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PubMed2005

The feasibility and acceptability of a specialist health and social care team for the promotion of health and independence in 'at risk' older adults.

Population ageing, escalating costs in pensions, health-care and long-term care have prompted a new policy agenda for active ageing and quality of life in old age across the European Union and other developed countries. In England, the National Service Framework for Older People (NSF OP) explicitly demands for the first time that the NHS and local authorities, in partnership, agree programmes to promote health ageing and to prevent disease in older people. These programmes are expected to improve access for older people to mainstream health promotion services and also to develop multiagency initiatives to promote health, independence and well-being in old age. This paper describes the evaluation of one interagency project team established to test out mechanisms for addressing health promotion for older people through primary care. A mixed methodology was used to understand the processes of service development, the impact of the team's intervention, and the primary and secondary outcomes for older people. The project demonstrated that multi-agency partnerships have the potential to improve the quality of the lives of older people deemed 'at risk' by their general practitioners, particularly through income generation but also in the identification of medical problems such as unrecognised hypertension, hearing loss and visual loss. It also offered some key learning points for other multi-agency groups developing similar services.

Activities of Daily Living↗

PubMed2004

Waste management in Guangdong cities: the waste management literacy and waste reduction preferences of domestic waste generators.

A questionnaire survey was conducted in 2002 on 1365 households in two prefectural-level cities in the Pearl River Delta, Jiangmen and Zhongshan. Three groups of issues are covered in this paper: 1) waste management literacy, concerns, and public participation; 2) waste recycling practices and the potential for waste avoidance; and 3) public environmental literacy. This study confirms findings from previous surveys and provides new information on important issues such as imposing monetary charges on waste and environmental activities, littering, source separation programs (SSPs), and public participation and expectations in local waste management. Saving up recyclable materials for redemption in waste depots is commonly practiced in mainland China regardless of the level of development of a city, although at the household level, high-income families tend to place less value on the revenues to be gained from redemption than lower income groups do. Data from the previous and the present studies indicate that such voluntary but largely economically driven waste recovery behavior diverts at least 10% of the household waste from the waste stream. Although uncompensated SSP is less appealing in the two cities than compensated SSP, it was found that when the median per capita income of a city reaches RMB2000 per month, a high participation rate for uncompensated waste recovery is more likely to occur. Education and income levels are the chief factors affecting littering behavior and the potential for waste avoidance. Contrary to general belief, the local Chinese community is active in microwaste management. The concern, however, is over the inability of the grassroots bureaucracy to deal with rising expectations for waste collection services and neighborhood cleanliness.

Adolescent↗

PubMed1989

A geriatric program in practice.

The geriatric patient represents an underutilized resource for the small animal practitioner. Thorough examination of the pet annually in detail allows detecting problems before they are too advanced. By using the systems approach to patient evaluation, one is better able to detect diseases and proceed with techniques to diagnose them. The use of in-house hematology and serum chemistry equipment benefits the pet and owner through rapid return of information and provides an added source of revenue for the practitioner. Developing and maintaining a system to reevaluate the geriatric patient is one of the most important aspects of a geriatric practice. Reminding clients that you care about their pet through routine scheduled evaluations develops loyal clients, which in turn generates additional hospital income.

Aging↗

PubMed1995

Economic viability of a model rural family practice.

BACKGROUND AND OBJECTIVES: A model rural clinic was established by the Quincy Family Practice Residency Program with the financial support of sponsoring local hospitals. The purpose of the study was 1) to determine the financial viability of such a model practice and 2) to determine the practice's financial effect on the sponsoring hospitals. METHODS: The rural practice was established in a medically underserved area 30 miles from the sponsoring hospitals. A cost analysis of months 7-18 of operation was performed, including an analysis of charges generated at the sponsoring hospitals. Theoretical models of practice to enhance economic viability were explored. RESULTS: The 3,051 office visits fell short of expectations. These visits generated a net practice income of $18,596. Had the practice sought full payment for these visits instead of accepting Medicare assignments, the net income potential would have been $39,182. Growth of the practice until it reached the average size of a typical rural family practice (6,000 annual visits) would produce a net income of $67,113 with Medicare assignments and $103,578 if Medicare assignments were not accepted. Had the practice been a federally designated rural health clinic, a mid-level practitioner with physician supervision could have generated a net practice income of $53,640 for 3,051 visits or $138,863 for 6,000 visits. Referrals from the model clinic for laboratory work, radiology, and hospital admissions generated $9.17 in charges for the sponsoring hospitals for each dollar charged by the clinic. CONCLUSIONS: The financial viability of rural practices is adversely affected by the Medicare reimbursement system. Our model clinic had a positive economic effect on the sponsoring hospitals, suggesting that innovative collaborative sponsorship of such clinics may be mutually beneficial.

