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PubMed2005

GIS supported solid waste management in coastal areas.

Planning of solid waste management (SWM) facilities in terrestrial as well as coastal areas addresses several situations, and requires considering numerous factors. This leads to large amounts of data and information that must be organized and analyzed. However, in many SWM systems, all of the relevant information cannot be managed properly due to insufficiencies in methods/tools and/or resources. To assist the solid waste decision making process, GIS-based decision support systems can be applied to deal with the multi-attribute and spatial nature of SWM systems. In this study, the application potential of GIS based decision support systems to functional elements of the SWM system are reviewed first. Then particular emphasis is given to landfill site selection. In this context, landfill siting process and key siting criteria were developed to incorporate the environmental, socio-political, engineering, and economic factors for an appropriate solution. To aid decision makers to determine landfill area requirements, an area estimation model, containing population projection and waste quantity forecasting modules, was developed in Visual Basic. Following the development of a graphical user interface, suitable areas for proposed landfill were determined in an IDRISI environment.

Decision Support Techniques↗
PubMed2006

Estimated prevalence of cardiovascular disease and distribution of cardiovascular risk in New Zealanders: data for healthcare planners, funders, and providers.

AIMS: New Zealand cardiovascular risk management guidelines advocate targeted risk assessment based primarily on age, gender, and ethnicity--and recommend drug management for people with a 5-year absolute cardiovascular disease (CVD) risk greater than 15%. To inform service planning and healthcare delivery for district health boards and primary healthcare organisations in New Zealand, we have produced population estimates of CVD prevalence and 5-year absolute CVD risk. METHODS: The 1993 Auckland Heart and Health Study provided the data for estimating CVD prevalence and absolute CVD risk distributions using the Framingham CVD risk prediction equation. These estimates were applied to population projections for 2005 based on 2001 New Zealand Census data. RESULTS: Of the projected 2.09 million people aged over 35 years in New Zealand in 2005, approximately 1.5 million (72%) meet national criteria for formal CVD risk assessment. About 151,000 (7%) are estimated to have suffered a non-fatal heart attack or stroke or have angina. A further 262,000 (13%) are estimated to have a 5-year CVD risk greater than 15% based on New Zealand CVD risk charts. This represents around 1 in 5 adults over the age of 35 years in New Zealand for whom pharmacological interventions are recommended according to the New Zealand CVD risk guidelines for the prevention of new or further CVD events. CONCLUSIONS: The latest published data available on the burden of CVD risk in New Zealand is now over 10 years old and does not include Maori, Pacific, and other non-European ethnic groups. Current data on the risk profile of adult New Zealanders is required for more accurate service planning. However the information reported here provides a reasonable estimate of the magnitude of the task. Although systematic identification and management of CVD risk in New Zealanders with raised CVD risk will be a major undertaking for healthcare services, it has the potential to produce significant health-gains while reducing health disparities.

Adult↗
PubMedDate not supplied

[The impact of family planning on the indices of social well-being].

The impact that family planning has on social welfare was quantified for each federal entity. Considering fertility the most important variable of the population growth rate during the last years, and the demographic dynamic in the future, a package of software was adapted to elaborate population projections up to the year 2010, in order to show, through basic indicators, the effect that in a middle-term of a successful or deficient family planning program, in terms of future needs of health, education, housing and job employment. Finally, programmatic and operative strategies were expounded to reinforce family planning activities at local health systems and dispersed rural communities.

Age Factors↗
PubMed1989

Medical services for the elderly.

The percentage of acute medical beds in Galway Regional Hospital, occupied by patients over 65 years old is more than 50%. This use of acute medical services by elderly, will increase over the next three decades, in line with population projections. Further development of the geriatric service, and more emphasis on training in geriatric medicine is necessary.

Aged↗
PubMed1986

The establishment of geriatric medicine at the University of Cape Town.

The birth of modern geriatric medicine in the USA and UK is briefly described as a prelude to the recognition of the need to establish facilities to teach this discipline at South African medical schools. The response of the University of Cape Town to this clearly shown need, the steps taken to endow a chair and the subsequent plans to commence a service are outlined. Consideration of population projections for the age group above 60 years between 1970 and the year 2020 suggests that formal training in the various disciplines involved in caring for the aged has been introduced none too soon. The first incumbent of the William Slater Chair of Geriatric Medicine commenced duty on 1 October 1981 and the milestones in the subsequent development of a service based upon the University of Cape Town and Groote Schuur and other hospitals are described.

