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PubMed1996

Eye care for elderly Americans with diabetes mellitus. Failure to meet current guidelines.

PURPOSE: The purpose of the study is to understand current pattern of eye care use among people with diabetes. METHODS: Study population included 175,015 Medicare beneficiaries who had physician-diagnosed diabetes. The authors estimated overall rate of eye care visits among these beneficiaries in 1992 and 1993 using Medicare physician claims data. In combination of Area Resource File, the authors examined association of eye care use with demographic characteristics, regional socio-economic characteristics, and regional eye care provider supply. RESULTS: Fifty-three percent of the population had at least 1 eye care visit in a 1-year period and 67% in a 2-year period. Younger age (ages < 75 years), male gender, black race, high regional poverty, and fewer ophthalmologist supply were related to lower rate of eye care use. There was no association between eye care use and regional education level and optometrist supply. CONCLUSION: The findings suggest that a large portion of elderly people with diabetes is not obtaining the necessary eye care, especially blacks, men, and those residing in poor areas with fewer ophthalmologists.

Black or African American↗
PubMed2004

Performance characteristics and economic comparison of broiler chickens fed wheat- and triticale-based diets.

The effects of triticale and wheat on broiler (mixed sexes) performance and cost of production were compared. In experiment 1, wheat- and triticale-based diets were fed to 3 strains of broilers (Ross x Ross, Hubbard x Hubbard, and Ross x Hubbard). Each of the diets was provided to 5 cages/strain (n = 10 chicks/cage; 1,273 cm2/bird). Weekly BW, gain, feed consumption, and feed conversion ratio (FCR; g of feed/g of gain) were determined. At 42 d, 4 chicks/pen were shipped to a commercial processing plant. The plucked, eviscerated carcasses were evaluated for carcass traits. Overall, the triticale-fed birds had lower final BW and average daily gain and higher FCR. Eviscerated carcass, thigh, and drum weights were lower, but pectoralis minor as a percentage of carcass weight was greater in triticale-fed birds. In experiment 2, a wheat diet and a diet in which triticale was substituted (by weight) for wheat were provided in a 3-phase feeding program. Each diet was provided to 2 identically-equipped commercial barns housing 17,034 broilers each. Individual BW of a sample of birds were recorded in each barn at 0, 19, 34, and 42 d, corresponding to the beginning and end of each dietary phase. Feed consumption and FCR were calculated for each barn. An analysis of each of the diets was calculated using a broiler chicken production cost model. Final BW, feed consumption, carcass weight at processing, flock uniformity, percentage of Grade A carcasses, and percentage of condemned carcasses were not affected by cereal source. Overall FCR (2.165, 2.036; P = 0.0052), feed cost (dollars 0.617, dollars 0.577/kg live weight; P = 0.0260), and total cost of production (dollars 1.019, dollars 0.972/kg live weight; P = 0.0183) were greater for the triticale than wheat diets, respectively. Triticale would be an economically feasible replacement for wheat in broiler diets when its price is less than or equal to 95% of the cost of wheat, less dollars 18 (Canadian). Increased knowledge of the available nutrient profile of triticale, as well as least-cost feed formulation would likely increase the value of triticale relative to wheat for broilers.

Animal Nutritional Physiological Phenomena↗
PubMed2004

Effects of feeding strategy and age on live animal performance, carcass characteristics, and economics of short-term feeding programs for culled beef cows.

