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PubMed2001

A river might run through it again: criteria for consideration of dam removal and interim lessons from California.

Resource managers are increasingly being challenged by stakeholder groups to consider dam removal as a policy option and as a tool for watershed management. As more dam owners face high maintenance costs, and rivers as spawning grounds for anadromous fish become increasingly valuable, dam removal may provide the greatest net benefit to society. This article reviews the impact of Endangered Species Act listings for anadromous fish and recent shifts in the Federal Energy Regulatory Commission's hydropower benefit-costs analysis and discusses their implications for dam removal in California. We propose evaluative criteria for consideration of dam removal and apply them to two case studies: the Daguerre and Englebright Dams on the Yuba River and the Scott and Van Horne Dams on the South Eel River, California.

Animals↗

PubMed2005

Communication strategies and interpersonal skills of instructors of esophageal speech: an observation study.

OBJECTIVE: In this article, the way that the Instructor of Esophageal Speech (IES) works is considered from an interactive-analytic perspective. METHODS: The observation project data were gathered during 6 months in 2004 at the training sessions of the Ginreikai-Asian Federation of Laryngectomees' Association using the Six Category Intervention Analysis framework (6CIA) by a trained communication specialist as an active-observer. RESULTS: Mean scores of each of the six categories and a series of percentage distributions were extracted from the usage-frequency data and interpreted together with the results of Chi-square analysis of usage-frequency units. We found the IES used more frequently authoritative categories and used less facilitative categories. Our results of the data analysis show that the 30 IES used more authoritative interventions and used more frequently the prescription and information giving than the confrontation or cathartic interventions. CONCLUSION: The results of the present study show that the 6CIA framework has its potential and value as an analytic tool to explore the IES' actual behavior in a specific therapy related context. PRACTICE IMPLICATIONS: We argue for the utility of the 6CIA as an analytic framework to investigate the interpersonal behavior of the IES in the Japanese cultural setting.

Aged↗

PubMed1999

Tamosterone Sulfates: A C-14 Epimeric Pair of Polyhydroxylated Sterols from a New Oceanapiid Sponge Genus.

Two novel, C-14 epimeric polyhydroxylated 15-keto steroid sulfates, tamosterone sulfate and 14beta-tamosterone sulfate (1 and 2), were isolated from a sponge belonging to a new genus collected in Yap, Federated States of Micronesia. Their structures were assigned by analysis of spectroscopic data and chemical conversions. 14beta-Tamosterone sulfate (2) has the rare naturally occurring C/D cis ring fusion and is the less stable epimer based on equilibration studies. Both compounds possess side-chain substitution patterns not observed previously in marine sterols.

Journal Article↗

PubMedDate not supplied

[Inpatient health care utilization for musculoskeletal disorders and injuries: a forecast study for Germany up to 2010].

BACKGROUND: The study is part of the project "Orthopaedics 2010 -- evaluation of the demand for the orthopaedic work force in the year 2010", initiated by the professional association of orthopaedists (BVO). The aim is to estimate the prospective number of orthopaedists for the sufficient medical care of musculoskeletal disorders and injuries. METHODS: The main data source was the official statistics of discharge rates from 1994 to 1999 and the German population forecasts from 1994 to 2010 of the Federal Office of Statistics, Wiesbaden, Germany. An univariate forecasting analysis was done using the Granger and Newbold method. RESULTS: All diagnostic categories of musculoskeletal disorders (arthropathies, dorsopathies, rheumatism, osteopathies) will increase up to four-fold from 1994 to 2010. Three of the four diagnostic categories of injuries (dislocations, sprains and strains; contusion; injuries and open wounds) will decrease by up to 15 percent, the diagnostic category of fractures will increase (10 percent). The stratified analyses by gender and age reveal that women and persons over 65 years old are more often affected by musculoskeletal disorders and injuries. CONCLUSIONS: Both demographic changes and changes in the utilization of inpatient care will lead to a substantial increase of hospital cases up to 2010. The presented results should be looked at together with their confidence limits as interval estimations. In addition, there are independent external factors such as the new prospective payment system (G-DRGs) that will influence the hospital admission rates as well.

