Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study.

BACKGROUND: Drug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management. METHODS: A population-based survey of 9254 persons aged 25-64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP >or= 160/95 mmHg) at the initial contact, 253 (47%) had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval. RESULTS: Among the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both). Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services) and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance). Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care. CONCLUSION: Low utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases.

Dental service utilization by Europeans aged 50 plus.

OBJECTIVES: To describe variations in the utilization of dental services by persons aged 50+ from 14 European countries and to identify the extent to which such variations are attributable to differences in oral health need and in accessibility of dental care. METHODS: We use data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Waves 2 and 3) and estimate a series of multivariate logistic regression models to analyze variations in dental service utilization (overall dental attendance, preventive treatment and/or operative treatment, dental attendance in early life years) RESULTS: Overall dental attendance and incidence of solely preventive treatment are comparatively high in the Netherlands, Sweden, Denmark, Germany, and Switzerland. In contrast, overall dental attendance is relatively low in Spain, Italy, France, Greece, Poland, and Ireland. Moreover, a high incidence of solely operative treatment is observed in Austria, Italy, and France, whereas in the Netherlands, Sweden, Denmark, Switzerland, and Ireland, the incidence of solely operative treatment is comparably low. By and large, these variations persist even when controlling for cross-country differences in oral health need and in accessibility of dental care. CONCLUSIONS: In comparison with other European regions, there is a tendency toward more frequent and preventive dental treatment of the elderly populations residing in Scandinavia and Western Europe. Such utilization patterns appear only partially attributable to differences in need for and accessibility of dental care.

Phosphorus utilization by corn as affected by green manure, nitrogen and phosphorus fertilizers

The objective of this work was to evaluate the utilization by corn plants of P from triple superphosphate fertilizer labeled with 32P (32P‑TSP), and of P from soil as affected by N rates and by the green manures (GM) sunn hemp (Crotalaria juncea) and millet (Pennisetum glaucum). The experiment was carried out using pots filled with 5 kg Oxisol (Rhodic Hapludox). A completely randomized design was used, in a 4x4x2 factorial arrangement, with four replicates. The treatments were: four P rates as TSP (0, 0.175, 0.350, and 0.700 g P per pot); four N rates as urea (0, 0.75, 1.50, and 2.25 g N per pot); and sunn hemp or millet as green manure. The additions of N and P by the GM were taken into account. After grain physiologic maturation, corn dry matter, P contents, accumulated P, and P recovery in the different treatments were measured. 32P‑TSP recovery by corn increased with N increasing rates, and decreased with increasing rates of 32P‑TSP. The mineral fertilizer provides most of the accumulated P by corn plants. The recovery of 32P‑TSP by corn was 13.12% in average. The green manure species influence the assimilation of 32P‑TSP by the plants.

