Higher Expenditure Research Articles

On the decomposition of the extensions of the Gini index that are based on the ‘metallic’ sequences of number theory

AbstractThe present paper extends the work of Subramanian (Econ Bull 41(4):2309–2319, 2021), as well as that of Creedy and Subramanian (Exploring a new class of inequality measures and associated value judgements: Gini and Fibonacci-type sequences, 2022), by showing how this new extension of the Gini index may be decomposed by income sources, income classes and population subgroups. It also gives an empirical illustration applying this extension of the Gini index to the analysis of the inequality in expenditure on social protection among European countries in 2018. In the decomposition by benefit function it appears that the housing function consistently exhibits the smallest contribution, due to its low expenditure weight, while the old-age function has the lowest inequality but the highest contribution, due to its substantial expenditure weight. The family/children function's contribution increases when a higher weight is given to lower expenditures, highlighting a pronounced inequality at lower expenditure levels. Conversely, the old-age function shows higher inequality among countries with higher expenditures. In the breakdown by welfare systems, we observe greater inequality between systems than within them.

AN ECONOMIC ANALYSIS OF BURIAL GROUND WORKERS IN VIRUDHUNAGAR DISTRICT, TAMILNADU

Burial ground workers has covered wide area of the economic analysis and therefore it is not possible to deal in the details of each them in this paper. We have tried to present some of these specific aspects of the total work. This study analyzed the socio economic analysis of burial ground workers in Virudhunagar district of Tamil Nadu. It is different types of burial grounds workers like manuval, gasifier and electric crematorium. Objectives of the study, to examine the characteristics of burial ground workers in Virudhunagar district and to study the burial ground worker income and expenditure pattern in Virudhunagar district. Result of the study, the income, saving, expenditure, and debt levels of crematorium of burial ground workers are influenced by a range of factors. While many workers have moderate income levels and save a significant portion of their income, they also tend to have high expenditure levels and carry some level of debt. Understanding these factors can help workers make informed financial decisions and achieve their financial goals. Finding of the study Challenges, the majority of participants (85%) reported feeling emotionally drained due to the nature of their work, while 70% reported experiencing physical exhaustion. Workload, Many participants (60%) reported feeling overwhelmed by their workload, citing inadequate staffing and inadequate training as contributing factors. Support, Only 30% of participants reported receiving adequate support from their employers or colleagues, leading to feelings of isolation and loneliness. Job Satisfaction, despite the challenges, 70% of participants reported being satisfied with their job, citing a sense of purpose and fulfillment. Suggestions for Improvement, Participants suggested improvements in staffing levels, training programs, and emotional support services. Conclusion of the study, while burial grounds present various economic challenges, they are integral to cultural heritage and societal values. The balanced approach that considers financial sustainability, environmental impact, and cultural significance is essential for the long-term management and preservation of these spaces. The findings suggest that burial ground workers in crematorium settings face significant challenges related to workload, emotional well-being, and support. Despite these challenges, many participants reported feeling satisfied with their job due to the sense of purpose and fulfillment it provides. KEYWORDS: manuval, gasifier, burial grounds workers, economic challenges, financial goals

Real-world treatment patterns, health care resource utilization, and costs in a US Medicare population with bronchiectasis.

Bronchiectasis carries a significant economic burden with high health care expenditures associated with frequent hospitalizations, physician visits, and treatments, including oral and intravenous antibiotics for repeated lung infections, airway-clearance therapy, and oxygen administration. Bronchiectasis exacerbations can contribute to this burden. To estimate US health care resource utilization (HCRU) and costs associated with bronchiectasis and with bronchiectasis exacerbations. This retrospective study used the 100% Medicare Fee-for-Service database (January 2014 to December 2020) to compare HCRU and costs among patients with bronchiectasis with those of patients without bronchiectasis (controls). For patients with bronchiectasis, the index date was a randomly selected bronchiectasis claim after more than 1 year of disease history and, for controls, a claim closest to their matched bronchiectasis patient's index date. All patients had continuous enrollment for at least 12 months pre-index (baseline) and at least 12 months post-index. Primary outcomes were all-cause, respiratory-related, and bronchiectasis-related HCRU and health care costs, which were presented by the overall sample and by segmented patient cohorts based on the number of exacerbations during baseline (0, 1, or ≥2). 92,529 patients with bronchiectasis (mean [SD] age, 76.7 [8.8] years; 72.3% female) and 92,529 matched controls qualified for the study. Compared with controls, patients with bronchiectasis presented greater mean (SD) all-cause physician visits (15.4 [10.0] vs 13.2 [9.7]; P < 0.001) and respiratory-related physician visits (5.2 [4.3] vs 1.9 [3.1]), pulmonologist visits (1.9 [2.2] vs 0.3 [1.0]), hospitalizations (0.4 [0.9] vs 0.3 [0.8]), emergency department visits (0.33 [1.0] vs 0.26 [1.0]), and total health care costs ($10,224 [$23,263] vs $6,704 [$19,593]). Respiratory-related HCRU was also greater in patients with more baseline exacerbations, with total health care costs of $8,506, $10,365, and $14,790 for patients with 0, 1, and at least 2 exacerbations, respectively (P < 0.01). This real-world study demonstrates the high disease burden associated with bronchiectasis and with exacerbations, highlighting the need to improve management and reduce exacerbations.

