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A total of 561 consecutive patients with stenosis of the left main coronary artery were identified during the study period. During the same period, 3389 isolated CABG procedures were performed. Patient characteristics are listed in Table 1. A large proportion of the patients were over 70 years old, were male, had CCS class III or IV symptoms and were admitted to hospital with unstable angina. Stenosis of the left main coronary artery greater than 70% was present in two-thirds of the cases. Each patient was assigned to a waiting queue Table 2 ; . Standard waiting times for these queues are as follows: emergent, no delay 0 days in-hospital urgent, 7 days; outof-hospital semi-urgent A, 21 days; and out-of-hospital semi-urgent B, 56 days.8, 11 The 343 patients 61.1% ; in the in-hospital urgent group had a median wait time of 2 days interquartile range 06 d 46 13.4% ; waited longer than the standard waiting time of 7 days, and 31 9.0% ; had been upgraded from a less urgent queue. Overall, 147 patients 26.2% ; waited longer than the standard; 52 9.3% ; were.
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The full description of the methods and results of the baseline can be found in Gamble Kelley et al 2001 ; . In summary, the results of the situation analysis household survey revealed a complex picture of the supply and demand for health care, a picture in which the price, quality, geographical access, and knowledge about acceptable health care practices by the populations are all important factors. From the demand side, the utilization of care whether for fever or maternal health services ; tended to be higher in urban areas Sikasso ; than in rural areas Bla ; , and among the better educated. The very poor were less likely to use modern care for fever treatments but no clear pattern for effect of SES was seen for assisted deliveries and pre- and postnatal care. User charges did not appear to be a factor in the choice of provider, but respondents often stated that they did not have money to pay for care. Among the people who do not utilize care for fever, the reasons most often given were lack of money and the expressed preference for home treatment. Most people who sought modern care had to pay for it, while less than four percent benefited from some kind of protection reduced price ; or solidarity mechanism and oxybutynin.
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REFERENCES Au, C. L., 1978 ; . the Ngai, H. K., Yeung, C. H. and Effect of adrenalectomy Wong, P.Y.D. and hormone This Health of Mr. research ACKNOWLEDGMENT and theo-dur.
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Human Behavior, The Miriam Hospital Brown Medical School, Providence, RI. Consistent with the Leventhal model, previous research has demonstrated associations between cancer survivors' cancer-related beliefs and health behavior changes made after diagnosis. We recruited 68 breast n 65; all female ; and colorectal n 3; all male ; cancer survivors mean age 56.2, SD 9.9 ; and 33 of their female ; first-degree relatives FDRs; mean age 46.3, SD 13.4 ; to assess cancer-related beliefs and health behavior change post-diagnosis. Assessments occurred within 3 months of survivors completing all surgery, chemotherapy, and or radiation therapy A1 ; and again 3 months later A2 ; . No significant differences were found between survivors and FDRs in beliefs about the cause of the survivor's cancer or the efficacy of behavioral strategies in preventing cancer occurrence recurrence. Relationships between survivors' cancer-related beliefs and health behavior changes have been reported previously. Consistent with hypotheses, FDRs were more likely to report modifying their diet since the survivor's diagnosis if they believed cancer could be prevented by eating: more fruits and vegetables, less high-fat food or more high-fiber food Betas .31- .38, p-values .04- .09 ; . A borderline significant association was found between decrease from A1- A2 in percentage of calories FDRs consumed from fat and the belief that cancer could be prevented by eating less high-fat food Beta .34, p .07 ; . Likewise, there was a borderline significant finding for FDRs to report greater increase in exercise since the survivor's diagnosis if they believed cancer could be prevented by moderate-intensity at A1, Beta .30, p .10 ; or vigorous-intensity at A2, Beta .33, p .09 ; exercise. These findings suggest that FDRs of cancer survivors may be motivated to adopt healthy behaviors they believe will reduce their risk for cancer. CORRESPONDING AUTHOR: Carolyn Rabin, Ph.D., Psychiatry, The Miriam Hospital, Coro, Suite 500, One Hoppin Street, Providence, RI, USA, 02903; CRabin lifespan.
