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PubMed2004

The increasing workload of general surgery.

BACKGROUND: With the aging of the baby boomers, individuals aged 65 years and older make up the fastest-growing segment of the US population. This aging of the population will lead to new challenges for the US health care system because older individuals are the largest consumers of health care. HYPOTHESIS: The general surgery workload will increase dramatically by 2020 as a result of the aging population. DATA SOURCES: The National Hospital Discharge Survey, National Survey of Ambulatory Surgery, US Census Bureau, and Centers for Medicare and Medicaid Services. SETTING: A nationally representative random sample of inpatient and outpatient general surgical operations performed in 1996 in the United States. METHODS: Age- and procedure-specific rates of general surgery were obtained from the National Hospital Discharge Survey and National Survey of Ambulatory Surgery. Population projections were derived from the census bureau. We used relative-value units as a proxy for surgical work. By linking these 3 data sources, we predicted the future general surgery workload by analyzing the rates of surgery and modeling both the aging and expansion of the population. RESULTS: General surgery operations (n = 63) were classified into 5 procedure categories. Whereas the population will grow by 18% between 2000 and 2020, the workload of general surgeons will increase by 31.5%. The amount of growth (19.9%-40.3%) varies among different categories of operations. CONCLUSIONS: To our knowledge, this is one of the only studies to analyze the future workload of general surgery. We project a dramatic increase in workload in the next 20 years, largely as a result of the aging US population. Our baseline assumptions are relatively conservative, so this forecast may be an underestimation. Hence, the challenge for general surgeons is to develop strategies to address this problem while maintaining quality of care for our patients.

Adolescent↗
PubMed1990

[Aging and education of the Quebec population].

"Having projected the composition of the population of the province of Quebec for the years 2011 and 2031 with respect to level of education, the author suggests ways in which an increase in the overall level of scholastic attainment could help Quebec meet the challenge of an aging population. According to him, a better educated population would be more productive and less dependent on public finances when it reached retirement. Such a population would cost less in terms of health care and could, if needed, remain in the labor force past retirement age." (SUMMARY IN ENG AND SPA)

Americas↗
PubMed2003

Acute pyelonephritis in US hospitals in 1997: hospitalization and in-hospital mortality.

PURPOSE: To describe the 1997 incidence of hospitalization for acute pyelonephritis in the US and the risk factors for in-hospital mortality associated with acute pyelonephritis. METHODS: Cases were defined as those with ICD9-CM codes corresponding to acute pyelonephritis in the 1997 Health Care Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). Frequencies and calculations were weighted to produce either national or state estimates. Hospitalization rates were calculated using 1997 US Census Bureau population projections for the denominator. RESULTS: Females were almost five times as likely as males to be hospitalized for acute pyelonephritis (11.7/10,000 vs. 2.4/10,000), but males had higher mortality rates (16.5/1000 vs. 7.3/1000); 30% greater after adjustment. Hospitalization and in-hospital mortality rates increased with age, but not with diabetes. Mortality rates increased with number of procedures, diagnoses and having a major diagnostic category other than disorders of the kidney and urinary tract. Persons living in zip codes with lower median incomes were also at higher risk of mortality. There was little variation in mortality by hospital size, ownership, location or teaching status. CONCLUSION: In hospital mortality for pyelonephritis was associated with patient rather than hospital characteristics suggesting uniform application of standard care across hospitals and populations.

Acute Disease↗
PubMed2001

Selective projections of cholecystokinin-8 immunoreactive fibers to galanin immunoreactive sympathetic preganglionic neurons in a teleost, Stephanolepis cirrhifer.