Aged↗
PubMed1986

How many doctors are needed in South Africa by 1990?

The 1983 register of medical and dental practitioners was used to describe the provincial and urban-rural distribution of non-specialist medical practitioners. The number of medical practitioners who will be registered in 1990 was estimated on the basis of current accrual and loss patterns. The number required by 1990 was estimated on the basis of the projected population growth using a linear prediction model in which the proportion of blacks resident in urban regions was varied. The requirements were based on doctor/population ratios either remaining as they were in 1980 or improving by 1990. We found that for South Africa there were 2 198 people per doctor. However, there were more people per doctor in rural regions than in urban regions, with the rural Cape Province the only rural region with fewer than 6 000 people per doctor. In black national states there were more than 14 000 people per doctor. There appears, therefore, to be a need for redistribution of medical practitioners to the rural regions. We estimated that, should doctor/population ratios in 1990 remain as they were in 1980 with only a modest increase in black urbanization, there would be enough medical practitioners registered in 1990 at current accrual rates. Should rural ratios be improved to 1:5 000 and urban ratios to 1:1 000 as proposed in the National Health Services Facility Plan, there will be fewer doctors registered than are needed in 1990, particularly if black urbanization increases markedly.(ABSTRACT TRUNCATED AT 250 WORDS)

Forecasting↗
PubMed1995

Perinatal regionalization versus hospital competition: the Hartford example.

OBJECTIVES: The increasingly competitive health care environment may undermine effective traditional regional organizations. It is urgent to document the benefits of perinatal regionalization for the emerging health care system. We present a case study that illustrates many of the challenges to and benefits of perinatal regionalization in the 1990s. BACKGROUND: The controversy in Hartford was sparked by a proposed merger of two major pediatric services into a full-service children's hospital. Community hospitals reacted with plans to upgrade their obstetrics/neonatal facilities toward level II (intermediate) or II+ (intensive) neonatal intensive care units (NICUs). The fear that unrestricted competition would drive up overall health care costs prompted the hospital association and Chamber of Commerce to retain consultants to evaluate the number and location of regional NICU beds. METHODS: The consultant team interviewed stake-holders in area hospitals, health maintenance organizations, insurance companies, businesses, state agencies, and community groups, and analyzed quantitative data on newborn discharges. RESULTS: The existing system worked remarkably well for clinical care, training, referrals, and provider and patient satisfaction. There was a high level of inter-hospital collaboration and regional leadership in obstetrics and pediatrics, but strong and growing competition between their hospitals. Hospital administrators enumerated the competitive threats that obligated them to compete and the financial disincentives to support the regional structures. Business leaders and insurance executives emphasized the need to control costs. Analysis of discharge data showed marginal adequacy of NICU beds but maldistribution between NICUs, particularly between level III and level II units. The consultants recommended no new beds based on population projections, declining lengths of stay nationally, and substantial gains available from aggressive back-transport of convalescing infants. The consultants emphasized the need for all stakeholders to support the regional infrastructure (referral, transport, education, evaluation, quality assurance) and to modify competition when it impaired effective regionalization. CONCLUSIONS: Regionalization permits better care at lower cost, yet competition may disrupt this effective system. Active cooperation by stakeholders is vital. Substantial new research is required to define optimal regional organization.

Bed Occupancy↗
PubMed1996

Cancer in older persons in Scotland.

BACKGROUND: The average age in many populations in increasing. As the risk of most epithelial cancers increases with age, numbers of people with cancer can also be expected to grow. METHODS: Incidence data from the Scottish Cancer Registry for the period 1981-1990 were used to examine the size of the cancer burden in those aged 75 years and over. The future burden of cancer in Scotland was estimated by applying current age specific rates to population projections. Cancer survival in older cancer patients in Scotland was examined and comparisons made with other selected countries. The place of treatment of people under and over 75 in Scotland was investigated. RESULTS: Approximately 30% of the total cancer burden in Scotland and other countries occurs in the elderly. The total number of incident cases in Scotland in those aged 75 and over is estimated to rise by approximately 60% in males and 20% in females by 2029. A decline in survival is seen with increasing age. Older people with cancer in Scotland are less likely to be treated outwit their area of residence and are more likely to be admitted to institutions which admit small numbers of patients. CONCLUSIONS: Cancer in older persons contributes a significant proportion of the overall cancer burden. The burden of cancer in the elderly is likely to grow. More work needs to be done characterising cancer and its treatment in older persons.

