Contribution of home economics research to the improvement of human nutrition.
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Dietetics↗
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A school-based intervention to promote dietary change.
PURPOSE: This study examined the effect of 2 school-based interventions on adolescents' consumption and knowledge of fish with the hypothesis that home economics education would enhance the effect of modifications in the school canteen. The school lunch intervention (SL) focused on changes in the school canteen, and the school lunch + home economics intervention (SL + HE) in addition consisted of changes in the home economics syllabus. Pupils in the 8th grade (n = 228) from 3 schools in Göteborg, Sweden, participated (control, n = 83; SL group, n = 58; SL + HE group, n = 87). METHODS: A controlled design was used in which behavior and knowledge were assessed before and after the intervention. In contrast to much previous research of this type, measurement of behavior was based primarily on direct observation as opposed to self-reported intakes. Behavior (fish consumption) was measured individually by structured observations in the school canteen 5 times (once a week) when fish was served. Nutritional knowledge was measured by means of 10 items in a questionnaire. To analyze changes in behavior, a nonparametric statistical method assessing systematic change in paired ordered categoric variables was used. RESULTS: At follow-up evaluation, consumption had increased significantly in the SL + HE group, a change that also differed from the control group. In addition, significant positive changes in knowledge were observed in both intervention groups, but not in controls. CONCLUSIONS: The results suggest that dietary change was achieved by modifying conditions in the school canteen together with changing the home economics syllabus. This study shows the importance of the school in the promotion of dietary change among adolescents.
Adolescent↗
Comments on the division of labor in occupations concerned with food.
The roles of men and women in relation to food have always been sharply defined: animals belonged to men and plants and food preparation to women. Thus, when the land-grant colleges were established, men were taught animal husbandry and agricultural methods; in home economics, women learned the "home-making" arts, including nutrition and were concerned with people. But, as nutrition became more scientific, men took it over, separating it from home economics. In so doing, less attention was paid to the human elements in food production. World food policies are now made without regard to feeding people, and women have been progressively left out in the decision-making. The increase in nutritional knowledge in the last half century has had little effect on policies. Because Americans set the pattern the rest of the world will emulate, we must come to the realization that we cannot alleviate hunger with money alone-hunger is relieved with food, and food supplies are finite. Real sacrifices in terms of food itself, such as were made in World Wars I and II, will be necessary. Knowledge that millions are truly hungry may convince mothers to feed their children and families in different ways.
Agriculture↗
Economics of home intravenous services.
Home care has become a more attractive option as economic constraints are placed on the total healthcare system. Over the past 25 years, home intravenous service programmes have developed simultaneously with the development of more reliable means of providing intravenous therapy in the home. Reports have been published on a variety of home intravenous programmes including antibiotic therapy, parenteral nutrition support, chemotherapy, blood product administration and pain control. This review examines the economics of home intravenous programmes, including such direct cost items as drugs, medical supplies and equipment, personnel, hospital room, inventory control, and carrying inventory. Indirect costs, assessed as loss of wages, are also analysed. Cost savings have been reported ranging from 18 to 75% for intravenous antibiotic programmes and 60 to 76% for parenteral nutrition programmes. Earlier reports concentrated on analysis of savings derived from comparison of direct costs only, but recent studies have explored a more comprehensive fiscal analysis.
Cost-Benefit Analysis↗
Hemophilia home treatment. Economic analysis and implications for health policy.
