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PubMed2002

Health care for the elderly: two cases of technology diffusion.

Diffusion of medical technology and the growing proportion of elderly people in the population are generally regarded as major contributors to the increasing health care expenditure in the industrialised world. This study explores the importance of one specific factor in this process, the change in the use of technology among elderly patients. In some instances, a new technology is first used among younger patients and then gradually extended to the elderly. Two such cases are studied, both representing costly procedures: coronary bypass surgery (treatment of coronary heart disease) and dialysis (treatment of uraemia). In both cases, we demonstrate significant diffusion to older age groups. It is also tentatively concluded that the diffusion of technology could have an important effect on per capita health care expenditure among the oldest of the old.

Adolescent↗
PubMed2002

Why is less money spent on health care for the elderly than for the rest of the population? Health care rationing in German hospitals.

The consequences of population ageing for the public health care system and health care costs may be less severe than is commonly assumed. Hospital discharge data from Germany's largest health insurer (AOK) show that the cost of caring for patients during their last year of life makes up a large part of total health expenditures. And this last year of life is less costly if patients die at an advanced age. As a multivariate analysis reveals, oldest old patients as a rule receive less costly treatment than younger patients for the same illness. Moreover, this pattern is more pronounced for elderly women than for elderly men. These findings suggest that health care is informally rationed according to the age and sex of the patient. The data also indicate that there may be more age-related rationing going on in Germany than in the United States. Future research should investigate the national, institutional, and individual factors behind health care rationing. In this paper, I discuss the physician's professional decision as one plausible determinant.

Adult↗
PubMed2004

Effects of early health-insurance programs on European mortality and fertility trends.

In this study, we examined the mortality and fertility effects of the early health-insurance programs sponsored by several European governments in the course of the demographic transition. Three sets of effects were hypothesized, and tested with data for five countries, covering the 1875-1913 period. First, although initially small, the growing health-insurance coverage of national populations accelerated longer-term downtrends in mortality. It not only expanded access to health care, but also helped in disseminating health information and awareness. Second, widening coverage also had an opposite effect on fertility; by lowering the costs of bearing and rearing children, it acted to slow the ongoing downtrend in marital fertility. Third, there was a diverse set of interactions between the mortality and fertility effects. Improved prospects for the survival of infants and children weakened parents' motivation to produce "extra" offspring to offset losses to mortality and to insure against future losses. Child survival was further enhanced by longer intervals between births and fewer children per family. However, the reduced cost of children tended to dilute these antenatal effects. Our regression results supported the expected pattern of partial effects, but simulations were needed to gauge the total impacts of health-insurance. Two sets of simulations were conducted: first, historical simulations, which closely tracked the actual experience of each sample country; second, counterfactuals, in which health-insurance coverage was set at zero for the entire time period. Comparisons of the historical and counterfactual simulations clearly indicated that health-insurance accelerated the downtrend in mortality, but slightly retarded the secular decline in marital fertility. These effects varied in magnitude, but not in direction, among the sample countries.

Birth Rate↗
PubMed2000

Contributions of intrinsic motor neuron properties to the production of rhythmic motor output in the mammalian spinal cord.

Motor neurons are endowed with intrinsic and conditional membrane properties that may shape the final motor output. In the first half of this paper we present data on the contribution of I(h), a hyperpolarization-activated inward cation current, to phase-transition in motor neurons during rhythmic firing. Motor neurons were recorded intracellularly during locomotion induced with a mixture of N-methyl-D-aspartate (NMDA) and serotonin, after pharmacological blockade of I(h). I(h) was then replaced by using dynamic clamp, a computer program that allows artificial conductances to be inserted into real neurons. I(h) was simulated with biophysical parameters determined in voltage clamp experiments. The data showed that electronic replacement of the native I(h) caused a depolarization of the average membrane potential, a phase-advance of the locomotor drive potential, and increased motor neuron spiking. Introducing an artificial leak conductance could mimic all of these effects. The observed effects on phase-advance and firing, therefore, seem to be secondary to the tonic depolarization; i.e., I(h) acts as a tonic leak conductance during locomotion. In the second half of this paper we discuss recent data showing that the neonatal rat spinal cord can produce a stable motor rhythm in the absence of spike activity in premotor interneuronal networks. These coordinated motor neuron oscillations are dependent on NMDA-evoked pacemaker properties, which are synchronized across gap junctions. We discuss the functional relevance for such coordinated oscillations in immature and mature spinal motor systems.

Animals↗
PubMed1989

Fertility and child mortality in rural Ethiopia: Gondar and Hararge regions.

This paper presents fertility and child mortality estimates for agricultural households of the Gondar and Hararge regions, based on the 1981 Rural Demographic Survey. The study shows that fertility and child mortality are quite high in both regions as in the rest of the country. However, Hararge has significantly higher mean parity and child mortality than Gondar.

Adolescent↗
PubMed2025

Chromatin Regulatory Targets for Anticancer Therapeutics.

