway obstruction. However, additional studies are needed to investigate underlying mechanisms for these findings