This analysis describes the development of technology for home self-infusion of factor VII in the treatment of hemophilia and its clinical, economic, and social consequences, and uses the case study of such home care treatment to illustrate the potentials and pitfalls of formal economic analyses of programs to treat chronically ill children. A comprehensive review of all original data on hemophilia programs, their related costs, and outcomes, conducted from 1966 through 1993, examined the economic outcomes for two hypothetical cohorts, one aged 0-4 years and the other aged 30-34 years. Including the measurement of treatment effects on the productivity of parental caregivers substantially increases the benefit-cost relationship of an intervention directed at chronically ill children. Increased economic productivity and societal return resulting from such a program for young adults exceeds those for a cohort of children, primarily due to assumptions related to discounting. However, estimation of quality-adjusted life years favors the younger age cohort, since children survive for a longer period of time and with each year survived comes a higher quality of life. Unlike simpler instances in which economic benefits can be shown to outweigh resource costs, policy decisions concerning services for chronically ill children raise an additional set of complex analytic issues. Inclusion of the benefits in productivity experienced by family caregivers provides an important added dimension to such analyses. The development of cost-benefit or cost-effectiveness analyses of these programs illustrates the importance of careful measurement of outcomes and explicit statements of underlying assumptions. Such an analysis of home care for children with hemophilia therefore demonstrates both the strengths and the limitations of this approach.
Adult↗
Food coping strategies: a century on from Rowntree.
The objectives of this study were to update Rowntree's food estimates to bring them into line with contemporary food habits and changing lifestyles; to determine whether food budgeting/ coping strategies of low income households observed by Rowntree at the turn of the century were still prevalent in low income groups today: and to evaluate whether expenditure by low income households on food was sufficient to meet minimum dietary recommendations. Two hundred questionnaires were completed face to face with the interviewer within the Merseyside boundary and included only those households who were in the Post code area. Many low income households are unable to access a healthier diet due to income limitations. Many used a variety of coping strategies to stretch their incomes and were also found to rely on help from outside the immediate family such as extended family and friends and voluntary agencies. Households with children were found to be spending slightly more on food than the reconstructed Rowntree minimum dietary. There are thus two issues; firstly that there are households spending slightly more than the minimum yet that are unable to achieve a healthy diet. Secondly all the low income households are spending much less per person than the average person in the United Kingdom. It is concluded that whilst sterling work is being achieved within health promotion departments and within community health settings there is still a great deal to be undertaken. The value of Home Economics teaching in schools should be better recognised, and Home Economics should be reinstated in the National Curriculum. Secondly it is recommended that a standard approach be adopted to inform both welfare benefit payments and in-work top up payments, thus allowing households on low incomes to make informed choices within a budget that will accommodate healthier eating strategies.
Adult↗
Does hospital-at-home make economic sense? Early discharge versus standard care for orthopaedic patients.
Hospital-at-home has been promoted as a potentially effective means of replacing costly inpatient care with cheaper domiciliary care. We studied three hospital-at-home schemes in West London providing intensive home care for early discharge orthopaedic patients, comparing their costs with those of standard inpatient care. Although costs per day of hospital-at-home care were lower than those of inpatient care, the schemes appeared to increase the total duration of orthopaedic episodes, so that the costs of standard care, per episode, were lower than those of hospital-at-home. While hospital-at-home may offer considerable future potential, substitution of home care for inpatient care will not necessarily save resources.
Cost-Benefit Analysis↗
The economics of home parenteral nutrition.
During the past 30 y long-term parenteral nutrition has evolved from a novel technique to a well-established intervention for gastrointestinal failure. The development of home care has been driven by technological advances and patient/family choice as well as financial constraints, reflecting a shift in resources from hospital to community. Annual costs for adult home parenteral nutrition have recently been estimated to range from US $150,000-250,000 in the USA, and are around 55,000 Pounds in the UK, perhaps only 25-50% of in-hospital costs. In the absence of any alternative treatment for children with gastrointestinal failure, parenteral nutrition is life saving, and when performed at home offers the prospect of maintaining a good quality of life. Cost-utility appraisals of home parenteral nutrition in adults incorporating quality of life assessment have shown the cost of one quality adjusted life year to be around 69,000 Pounds in the UK (1995), and Can $14,600 in Canada (1984), making home parenteral nutrition relatively cost-effective compared with other ways of spending money to improve health. Because there are no published economic appraisals of pediatric home parenteral nutrition, this paper is based on a review of the literature relating to adult patients.