Age Distribution↗

PubMed1984

[Ophthalmological experiences with automobile drivers with inadequate vision].

A total of 369 ophthalmological practices were asked to report the number of patients seen within one test week who drove their cars but did not satisfy minimum legal requirements for diurnal visual acuity applicable for applicants for a West German Class 3 driver's license. There were 471 such patients. From this number it can be calculated that approximately 570 000 individuals (+/- 9%) drive cars in the Federal Republic of Germany with inadequate visual acuity. An analysis of the questionnaire produced the following results: Fifty percent of these patients are less than 62 years of age. The main cause of inadequate visual acuity is age. In younger drivers refractive errors were the prime cause and in most cases correction with glasses was possible. In older drivers the loss of acuity was mainly due to opacities of the lens which for the most part could not be corrected by spectacles. Two-thirds of the drivers with inadequate visual acuity consider their vision to be "sufficient" or "good" for driving; younger drivers are more self-critical than older ones. Only 31% of these drivers stopped driving at night of their own accord. As many as two-thirds of the drivers who consider their acuity to be "insufficient" drive their cars during darkness. The authors show that the findings in patients suffering from severe loss of visual acuity must in principle also be valid for patients with minor visual impairments who still meet the minimum legal requirements. This agrees well with published statistical investigations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

Prognostic significance of tumor cell morphometry, histopathology, and clinical parameters in advanced ovarian carcinoma.

The prognostic value of clinicopathologic data and tumor cell morphometry was assessed in 49 consecutive patients with advanced epithelial ovarian carcinoma (Stage III-IV as defined by the International Federation of Gynaecologists and Obstetricians [FIGO]). Single-variant analysis proved that nuclear area at the 10th, 50th, and 90th percentiles and nuclear density were the strongest prognostic factors. To assess difference in prognostic influence between morphometric and clinicopathologic factors, Cox regression analysis was carried out and revealed nuclear density and age as prognostically significant (p less than 0.0003 and p less than 0.0004, respectively). Choice of chemotherapy, FIGO stage, histologic grade, and mitotic activity index (MAI) were not of additional prognostic importance. Objective measurement of morphometric factors is simple, highly reproducible, and adequate for routine work and promises to be of clinical value in therapeutic decision-making in advanced ovarian carcinoma.

Adult↗

PubMed2001

Comparison of positivity frequency of bcl-2 expression in prostate adenocarcinoma with low and high Gleason score.

CONTEXT: Multiple genetic and epigenetic factors have been implicated in the oncogenesis and progression of prostate cancer. The major difficulty is in that the clinical management stems from the reality that reliable and accurate prognostic biomarkers are not available and that effective treatment regimens forming hormone-resistant prostate cancers are yet to be developed. Among the most important regulators of apoptosis and programmed cell death is the bcl-2 gene and its related proteins. Elevated levels of bcl-2 protein may contribute to the progression of prostate cancers to a metastatic and hormone-insensitive state characterized by poor responses to chemotherapy. OBJECTIVE: To characterize the expression of bcl-2 proteins as a prognostic factor in humans. DESIGN: A retrospective approach. SETTING: Urology section, Federal University of São Paulo. DIAGNOSTIC TEST USED: Immunohistochemical analysis using bcl-2 protein antibody and normal staining by hematoxylin-eosin. MAIN MEASUREMENTS: Prognostic relations and protein expression were evaluated considering the total sample (28) divided into two groups, high (8 to 10) and low (2 to 4), separated according to the histological differentiation grade (Gleason score) with 10 and 18 samples, respectively. RESULTS: The differentiation of grade into two groups separated according to the Gleason score in low and high types presented different bcl-2 expression (P < 0.001). CONCLUSION: The higher frequency of bcl-2 immunostaining in tumor samples was observed in association with more advanced Gleason scores and suggests that an increase in the ratio of this anti-apoptotic protein often occurs during progression of prostate cancers.