To evaluate production and economic effects of feeding management strategy and age on intensively managed culled beef cows, a study was conducted using 125 cows of British breeding blocked by age (Young = 3 and 4 yr olds; LowMid = 5 and 6 yr olds; HighMid = 7 and 8 yr olds; and Aged = 9 yr and older) and assigned to one of three steam-flaked corn based feeding strategies. Treatments were as follows: Conservative (CSV), 30% roughage throughout; Standard (STD), decrease roughage from 30 to 10% over 20 d; and Aggressive (AGR), decrease roughage from 30 to 10% over 10 d. There were four pens per treatment in a randomized complete block design. Cows were fed for a total of 54 d, and BW was measured on d 0, 14, 28, 42, and 54. Half the cows from each pen were randomly selected and slaughtered at a commercial abattoir, and carcass data were collected. Average daily gain, daily DMI, and G:F during each weigh period and across the entire feeding period were calculated. Over the 54-d feeding period, strategies that employed more energy-dense diets numerically increased ADG (1.28, 1.63, and 1.55 +/- 0.14 kg/d for CSV, STD, and AGR; P = 0.26) and decreased DMI (11.91, 10.74, and 10.89 +/- 0.27 kg/d for CSV, STD, and AGR; P = 0.05), such that G:F was lower for CSV than for STD or AGR (0.105, 0.150, and 0.141 +/- 0.010; P = 0.05). Carcass weight was least for the CSV strategy (298 kg) and greatest for STD (328 kg); AGR resulted in intermediate carcass weight (317 +/- 6 kg; P = 0.04). Total cost of gain was over 30% greater for CSV strategy than for STD or AGR strategies (P < 0.01). In many cases, block effects (age) had a greater effect on responses than treatments. Average daily gain, DMI, and G:F decreased linearly with age (P < 0.01). Hot carcass weight, dressing percent, and fat thickness decreased linearly with age (P < 0.03); yield grade decreased and carcass maturity attributes increased linearly with age (P < 0.02). Performance and intake differences resulted in linear increases in total cost of gain (P < 0.01) and breakeven price (P = 0.03) with increasing age. These data indicate advantages to more aggressive feeding management strategies for culled beef cows, although maximal intake may be achieved with higher-roughage diets. Despite management effects, an increase in market price above purchase price may be required for intensive feeding of culled beef cows to be a profitable enterprise.

Aging↗
PubMed2002

Current clinical characteristics and economic impact of subacute stent thrombosis.

Subacute stent thrombosis (SAT), while uncommon, continues to produce serious clinical consequences, including major myocardial infarction (MI) in 60 70% of cases, and short-term mortality rates of 20% or higher. A number of procedural and patient factors have been shown to predict the occurrence of SAT, including longer stent length, smaller minimum luminal diameter, persistent dissection, multivessel intervention, and possibly acute coronary syndrome (ACS) presentation. Despite substantial knowledge about the clinical and technical aspects of SAT, the economic impact of these events has not been previously reported. Methods. We retrospectively reviewed 26 cases of SAT that occurred at our institution from 1998-2000. Baseline clinical and procedural data, as well as clinical outcomes for the initial hospital admissions required to treat SAT, were obtained by record review. Direct health care costs for these admissions were calculated based on hospital billing data and measured resource utilization for catheterization laboratory procedures. Results. Most cases of SAT occurred in high-risk circumstances, including ACSs, multi-stent interventions, and treatment of 3.0 mm or smaller vessels. Most patients suffered significant MIs and were treated with repeat percutaneous coronary intervention. The median time to SAT was 3.5 days, with 58% of events occurring on an outpatient basis. Median total hospital costs were $11,100 per patient, with more than half of the costs generated by the catheterization laboratory and pharmacy. Conclusions. Despite its low overall frequency, the clinical and economic costs of SAT are substantial. Specific strategies at preventing its occurrence are warranted, particularly in high-risk situations.

Aged↗
PubMed2006

Tobacco use and cardiovascular disease: a knowledge, attitude and practice study in rural Kerala.

BACKGROUND: Tobacco consumption, either in smokeless form or as smoking, is reported to be responsible for major non-communicable diseases, namely, cardiovascular diseases, chronic obstructive pulmonary diseases and cancers. Whatsoever control strategy is being used, the community participation is of utmost importance, which will depend largely on the level of the knowledge in the community. AIM: To assess the knowledge and attitude of a rural community towards the harmful effects of tobacco use. SETTING AND DESIGN: Venganoor Gram Panchayat of Thiruvananthapuram district of Kerala; cross-sectional study. MATERIALS AND METHODS: Interview schedule was used to collect the information on pre-designed and pre-tested proforma. The information recorded, included the demographic characteristics and socio-economic characteristics. The awareness regarding tobacco use and the attitude towards its non-usage was done, by putting forward, open and closed-ended questions. STATISTICAL ANALYSIS: Percentages and proportions; t-test; chi-square test. RESULTS: The present study included 302 (64.7%) females and 165 (35.3%) males. Among the males, 44 (38.5%) were ever smokers. Though 451 (96.6%) of the subjects knew that tobacco use is harmful for health, only 101 (22.5%) of the subjects knew that it causes cardiovascular diseases. Electronic and print media were the common source of such knowledge being reported by 265 (58.7%) and 202 (44.7%) subjects, respectively. CONCLUSIONS: The subjects were aware about the harmful effects of tobacco use. However, more efforts are needed to make them aware about the role of tobacco smoking and chewing, in causing cardiac problems.