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Either hydroxyurea or busulfan as single agents can provide haematologic control in the majority of patients 75% ; with chronic phase CML. These haematologic "remissions" are characterised by persistence of Ph chromosomepositive Ph + ; cells in the marrow, with an inevitable progression to blast crisis. Suppression of the Ph chromosome cytogenetic response ; has rarely been observed during treatment with either hydroxyurea or busulfan. This usually occurs in the setting of therapy-induced myelosuppression and is transient. Hydroxyurea has a better toxicity profile than busulfan, making it a superior agent for the treatment of chronic phase CML. Main side effects associated with hydroxyurea include: Nausea Diarrhoea Mucosal ulcers Dermatologic reaction Hydroxyurea is the most popular cytotoxic drug for the management of CML in the chronic phase. Compared with busulfan, hydroxyurea provides more rapid but transient control of haematologic manifestations and thus requires more frequent follow-up. It is often used prior to either SCT or IFN- in order to get the high WBC counts under control rapidly. It is taken orally and its use does not appear to affect the results of subsequent treatment with SCT or IFN-. It is given in doses of 1 to daily depending on the WBC count, presence of symptoms, and urgency to lower the WBC count. As the WBC count falls, the dose of hydroxyurea is adjusted to maintain leukocyte counts in the normal range of 5 to 109 L.
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The pharmaceutical industry has provided many wonderful advances in drug therapy that have allowed patients to live longer and more comfortably, but at the same time the industry has enjoyed years of enormous financial gains by charging prices that often prohibit those that need drugs from getting them. The pharmaceutical industry has been aided in maintaining its favorable status by keeping a close watch on key legislation, and wisely contributing to politicians that are in line with its financial interests. The industry has successfully blocked most legislation that might threaten its bottom line, such as taxes, price controls, and patent extensions. Currently, the issue of interest to pharmaceutical companies is drug coverage for Medicare beneficiaries. The drug industry favors the Republican plan because it has Republicans Democrats ! Republicans believe that Medicare ! Most Democrats believe that the beneficiaries should receive Medicare program should be prescription drug coverage from expanded to offer drug coverage to private, managed care plans. They its beneficiaries. However, some would develop incentives to Democrats believe in a plan similar encourage insurance companies to to the Republican proposal. ! Democrats are divided on how to offer such coverage, and would subsidize the premiums seniors had achieve lower costs. Some would to pay. However, the insurance rely on Pharmacy Benefit industry has stated that the cost is Managers PBMs ; , which would too great for them to offer such buy drugs in bulk for large areas. coverage. Others favor legislation to give ! Lower prices will be achieved by seniors the discounts other federal bulk purchasing through multiple, agencies receive--40-50% off retail. private plans. many different buyers. The multiple purchasers of the Republican plan would not be able to lower prices as much as either of the Democrat plans, which would rely on a few regional buyers, or legislate guaranteed lower prices for seniors. Pharmaceutical companies fear the Democrat plans Figure #3, Data from Center for Responsive Politics, opensecrets because they feel that these plans would lead to price controls, which would bring down their $12.0 Drug Industry Contributions millions ; profits. Because of these fears, the pharmaceutical industry has $10.0 spent millions lobbying $8.0 politicians sympathetic to their cause. As figure #3 $6.0 demonstrates, their dollars have $4.0 convinced Republicans to offer a plan that is more palatable to the $2.0 drug industry. Public Citizen describes $0.0 the Republican-backed Medicare 1990 1992 1994 Rx 2000 Act HR 4680 ; , which on June 28, 2000 passed the US House of Representatives, as being a "political placebo."26 According to Public Citizen, the bill fails to guarantee drug coverage because it relies on private insurers, and it only assumes a 15% discount on drug prices rather than the deeper discounts that would be available through other plans. The Republican plan would like to rely on the private sector for health benefits for the elderly; however, as illustrated earlier, private Medicare HMOs have had a poor track record in regard to covering seniors. Lobbying and campaign ! Since 1993, the drug industry has spent $33.4 contributions are not the only way million on campaign contributions. the pharmaceutical companies ! From 1997 to 1999, the drug industry has spent promote their agenda. The $235.7 million to lobby officials in Congress and industry has formed an the Executive branch. organization called Citizens for a ! The drug industry spends more on lobbying than Better Medicare CBM ; that any other industry. describes itself as a "broad-based ! The drug industry has hired 297 lobbyists, one bipartisan group.concerned with lobbyist for every two members of Congress to health of Americans and our promote its agenda on Medicare and pricing. From Public Citizen, "Addicting Congress: Drug Companies' Campaign Medicare system."27 CBM has run Cash &Lobbying Expenses." July 2000. countless television commercials depicting busloads of seniors coming from Canada to the United States to obtain medical care. Rep. Tom Allen DMaine ; and others such as Public Citizen have worked to expose CBM. In a June 2000 press release, Allen decribes Citizens for Better Medicare as ".the pharmaceutical industry's shameless and cynical smokescreen."28 CBM reportedly will spend $65 million from July 1999 to November 2000 to increase public opposition to any Medicare drug program that substantially reduces prices and to oppose a political candidate that threatens the pharmaceutical companys' agenda.29, for example, metrogel sun.
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