In the cellular column of sympathetic preganglionic neurons (SPNs) of the filefish Stephanolepis cirrhifer, neurons containing galanin (GAL) form a distinct population projecting specifically to non-adrenergic postganglionic neurons in the celiac and cranial sympathetic ganglia. The present study showed that virtually all of the GAL-immunopositive SPNs made contact with many nerve terminals immunopositive for cholecystokinin octapeptide (CCK-8). GAL-negative preganglionic neurons made contact with only 26% of this type of nerve terminal; CCK-8-immunopositive nerve fibers appeared to project selectively to GAL-immunopositive SPNs with projections to specific targets. The CCK-8-positive nerve fibers might be of primary sensory origin, and participate in the visceral reflexes.

Acetylcholine↗
PubMedDate not supplied

Report on the American Cancer Society Workshop on Community Cancer Detection, Education, and Prevention Demonstration Projects for Underserved Populations.

The American Cancer Society has been funding six pilot projects organized with the stated purpose of demonstrating how to implement cancer prevention and control projects for socioeconomically disadvantaged and underserved populations. This article reports on the results of a workshop held to evaluate project experiences and develop recommendations for the future.

Adult↗
PubMed1998

Toward a new urban health model: moving beyond the safety net to save the safety net--resetting priorities for healthy communities.

Parkland Health and Hospital System has been successful by every measure of comparison among its peer institutions, yet it recognizes the imperative of adapting to changes in the regulatory, legislative, and market environments. Given its mandate and a desire to preserve its multiple missions and its partnerships with a highly rated medical school, the playing field for achieving robust survival is very uneven. This article describes the evolution of one of the best "sick care systems" in the United States into an integrated, excellent health care system for the 21st century. The problems faced by the safety net in many urban areas of this country are similar. Many problems are structural in nature and will, therefore, require structural solutions at the local, state, and national levels. Parkland will continue and will be needed for many years as the tertiary and quaternary center of a comprehensive service network made up also of a series of outreach Community Oriented Primary Care clinics and special populations projects. In addition, we hope to help create a community-oriented managed-care plan that encompasses the desire to work with both denominator and numerator populations in a real partnership with many other stake-holders.

Academic Medical Centers↗
PubMed2003

Revised birth and fertility rates for the 1990s and new rates for Hispanic populations, 2000 and 2001: United States.

OBJECTIVES: This report presents revised birth and fertility rates for 1991-99, as well as previously published revised rates for 2000-2001, based on populations consistent with the April 1, 2000, census. Revised rates for Hispanic subgroups (Mexican, Cuban, Puerto Rican, and other Hispanic) are also included in this report. Rates are presented by age, race, and Hispanic origin of mother; by age, race, Hispanic origin, and marital status of mother; by age and race of father; and by age of mother and by State. This report also presents new rates by age and Hispanic origin (subgroups) of mother for 2000 and 2001. The revised rates are compared with previously published rates that used July 1 population estimates based on the 1990 census. METHODS: Populations for most rates were produced for the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) under a collaborative arrangement with the U.S. Census Bureau. Populations for teenage subgroups 15-17 and 18-19 years by race and Hispanic subgroups were produced by NCHS. The populations reflect the results of the 2000 census. This census allowed people to report more than one race for themselves and their household members, and also separated the category for Asian or Pacific Islander persons into two groups (Asian and Native Hawaiian or Other Pacific Islander). These changes reflected the Office of Management and Budget's (OMB) 1997 revisions to the standards for the classification of Federal data on race and ethnicity. Because only one race is currently reported in birth certificate data, the 2000 census populations were "bridged" to the single race categories specified in OMB's 1977 guidelines for race and ethnic statistics in Federal reporting, which are still in use in the collection of vital statistics data. RESULTS: Revised population-based birth and fertility rates from 1991 to 1999, based on the 2000 census, are with few exceptions lower than the rates previously published based on populations projected from the 1990 census. As expected, the differences in rates for American Indians, Hispanics, and Asian or Pacific Islanders were considerable. However, revised rates for most other population subgroups (i.e., non-Hispanic whites and blacks) differed little from those previously published. Regardless of the magnitude, the differences between the 2000-based and 1990-based rates progressively diverged through time so that previously published trends were generally retained but lower. Because of this shift, especially for Hispanic women, the differentials in fertility among population subgroups remain, but were somewhat reduced.