Adolescent↗
PubMedDate not supplied

Telomeres, cancer, and aging. Altering the human life span.

Population projections of the aging global society and its fiscal and social impact have depended on assumptions regarding the human life span. Until now, the assumption that the maximum human life span is fixed has been justified. Recent advances in cell biology, genetics, and our understanding of the cellular processes that underlie aging, however, have shown that this assumption is invalid in a number of animal models and suggest that this assumption may become invalid for humans as well. In vitro alteration of telomeres affects cellular senescence, and in vivo manipulation of genes and diet can increase maximum life span in animal models if these discoveries are extended to humans. We may soon be able to extend the maximum human life span and postpone or prevent the onset of diseases associated with aging. Such a possibility requires that we recognize a growing uncertainty in any attempt to project international health care costs into the next few decades. The costs may be significantly lower than projections, if life span increases and age-related disabilities are postponed or less severe, or perhaps higher, if life span increases without altering the onset and severity of disability. An appropriate uncertainty regarding the human life span undermines any attempt to accurately predict health costs in the next century.

Aging↗
PubMed2000

Projections of the population by ethnic group: a sufficiently interesting or a definitely necessary exercise to undertake?

This article considers the range of needs which would be met by having available projections of the population by ethnic group, and, in particular, the rôle these projections would usefully play in informing current and future policy issues. The article first identifies and lists the main uses, and potential users, of such projections and gives an appraisal of the likely applications in each context. Some of the challenges involved in using the main datasources--the census and surveys--for making such projections are then addressed; the article considers what is measured by asking questions on ethnicity, and discusses the implications of ethnicity being self-assessed--two important considerations which affect the potential usefulness of ethnic projections. Finally, details are given of a co-operative project involving a multi-disciplinary team of academic experts to explore the feasibility of making such projections.

Data Collection↗
PubMed1996

[Iodine consumption in France. National results of the Thyromobile project in a population of schoolchildren aged 6-14 years].

The "Thyromobile" project was initiated to update information on iodine supply in school-children aged 6-14 years in Europe. It involved 4 places in France: Lorraine, Rhône-Alpes, Languedoc-Roussillon, Midi-Pyrénées. Schools of the three former places had been investigated in 1986 during the Mornex's study whereas in the latter they had never been investigated in the past. With a mobile unit, all children (n = 1522) had a thyroid echography performed by the same trained investigator, and urinary iodine concentration was determined in 1458 of them. The mean +/- SD of urinary iodine concentration was 13.0 +/- 7.4 micrograms/dl, but 38% of urinary iodine concentrations were below 10 micrograms/dl and 10% were under 5 micrograms/dl. The prevalence of goitre was 4.1% in boys and 3.1% in girls. There was a negative correlation between urinary iodine concentration and thyroid volume (p < 0.001). Therefore, the results of the "Thyromobile" project show that the places, investigated in France, are not in an area of endemic goitre due to iodine deficiency. However, other epidemiological studies must be done to provide further information about iodine supply in all parts of France.

Adolescent↗
PubMed1992

[Results of treatment--the Nord-Gudbrandsdal Project--circulatory collapse in sparsely populated regions].

In Project Nord-Gudbrandsdal we aimed to reduce prehospital mortality from myocardial infarction in a sparsely populated area. The ambulance system consisted of local ambulances with semi-automatic defibrillators (the ambulance personnel were trained in the use of these), combined with advanced medical support from the local doctor and/or the air ambulance doctor. During the three-year period (1987-89) 75 prehospital cardiac arrests were observed in a population of 22,000 inhabitants. 12 patients with ventricular fibrillation were defibrillated, and eight primarily with success. Four patients were discharged from hospital in a satisfactory condition. We discuss the factors determining successful resuscitation.

Adult↗
PubMed2006

Lifetime cost of ischemic stroke in Germany: results and national projections from a population-based stroke registry: the Erlangen Stroke Project.