Naudan lietelannan käsittelymenetelmien taloudellinen vertailu

Maataloudessa syntyvä lanta on arvokas lannoite ja maanparannusaine, jonka käsittelystä aiheutuu sekä kustannuksia että ympäristövaikutuksia. Muita haasteita ovat esimerkiksi lannan mikrobit, lannan levitykseen soveltuvan ajankohdan lyhyys, lannan ravinteiden sovittaminen kasvien tarpeisiin ja lannan ravinteiden määrä suhteessa levityskelpoisen peltoalan määrään. Tutkimuksen tavoitteena oli tunnistaa naudan lietelannan käsittelyketjuihin liittyvät kustannukset ja osoittaa eri käsittelyketjujen kustannusten eroavaisuudet. Tavoitteena oli myös tunnistaa ja osoittaa käsittelyketjujen laadulliset erot. Kustannukset selvitettiin kustannuslaskelmin ja laadulliset erot SWOT-menetelmällä. Tutkimuksen kohteeksi valittiin 6 tilakokoluokkaa ja käsittelyketjuiksi lietelanta-, kompostointi- ja mädätysketju. Tutkimuksessa alhaisimmat kustannukset olivat lietelantaketjulla, jonka kustannukset 25 – 250 naudan tilalla olivat 5 200 – 6 600 €/a ja yksikkökustannukset 1 – 9 €/m3. Mädätysketjun kustannukset vastaavissa tilakokoluokissa olivat noin 33 000 – 50 000 €/a ja yksikkökustannukset 8 – 55 €/m3. Kompostointiketjun kustannukset olivat 35 000 – 143 000 €/a ja yksikkökustannukset 24 – 58 €/m3. Lietelantaketjun edullisuus johtui vähäisistä laite- ja rakennusinvestoinneista ja pienistä työmääristä ja kompostointiketjun kalleus suurista tukiaine- ja investointikustannuksista. Käsittelyketjujen asettaminen paremmuusjärjestykseen oli hankalaa. Työn määrä oli pienin lietelantaketjussa ja toiseksi pienin suurilla tiloilla mädätysketjussa. Kompostointiketjulla itse levitykseen kuluva aika oli pienin. Ravinteiden osalta mädätysketju oli parhain ja kompostointiketju huonoin. Ympäristövaikutuksiltaan ja hajuhaitoiltaan kompostointi- ja mädätysketju olivat parhaimmat. Mikrobien osalta parhain oli kompostointiketju.

Clinical relevance of L-carnitine-supplemented total parenteral nutrition in postoperative trauma. Metabolic effects of continuous or acute carnitine administration with special reference to fat oxidation and nitrogen utilization.

Carnitine-free total parenteral nutrition (TPN) is claimed to result in a carnitine deficiency with subsequent impairment of fat oxidation. The present study was designed to evaluate the possible benefit of carnitine supplementation on postoperative fat and nitrogen utilization. Sixteen patients undergoing total esophagectomy were evenly randomized and received TPN without or with L-carnitine supplementation (74 mumol.kg-1.d-1) during 11 postoperative days. On day 11, a 4-h infusion of L-carnitine (125 mumol/kg) was performed in both groups. The effect of supplementation was evaluated by indirect calorimetry, N balance, and repeated measurements of plasma lipids and ketone bodies. Irrespective of continuous or acute supplementation, respiratory quotient and fat oxidation were similarly maintained throughout the study in both groups whereas N balance appeared to be more favorable without carnitine. We conclude that carnitine-supplemented TPN does not improve fat oxidation or promote N utilization in the postoperative phase.

Effect of physical exercise on glycogen turnover and net substrate utilization according to the nutritional state.

To determine the metabolic effects of a single bout of exercise performed after a meal or in the fasting state, nine healthy subjects were studied over two 8-h periods during which net substrate oxidation was monitored by indirect calorimetry. On one occasion, exercise was performed 90 min after ingestion of a meal labeled with [U-13C]glucose [protocol meal-exercise (M-E)]. On the second occasion, exercise was performed after an overnight fast and was followed 30 min later by ingestion of an identical meal [protocol exercise-meal (E-M)]. Energy balances were similar in both protocols, but carbohydrate balance was positive (42.2 +/- 5.1 g), and lipid balance was negative (-11.1 +/- 2.0) during E-M, whereas they were nearly even during M-E. Total glycogen synthesis was calculated as carbohydrate intake minus oxidation of exogenous 13C-labeled carbohydrate (calculated from 13CO2 production). Total glycogen synthesis was increased by 90% (from 47.6 +/- 3.8 to 90.7 +/- 5.4 g, P < 0.0001) during E-M vs. M-E. Endogenous glycogen breakdown was calculated as net carbohydrate oxidation minus oxidation of exogenous carbohydrate and was increased by 44% (from 35.8 +/- 5.6 to 51.7 +/- 6.6 g, P < 0.004) during E-M. It is concluded that exercise performed in the fasting state stimulates glycogen turnover and fat oxidation.