Chromatin serves to organize and compact the genome but also functions as a signaling hub for the dynamic regulation of transcriptional programs that control cell type specification. The historical discovery that several pro-differentiation anti-cancer agents target chromatin regulatory enzymes buoyed early interest in developing drugs that modulate chromatin structure and function. Chromatin-based drug discovery has since flourished alongside major advances in discovery chemistry and target selection, producing a rich collection of chemical probes, drugs, and drug candidates targeting chromatin regulatory processes. The substantial growth and maturity of this field over the last several decades provides an opportunity to reflect on the successes and failures associated with translating chromatin regulatory targets into anti-cancer drugs. Taking a target-centric perspective, we discuss the motivation for pursuing specific chromatin regulatory proteins and review the chemistries that enabled small molecule discovery and development. In so doing, we hope to evaluate the strength of these targets, the agents that prosecute them, and the prospects for future efforts in this field.

Humans↗
PubMed2002

"Primary" rationing of health services in ageing societies--a normative analysis.

While most of the debate on "rationing in health care" focusses on the distribution of scarce medical resources among competing needs, which we propose to call "secondary rationing," this paper is concerned with "primary rationing," i.e., the conscious decision by society to limit the amount of resources devoted to a collectively financed health care system. Based upon a number of transparent normative criteria, we analyze whether primary rationing should be performed and, if so, what type should be chosen (hard vs. soft, explicit vs. implicit). Finally we discuss whether age should be used as a criterion in any systematic attempt at primary rationing of health care.

Adult↗
PubMed2003

[Geriatrics: the day hospital as a part of comprehensive medical care of elderly patients--also or especially in threatened rationing].

The wrong conclusion of elderly people being the reason for increasing costs of public health is corrected by several differentiated statements. Geriatrics as a comprehensive medicine for the elderly can be realized in an exemplary way, even in a day hospital. An attitude of solidarity and a high level of interpersonal communication play the important and decisive part.

Aged↗
PubMed2003

Air flow and particle control with different ventilation systems in a classroom.

Most ventilation and air conditioning systems are designed without much concern about how settling particles behave in ventilation air flows. For displacement ventilation systems, designers normally assume that all pollutants follow the buoyant air flow into an upper zone, where they are evacuated. This is, however, not always true. Previous studies show that high concentrations of settling respirable particles can be found in the breathing zone, and that the exposure rates can be a health hazard to occupants. The emphasis here is on how ventilation systems should be designed to minimize respirable airborne particles in the breathing zone. The supply and exhaust conditions of the ventilation air flow are shown to play an important role in the control of air quality. Computer simulation programs of computational fluid dynamics (CFD) type are used. Particle concentrations, thermal conditions and modified ventilation system solutions are reported.

Air Movements↗
PubMed2026

Metabolites with a message: impacts on epigenetics and implications for epimetabopathies.

Once identified primarily as a bioenergetic organelle, the mitochondrion has now emerged as a pivotal signalling hub that communicates with the nucleus to shape cellular fate. It integrates the cell's metabolic state with transcriptional and epigenetic programs, tweaking gene expression. Mitochondrial metabolites serve as regulators of cellular physiology, functioning as important signalling intermediates and modulating enzymes involved in epigenetic modifications. In parallel, nuclear transcriptional programs govern mitochondrial biogenesis, dynamics and quality control to preserve metabolic homeostasis under stress. Moreover, circulating metabolites can function as systemic messengers coordinating interorgan crosstalk and immune responses. Perturbations in this dynamic reciprocity can rewire the cellular script and spiral into "epimetabopathies", where metabolic-epigenetic conflicts ignite pathological conditions. This review discusses how mitochondria-nucleus crosstalk coordinates genome surveillance, metabolite-driven epigenetic regulation and systemic metabolic signalling. It further offers an overview of epimetabopathies with potential implications for future diagnostics and therapeutics.

Humans↗
PubMed2000

Drug utilization and nutrition patterns among children from indigent and emigrant families in Crete, Greece.

AIM: To examine pharmaceutical needs, prescribed drugs, knowledge about pharmacotherapy and dietary patterns among indigent children. PATIENTS: 101 children (< or =18 y old), typically poor, from low-income families and emigrants coming back home from other countries, registered under Social Care in Chania, Crete. The control group comprised 81 Social Security insured children (< or =18 y old). The length of the study was from January 1995 to December 1997. RESULTS: The socio-demographic profile of the Social Care children reveals a no schooling rate of 9.7% vs 0% of the control group. The most common disease diagnosed in the indigent children was bronchitis (18.5%) compared with respiratory infection (14.6%) in the control group. Tuberculosis was diagnosed in 2.0% of the Social Care indigent children and in none of the insured children. The most frequently prescribed drug category in both groups as Defined Daily Doses (D.D.D.) was for the respiratory system (32.4% vs 21.2%), while antibiotics were the most expensive (41.6% in the indigent vs 54.9% in the control group). Only 27.4% of Social Care indigent patients, versus 51.2% of insured patients, understood the instructions regarding the proper use of their drugs. Regarding the dietary patterns, significant differences were found in the consumption of breakfast every day (73.7% vs 87.7%), red meat > or =4 per week (0% vs 6.3%) and fruits often (60.1% vs 75.0%). CONCLUSION: The present study emphasises the need for more information on drug use and the necessity for a continuing health educational intervention among indigent children.