Adenocarcinoma↗

PubMed1994

Activities of daily living and costs in nursing homes.

Functionality, as measured by activities of daily living (ADL), is the most important predictor of the cost of nursing home care. Data from a field-test version of the federally mandated Minimum Data Set (MDS) were examined using analysis of variance (ANOVA) and recursive partitioning methods to determine the relationships between ADL limitations and nursing cost (wage-weighted nursing time) among nursing home residents (n = 6,663). From this analysis, an index based on limitations in four ADLs was created. The developed ADL index is a readily determined measure of functional status useful in allocating nursing staff within nursing homes and in comparing the functional status of groups of residents, explaining 30 percent of variance in nursing costs among nursing home residents.

Activities of Daily Living↗

PubMed2001

LTC insurance. Changing dynamics, differing perspectives.

Many have challenged the best minds in the industry in designing and pricing long-term care (LTC) insurance. Marketing LTC insurance requires a thorough understanding of public policy issues and programs in addition to exceptional business expertise. However, the results have been worthwhile. Today, the market offers affordable products with solid benefits. Not only can LTC insurance protect individual lifestyles and savings, it can also reduce burgeoning state and federal Medicaid spending.

Actuarial Analysis↗

PubMed1981

Measuring interstate migration flows: an origin-destination network based on Internal Revenue Service records.

"This paper examines gross interstate migration flows for five periods for the years between 1969 and 1978. The analysis is based upon a newly available data source--Federal income tax returns. Approximately 90% of the US population is covered by this data series. The matching of Internal Revenue Service (IRS) returns between filing dates enables the determination both of the origin and of the destination of migrants, with few of the risks of geographic miscoding present. "These data illustrate that despite divergent economic fluctuations over the past nine years, the patterns of interstate migration have remained virtually unchanged. With few exceptions, the number of migrants either leaving or entering a particular state comprise identical proportions over time.... In addition, these data offer considerable evidence that current residence has a significant impact on the selection of a destination." Comparisons are made with data from the Current Work History Sample and the 1970 census.

Americas↗

PubMed2006

[The effectivness of direct observed treatment short course (DOTS) in tuberculosis treatment].

UNLABELLED: In 1994 the National Tuberculosis (TB) Programme of our country adopted direct observed treatment short course (DOTS) as National TB control strategy. After that DOTS has been implemented in different parts of country. OBJECTIVE: to define the effectiveness of DOTS strategy implementation in Sarajevo Canton. PATIENTS AND METHODS: Medical histories and treatment cards of TB smear patients admitted in the University Clinic Sarajevo during 1998 and 1999, as well as Referral Microbiological Laboratory Registers of Federation of Bosnia and Herzegovina were used for the analysis. The control group consisted of patients treated in the area which covers present Sarajevo Canton in the period when DOTS strategy was not used. RESULTS: In 1998 there were 83.6 % new TB cases and 89.5 % in 1999. The smear sputum conversion rate was 89.5 % in 1998 and 93 % in 1999. Smear sputum conversion rates were achieved in the period of 30-45 days after antituberculous treatment onset in 50.0 % patients in 1998 and in 51.7 % in 1999. Chest X-ray partial regression in the initial phase (at the end of second month of treatment) was achieved in the examined groups in higher percentages (70.1 % in 1998 and 77.9 % in 1999.) compared with the control group (44.29 %). It was evident that partial radiographic regression was achieved up to 45 days after treatment onset in the examined group in 42.6 % cases in 1998 and in 61.2 % in 1999. In this period in the control group partial radiographic regression was not achieved at all. Total chest X-ray regression was achieved neither in examined groups nor in control group. CONCLUSION: These data are the results of successfulness of the DOTS treatment.

Adolescent↗

PubMed1985

[The development of legal premises in the rehabilitation of the physically handicapped from Bismarck to today--a brief overview].