Utilization of Knowledge Management in Business Process Modeling and Process Improvements

Tutkimuksen tavoitteena on tutkia telekommunikaatioalalla toimivan kohdeyrityksen ohjelmistojen toimitusprosessia° Tutkimus keskittyy mallintamaan toimitusprosessin, määrittelemään roolit ja vastuualueet, havaitsemaan ongelmakohdat ja ehdottamaan prosessille kehityskohteita. Näitä tavoitteita tarkastellaan teoreettisten prosessimallinnustekniikoiden ja tietojohtamisen SECI-prosessikehyksen läpi. Tärkein tiedonkeruun lähde oli haastatteluihin perustuva tutkimus, johon osallistuvat kaikki kohdeprosessiin kuuluvat yksiköt. Mallinnettu toimitusprosessi antoi kohdeyritykselle paremman käsityksen tarkasteltavasta prosessista ja siinä toimivien yksiköiden rooleistaja vastuualueista. Parannusehdotuksia olivat tiedonjaon kanavoinnin määritteleminen, luottamuksen ja sosiaalisten verkostojen parantaminen, ja tietojohtamisen laajamittainen implementointi.

Apparent digestibility of nutrients, energy, and amino acid of nontoxic and detoxified physic nut cakes for Nile tilapia

Abstract:The objective of this work was to evaluate the apparent digestibility coefficients of nutrients, energy, and amino acids of nontoxic and detoxified physic nut cakes treated with solvent plus posterior extrusion, for Nile tilapia. The apparent digestibility coefficients of crude protein and gross energy were higher for detoxified than for nontoxic physic nut cake. However, the apparent digestibility coefficient of ether extract of the nontoxic physic nut cake was higher than that of the detoxified one. The apparent digestibility coefficient of amino acids of both feed ingredients was superior to 80%, except for glycine, for the nontoxic psychic nut cake, and for threonine, for the detoxified one. Nontoxic and detoxified physic nut cakes show apparent digestibility coefficient values equivalent to those of the other evaluated oilseeds and potential for inclusion in Nile tilapia diets.

Glutamate reduces glucose utilization while concomitantly enhancing AQP9 and MCT2 expression in cultured rat hippocampal neurons.

The excitatory neurotransmitter glutamate has been reported to have a major impact on brain energy metabolism. Using primary cultures of rat hippocampal neurons, we observed that glutamate reduces glucose utilization in this cell type, suggesting alteration in mitochondrial oxidative metabolism. The aquaglyceroporin AQP9 and the monocarboxylate transporter MCT2, two transporters for oxidative energy substrates, appear to be present in mitochondria of these neurons. Moreover, they not only co-localize but they interact with each other as they were found to co-immunoprecipitate from hippocampal neuron homogenates. Exposure of cultured hippocampal neurons to glutamate 100 μM for 1 h led to enhanced expression of both AQP9 and MCT2 at the protein level without any significant change at the mRNA level. In parallel, a similar increase in the protein expression of LDHA was evidenced without an effect on the mRNA level. These data suggest that glutamate exerts an influence on neuronal energy metabolism likely through a regulation of the expression of some key mitochondrial proteins.

Treatment patterns and health care resource utilization in a 1-year observational cohort study of outpatients with schizophrenia at risk of nonadherence treated with long-acting injectable antipsychotics

Purpose: To describe (1) the clinical profiles and the patterns of use of long-acting injectable (LAI) antipsychotics in patients with schizophrenia at risk of nonadherence with oral antipsychotics, and in those who started treatment with LAI antipsychotics, (2) health care resource utilization and associated costs. Patients and methods: A total of 597 outpatients with schizophrenia at risk of nonadherence, according to the psychiatrist's clinical judgment, were recruited at 59 centers in a noninterventional prospective observational study of 1-year follow-up when their treatment was modified. In a post hoc analysis, the profiles of patients starting LAI or continuing with oral antipsychotics were described, and descriptive analyses of treatments, health resource utilization, and direct costs were performed in those who started an LAI antipsychotic. Results: Therapy modifications involved the antipsychotic medications in 84.8% of patients, mostly because of insufficient efficacy of prior regimen. Ninety-two (15.4%) patients started an LAI antipsychotic at recruitment. Of these, only 13 (14.1%) were prescribed with first-generation antipsychotics. During 1 year, 16.3% of patients who started and 14.9% of patients who did not start an LAI antipsychotic at recruitment relapsed, contrasting with the 20.9% who had been hospitalized only within the prior 6 months. After 1 year, 74.3% of patients who started an LAI antipsychotic continued concomitant treatment with oral antipsychotics. The mean (median) total direct health care cost per patient per month during the study year among the patients starting any LAI antipsychotic at baseline was 1,407 ( 897.7). Medication costs (including oral and LAI antipsychotics and concomitant medication) represented almost 44%, whereas nonmedication costs accounted for more than 55% of the mean total direct health care costs. Conclusion: LAI antipsychotics were infrequently prescribed in spite of a psychiatrist-perceived risk of nonadherence to oral antipsychotics. Mean medication costs were lower than nonmedication costs.

