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PubMed1980

Migration, urbanization, resources and development.

The author adopts "Coale's scenario-building approach to focus on some of the demoeconomic consequences of rapid urbanization....[He describes] the construction and evolution of four alternative population scenarios and then [examines] the implications that these alternative trends in migration and fertility would have for Coale's three important population characteristics: the dependency burden, the growth rate of labor force 'eligibles,' and the density of the population."

Demography↗
PubMed1993

Total and segmental colon transit time in constipated children assessed by scintigraphy with 111In-DTPA given orally.

Serial colon scintigraphy using 111In-DTPA (2 MBq) given orally was performed in 39 children referred for constipation, and the total and segmental colon transit times were measured. The bowel movements during the study were recorded and the intervals between defecations (ID) were calculated. This method proved able to identify children with normal colon morphology (no. = 32) and those with dolichocolon (no. = 7). Normal children were not included for ethical reasons and we used the normal range determined by others using x-ray methods (29 +/- 4 hours). Total and segmental colon transit times were found to be prolonged in all children with dolichocolon (TC: 113.55 +/- 41.20 hours; RC: 39.85 +/- 26.39 hours; LC: 43.05 +/- 18.30 hours; RS: 30.66 +/- 26.89 hours). In the group of children with a normal colon shape, 13 presented total and segmental colon transit times within the referred normal value (TC: 27.79 +/- 4.10 hours; RC: 9.11 +/- 2.53 hours; LC: 9.80 +/- 3.50 hours; RS: 8.88 +/- 4.09 hours) and normal bowel function (ID: 23.37 +/- 5.93 hours). In the remaining children, 5 presented prolonged retention in the rectum (RS: 53.36 +/- 29.66 hours), and 14 a prolonged transit time in all segments. A good correlation was found between the transit time and bowel function. From the point of view of radiation dosimetry, the most heavily irradiated organs were the lower large intestine and the ovaries, and the level of radiation burden depended on the colon transit time. We can conclude that the described method results safe, accurate and fully diagnostic.

Administration, Oral↗
PubMed2002

Measure-dependent variation in burden of disease estimates: implications for policy.

BACKGROUND: Health adjusted life years (HALYs) are used for estimating burden of disease and as outcomes in cost-effectiveness analyses of medical care and public health interventions. OBJECTIVES: The impact of use of health-related quality of life (HRQL) scores associated with the disability-adjusted life year (DALY), the quality-adjusted life year (QALY), and the years of healthy life (YHL) measure on burden of disease estimates by income and race for five illnesses was studied. RESEARCH DESIGN: Abridged life tables were constructed using 1997 death certificate data from the National Center for Health Statistics. These tables were then quality-adjusted using prevalence data from the National Health Interview Survey and HRQL scores obtained using the Quality of Well-Being scale, the DALY, and the YHL measure to estimate burden of disease for five common diseases. Separate estimates were made for low and higher income families as well as black persons and white persons. RESULTS: Measure-related burden of disease estimates differed substantially from one another. Rank order of disease burden was not maintained across measures. Discrepancies in the rank order of disease were greater when different sociodemographic groups were examined. CONCLUSIONS: Diseases and demographic groups will receive differing priorities for intervention or research depending on which measurement system is used to inform decision-making. Refinement and standardization of measures is necessary to enhance their utility for medical care and public health policy applications.

Chronic Disease↗
PubMed1998

Economic burden of drug dependency. Social costs incurred by drug users at intake to the National Treatment Outcome Research Study.

BACKGROUND: The use of illegal drugs is seen as a major social problem. The social costs can be high. METHODS: Self-report data from interviews at intake to the National Treatment Outcome Research Study (NTORS) for 1075 drug users and cost data from various sources were used to estimate criminal behaviour and health and addiction service costs for a 12-month period. Multivariate statistical analysis was used to analyse cost variations. RESULTS: Total costs for one year for the drug users amounted to over 12 million Pounds, the majority attributable to self-reported criminal behaviour. Social costs were positively related to a variety of factors including instability in living circumstances, amount of heroin used and whether or not drugs were taken intravenously. CONCLUSIONS: The study clearly demonstrates the economic and social burden associated with heavy drug users and highlights the need for further investigations into the costs and benefits of policies that can reduce these social costs.