Adult↗
Ethnic differences in children's intelligence test scores: role of economic deprivation, home environment, and maternal characteristics.
We examine differences in intelligence test scores of black and white 5-year-olds. The Infant Health and Development Program data set includes 483 low birthweight premature children who were assessed with the Wechsler Preschool and Primary Scale of Intelligence. These children had been followed from birth, with data on neighborhood and family poverty, family structure, family resources, maternal characteristics, and home environment collected over the first 5 years of life. Black children's IQ scores were 1 SD lower than those of white children. Adjustments for ethnic differences in poverty reduced the ethnic differential by 52%. Adjustments for maternal education and whether the head of household was female did not reduce the ethnic difference further. However, differences in home environment reduced the ethnic differential by an additional 28%. Adjustments for economic and social differences in the lives of black and white children all but eliminate differences in the IQ scores between these two groups.
Black or African American↗
Economics of home vs. hospital breastfeeding support for newborns.
AIM: This paper presents the findings of research comparing the incremental costs associated with the provision of home-based vs. hospital-based support for breastfeeding by nurse lactation consultants for term and near-term neonates during the first week of life. BACKGROUND: A consequence of both consumer demands and increasing health resource constraints is that alternative care delivery models for safe, efficacious and cost-effective breastfeeding programmes have steadily evolved. To date, the economic impact of the setting (home or hospital) where lactation support is delivered has received little research attention. METHODS: Mother-infant dyads were stratified by gestational age as term (>37 weeks gestational age; n = 101) or near term (35-37 weeks gestational age; n = 37) and randomized to standard hospital care and postpartum follow-up (standard care), or to standard hospital care plus home support from certified nurse lactation consultants (experimental). Data collection occurred at study entry, hospital discharge and at a seventh day postpartum follow-up session. Costs to the family (out-of-pocket and time costs) and to the healthcare system (during hospitalization and after hospital discharge) were measured. Total societal costs were defined as the sum of both family and healthcare system costs. RESULTS: Compared with standard hospital-based care, home support by nurse lactation consultants showed no statistically significant differences in either time costs to the family or total societal costs. Term infants who received home support had statistically significantly greater postdischarge system costs (P < 0.0001), with a trend towards lower out-of-pocket expenses to their families (P = 0.12). There were no statistically significant differences between the two groups in overall combined family and healthcare system costs. CONCLUSIONS: These results suggest that the cost of home lactation support programmes were comparable with the costs of hospital-based standard care. Breastfeeding support at home by lactation consultants should be considered as an option as it was no more costly than support from lactation consultants in the hospital setting. The findings for near-term infants need to be interpreted with caution, given the small sample size.
Adult↗
Home care economics: challenge and opportunities for future nursing practitioners.
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Aged↗
A comparative study of the economics of home care.
The costs of home care and treatment solely in hospital for patients in a variety of short-term diagnostic categories are compared. Five hundred and eighty-three patients included in an experimental home care program were randomly assigned either to a group which received home care as part of their treatment, or to a control group that remained in hospital the traditional length of time. It is argued that the only costs relevant in an economic comparison of the two modes of treatment are those attributable to the direct care of the patient. A technique is presented whereby changes in the daily amount of nursing service provided can be costed. The economic analysis shows that, when similar diagnoses are compared for an episode of illness, there is basically no difference in cost between home care and treatment in hospital.
Adult↗
Nutritional knowledge, attitudes, and practices of high school graduates.
A mail survey was conducted to investigate the relationship between previous nutrition education in high school home economics classes and the present nutritional knowledge, attitudes, and practices of Ohio high school graduates. Findings revealed that young women previously enrolled in home economics courses with a unit in food, nutrition, and health did not achieve significantly higher scores in tests of nutritional knowledge, attitudes, and practices than did those who had not been exposed to such nutritional education. Attitudes toward food and nutrition were found to mediate the nutritional knowledge and practices of these high school graduates.