Metsäteollisuuden lentotuhkien laadun vaikutus hyötykäyttösovellutuksiin

Työn tavoitteena oli kartoittaa metsäteollisuuden tuotantolaitoksissa syntyvän lentotuhkan laadun vaikutusta hyötykäyttökohteisiin. Hyötykäyttökohteista tarkasteltiin tuhkien soveltumista maarakentamiseen, päällystettyyn- ja peitettyyn rakenteeseen, pelto- ja puutarhakäyttöön, maisemointiin ja viherrakentamiseen sekä metsäkäyttöön. Tuhka-analyysien tietojen perusteella tuhkalle määritettiin mahdollinen hyötykäyttökohde verrattaessa niitä lainsäädännönasettamiin raja-arvoihin jokaisessa hyötykäyttökohteessa. Lisäksi tarkasteltiinmahdollisia esteitä tuhkan käytölle tietyissä hyötykäyttökohteissa sekä pyrittiin saamaan tuhkalle järkevämpi loppusijoituspaikka kuin kaatopaikka. Kirjallisuusosaan on koottu metsäteollisuudessa käytössä olevat polttomenetelmät sekä poltettavat raaka-aineet. Eri polttojakeiden tuhkien koostumuksista on tehty yhteenveto kirjallisuudesta löytyvien tietojen perusteella. Lisäksi kirjallisuusosassa on esitetty lentotuhkan fraktiointimenetelmiä sekä eri hyötykäyttökohteet ja niiden vaatimukset lentotuhkalta. Kokeellisessa osassa on vertailtu olemassa olevien tuhkanäytteiden haitta-aineiden pitoisuuksia eri hyötykäyttökohteiden vaadittuihin raja-arvoihin. Tähän työhön valittiin viisi eri metsäteollisuuden tuotantolaitosta Suomesta ja niille jokaiselle pyrittiin löytämään parhaiten soveltuva loppukäyttö. Metsäteollisuuden tuotantolaitoksilla poltetaan useita eri polttojakeita. Lisäksi polttoainekoostumus ja -määrä vaihtelevat vuositasolla. Tämä vaikuttaa tuhkan laatuun ja vaikeuttaa tuhkan hyödyntämistä eri hyötykäyttökohteissa. Jokaiselle tuhkan eri hyötykäyttökohteelle on säädetty omat raja-arvonsa, joka rajoittaa tuhkan hyötykäyttöä. Tällä hetkellä tuhkaa hyödynnetään eniten metsälannoitteena, jolloin puuaineksen mukana poistuneet ravinteet saadaan palautettua takaisin luontoon. Myös tuhkan hyödyntäminen maarakentamisessa on järkevää, koska silloin korvataan maa-ainesta tuhkalla ja vältytään kaatopaikkasijoittamiselta. Yleisesti pelto- ja puutarhakäyttöä ajatellen raja-arvot ovat liian tiukat metsäteollisuuden lentotuhkalle.