The legal bases for rehabilitation and integration of the physically disabled have developed from public welfare provisions, the beginnings of disability care having been part of public poor relief schemes. Ensueing developments range from cripple care programmes to today's efforts to establish a uniform social code, which is expected to benefit the individual disabled person by bringing about a marked simplification of the current legal and administrative situation. The extension of the scope of rehabilitative efforts, which since Bismarck's time had comprised nursing and institutional care in cases of physical and mental ailings within the framework of poor relief, had initially occurred outside Prussia by including education and vocational training for disabled people (the beginnings of "rehabilitation"). A more comprehensive approach to disability care in the sense of extended assistance was embodied in the Prussian cripple welfare act of 1920. The Federal Social Assistance Act of 1962, in the final analysis, had developed from this tradition. This 1962 act not only established a duty to provide public welfare but also gave those concerned a legal title to this kind of assistance.

Persons with Disabilities↗

PubMed2006

Identifying and closing gaps in environmental monitoring by means of metadata, ecological regionalization and geostatistics using the UNESCO biosphere reserve Rhoen (Germany) as an example.

In Germany, environmental monitoring is intended to provide a holistic view of the environmental condition. To this end the monitoring operated by the federal states must use harmonized, resp., standardized methods. In addition, the monitoring sites should cover the ecoregions without any geographical gaps, the monitoring design should have no gaps in terms of ecologically relevant measurement parameters, and the sample data should be spatially without any gaps. This article outlines the extent to which the Rhoen Biosphere Reserve, occupying a part of the German federal states of Bavaria, Hesse and Thuringia, fulfills the listed requirements. The investigation considered collection, data banking and analysis of monitoring data and metadata, ecological regionalization and geostatistics. Metadata on the monitoring networks were collected by questionnaires and provided a complete inventory and description of the monitoring activities in the reserve and its surroundings. The analysis of these metadata reveals that most of the monitoring methods are harmonized across the boundaries of the three federal states the Rhoen is part of. The monitoring networks that measure precipitation, surface water levels, and groundwater quality are particularly overrepresented in the central ecoregions of the biosphere reserve. Soil monitoring sites are more equally distributed within the ecoregions of the Rhoen. The number of sites for the monitoring of air pollutants is not sufficient to draw spatially valid conclusions. To fill these spatial gaps, additional data on the annual average values of the concentrations of air pollutants from monitoring sites outside of the biosphere reserve had therefore been subject to geostatistical analysis and estimation. This yields valid information on the spatial patterns and temporal trends of air quality. The approach illustrated is applicable to similar cases, as, for example, the harmonization of international monitoring networks.

Ecology↗

PubMed1996

[Cardiovascular risk factors and occupation: results of the health survey of the German Cardiovascular Prevention Study].

It is examined which occupation specific differences exist in the prevalence of cardiovascular disease risk factors in the Federal Republic of Germany (old federal states). The following risk factors for cardiovascular diseases were considered: cigarette smoking, hypertension, hypercholesterolemia, low HDL-cholesterol, obesity, diabetes mellitus, lack of physical activity and Type-A behavior. Data basis are the national and regional health surveys, conducted in the framework of the German Cardiovascular Prevention Study between 1984 and 1991. 17,596 males and 17,403 females, aged 25-69 years, were included in the analysis. Occupations were coded according to the classification of the Germany Federal Statistical Office. With the exception of Type-A behavior it was found for all cardiovascular disease risk factors that higher prevalence rates exist for less qualified occupations. The differences in risk factor prevalence were strongest for obesity and lack of physical activity. Only minor differences were found for hypercholesterolemia. This analysis confirms the results of other studies that health related aspects in the lifestyles of the most qualified occupational groups (professionals, managers, engineers) are characterized by non-smoking, leisure-time physical activity and avoidance of overweight. Up to now, there are no hints that these lifestyles may be adopted from members of less qualified occupations as well.

Adult↗

PubMed1999

Model Spinal Cord Injury System trends, and implications for the future.