Age Factors↗
PubMed1997

Lipid content and time-to-death-dependent lethal body burdens of naphthalene and 1,2,4-trichlorobenzene in fathead minnow (Pimephales promelas).

For naphthalene (NAPH) and 1,2,4-trichlorobenzene (TCBz), lethal body burdens (LBB) of 8 +/- 3.1 mmol/kg wet wt (ww) and 14 +/- 4.5 mmol/kg (ww), respectively, were determined in fathead minnow (Pimephales promelas). LBBs of both compounds were found to increase with increasing lipid content and time-to-death of fish within the same aquarium. The correlation with time-to-death suggests that besides lipid content at least one other factor causes intraspecies variation in LBBs. When intraspecies variation is excluded by comparing mean LBBs from different aquaria and exposure regimes, LBBs still vary with time-to-death. In contrast to the situation within one aquarium, between different aquaria and exposure regimes often a decrease in LBB with time-to-death is found. The present study and others indicate that LBBs can vary with time-to-death. Therefore, a time-independent LBB cannot be assumed.

Animals↗
PubMed2000

Efficacy of a replication-selective adenovirus against ovarian carcinomatosis is dependent on tumor burden, viral replication and p53 status.

Intraperitoneal (i.p.) recurrence of cisplatin-refractory and p53 mutant ovarian cancer is a major clinical problem, despite surgery and chemotherapy. dl1520 (ONYX-015) is an E1B-55 kDa gene-deleted adenovirus engineered selectively to replicate in and destroy cancer cells lacking functional p53. However, a correlation between efficacy and p53 function has not been definitively studied in vivo to date, and efficacy following i.p. administration had not been previously described. We therefore carried out experiments to address these issues in three nude mouse-human ovarian carcinomatosis xenograft models. Intraperitoneal treatment with dl1520 led to complete tumor eradication and/or significantly improved survival in two p53(-) nude mouse-human ovarian tumor xenograft models. OVCAR3 i.p. xenografts underwent complete regressions in 11 of 12 mice (versus one of seven controls; P = 0.001), while mice bearing cisplatin-resistant A2780 tumors had significantly improved survival versus controls (P = 0.05). In contrast, the A2780 p53(+) ovarian cancer xenograft was resistant to dl1520. The efficacy of i.p. dl1520 in the p53(-) models correlated strongly with tumor burden present at the time of treatment initiation, and no efficacy was seen with non-replicating/UV-inactivated dl1520. Selectively replicating viruses such as dl1520 hold promise as i.p. therapies for p53-deficient and chemotherapy-resistant ovarian carcinomas. A phase I clinical trial of i.p. dl1520 (ONYX-015) is underway in patients with cisplatin-resistant ovarian carcinoma.

Adenoviridae↗
PubMed2003

Recrudescence in artesunate-treated patients with falciparum malaria is dependent on parasite burden not on parasite factors.

Artemisinin derivatives are first-line antimalarial drugs in Thailand. No firm evidence of clinically relevant artemisinin resistance exists. When used as monotherapy, artesunate has been associated with a high treatment failure (recrudescence) rate, which could be due to low-level artemisinin resistance. To understand the causes of recrudescence, we retrospectively studied a cohort of 104 malaria patients treated with artesunate monotherapy, 32 of whom recrudesced. There was no difference in in vitro artesunate sensitivities between 6 nonrecrudescent isolates and 16 paired admission and recrudescent isolates. Paired admission and recrudescent isolates from 10 patients were genotyped; only 3 had pfmdr1 mutations. Patients with admission parasitemias >10,000 per microl had a 9-fold higher likelihood of recrudescence (adjusted odds ratio) compared with patients with lower parasitemias. This study suggests (1) recrudescence after treatment with artesunate is not the result of inherent parasite resistance, and (2) admission parasitemia may be useful in choosing therapeutic options.

ATP-Binding Cassette Transporters↗
PubMed1996

[Measuring the burden for carers of dependent elderly with the Zarit inventory].

The aim of this study was to measure the subjective burden felt by persons who care for dependent elderly people living in their home. A questionnaire was administered to 291 persons. The burden is measured by the Zarit "Burden Inventory" in the French version; it is a 22 question scale exploring the consequences of caring activities in the physical, psychological and social area. The burden score is related to the physical dependency and mostly to the behavioural troubles of the elderly. It is not different according to the carer's family relationship but it is related to his family situation, his self-rated health and the desire to institutionalize the elderly person. This synthetic tool seems to measure the quality of life of carers, but longitudinal studies are necessary to measure its predictive value concerning behaviours in this population.