Absorptive capacity and the effect of social integration mechanisms in knowledge utilization

Tiedosta on tullut määräävä tekijä yrityksensuorituskyvylle. Yritykset hankkivat aktiivisesti uutta tietoa ulkoisesta ympäristöstään ja tallentavat sitä tietokantoihinsa. Uusi tieto on innovaatioiden ja uusien ideoiden peruselementti. Uudet ideat pitää myös kaupallistaa, jotta niiden avulla voidaan hankkia kilpailuetua. Absorptiivisen kapasiteetin malli yhdistää tiedon prosessointiin liittyvät kyvykkyydet, jotka vaikuttavat yrityksen kykyyn hyödyntää tietoa tehokkaasti. Ennen kuin tietoa voidaan käyttää uusien tuotteiden ja palveluiden luomiseen, täytyy sitä jakaa yrityksessä ja muuttaa se yrityksen toimintaa palvelevaksi. Aiemmissa tutkimuksissa innovaatiot ovat vahvasti liitetty yrityksen kykyyn uudistua. Tämä pro gradu -tutkielma tutkii sosiaalisten integraatiomekanismien vaikutusta potentiaalisen absorptiivisen kapasiteetin muuttamiseen toteutuneeksi absorptiiviseksi kapasiteetiksi. Yksilöiden ja osastojen välisen yhteistyön sekä luottamuksen vaikutus tiedon sisäistämiseen tutkittiin. Tutkielma pohjautuu monikansallisessa yrityksessä keväällä 2006 suoritettuun uudistumiskyky-tutkimukseen. Tutkielma keskittyy yrityksen kykyyn uudistua uuden tiedon ja innovaatioiden avulla. Tutkielma on kvantitatiivinen tapaustutkimus. Tutkielmassa tehtyjen havaintojen mukaan sosiaaliset integraatiomekanismit ovat tärkeitä uuden tiedon hyödyntämisessä. Tiedon eksplisiittyyden havaitaan vaikuttavan tiedon muuttamiseen yritykselle hyödylliseksi resurssiksi.

Emergency hospital services utilization in Lleida (Spain): a cross-sectional study of immigrant and Spanish-born populations

Background: The use of emergency hospital services (EHS) has increased steadily in Spain in the last decade while the number of immigrants has increased dramatically. Studies show that immigrants use EHS differently than native-born individuals, and this work investigates demographics, diagnoses and utilization rates of EHS in Lleida (Spain). Methods: Cross-sectional study of all the 96,916 EHS visits by patients 15 to 64 years old, attended during the years 2004 and 2005 in a public teaching hospital. Demographic data, diagnoses of the EHS visits, frequency of hospital admissions, mortality and diagnoses at hospital discharge were obtained. Utilization rates were estimated by group of origin. Poisson regression was used to estimate the rate ratios of being visited in the EHS with respect to the Spanish-born population. Results: Immigrants from low-income countries use EHS services more than the Spanish-born population. Differences in utilization patterns are particularly marked for Maghrebi men and women and sub-Saharan women. Immigrant males are at lower risk of being admitted to the hospital, as compared with Spanish-born males. On the other hand, immigrant women are at higher risk of being admitted. After excluding the visits with gynecologic and obstetric diagnoses, women from sub-Saharan Africa and the Maghreb are still at a higher risk of being admitted than their Spanish-born counterparts. Conclusion: In Lleida (Spain), immigrants use more EHS than the Spanish born population. Future research should indicate whether the same pattern is found in other areas of Spain and whether EHS use is attributable to health needs, barriers to access to the primary care services or similarities in the way immigrants access health care in their countries of origin.

RAPD markers utilization and other parameters in the determination of mango hybrids genitors

Actually mango (Mangifera indica, L.) is considered one of the largest Brazilian fruitbusiness for the export market. Cultivar selection having high fruit quality is a fundamental step to obtain excellent results in this business. A mango breeding program based on intervarietal hybridization may produce new improved cultivars for mango growers. Mango hybrids have been obtained by controlled or open crosses. In the last one, it is important to identify the male parent because it is useful for the genetic cultivar history, thus it is important for planning further improvements. This work presents a parentage test using among others parameters RAPD (Random amplified Polymorphic DNA) markers to estimate the male parent of the selected hybrids in an open cross plot by using five mango cultivars densely planted in a latin square design.