In the 25 years since the federally designated Model Spinal Cord Injury Systems program was started, many changes have occurred. The systems have increased in number and location and have changed in composition. Data are available on approximately 19,000 acutely injured traumatic spinal cord injured individuals, with more than 117,000 total records. This volume of data allows analysis of many trends affecting the care of people with spinal cord injuries. The time span covered by the database allows comparison of various time periods, including the most recent decade--during which managed care has emerged as a dominant force in health care evolution. This article summarizes these trends, based on information in the articles in this special issue devoted to the Model Spinal Cord Injury Systems. Finally, this article offers an analysis of future implications for SCI care in general and the federally designated Model Spinal Cord Injury Systems program in particular.

Databases, Factual↗

PubMed2006

Barriers to SCHIP enrollment: A cross-county study of the State Children's Health Insurance Program in Pennsylvania.

BACKGROUND. Enrollment in the State Children's Health Insurance Program (SCHIP), created under the federal Balanced Budget Act of 1997, had a distressingly slow start and varied substantially county-to-county in many states, including Pennsylvania. METHODS. We performed a quantitative county-level analysis of barriers to enrollment in Pennsylvania's Children's Health Insurance Program (CHIP) for the year 2000, seven years after it was implemented and three years after federal SCHIP legislation. Using multivariate regression analysis with a county as the unit of observation, we modeled enrollment in SCHIP as a function of accessibility to health care, availability of clinicians, and community economic health. RESULTS. High clinic density and Medicaid managed-care membership predicted SCHIP enrollment success, while female head-of-household predicted SCHIP enrollment failure. A principal-components factor analysis revealed four underlying barriers to enrollment: accessibility, availability, affordability, and effort. CONCLUSIONS. The most formidable barriers to SCHIP enrollment success in Pennsylvania were not programmatic; they were correlates of poverty itself.

Journal Article↗

PubMed2006

HIV incidence and CDC's HIV prevention budget: an exploratory correlational analysis.

BACKGROUND: The central evaluative question about a national HIV prevention program is whether that program affects HIV incidence. Numerous factors may influence incidence, including public investment in HIV prevention. Few studies, however, have examined the relationship between public investment and the HIV epidemic in the United States. METHODS: This 2006 exploratory analysis examined the period from 1978 through 2006 using a quantitative, lagged, correlational analysis to capture the relationship between national HIV incidence and Centers for Disease Control and Prevention's HIV prevention budget in the United States over time. RESULTS: The analyses suggest that early HIV incidence rose in advance of the nation's HIV prevention investment until the mid-1980s (1-year lag correlation, r=0.972, df=2, p <0.05). From that point on, it appears that the nation's investment in HIV prevention became a strong correlate of HIV incidence (1-year lag correlation, r=-0.905, df=18, p <0.05). CONCLUSIONS: This exploratory study provides correlational evidence of a relationship between U.S. HIV incidence and the federal HIV prevention budget over time, and calls for further analysis of the role of funding and other factors that may influence the direction of a nation's HIV epidemic.

Budgets↗

PubMed1984

Race and sex differences in hip fracture incidence.

Incidence rates for hip fracture in the United States were estimated using non-federal hospital discharges from the National Hospital Discharge Survey for the years 1974-1979. Age-specific incidence curves for women and for men showed similar patterns of increase in risk with age, with risks approximately doubling every five years after age 50. Age-specific rates by five-year age groups were compared among the four race-sex groups. No significant differences were observed between Black females, Black males, and White males. In contrast, rates for White females were one and one-half to four times those for Black females after age 40 and were approximately double those for White males after age 50. Analysis based on an independent data source of non-federal hospital discharges in Washington, DC confirmed these relationships. In the Washington study, White women were at twice the risk for hip fracture (controlled for age) compared with Black women and at 2.7 times the risk for hip fracture (controlled for age) compared to White men. No significant differences were observed between Black women and Black men.

Adult↗