Activities of Daily Living↗
PubMed1992

Population aging and social policy.

The author examines current demographic trends in developed countries and finds that they may force us to challenge the existing arrangement in which pre-retirement adults entirely support the aged. "Not only is the ratio of the older to younger adults increasing, but also an increasing proportion of adults entering old age have the ability to make significant contributions (i.e. they are well educated, healthy, economically secure, and politically astute). Concern over this growing mismatch between older people's abilities and the roles they are expected to fill leads to a discussion of social policy. How might social policy increase the productivity of the elderly and/or reduce the burden of supporting a growing dependent older population. Three major categories of policies responsive to this question are considered. The outcome of these policy debates will significantly shape the future of aging in the United States."

Adult↗
PubMed2000

Burnout among relatives of psychiatric patients attending psychoeducational support groups.

OBJECTIVE: The effectiveness of family interventions may be improved by concentrating on elements of objective burden that best predict subjective burden. The relationship between subjective burden and objective burden was investigated among caregivers of patients with serious mental illness in the Netherlands who were attending psychoeducational support groups. METHODS: The study used pretest data from an intervention study in which psychoeducational family support groups in the Netherlands were evaluated. A total of 164 participants from 19 psychoeducational groups organized by nine community mental health centers completed the Dutch translation of the Maslach Burnout Inventory and the Involvement Evaluation Questionnaire. Regression analyses were conducted, with elements of subjective burden as dependent variables and elements of objective burden, demographic characteristics, and characteristics of the patient's disorder as predictors. RESULTS: Burden in general and emotional exhaustion were the aspects of subjective burden best predicted by objective burden. In two regression models, objective burden together with the other predictors explained 57 percent and 54 percent of the variance in subjective burden. Two aspects of objective burden-strain on the relationship with the patient and ability to cope with the patient's behavior-were related to almost all the investigated aspects of subjective burden. CONCLUSIONS: Strong evidence was found for the relationship between objective and subjective burden and for the hypothesis that particular elements of objective burden contribute more to subjective burden than others. The findings suggest that psychoeducation should concentrate on helping relatives cope with the strain on the relationship with the patient and on improving their ability to cope with the patient's behavior.

Adaptation, Psychological↗
PubMedDate not supplied

Appraisal and caregiving burden in family members caring for patients receiving chemotherapy.

The purposes of this exploratory study of 49 family caregivers of patients receiving chemotherapy were to describe the time and difficulty associated with caregiving tasks, examine caregivers' appraisals of their situations, and to explore what variables are predictive of caregiver mood. Measures used in this study included the Caregiving Burden Scale, Appraisal of Caregiving Scale, Family Hardiness Index, and an abbreviated form of the Profile of Mood States. Multiple regression was used to examine predictive relationships. The 25 women and 24 men reported spending the most time giving emotional support and assisting with household tasks, errands, and transportation. Giving emotional support was the most time-consuming and difficult task; therefore, it received the highest burden score. Burden was predicted by level of patient dependency. Caregiving burden, family hardiness, and caregiver health predicted 50% of the variance in negative appraisal of caregiving. Negative appraisal and age of the caregiver explained 49% of the variance in mood disturbance. Findings suggest that caregivers' appraisals of their situations may mediate the effects of illness and contextual factors on caregiver outcomes and that family hardiness is an important caregiver resource.

Adult↗
PubMed1998

Brain MRI lesion volume measurement reproducibility is not dependent on the disease burden in patients with multiple sclerosis.

We evaluated the potential effect of the lesion burden on the reproducibility of repeated lesion volume (LV) measurements from brain magnetic resonance imaging (MRI) scans of patients with multiple sclerosis (MS). Dual-echo, conventional spin echo brain MRI scans were obtained from 107 patients with MS. On proton density-weighted images, LV was assessed three times by the same raters, using a semi-automated, local thresholding technique for lesion segmentation. Mean LV (MLV) was 16.1 mL (range = 0.7-57.3 mL). The mean intra-observer coefficient of variation (COV) for the three measurement replicates was 2.6% (range = 0.2-7.2%). The intra-observer measurement variance (Var) increased with MLV and the fitted model was Var = 0.00187 MLV1.84. This indicates that LV measurements can be considered as measures whose variances are proportional to the square of their mean values, i.e., these measures have constant COV. Using a semi-automated, local thresholding segmentation technique, the reproducibility of LV measurements from brain MRI scans of patients with MS is not significantly influenced by varying lesion burdens.

