Ravishankar Jayadevappa

International trade and environmental quality: a survey

Abstract International trade has been incorporating various aspects of environmental issues since 1970. The extent to which environmental problems might affect many facets of trade, or vice versa, has been the subject of considerable debate over these years. In this article we have attempted to establish some of the links between international trade and environmental quality by performing a comprehensive literature review. We discuss issues such as establishing direct and indirect effects of international trade on environmental quality, effects of trade on economic development, environmental quality, and energy and their relation with each other, and, finally, the role of governments and international organizations in this context. Studies have so far revealed some linkages between trade and environment through conventional trade theory. However, interactions between international trade and types of pollution, their sink and assimilative capacity need to be analyzed using a general equilibrium approach. Currently, very little knowledge and agreement on the nature of interactions between trade theories, development process and environmental quality exist. Existing studies have shown that the structure of environmental regulations should be modified to reflect the existence of trade under imperfect competition. Therefore, further research on the interaction between new trade theory and environmental regulation is needed. Also, theoretical and quantitative analysis regarding the effects of environmental regulations on competitiveness and location decision is needed. The intensity and type of environmental measures vary across issues and countries. Therefore, harmonizing environmental measures creates an inefficient atmosphere, and to assume that trade restrictions will either improve or reverse the environmental damages is a serious mistake. Given the dynamic and intricate nature of the problem, trade and environment debate continues despite vast research and poses a challenge for researchers and policy makers in the foreseeable future.

The burden of depression in prostate cancer

We sought to analyze the prevalence and incremental burden of depression among elderly with prostate cancer.

Patient Centered Care - A Conceptual Model and Review of the State of the Art

Background: Patient-centered care that encompasses informed decision making can improve treatment choice, quality of care and outcomes. Patient-centered care recognizes the need for major changes in the process of care that arranges health care system around the patient. Objective: Study objective was to evaluate and discuss the interplay of components of patient- centered care by developing a conceptual model of patient-centered care. Methods: Comprehensive literature review was conducted using Medline, CINAHL, and Cochrane databases. Included were English language studies addressing issues related to patient-centered-care and patient reported outcomes. Results: Though the concept of patient-centered care emerged in the early 50s, it exploded in the health care research policy arena exponentially in the late nineties. The conceptual model described here can aid objective and subjective evaluation of patient-centered care. As we strive to improve the quality of care, patient-centered care can play a pivotal role in this process. This however requires changes in our healthcare system so as to improve overall quality of care by minimizing wasteful health resource consumption. Conclusions: With healthcare costs projected to continue their rapid increase, the current paradigm of healthcare is unsustainable. More research is needed to explore the various attributes of patient-centered care, its acceptability, and comparative effectiveness in the healthcare arena.

Nonspecific Presentation of Pneumonia in Hospitalized Older People: Age Effect or Dementia?

OBJECTIVES: Older adults, when presenting with pneumonia, are often thought to present with nonspecific symptoms instead of more suggestive symptom(s). However, studies designed to determine whether age is associated with nonspecific presentations have yielded contradictory results. Many studies have not distinguished between the effects of preexisting cognitive impairment that results from dementia and the effects of age. The aim of this study is to determine whether there are significant differences in the presentation of pneumonia in demented versus nondemented patients across two age groups. We hypothesized that the nonspecific presentation of pneumonia in older people is due to dementia rather than to chronological age.

Ethnic variation in return to baseline values of patient-reported outcomes in older prostate cancer patients.

Ethnic variation in patient‐reported outcomes such as health‐related quality of life (HRQoL) and satisfaction with care are understudied areas in the management of elderly prostate cancer (PCa) patients.

Dissemination and characteristics of acute care for elders (ACE) units in the United States

OBJECTIVE The objective of this paper is to determine prevalence and characteristics of acute care for elders (ACE) units and hospital characteristics associated with the presence of an ACE unit. METHODS Data on characteristics and prevalence of ACE units were obtained by surveying all established geriatric medical divisions across U.S. medical schools. Data on hospital characteristics such as number of beds, revenue, number of Medicare inpatients, and average length of stay were obtained from the 1999 American Hospital Association Annual Survey Data. Descriptive statistics and t test were used to analyze the characteristics of ACE units. Stepwise logistic regression was used to analyze the hospital characteristics associated with the presence of an ACE unit. RESULTS The survey identified 16 geriatric divisions and programs with ACE units. Hospitals that have ACE units differ significantly with respect to number of beds and total revenue, compared with institutions that do not have an ACE unit. Stepwise logistic regression indicated total hospital revenue was the only factor significantly associated with the presence of an ACE unit. CONCLUSIONS ACE units are attractive interdisciplinary models to address the particular needs of the elderly during their hospital stay. Low presence of ACE units warrants further research as to reasons more hospitals have not included them, given the available evidence for clinical, functional, and economic benefits.