BACKGROUND AND PURPOSE: The number of stroke patients and the healthcare costs of strokes are expected to rise. The objective of this study was to determine the direct costs of first ischemic stroke and to estimate the expected increase in costs in Germany. METHODS: An incidence-based, bottom-up, direct-cost-of-ischemic-stroke study from the third-party payer's perspective was performed, incorporating 10-year survival data and 5-year resource use data from the Erlangen Stroke Registry. Discounted lifetime year 2004 costs per case were obtained and applied to the expected age and sex evolution of the German resident population in the period 2006 to 2025. RESULTS: The overall cost per first-year survivor of first-ever ischemic stroke was estimated to be 18,517 euros (EUR). Rehabilitation accounted for 37% of this cost, whereas in subsequent years outpatient care was the major cost driver. Discounted lifetime cost per case was 43,129 EUR overall and was higher in men (45,549 EUR) than in women (41,304 EUR). National projections for the period 2006 to 2025 showed 1.5 million and 1.9 million new cases of ischemic stroke in men and women, respectively, at a present value of 51.5 and 57.1 billion EUR, respectively. CONCLUSIONS: The number of stroke patients and the healthcare costs of strokes in Germany will rise continuously until the year 2025. Therefore, stroke prevention and reduction of stroke-related disability should be made priorities in health planning policies.

Aged↗
PubMed1995

Military personnel and dependents in population analysis and projection.

"Concentrations of [U.S.] armed forces and their dependents create some unusual (and little recognized) problems for applied demographers, both in analysis and projection.... Their presence complicates both the collection and interpretation of data, and has special impact on the preparation of projections." The authors discuss possible ways of resolving these problems.

Americas↗
PubMed1978

PREFABRICATION DESIGN CONSIDERATIONS FOR A LONG-TERM ELECTRICALLY-ACTUATED ABDOMINAL LEFT VENTRICULAR ASSIST DEVICE (E-TYPE ALVAD).

The conceptual design and development of a long-term, low-profile intracorporeal left ventricular assist device is a multifaceted project involving a series of technical, anatomic and physiologic considerations. Patients with severe left ventricular failure refractory to all other forms of therapy could benefit from such a device. Prior to fabrication of such a blood pump, consideration must be given to physiologic parameters of the projected patient population. The pump must be designed to meet physiologic demands and yet conform to the anatomic constraints posed by the patient population. We measured the body surface area (BSA) of a group of patients (n=50) and found the mean BSA for this group to be 1.804 +/- 0.161 m(2). Using 25 ml/m(2) as a stroke volume index indicative of left ventricular failure and a stroke volume index of 45 ml/m(2) as normal, distributions of stroke volumes (normal and in left ventricular failure) were plotted for a potential population and demonstrated that 63% of the projected population can be returned to normal by a pump with a stroke volume >/= 83 ml. Cadaver fitting studies established that 73% of the potential population can accommodate an ALVAD 10.8 cm in diameter. In-vitro tests demonstrated that a pump stroke volume >/= 83 ml could be achieved by the proposed pump with a 15 mmHg filling pressure at rates up to 125 B/min. A pusher-plate stroke of 0.56 inches would be necessary to provide a stroke volume >/= 83 ml. The percent of the patient population that could be served was determined by excluding those in whom the pump would not fit or in whom it would provide less than a normal resting stroke volume. Approximately 73% of the projected patient population would accommodate this pump and be returned to normal circulatory dynamics.

Journal Article↗
PubMed1984

Projecting Australia's aged population: problems and implications.

Issues concerning the projection of Australia's population aged 60 years and over are examined. "The aims of this paper are to examine the extent to which projections made during the 1970s underestimated the growth of the aged population and, more particularly, to establish precisely what the demographic components of that under-projection were. Some of the implications of this analysis for planning provision of services for the aged are then explored."

Adult↗
PubMed1981

Proposed rehabilitation research or demonstration projects: estimating target population size.

In connection with developing a benefit-cost approach to evaluating proposed rehabilitation research or demonstration projects, the need to estimate the numerical size of the associated target population is explained and a process is described for making such estimates. The process consists of 7 steps: (1) delineating project objectives, (2) specifying target group(s) in operational terms, (3) determining whether satisfactory target population prevalence estimates are available, (4) in the absence of such estimates, identifying a critical parent population and establishing its prevalence, (5) identifying an accessible population, (6) enumerating the number and proportion of target group members in the accessible population, (7) calculating the estimated target population by multiplying data yielded in steps (4) and (6), adjusting for inferred biases and indicating uncertainties of estimation. Consideration is given to the kinds of data bases upon which this estimation process depends, to the feasibility of providing such estimates, and to their probable accuracy.

Cost-Benefit Analysis↗
PubMed1992

Projections of households and household populations by household size propensities.

"This paper describes a method for constructing projections of numbers of households of various types and the numbers of people in that structure. The method uses the concept of household size propensity.... Using data from the 1981 and 1986 Censuses and population projections to the year 2011, the method produces projections of Australian households and household populations by size of household for five-year intervals from 1991 to 2011."

Age Factors↗