Adolescent↗
PubMed2006

[The acerola fruit: composition, productive characteristics and economic importance].

The acerola (Malpighia emarginata Sessé y Mociño ex DC) is a wild plant grown in zones of tropical and subtropical climate. Acerola is origin from South of Mexico, Central America and Septentrional area of South America. Its scientific name was adopted in 1986 by the International Council of Vegetable Genetic Resources. Malpighia emarginata has a subglobulose drupa fruit with three seeds which account between the 19 - 25% of the total weight. The diameter and weight of the fruit varies between 1 - 4 cm and 2 - 15 g, respectively. The fruit shows green color when it is developing, which changes to yellow and red tones when it is mature. Each plant produces annually 20 - 30 kg of fruits. This fruit contents macro and micronutrients: proteins (0.21-0.80 g/100 g), fats (0.23-0.80 g/100 g), carbohydrates (3.6-7.80 g/100 g), mineral salts (iron 0.24, calcium 11.7, phosphorus 17.1 mg/100 g) and vitamins (thiamine 0.02, riboflavine 0.07, piridoxine 8.7 mg/100 g). Its high content in vitamin C (695 a 4827 mg/100 g) is remarkable, therefore acerola has an increasing economic value by its great consume during last years. Acerola also presents carotenoids and bioflavonoids which provide important nutritive value and its potential use as antioxidant. Brazil has a climate and soil appropriate for the culture of acerola, thus this country is the main mundial productor. Acerola is commercialised as juices, jams, ices, gelatins, sweets or liquors. Bibliographical data have been mainly supplied by Electronic Resources of the University of Seville and the University do Vale do Itajaí (Santa Catarina, Brazil).

Antioxidants↗
PubMed1995

Socio-economic client characteristics and consequences of abortion in Nairobi.

In Nairobi, 281 women presenting with alleged miscarriage were subdivided in the following subgroups, 91 spontaneous abortions (group 1), 152 suspected induced abortions (group 2) and 38 admittedly induced abortions (group 3). In the statistical analysis women in group 1 were compared with women from groups 2 and 3 combined (here referred to as group 4). Group 4 differed significantly from group 1 in the following respects: they were younger (p = 0.03) although they had previously born more babies (p = 0.008), lived more often together with their parents (p = 0.024), were less often married (p = 0.000012), worked more often as housewives (p = 0.00079), and lived in bigger households (p = 0.000015). No significant differences were encountered regarding religious beliefs. Group 4 women were more informed about contraceptives than group 1 (p = 0.04), particularly regarding injectables (p = 0.000096) and oral contraceptives (p = 0.0013) but also intra uterine devices (p = 0.024). Almost 90% of group 4 women indicated post abortion contraceptive interest, while only 1/3 of group 1 women did so. Group 3 women needed extensive parenteral treatment with a total hospital treatment cost amounting to 300 times that of group 1. The total cost of intravenous infusions was almost 10 times as high in group 3 as in group 1. The total number of days in hospital was significantly higher in group 4 than in group 1 (p = 0.0098).(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Illegal↗
PubMed2004

Malaria incidence in rural Benin: does economics matter in endemic area?

Malaria represents a major health problem with over 1 million annual deaths in Africa alone. There are a limited number of policies tackling the health problems of people at greater risk, namely the poor and rural communities. This is partly due to the lack of evidence available on the range of factors affecting their health status. Despite endemic malarial situations, there is still little understanding of the relative importance of economic factors that contribute to people acquiring malaria. This paper examines the socio-economic and economic factors that affect the incidence of malaria in rural community households in Benin, where malaria is endemic. A sample of 1585 households was determined to collect information on socio-economic characteristics and the presence of malaria symptoms. Probit estimation techniques were used to assess the impact of socio-demographic and socio-economic factors on the incidence of malaria, comparing households with and without malaria patients. Predisposing characteristics of the household head such as age, knowledge of malaria, education and the size of the household significantly affect the incidence of malaria as anticipated by economic theory. Enabling factors reflecting higher economic status, measured by monthly expenditure and a socio-economic index, have a statistically significant and positive impact on the incidence of malaria. This could reflect that better-off have improved case reporting and are likely to seek treatment. Variations in socio-economic and economic characteristics are significant in explaining the incidence of malaria, even in an endemic malarial setting.