Adolescent↗
PubMed1988

A method for calculating projected increases in the number of dementia sufferers.

A new method of projecting increases in the number of dementia cases is described. This method is based on a statistical analysis of all published prevalence studies which shows that prevalence rate rises exponentially with age. The method can be easily applied to any age-specific population projections. When applied to Australia and New Zealand, the method shows that the increase in dementia will greatly exceed the total population growth rate, and even surpass the expected rise in the elderly group over the next third of a century. The method predicts that the Australian demented population will increase by 136-139% between 1984 and 2021, compared to a general population increase of only 42-54%. Over the period 1982 to 2016, the New Zealand demented population will grow by 96-100% against a rise of 18-26% in the general population. The validity of this method and its implication for future service demands are discussed.

Aged↗
PubMedDate not supplied

Evidence for spatial regularity among retinal ganglion cells that project to the accessory optic system in a frog, a reptile, a bird, and a mammal.

The vertebrate retina contains only five major neuronal classes but these embrace a great diversity of discrete types, many of them hard to define by classical methods. Consideration of their spatial distributions (mosaics) has allowed new types, including large ganglion cells, to be resolved across a wide range of vertebrates. However, one category of large ganglion cells has seemed refractory to mosaic analysis: those that project to the accessory optic system (AOS) and serve vestibulocerebellar mechanisms of motion detection and image stabilization. Whenever AOS-projecting cells have been analyzed by nearest-neighbor methods, their distribution has appeared almost random. This is puzzling, because most aspects of visual processing require the visual scene to be sampled regularly. Here, spatial correlogram methods are applied to distributions of large ganglion cells, labeled retrogradely from the AOS in frogs, turtles, and rats, and to the AOS-projecting displaced ganglion cells of chickens. These methods reveal hidden spatial order among AOS-projecting populations, of a form that can be simulated either by superimposing a single regular mosaic on a random population or, more interestingly, by overlapping three or more regular, similar but spatially independent mosaics. The rabbit is known to have direction-selective ganglion cells (not, however, AOS projecting) that can be subdivided into functionally distinct, regular mosaics by their tracer-coupling patterns even though they are morphologically homogeneous. The present results imply that the direction-selective AOS-projecting ganglion cells of all vertebrates may, likewise, be subdivided into regular, independent mosaics.

Accessory Nerve↗
PubMed2005

Increasing taxes to reduce smoking prevalence and smoking attributable mortality in Taiwan: results from a tobacco policy simulation model.

OBJECTIVE: To develop a simulation model to predict the effects of tax policies on smoking prevalence rates and smoking attributable deaths. METHODS: Using data from Taiwan, a simulation model is developed that projects population using birth and death rate data, future smoking rates using initiation, cessation and relapse data, and smoking attributable deaths using smoking prevalence and relative risk estimates. The model projects the number of smokers and smoking related deaths from a baseline year forward. The effects of taxes of different sizes, indexed and unindexed, and temporary versus sustained are modelled using elasticities based on published studies of demand. RESULTS: The model predicts that sustained tax increases have the potential to substantially reduce the number of smokers and the number of premature deaths, with the effects growing over time. Indexing taxes to inflation stems erosion of the tax effect. In our model, when the tax increases by 10 times (NTD 50) over the recent tax increase (NTD 5) and taxes are indexed to inflation, the smoking prevalence rate falls by over 15% soon after the tax increase, and by about 30% in relative terms by the year 2040, resulting in 4500 lives saved per year. CONCLUSIONS: Tax rises have the ability to substantially affect smoking rates in Taiwan. These effects grow over time and lead to substantial savings in lives and health care costs.

Adolescent↗
PubMed1983

Massive retinotectal projection in rats.