Costs and Cost Analysis↗

PubMed1993

Assessing the implementation of physician-payment reform.

BACKGROUND: The Medicare program fundamentally changed its system of payment for physicians' services in 1992. Controversy over the new Medicare fee schedule has focused on three issues: the adequacy of the conversion factor used to translate resource-based relative-value units into fees; the ability of the new payment system to capture differences in work between surgeons and physicians in other specialties; and the allocation of practice expenses across services. METHODS: Using a standard service in each specialty, we developed simulation methods to assess the implementation of physician-payment reform. With these methods we calculated the potential net income for each specialty, as generated by different payment scenarios, including the Medicare fee schedule. RESULTS: We found that Medicare's current monetary-conversion factor yields an unreasonably low level of income for most specialties. Furthermore, the Medicare fee schedule misallocates practice expenses; invasive services are reimbursed for more than actual expenses, and medical services are reimbursed for less. Thus, physicians continue to be paid more generously for invasive services. Finally, the Medicare fee schedule does recognize the wide differences in the intensity of work performed by physicians in various specialties. CONCLUSIONS: The misallocation of practice expenses in the Medicare fee schedule results in serious underpayment for medical services. We think it likely that physicians compensate by performing more lucrative services, such as diagnostic tests. Even if legislation is passed to deal with the misallocation of expenses, the current conversion factor still produces unreasonably low levels of payment overall, which could dissuade those considering a career in medicine from entering the field. Finally, the simulation method we developed can be used as a tool for fee negotiations.

Economics, Medical↗

PubMed1999

Can Medicare survive its saviors?

It is now an open question whether Medicare will provide adequate health coverage to the baby-boom generation as it begins turning 65 just over a decade from now. The source of uncertainty is not whether America has the resources to sustain the program; we do. The real challenge comes instead from proposals to save Medicare. Far from preserving its benefits, the major restructuring proposals under discussion would radically alter the principles on which Medicare rests and erode the protection it affords.

Aged↗

PubMed1997

An integration programme of poverty alleviation and development with family planning.

The State Council (the central government) recently issued a Circular for Speeding Up the Integration of Poverty Alleviation and Development with the Family Planning Programme during the Ninth Five-year Plan (1996-2000). The Circular was jointly submitted by the State Family Planning Commission and the Leading Group for Poverty Alleviation and Development. The document sets the two major tasks as solving the basic needs for food and clothing of the rural destitute and the control of over-rapid growth of China's population. Practice indicates that a close Integration Programme is the best way for impoverished farmers to alleviate poverty and become better-off. Overpopulation and low educational attainments and poor health quality of population in backward areas are the major factors retarding socioeconomic development. Therefore, it is inevitable to integrate poverty alleviation with family planning. It is a path with Chinese characteristics for a balanced population and sustainable socioeconomic development. The targets of the Integration Programme are as follows: The first is that preferential policies should be worked out to guarantee family planning acceptors, especially households with an only daughter or two daughters, are the first to be helped to eradicate poverty and become well-off. They should become good examples for other rural poor in practicing fewer but healthier births, and generating family income. The second target is that the population plans for the poor counties identified by the central government and provincial governments must be fulfilled. This should contribute to breaking the vicious circle of poverty leading to more children, in turn generating more poverty. The circular demands that more efforts should focus on the training of cadres for the Integrated Programme and on services for poor family planning acceptors.

Asia↗

PubMedDate not supplied

Personal income and finances: regional comparisons.

As the "baby boom" generation moves closer to retirement and Social Security and Medicare face potential problems, the financial condition of U.S. households and families has become a much discussed topic. The personal saving habits, wealth and debt burden of society have been intensely analyzed in order to gauge the future impacts on the economy. This article views personal income growth from a regional perspective, pointing to the vastly differing outcomes of total and per capita data. The importance of regional differences in cost of living and taxation and the possible impacts on personal finances are highlighted. A review and debate on the broad brush approach of many federal programs is suggested.