Adolescent↗
PubMed2005

A simultaneous analysis of neighbourhood and childhood socio-economic environment with self-assessed health and health-related behaviours.

Childhood socio-economic environment and neighbourhood socio-economic environment later in life are closely related. However, few studies have considered their effects simultaneously. Using cross-sectional data of approximately 8000 respondents in 86 neighbourhoods in the city of Eindhoven, The Netherlands, we study associations of both determinants with self-assessed health, smoking, alcohol consumption and overweight. Growing up in a low socio-economic environment increased the probability to live a more deprived neighbourhood in adulthood. Controlling for individual socio-economic characteristics, both childhood and neighbourhood socio-economic environment were related to smoking and overweight, but not with excessive alcohol consumption. Associations between childhood socio-economic environment and smoking and overweight are still substantial after controlling for neighbourhood socio-economic environment. Similarly, neighbourhood inequalities in smoking and overweight remain substantial after controlling for childhood socio-economic environment.

Adult↗
PubMed2003

Comparison of road crashes incidence and severity between some French counties.

Our aim is to compare traffic safety among several counties in France, and explore whether observed differences can be explained by differences in road types distribution and by differences in socio-economic characteristics between counties. Traffic safety is measured by incidence and severity, where incidence is defined by the ratio of counts of injury accidents and exposure, measured by the amount of kilometres driven. Severity is measured by the ratio between fatal and injury accidents. These indexes are analysed in the framework of Generalised Linear Models: counts of injury accidents are analysed with a Negative Binomial regression, which accounts for over-dispersion. Severity being the proportion of fatal accidents among injury accidents corresponds to the probability of a Binomial setting and this is modelled by a logistic regression. This modelling provides an easy way to adjust for covariates such as road type, environment (urban/rural) and evolution over time, and to test their possible interactions. We find that the time trend of each indice (incidence and severity) is the same across counties and across road types. There is a significant interaction between county and road type, meaning that, first, differences in traffic safety between counties are not fully explained by different road type distributions, and second, that the "ranking" of counties in term of incidence or severity varies according to the road type considered, and vice-versa. It was planned to explore global characteristics of the counties (driving and socio-economic data) as possible explanatory factors of differences between counties, but the existence of an interaction of county with road types shows the necessity of collecting and exploring characteristics of the sub-levels of road type within county.

Accidents, Traffic↗
PubMed2004

Utilization of maternal care in rural HeBei Province, the People's Republic of China: individual and structural characteristics.

PURPOSE: To study the effect of individual's socio-economic characteristics and the structure of the health services in the village on utilization of maternal care in rural HeBei, the People's Republic of China (PRC). DATA: Data were collected from 4273 women who gave birth to one child at least, living in a stratified sample of 288 villages in HeBei Province. FINDINGS: 54.8% of the women had at least one pre-natal care visit, 27.5% gave birth in a health care facility, and 18.1% had post-natal check-up. Utilization was inversely related to age and parity and positively to education. Occupation was related to use of pre- and post-natal services, but not to home birth. Per-capita income and living arrangement are not related to utilization. MCH worker in the village promote pre- and post-natal care, but also home delivery. Village doctors promote pre-natal care and hospital delivery but do not promote post-natal check-up. Women tend to avoid the maternal services in the township health centers but some are ready to travel to city hospitals for delivery and post-natal care. CONCLUSIONS: Health education programs regarding the importance of all three maternal care services are clearly needed. These programs should address not only women of child bearing age but also care providers, MCH workers in particular. Township health center should reach-out and motivate women to use their accessible services.

China↗
PubMed1985

Characteristics of rural communities and the changing geographic distribution of physicians.

This research paper presents the results of a comparison of the characteristics of rural counties which attracted and failed to attract young physicians during the past decade. The data utilized in this research were from the Area Resource File which contains data on physicians for 1975 and 1979 and which permitted the examination of flows of physicians in counties over this period. Characteristics of rural counties examined included demographic and economic characteristics, population density, physical characteristics, health status measures, and the availability of health resources. Results from this preliminary analysis indicate that counties with at least 25,000 population were more likely to have gained a young physician and that, of all counties which added young physicians, the majority gained only one or two. Characteristics which best distinguished counties gained or lost physicians included population and population growth rate, health resources, growth rate of per capita income, and the proportion of the population agriculture.

