Longitudinal Impacts of Precision Greenness on Alzheimer's Disease.

BACKGROUND: The potential for greenness as a novel protective factor for Alzheimer's disease (AD) requires further exploration. OBJECTIVES: This study assesses prospectively and longitudinally the association between precision greenness - greenness measured at the micro-environmental level, defined as the Census block - and AD incidence. DESIGN: Older adults living in consistently high greenness Census blocks across 2011 and 2016 were compared to those living in consistently low greenness blocks on AD incidence during 2012-2016. SETTING: Miami-Dade County, Florida, USA. PARTICIPANTS: 230,738 U.S. Medicare beneficiaries. MEASUREMENTS: U.S. Centers for Medicare and Medicaid Services Chronic Condition Algorithm for AD based on ICD-9 codes, Normalized Difference Vegetation Index, age, sex, race/ethnicity, neighborhood income, and walkability. RESULTS: Older adults living in the consistently high greenness tertile, compared to those in the consistently low greenness tertile, had 16% lower odds of AD incidence (OR=0.84, 95% CI: 0.76-0.94, p=0.0014), adjusting for age, sex, race/ethnicity, and neighborhood income. Age, neighborhood income and walkability moderated greenness' relationship to odds of AD incidence, such that younger ages (65-74), lower-income, and non-car dependent neighborhoods may benefit most from high greenness. CONCLUSIONS: High greenness, compared to low greenness, is associated with lower 5-year AD incidence. Residents who are younger and/or who reside in lower-income, walkable neighborhoods may benefit the most from high greenness. These findings suggest that consistently high greenness at the Census block-level, may be associated with reduced odds of AD incidence at a population level.

Adjuvant trastuzumab in early HER2-positive breast cancer: Journeying towards the optimal duration of therapy in South Africa.

Trastuzumab was added to the South African Essential Medicines List (EML) in 2017 for the adjuvant management of human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. However, access has remained inconsistent, as some provinces continue to regard trastuzumab as unaffordable within the contexts of their respective oncology budgets. The intention of providing access to trastuzumab through its inclusion on the EML, therefore, has not been met. The National EML Committee (NEMLC) recently reviewed newly published peer-reviewed information investigating the impact of a shorter trastuzumab treatment period on both clinical efficacy and safety. On account of this review, and with a view to improving access while reducing cost and toxicity, the NEMLC has revised the duration of trastuzumab therapy, i.e. from 12 months to 6 months in the adjuvant management of early HER2-positive breast cancer. This article explores and reports on the data used to make this policy amendment.

The prison healthcare service: a workforce committed to change.

This article discusses the changes that are needed in the prison healthcare service, outlining the move to a multidisciplinary team approach, away from the outdated, medically dominated service which prevails today. This article supports the partnership arrangements put forward in 'The Future Organization of Prison Health Care' (Department of Health (DoH), 1999) and suggests how this can be achieved locally, calling on nurses working in the prison environment to be proactive and forge links with colleagues in local NHS services. The need for clinical governance to be firmly established and regular reports to be submitted to prison governors on the quality and provision of services is highlighted.

Exploring the NHS executive document Signposts for Success.

The recent document 'Signposts for Success' (Department of Health (DoH), 1988a) offers an extensive blueprint for the strategic development of services for people with a learning disability in the next decade. This article discusses the key issues raised and some of the controversial aspects that have to be addressed.

Equity and access to health care for women with learning disabilities.

The increased expectation for women with learning disabilities to become more autonomous and independent is generally a positive and dynamic force. However, care must be taken to ensure that, within this environment, women with learning disabilities are not isolated or lack support as this increases their vulnerability. These issues exist for all women within our society, but women with learning disabilities are more vulnerable because of their lack of voice both individually and politically. Within this new culture of independence and rights for women with learning disabilities, nurses must ensure that they address their own accountability and responsibility.

Learning disability nursing and primary healthcare.

This article addresses the issues surrounding the role of learning disability nurses and their relationship with primary healthcare colleagues. It highlights opportunities in general practice for the learning disability nurse who has become a key player in shaping services for this client group as services swing towards primary healthcare. The NHS Executive document NHS Priorities and Planning Guidance 1997-98 is explored and the opportunities that this gives the community learning disability nurse are discussed. The article stresses the need for learning disability nurses to obtain quality research-based evidence on effective caring interventions. The importance of clinical audit and outcome measurements from interventions are highlighted. Finally, the importance of good communication and being able to respond to this client group's needs is emphasized.

Where does all the money go? An audit of cost and waste distribution in a second-tier peri-urban hospital.

OBJECTIVE: To determine the probable effect of increasing clinical frugality on health system expenditure by measuring cost distribution and waste at an individual patient level. DESIGN: Retrospective cost analysis evaluating the distribution of variable costs (i.e. costs excluding salaries and other fixed expenses) and wastage (i.e. expenditure without adequate clinical gain). SETTING: A peri-urban regional referral (level 2) hospital and two district hospitals. SUBJECTS: 500 folders (350 inpatient and 150 outpatient). RESULTS: Accommodation costs accounted for the largest proportion of overall admission costs (42.3%), followed by drugs (19.5%), intravenous fluids (15.4%), laboratory investigations (12.9%) and radiology (10%). Waste accounted for 4.4% (R15.15, SD 41.92) of mean inpatient variable costs of R344.33 (median R208.89, minimum R19.06, maximum R5, 627.25) and this mean admission cost concealed a group of high-cost admissions, with the most expensive 5% accounting for 27.1% of total variable costs and 24.9% of waste. CONCLUSION: Four concepts important for economical bedside decision-making emerged: 1. Cumulative costs mount rapidly, even if individual items appear cheap. 2. The savings achieved by foregoing the use of an individual item (the variable cost) may be considerably less than the listed total cost to the State of that item (fixed costs are unaffected by reduced short-term utilisation.) 3. More care when ordering investigations and therapy may reduce waste. 4. Global views of hospital costs conceal a group of patients whose care is more expensive than average but who may be difficult to identify prospectively. Although the wastage rate in this group is about the same as the global rate, it may represent a useful target for future study.

Health of the Nation for people with learning disabilities.

This article explores issues related to the health of people with learning disabilities, with particular reference to the Department of Health (1995a) document The Health of the Nation: A Strategy for People with Learning Disabilities. This publication has stimulated care staff across all agencies to take a fresh look at this client group and their health needs in the five key areas: coronary heart disease and stroke; cancers; HIV/AIDS and sexual health; accidents; and mental health.