Economics↗

PubMed2026

Berberine shows potential in mitigating PM2.5-induced breast cancer progression by inducing DNA damage and inhibiting error-prone DNA repair pathways.

Breast cancer remains the most common cancer among women, with 2.3 million new cases reported globally in 2022. Alongside established risk factors such as age, family history, genetics, obesity, smoking, and alcohol, exposure to fine particulate matter (PM2.5) has recently emerged as an environmental contributor. This risk is especially concerning for low- and middle-income countries (LMICs), where both PM2.5 exposure and cancer burden are disproportionately high; however, mechanistic studies from these regions remain limited. To address this gap and develop mitigation strategies, we investigated the oncogenic potential of water-soluble PM2.5 collected from ambient air on breast cancer and evaluated the potential role of nutraceuticals in mitigating these effects. PM2.5 exposure increased proliferation, migration, and ROS generation, while promoting the formation of multinucleated giant cells, leading to genomic instability. Berberine, a natural alkaloid, countered these effects by increasing DNA damage and exploiting tumor-specific genomic vulnerabilities through disruption of DNA damage response and repair networks, thereby promoting programmed cell death. Transcriptomic profiling of Delhi PM2.5-treated MCF7 cells revealed a Delhi PM2.5-associated carcinogenic gene signature enriched in MAPK signalling, reactive oxygen species, metabolic, lysosomal, and ribosomal pathways. We also found that several genes, including BIRC5, WSB1, and RCC1, within this PM2.5-induced gene signature were dysregulated in breast cancer patients and were inversely regulated by berberine treatment, suggesting that berberine counteracts the transcriptional effects of PM2.5. Our findings highlight ambient PM2.5 exposure as a driver of breast cancer progression and identify berberine as a promising candidate in mitigating PM2.5 effects; however, thorough preclinical and clinical validations are warranted.

Berberine↗

PubMed2002

A case-control study of dietary phytoestrogens and testicular cancer risk.

A few dietary studies have found elevated testicular cancer risks for higher red meat, fat, and milk intakes and lower intakes of fruits, vegetables, and fiber. Because hormonal modulation by dietary intake of plant estrogens could affect risk of testicular cancer, we chose to explore the possible relationship between dietary phytoestrogens and testicular cancer. We conducted a hospital-based case-control study of 159 testicular cancer cases diagnosed between 1990 and 1996 and 136 adult friend-matched controls at the University of Texas M. D. Anderson Cancer Center. Amounts of phytoestrogenic compounds in foods were added to the National Cancer Institute's DietSys program and then grouped into prelignans, lignans, flavonoids, isoflavonoids, phytosterols, and coumestrol for statistical analysis, expressed per 1,000 kcal. The results of multivariate logistic regression analysis showed, after adjustment for age, education, income, ethnicity, cryptorchidism, body mass index, baldness unrelated to therapy, severe acne in adolescence, early puberty, daily fiber and fat intake, and total daily calories, no discernable monotonic increased or decreased risk estimates across quartiles of phytoestrogen intake. A U-shaped pattern was observed for lignans and coumestrol. Further evaluation of this pattern by cubic spline parameterization did fit the data, but the data were also consistent with no effect. This hypothesis-generating study does not support the premise that dietary phytoestrogens increase or decrease testicular cancer risk in young men.

Adolescent↗

PubMed1992

Financial analysis of a family practice residency threatened with closure.

Family practice residency programs often find themselves needing to fiscally justify their existence to their sponsoring institutions. One such program in a community hospital was threatened with closure, to be replaced by salaried and/or fee-for-service physicians. We present an applied research methodology for comparing the residency budget and revenues with that of a replacement delivery system with no educational mission. The total expenses for nonresidency physicians were projected to be from 10.5% to 25.1% less than the residency budget. Revenues generated by nonresidency physicians were projected to be from 29.4% to 37.6% less than those of the residency, primarily due to the loss of grants and graduate medical education reimbursement through the Medicare program. Proposed reductions in grants and graduate medical education reimbursement threaten the budget/revenue balance of this and other family practice residency programs.