Analysis of Variance↗
PubMed1993

Aging, intergenerational distribution and public pension systems.

"This paper develops an intertemporal simulation model capable of addressing the macroeconomic and distributional effects of demographic shocks in a small open economy. Two sources of population aging are examined, viz. lower birth rates and prolonged expected lifetimes at retirement age. Due to strong expectational effects, both shocks are found to change average consumption in a downward direction, in the short run as well as in the long run. This effect is matched by a strong net acquisition of foreign assets. Furthermore, it turns out that the intergenerational distribution of the burden of adjusting to an aging population is strongly dependent on whether the benefit rate, the contribution rate, or the relative non-capital income of pensioners and workers is held fixed."

Demography↗
PubMed2000

Burden in caregivers of cognitively impaired older adults living in the community: methodological issues and determinants.

Considerable burden is reported by informal caregivers of older individuals with cognitive impairment. Significant progress in the understanding of determinants of this burden has been achieved. However, further progress could be attained if we considered important methodological issues that may have limited our understanding of caregiver burden. These issues include subgroups of care recipients and caregivers, measurement issues, research design, and statistical techniques. Fifty-three studies published between 1980 and 1997 (inclusive) that focused on caregiver burden were abstracted to determine the extent to which the methodological issues discussed above were considered. Overall, we found considerable variability among the studies surveyed. Further understanding of the caregiving process and reductions in caregiver burden will depend on the attention to methodological issues and understanding of burden across the whole caregiving career.

Aged↗
PubMed2006

Receipt of exercise counseling by older women.

OBJECTIVES: To compare the national prevalence of reported receipt of clinician exercise counseling across four age groups of women (50-64, 65-74, 75-84, and > or =85) and to determine whether age or health are barriers to reported receipt of exercise counseling. DESIGN: 2000 National Health Interview Survey (NHIS). SETTING: United States. PARTICIPANTS: Six thousand three hundred eighty-five women aged 50 and older who responded to the 2000 NHIS, representing an estimated 34.5 million noninstitutionalized women nationally. MEASUREMENTS: Exercise counseling, disease burden, functional dependency, and physical inactivity were assessed by questionnaire. RESULTS: Of the 6,385 women, 52.2% were aged 50 to 64, 24.8% were aged 65 to 74, 18.0% were age 75 to 84, and 5.1% were aged 85 and older. Overall, 28.3% reported that a clinician had recommended that they begin or continue to perform any type of exercise or physical activity during the previous year: 31.4% of women aged 50 to 64, 29.2% of women aged 65 to 74, 21.6% of women aged 75 to 84, and 14.4% of women aged 85 and older. Women aged 75 to 84 (adjusted odds ratio (AOR)=0.8, 95% confidence interval (CI)=0.6-1.0) and women aged 85 and older (AOR=0.6, 95% CI=0.4-0.9) were substantially less likely to report clinician counseling about exercise, before and after adjustment. Further adjustment for illness burden and functional dependency did not attenuate the effect of receipt of exercise counseling. CONCLUSION: Reported receipt of exercise counseling by older women is low nationally. Despite known benefits of late-life exercise, women aged 75 and older are less likely to report receiving exercise counseling from their clinicians than women aged 50 to 64. Interventions should be aimed at increasing clinician counseling about exercise, especially to older women.

Aged↗
PubMed1989

[How strongly does the radiation burden of diagnostic x-ray studies depend on the imaging technic?].

The radiation burden of an individual patient caused by a radiological examination depends strongly on the technical parameters, such as kV and mAs. As an inquiry among 150 swiss physicians showed, rather different irradiation techniques are used for the same examination. Depending on these irradiation techniques, the doses may vary by almost a factor of ten. These large variations in dose indicate that in some clinics or hospitals the radiographic techniques and the film processing are at fault. This fact has to be accounted for by future efforts of quality assurance in diagnostic radiology.

Humans↗