Catchment Area, Health↗
PubMed1996

[Characteristics of the Gypsy population].

"The study sums up the number and socio-economic characteristics of [the] gipsy population in Hungary. The history of gipsy surveys, dating back more than one hundred years, is reviewed.... The present situation is described drawing on the 1990 population census and the data of a special gipsy survey carried out in 1993. In the course of their analysis the authors discuss in detail the demographic characteristics, regional structure, labour market position, household budget situation, and housing conditions of gipsies." (SUMMARY IN ENG)

Culture↗
PubMed1998

Brain injury as a result of violence: preliminary findings from the traumatic brain injury model systems.

OBJECTIVES: To identify possible risk factors that may predispose individuals to violent traumatic brain injury (TBI) and to determine the effect of etiology of injury on outcomes. STUDY DESIGN: Prospective, longitudinal multicenter study. SETTING: TBI Model Systems (TBIMS) located at Wayne State University/Rehabilitation Institute of Michigan, Detroit, MI; The Institute for Rehabilitation and Research, Houston, TX; Medical College of Virginia, Richmond, VA; and Santa Clara Valley Medical Center, San Jose, CA. SUBJECTS: Individuals treated in the four TBIMS programs between 3/89 and 9/96 who met the criteria for inclusion in the TBIMS National Database and for whom the etiology was known (n=812). MAIN OUTCOME MEASURES: Functional Independence Measure, Alcohol Quantity Frequency Variability Index, Community Integration Questionnaire. RESULTS: Individuals who incur violence-related TBI tend to be male, nonwhite, unmarried, living alone, less educated, and unemployed at time of injury. They tend to have less severe brain injuries and better motor function at the time of admission to inpatient rehabilitation. At 1 year postinjury, they score lower on community integration measures; however, no difference exists in functional status. Etiology of injury was found to only play a minor role in the prediction of social and productive integration at 1 year postinjury. CONCLUSIONS: Survivors of violent and nonviolent TBI have similar functional outcomes; however, they differ in preinjury and postinjury socio-economic characteristics, injury severity, and postinjury community integration. Socio-economic factors appear to play a large role in the risk for violent injury and in community integration following injury.

Activities of Daily Living↗
PubMed1997

Informing prescribing allocations at district level in England.

OBJECTIVES: To derive a predictive model based on the morbidity, demographic and socio-economic characteristics of district populations to explain variations in prescribing costs in England. METHOD: Inter-relations between morbidity, demographic, socio-economic, general practice supply characteristics and net ingredient cost per age, sex and temporary resident originated prescribing unit (ASTRO-PU) were explored statistically for 90 districts in England using 1994 cost data. The possibility of mutual inter-relationship between 'supply' and 'demand' was examined; then the associations between a range of factors and prescribing costs were estimated using ordinary least squares regression and the predictive power of the possible models was systematically examined. RESULTS: Whilst there was a relatively weak relationship between the supply factors that were measured, there did not appear to be any reciprocal relationship. Three parsimonious models estimated using ordinary least squares multiple regression techniques based on combinations of permanent sickness, low birth weight and the proportion of general practitioners registered for postgraduate certificate of education were identified. The models explained up to 61% of variation between districts in prescribing costs. CONCLUSIONS: 'Need' and 'supply' characteristics are independently associated with variations in prescribing costs at district level. The negative association between the proportion of general practitioners eligible for postgraduate education allowance and prescribing costs may reflect 'better' prescribing but could not be introduced into a resource allocation formula without introducing perverse incentives. The combination of permanent sickness and low birth weight complement each other by providing a proxy measure of morbidity mostly applicable to adult males (permanent sickness) and mothers (low birth weight being a measure of maternal health). These variables should be considered further for use in the process of allocating resources for prescribing to districts.

Cost Allocation↗
PubMed1994

[Economic welfare of Canadian children: changes and implications for social policy].

"This study recommends courses of action within the scope of social policy revision in Canada, aiming to increase funding for children. These recommendations stem from a critical review of guaranteed income programmes and an analysis of the actual economic welfare of children. The authors describe the evolution of the nature of the family in Canada over the past twenty years and of the economic status of children. Their assessments are based on an analysis of cross-sectional micro-level data on income and socio-economic characteristics drawn from a very large sample of Canadian families." (SUMMARY IN ENG AND SPA)

Adolescent↗