Budgets↗

PubMed1990

Population ageing, retirement policy and living conditions of the elderly in China.

The authors discuss economic and social aspects of the predicted rapid aging of China's population. They conclude that "its economic impact will depend on the outcome of the birth control campaign in rural areas...and on the pace of transition towards the nuclear family. In view of the very primitive nature of the retirement and health insurance systems, a rapid breakdown of family structures would constitute a major threat to the welfare of the elderly. Excepting certain middle- or upper-class pensioners in large cities, the standard of living of the elderly population remains very low and, due to the co-residence of generations, it is closely linked to trends in average income."

Adult↗

PubMed1984

Population age structure and the size of social security.

"This paper uses a general overlapping generations model to analyze social security. Rather than focusing on intertemporal price and income considerations, however, the paper focuses on the effect of contemporaneous (same period) prices and income. The analysis shows that the old-age dependency ratio acts as a shadow price for old-age benefits. With this new shadow price, the equilibrium price and quantity of social security benefits and the level of the payroll tax rate are determined in a demand-supply framework with individual utility maximization. Three explicit demand functions (intergenerational contracts) are analyzed. The model is tested using [U.S.] time series data for the social security Old-Age and Survivors (OASI) program."

Adult↗

PubMed2005

Obstetricians, gynecologists and the anti-smoking campaign: a national survey.

OBJECTIVE: To asses the role Jordanian obstetricians and gynecologists play as tobacco cessation counsellors through examining their smoking status, opinions on health risks, factors that influence tobacco use and their perceived barriers to providing effective counselling. STUDY DESIGN: The setting is a tertiary referral university hospital. A pre-tested postal questionnaire survey was mailed to all 462 licensed obstetricians and gynecologists in Jordan. Descriptive statistics were generated and statistical significance was determined by the chi2-test. RESULTS: Of 392 respondents, 37.9% were smokers. Most associated smoking with low birth weight and sudden infant death syndrome. Fewer associated smoking with infertility, ectopic pregnancy, placenta praevia, abruptio placentae and cancer of the uterine cervix. Friends, stress, parents' attitude, genetic predisposition, income and education were implicated factors for smoking. Current smokers were more likely to permit smoking in their practices. Non-smokers were most inclined to record their patients' tobacco habits. Only 54.3% provided cessation counselling. Lack of time and inadequate training were perceived barriers. CONCLUSIONS: A high proportion of obstetricians and gynecologists are smokers. A training program is needed to equip health workers with the skills necessary for the implementation of a successful anti-smoking campaign.

Adult↗

PubMed1989

The medical school--where does it go from here?

Two developments profoundly modified the single mission of U.S. medical schools to educate physicians: the decision of the federal government to develop federal research programs within the nation's universities rather than in separate research institutes; and the entry of the federal government into the purchase of health services through the Medicare and Medicaid programs. The presence of biomedical research in the schools has created dilemmas for educators and administrators. The schools need to deploy large amounts of capital for research, they find a decreasing relevance of new research knowledge to medical practice, and they see a great need to increase interdepartmental collaboration. These factors create a new kind of tension that may make the medical school of the next generation less attractive as the exclusive institution in which biomedical research is conducted within the university. At the same time, cuts in federal funding for health services have caused medical schools to organize their faculties into practice plans. If the plans feel cuts in income because of federal reimbursement mandates, there will probably be controversy among faculty members about the plans' continuing contributions to the schools. A hypothetical scenario illustrates the plight of a medical school faced with a significant reduction in funds to support health services.

Education, Medical↗

PubMed1977

Further evidence on the relative performance of proprietary and nonprofit hospitals.