Retinal ganglion cells were labeled with horseradish peroxidase injected into the superior colliculus of normal pigmented rats. It is shown that virtually all ganglion cells with crossed axons project to the tectum, thus including all cell types described so far in the rat. The results contrast with the conclusion that only one-third of the ganglion cell population project to the tectum in normal hamsters.

Animals↗
PubMed1984

The second, intralaminar thalamo-cortical projection system.

In the marmoset (Callithrix jacchus), HRP and 3H-apo-HRP were injected into various cortical regions and the positions of labelled neurons in the non-specific, intralaminar thalamic nuclei (N. centralis and centre m edian ) were investigated. Although neuron populations projecting to the different cortical regions overlap widely, a coarse topology exists inasmuch as intralaminar neurons projecting to the posterior cortex were located more rostrally and those projecting to the anterior cortex were located more caudally in the intralaminar complex. With injections into nearby cortical regions of the parieto-temporal association cortex with HRP and 3H-apo-HRP, respectively, no double labelled cells were found in the intralaminar nuclei, although the fields of labelled cells completely overlapped. Also in the specific projection nuclei no double labelled cells were encountered. About 10-20% of the thalamo-cortical projection cells are located in the intralaminar nuclei. Some functional aspects of this second thalamo-cortical projection system are discussed.

Animals↗
PubMed2000

Issues affecting Australia's rural occupational therapy workforce.

The unequal distribution of health workers across Australia in favour of urban areas affects the provision of effective health services to rural and remote communities. Additional pressures on the current and future supply of occupational therapists may arise from a restructuring of the health labour force and demographic changes in the age structure of the population. Projections made on the basis of these data indicate that employment growth for occupational therapists will create a demand for 9600 therapists in 2005, or 79.9% more than the number of occupational therapists employed in 1994. Factors such as reductions in the level of immigration and the number of people of working age, and a diminishing population of school leavers to fill student places in universities will make it difficult to meet the projected demand for occupational therapists. Occupational therapy labour force planning suffers from a lack of detailed data on under-serviced areas. Such data are critical for clarifying the magnitude of the projected discrepancy between future demand and supply needs for occupational therapists in rural and urban areas in Australia.

Australia↗
PubMed1992

[Perspective in the incidence of Alzheimer's disease in Austria by the year 2050].

Population projections of the Austrian Central Statistical Office show a dramatic increase in the proportion of people of 65 years of age and over in Austria by the year 2050. Since this population group is at higher risk to develop Alzheimer's disease (AD/SDAT), it will be necessary to modify the currently available facilities for social and medical care to meet this increasing demand. Based on official demographic data and epidemiological findings of the "Eurodem" group, our computations show that the number of persons with AD/SDAT aged 65 or over will rise from 48,000 at present to over 113,500 in 2050 (1990: 614/100,000, 2050: 1505/100,000 persons of the total population), equivalent to an increase of 140%. By forecasting the number of persons affected, it should be possible to intensify (and in some areas introduce) long-term health planning with respect to the social, financial and medical care of aged, demented people in Austria.

Aged↗
PubMed1992

[Epidemiologic progression of dementia diseases in Austria until the year 2050].

Population projections of the Austrian Central Statistical Office show a dramatic increase of the proportion of people of 65 years of age and over in Austria until the year 2050. Since this population group is at higher risk to develop dementia, it will be necessary to suitably modify the presently available facilities for social and medical care to meet this increasing demand. Based on official demographic data and epidemiological findings of the "Eurodem"-group (12) our computations show that the number of demented persons, aged 65 or over, will rise from presently 80,000 to over 189,000 in 2050 (1990: 1,023/100,000, 2050: 2,509/100,000 persons of the total population), equivalent to an increase by 140%. By forecasting the number of persons affected, it should be possible to intensify (and in some areas introduce) long-term health planning in respect of aged people, dementia and social, financial and medical care in Austria.

Aged↗
PubMed2004

[Keys to demographic changes in the new millennium].