Extending the Pipeline for Minority Physicians: A Comprehensive Program for Minority Faculty Development.

Medical schools must become more successful in training minority faculty. Minority faculty development programs at schools of medicine must involve trainees from the undergraduate years (if not before) through junior faculty and must involve MD and combine-degree (MD-PhD) students. The authors describe the comprehensive minority faculty development program at the University of Pennsylvania School of Medicine, which involves minority undergraduates, medical students, residents, fellows, and faculty. This program provides the administrative staff and research methodologists to assist trainees at all levels across all departments in the school of medicine. The principal student recruitment program is the undergraduate premedicine enrichment program. The medical student component provides general counseling, research development, and activities to enhance performance in the clinical courses. The components for advanced trainees (residents, fellows, and postdoctoral trainees) and faculty consist of training in research methods, mentoring, teaching skills, and scientific writing skills. Through this program, the University of Pennsylvania School of Medicine has increased the number of under-represented minority faculty by 32% since 1993-94 and created an environment conducive to the professional growth and development of minority faculty.

Satisfaction with Care: A Measure of Quality of Care in Prostate Cancer Patients

Background. Patients’ assessment of satisfaction with care, quality of care, and outcomes has become a central issue in patient-centered prostate cancer (PCa) care. We sought to analyze the association between patient-reported satisfaction with care and health-related quality of life (HRQoL) in newly diagnosed PCa patients. Methods. Prospective cohort design was used to recruit 590 newly diagnosed PCa patients from an urban academic hospital and a VA hospital. Participants completed satisfaction with care (CSQ-8) and HRQoL (SF-36 and UCLA-PCI) surveys prior to treatment and at 3, 6, 12, and 24 months’ follow-up. Cross-lagged analysis was used to ascertain the causal direction between satisfaction with care and HRQoL. Propensity scores were used to adjust for potential selection bias between treatment groups. Linear mixed models were used to analyze the association between satisfaction with care, process of care (treatment), and outcomes (generic and prostate-specific HRQoL) after adjusting for covariates. Results. Cross-lagged correlation results are consistent with a cause-effect association between HRQoL and satisfaction with care. After controlling for clinical and demographic covariates, radical prostatectomy (RP) treatment was associated with higher satisfaction with care (odds ratio [OR], 7.9; P = 0.043). Improved generic and prostate-specific HRQoL were associated with higher satisfaction with care, after adjusting for demographic and clinical covariates. Conclusion. Satisfaction with care appears to be associated with process of care and outcomes of care. Assessment of satisfaction with care is useful for evaluating the quality of PCa care. Satisfaction with care is an important arena in cancer outcomes research, whose full potential remains unexploited.

Health-related quality of life and satisfaction with care among older men treated for prostate cancer with either radical prostatectomy or external beam radiation therapy

To analyse health‐related quality of life (HRQoL) and satisfaction with care across potential curative treatments for older patients newly diagnosed with prostate cancer.

Comparison of Distribution‐ and Anchor‐Based Approaches to Infer Changes in Health‐Related Quality of Life of Prostate Cancer Survivors

OBJECTIVE To determine the minimal important difference (MID) in generic and prostate-specific health-related quality of life (HRQoL) using distribution- and anchor-based methods. STUDY DESIGN AND SETTING Prospective cohort study of 602 newly diagnosed prostate cancer patients recruited from an urban academic hospital and a Veterans Administration hospital. Participants completed generic (SF-36) and prostate-specific HRQoL surveys at baseline and at 3, 6, 12, and 24 months posttreatment. Anchor-based and distribution-based methods were used to develop MID estimates. We compared the proportion of participants returning to baseline based on MID estimates from the two methods. RESULTS MID estimates derived from combining distribution- and anchor-based methods for the SF-36 subscales are physical function = 7, role physical = 14, role emotional = 12, vitality = 9, mental health = 6, social function = 9, bodily pain = 9, and general health = 8; and for the prostate-specific scales are urinary function = 8, bowel function = 7, sexual function = 8, urinary bother = 9, bowel bother = 8, and sexual bother = 11. Proportions of participants returning to baseline values corresponding to MID estimates from the two methods were comparable. CONCLUSIONS This is the first study to assess the MID for generic and prostate-specific HRQoL using anchor-based and distribution-based methods. Although variation exists in the MID estimates derived from these two methods, the recovery patterns corresponding to these estimates were comparable.