Proposed implementation of health systems agencies (HSA) gives potentially large roles to consurers and local government officials. The paper argues that there will be a tendency for HSAs to discriminate against proprietary hospitals. It is important, therefore, to have information on whether proprietaries belong in an efficient hospital system. The paper discusses and extends the empirical evidence on the relative dynamic efficiency of proprietary and nonprofit hospitals in responding to changes in the economic environment. It is shown that the models used by Lave and Lave and by Steinwald and Neuhauser to generate empirical evidence can give different policy recommendations depending on the relative size of the proprietary and nonprofit bed stocks. An alternative model is devised which produces unambiguous policy recommendations. The empirical model is applied to four six-year cross sections for the years 1954-1971. Some of the conclusions reached are 1) that proprietary bed stocks are proportionally more responsive than nonprofit stocks to population changes, 2) that the nonprofit stocks show a larger absolute response, and 3) that income growth is not strongly associated with conversion to nonprofit status. A more complex model is estimated including some variables to capture the effect of the Hill-Burton program. The 1964 program shift away from a rural emphasis is expected to show in the growth pattern of hospital stocks. Analysis of the data, however, fails to show significantly different behavior before and after the shift. Based on the similarity of the regression equations, new equations are run on pooled data. The pooled regressions explain 90 per cent of the variation in nonprofit bed stock growth, but the explanation of proprietary behavior remains meager. Based on analysis of the pooled data, proprietaries responded positively to population growth while the nonprofit bed stock showed a negative association. An explanation is that the Hill-Burton program caused beds to be built where population was declining. Proprietary and nonprofit stocks grew with ability to pay and the proprietary stocks were proportionately more responsive. Both types of bed stocks showed an adjustment to bed shortages with the proportional responses being insignificantly different. Overall, it is concluded that proprietary bed stocks are more responsive to population changes and changes in ability to pay than nonprofit stocks. No numbers when the ability to pay increases. The lack of significantly different patterns before and after 1964 suggests that the shift in Hill-Burton emphasis made little or no difference in proportional bed stock changes. Short-run expansion of nonprofits in bed shortage areas was proportionally no greater than the expansion of the unsubsidized proprietaries. The central conclusion is that proprietary hospitals have a significant role in an efficient hospital system. Planning and regulating agencies must take care to guard the proprietary role against pressures inherent in their own structures...

Efficiency↗

PubMed2006

Socioeconomic gradients in clinical stage at presentation and survival among breast cancer patients in the Stockholm area 1977-1997.

A program to ensure an equivalent standard of care for all patients with breast cancer was initiated in the Stockholm area in the mid 1970s. As part of an evaluation of this program, social gradients in clinical stage at presentation and survival were analyzed among patients diagnosed during 1977 through 1997. The patients (n = 15,021) were selected from a database covering about 88% of all diagnosed breast cancer cases in the region. Putative associations were analyzed between clinical stage, survival and different socioeconomic indicators (level of education, income and occupation). There were significant social differences (p < 0.01) in distribution of clinical stage as well as in total and stage-specific survival. High income, more skilled work and a high level of education were all associated with clinically less advanced tumors and hence better survival. However, stage-specific survival differences were mostly generated by differences in nonbreast cancer mortality. The results indicate social inequalities regarding awareness of the disease and/or access to early detection. Social gradients in nonbreast cancer mortality were also found to influence observed survival. In contrast, we observed no significant social differences in stage-specific breast cancer mortality.

Adolescent↗

PubMed1994

Epidemiologic factors correlated with multiple sexual partners among women receiving prenatal care.

A cross-sectional survey methodology was used to respond to the need of a local health department to identify correlates of high-risk behaviors related to human immunodeficiency virus (HIV) transmission among pregnant women attending prenatal care clinics. This study of 488 maternity patients was conducted at two public health clients in Tampa, Florida, in 1991. The prevalence of high-risk behaviors was assessed using a self-administered questionnaire. Out of 428 respondents, 25% reported having had intercourse with two or more male partners in the past year. Following multiple logistic regression analysis, four variables remained consistently and significantly associated (P < 0.05) with having two or more sexual partners: (1) annual household income of less than $10,000/y (prevalence odds ratio (POR) = 4.5; 95% confidence limits (CL): 1.5, 13.1); (2) history of prostitution (POR = 8.1; 95% CL: 1.5, 42.1); (3) history of rape or forcible intercourse (POR = 2.2; 95% CL: 1.0, 4.6); and (4) an expressed desire for confidentiality among women seeking further information about acquired immunodeficiency syndrome (AIDS) prevention (POR = 2.1; 95% CL: 1.1, 4.0). Assessment of these factors may lead to better direction of HIV education programs, as well as identification and counseling of specific individuals at high risk for engaging in behaviors that can lead to HIV infection. Short, self-administered questionnaires provide confidential, rapid, and inexpensive means of generating baseline data for further interventions.

Acquired Immunodeficiency Syndrome↗