This article describes the main features of the dynamics of demographic change in the population of Spain during the twentieth century, emphasizing the most recent developments: population ageing, the establishment of a very low fertility regime and the increasing importance of foreign immigration as well as the impact which all these have on the composition of households. Those aspects most directly related to the provision of health and social services is discussed, such as the impact of increased life expectancy on the incidence of illness and handicap in the population, the role of foreign immigration in providing personal services within the family and the health implications of the new model of delayed fertility. Finally, the health implications of population projections for the next 50 years are discussed.

Emigration and Immigration↗
PubMed1998

Psychiatry and the burden of mental illness.

OBJECTIVE: To examine the morbidity produced by mental disorders, to project changes in morbidity likely to be produced by demographic and economic change, and to review the possible role of psychiatry in the health care system. METHODS: Using prevalence data for psychiatric disorders and population projections, this paper presents the likely changes in morbidity over the next 20 years. A review of social and economic information indicates changes in social attitudes and their effects on mental health. This paper examines the determinants of health and how they are likely to change and explores some possible directions for changes in health care delivery. RESULTS: Psychiatric disorders have been greatly underestimated as a cause of disability but account for 5 of the 10 leading causes of disability and 47.2% of all years lived with a disability (YLD) in developed countries. By 2016, there will be significant changes in the distribution and type of psychiatric disorders seen in the population, with cases of dementia almost doubling. Most of the population growth will be in the older age-groups, who will be well informed and will demand high standards of service. The gap between rich and poor will increase, and the results of childhood poverty and abuse will become more apparent. The disadvantaged, including many mentally ill, will suffer deprivation as disability payments decline, but youth unemployment will improve, possibly reducing crime rates. Forced early retirements will decline. Alternative medicine will make inroads into health care. A crisis in subsidized accommodation for the elderly can be anticipated, which perhaps will lead to reopening institutions that are currently being closed or to developing new forms of care. As the baby boomers pass 50 years of age and begin consuming health care services, governments will revise plans and eligibility for services; users will pay for services more directly. CONCLUSIONS: Psychiatry is very vulnerable to minor changes in health care schemes and will increasingly be called on to show economic arguments to justify its services. Pressure to support a primary care model by changing practice styles, developing new skills, and training practitioners will probably occur. The major growth area likely will be geriatric psychiatry.

Adolescent↗
PubMed2005

Infectious disease hospitalizations among older adults in the United States from 1990 through 2002.

BACKGROUND: To understand conditions associated with substantial morbidity among older adults (aged > or = 65 years), we describe hospitalization rates and trends for overall infectious disease (ID) and for specific ID groups among older adults in the United States from January 1, 1990, through December 31, 2002. METHODS: The National Hospital Discharge Survey was used to generate hospitalization estimates from 1990 through 2002 for the US population of older adults. By using a comprehensive list of International Classification of Diseases, Ninth Revision, Clinical Modification codes associated with IDs, we identified and analyzed hospitalizations associated with specific ID and ID-related categories. RESULTS: There were approximately 21.4 million (SE, 636 000) ID hospitalizations among older adults from 1990 through 2002, and between 1990 through 1992 and 2000 through 2002, the ID hospitalization rate increased 13% from 449.4 to 507.9 hospitalizations per 10 000 older adults (P = .01). This increase was caused in part by the increasing relative contributions of patients aged 75 through 84 years and 85 years or older to the older adult ID hospitalization rate. Almost half of ID hospitalizations (46% [SE, 0.7%]) and ID-related hospital deaths (48% [SE, 1.6%]) among older adults were associated with lower respiratory tract infections from 2000 through 2002. CONCLUSIONS: The hospitalization rate for IDs increased slightly among the older adult US population during the 13-year study and was associated with the aging of the older adult population. The reduction of ID hospitalization rates among older adults could help attenuate the anticipated increase in the number of hospitalizations among older adults and should be a high priority given the projected population growth among older adults in the United States.

Age Distribution↗