Adolescent↗
The status of school-based nutrition education at the state agency level.
The status of school-based nutrition education at the state agency level was examined. Telephone interviews with agencies in all 50 states revealed that nine states mandated nutrition be taught and another 21 included nutrition as a required topic in mandated subjects, frequently health. The other states had initiatives to promote school-based nutrition education but it was not required. Published requirements for teacher certification in elementary education, home economics, and health education seldom (two to three states) specified nutrition as a requirement. However, follow-up investigations revealed many states indirectly promote nutrition preparation for home economics and health education teachers through guidelines for approval of college programs in these areas. An inventory of nutrition education curricular materials revealed they were most frequently directed to grades K-6 and focused mainly on general foods and nutrition or that related to health. Given the links that emerged between health and nutrition, incorporating nutrition into health education may help promote school-based nutrition education.
Certification↗
The mentally ill in nursing and old people's homes. An economic method of case-finding and assessment.
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Aged↗
Six-year experience of caring for forty-four patients with a left ventricular assist device at home: safe, economical, necessary.
OBJECTIVE: With increasing numbers of implantations, left ventricular assist device programs can put a financial strain on a hospital unless an efficient and safe outpatient program is developed. However, the left ventricular assist device is not widely recognized in the medical community as being reliable enough to support a patient at home. We reviewed our experience with these patients at home to assess the safety and the benefits of such a program. METHODS: Our institutional 6-year experience with 90 consecutive recipients of a wearable left ventricular assist device was analyzed. RESULTS: Forty-four (49%) of the 90 patients who received TCI vented-electric left ventricular assist devices (Thermo Cardiosystems, Inc, Woburn, Mass) were discharged, spending a total of 4546 days (12.5 years) at home with an average of 103 +/- 16 days of outpatient support (range 9-436 days). Of these 44 patients, all were successfully bridged to transplantation (42 patients, 96%) or planned explantation (2 patients, 4%). None of the outpatients died. The cumulative events per outpatient month were 0.020 for bleeding, 0.053 for device infection, 0.0068 for thromboembolus, and 0.020 for major malfunctions. Our estimated average cost to bridge a patient to transplantation or explantation once discharged is $13,200 and as an inpatient over the same length of time, including only room and board, is $165,200. Thirty percent of outpatients were able to return to work or school, 33% to sexual activity, and 44% to driving. All outpatients performed activities of daily living. CONCLUSION: Current left ventricular assist device technology provides effective and economical outpatient support and is associated with limited morbidity and a satisfactory quality of life.
Ambulatory Care↗
Economics of home parenteral nutrition.
The past 30 years have seen long term parenteral nutrition evolve from a novel technique to an accepted intervention for gastrointestinal failure. The development of home parenteral nutrition (HPN) has parallelled a shift in resources from hospital to community care and has been driven by technological advances, the growth of commercial home care companies and patient choice. Costs for HPN per patient year have been estimated to range from $US 150,000 to $US 250,000 in the US, and are around 55,000 pounds in the UK, perhaps only 25 to 50% of in-hospital costs. In the absence of any alternative treatment for many patients with gastrointestinal disease, parenteral nutrition is life saving and offers the prospect of maintaining a good quality of life. The cost of 1 quality-adjusted life-year for HPN has been estimated as 69,000 pounds in the UK (1995 values), and $Can 14,600 in Canada (1984 values), making HPN relatively cost effective compared with other ways of spending money to improve health. HPN is also given to patients in whom life expectancy is unlikely to be influenced, such as those with cancer or AIDS. Although there is considerable heterogeneity between countries in the proportion of HPN patients with a particular disease, malignancy is now the single most common indication. HPN can be expected to improve quality of life over a short period of terminal care, and whilst a strong case can be made for use of HPN in some of these patients, its use has not been subjected to detailed medical or economic appraisal.
Humans↗