Adolescent↗
PubMed2006

[Incidence of hip fracture in Germany--person-related analysis of health insurance population].

BACKGROUND AND PURPOSE: An increasing number of hip fractures were reported world wide during the last decades. Up to now incidence data are rare for Germany. The aim of this study is to determine actual person-related age- and sex-specific rates of hip fractures in Germany. METHODS: The linkable and person-specific but non-identifying database of a German statutory health insurance company, Gmuender ErsatzKasse (GEK), was used. All subjects who were admitted to hospital with a primary diagnosis of hip fracture (ICD-10: S72.0-S72.2) in 2004 were identified. Incidence rate ratios (IRR), age- and sex-specific rates (per 1000 person-years) were calculated. Annual numbers of hip fractures for all persons covered by statutory health insurances (Gesetzliche Krankenversicherung- GKV) and the German population were estimated. RESULTS: The incidence of hip fracture increases exponentially with age. Hip fractures occur 129 times more often (IRR: 129.07; 95 % CI: 66.55 - 269.78) in women aged 90 - 94 years and 79 times more often (IRR: 78.97; 95 % CI: 30.02 - 185.87) in men aged 90 - 94 years compared to those aged 50 - 54 years. Approximately 101 037 (95 % CI: 91 779 - 110 294) persons are annually admitted to hospital in Germany due to this event. CONCLUSION: Hip fractures are common in the elderly and especially in women. Because of demographic changes and a possible secular trend an increasing number of hip fractures are to be expected in the future.

Adolescent↗
PubMed1983

Changes in neuromuscular performance in voluntary and reflex contraction during strength training in man.

Eleven male subjects went through heavy resistance strength training 3 times a week for 16 weeks. The training program consisted mainly of dynamic exercise for the knee extensor muscles with loads of 80%-120% of one maximum repetition in the squat lift. The investigation was undertaken to examine effects of strength training on neuromuscular performance both in voluntary and reflex contractions with special interest in their possible relationships. In addition to a large (P less than 0.001) increase in maximal isometric force and a more (P less than 0.05) economical activation of the knee extensor muscles, significant (P less than 0.05) improvements were noted in isometric force-time parameters, which were related (P less than 0.05) to the increase in the fast-twitch/slow-twitch (FT/ST) muscle fiber area ratio. No changes were observed in reflex time components, but the relative change in reflex electromechanical delay (EMD) was related (P less than 0.05) to the relative change in the FT/ST area ratio. A significant (P less than 0.05) decrease in the peak-to-peak amplitude of the reflex electromyogram (EMG), was noted during the training, and a decrease (P less than 0.05) in reflex EMG/force ratio was related (P less than 0.02) to the change in maximal integrated electromyogram (iEMG)/force ratio of the voluntary contraction. The decrease of reflex EMG may indicate a change in sensitivity of the muscle spindle. The interrelationship between the changes in EMG/force ratios of the reflex and voluntary contractions suggests that the mechanical response of individual muscle fibers of the respective motor units has improved.

Electromyography↗
PubMed1998

The effects of self-administering emergency contraception.

BACKGROUND: Emergency postcoital contraception prevents pregnancy, but it must be prescribed by a doctor and taken within 72 hours of intercourse. It has been proposed that emergency contraception be made available without a prescription. We undertook a study to learn how women might behave if given a supply of emergency contraceptive pills to keep at home. METHODS: We assigned 553 women to be given a replaceable supply of hormonal emergency contraceptive pills to take home (the treatment group) and 530 women to use emergency contraception obtained by visiting a doctor (the control group). The frequency of use of emergency contraception, the use of other contraceptives, and the incidence of unwanted pregnancy were determined in both groups of women one year later. RESULTS: The results for 549 women in the treatment group and 522 women in the control group were available for analysis. Three hundred seventy-nine of the women in the treatment group (69 percent) and 326 of the women in the control group (62 percent) contributed detailed information at follow-up. One hundred eighty of the women in the treatment group (47 percent) used emergency contraception at least once. Among those who returned the study questionnaire, 98 percent used emergency contraception correctly. There were no serious adverse effects. Eighty-seven women in the control group (27 percent) used emergency contraception at least once (P<0.001 for the comparison with the treatment group). The women in the treatment group were not more likely to use emergency contraception repeatedly. Their use of other methods of contraception was no different from that of the women in the control group. There were 18 unintended pregnancies in the treatment group and 25 in the control group (relative risk, 0.7; 95 percent confidence interval, 0.4 to 1.2). CONCLUSIONS: Making emergency contraception more easily obtainable does no harm and may reduce the rate of unwanted pregnancies.

Adolescent↗