A numerical comparison of heavy‐purge and dual‐reflux strategies in pressure swing adsorption for methane enrichment

AbstractDual reflux pressure swing adsorption (DR‐PSA) has been regarded as a state‐of‐the‐art adsorption‐based process which can simultaneously obtain two streams of pure product gases with a narrow pressure window. However, the DR‐PSA has not yet been reported in industrial applications. Herein, a DR‐PSA and a heavy‐purge pressure vacuum swing adsorption (HP‐PVSA) were numerically investigated for the enrichment of 1%, 8% and 15% CH4 from N2 gas mixtures in pilot‐scale. Key separation indicators such as purity, recovery and energy cost of the two cycles were compared to analyze the limitations of the DR‐PSA process while scaling‐up. This study reveals the impact of heavy to feed (H/F) ratios on purity and recovery for both cycles and analyses the energy consumption of each process. For feed gas with 15% CH4, while DR‐PSA can achieve a slightly better purity and recovery (88.3% and 88.3%, respectively) compared to HP‐PVSA (87.5% and 80.3%, respectively), it also involves an order of magnitude higher energy consumption (181.6 versus 24.6 kJ/mol CH4 captured). DR‐PSA shows significantly superior performance than HP‐PVSA when the CH4 content in the raw feed gas is low. Under the investigated operating conditions, HP‐PVSA can only enrich 1% CH4 to 10% with 78.7% recovery while DR‐PSA can obtain 75.3% purity and 77.3% recovery. Results indicate that DR‐PSA exhibits superiority in enrichment of dilute gas, however, its high energy consumption, high capital expenditures and limitations in processing high throughput are the chief reasons hindering its industrial application.

Adult Pharmacy Costs and Characteristics of Very High-Cost Prescription Drug Users in the United States, 2018–2022

Objective: This study sought to identify: (1) the demographic and clinical characteristics of very high-cost users (defined as patients with pharmaceutical expenditures that were equal to or greater than the 99th percentile), (2) whether or not these characteristics changed over time, (3) sociodemographic and clinical correlates of being very high-cost users, (4) the average pharmaceutical costs of very-high cost users, and (5) the therapeutic classes and medications that contributed to these high costs Background: There are growing public concerns about rising drug costs, in part due to increased availability, greater effectiveness, and market considerations. There is a concentrated portion of patients that accounts for a disproportionately large portion of pharmaceutical expenditures. Methods: A large serial cross-sectional study was conducted with De-identified, member-level pharmacy claims (n = 65,739,791) from a large, national pharmacy benefits manager from January 1, 2018 to December 31, 2022. The main outcome and measures were 2018–2022 pharmaceutical expenditures; amounts were adjusted for inflation to reflect 2022-dollar values. Results: Across the study period, the odds of being classified as a very high-cost user were 1.31 times as high for those 45–64 years old compared with those 18–44 years old (reference category); the odds were 1.42 times as high for males compared with females; 1.13 times as high before those identifying as non-Hispanic Black compared with non-Hispanic white; 1.11 times as high for those enrolled in a health care exchange plan compared with a commercial plan. In addition, very high-cost users lived in areas with higher social needs. Human immunodeficiency virus, inflammatory conditions, multiple sclerosis, and cancer accounted for the largest share of costs among this group. Conclusions: This study identified the unique characteristics of very high-cost pharmaceutical users and identified the top conditions and prescription drugs that drove high pharmaceutical expenditures among this population. These findings are essential to understanding rising pharmaceutical costs in the United States and can help identify the issues and solutions of specific cost drivers within our health care policies.

Association Between Government Expenditures, Inflation and Interest Rate in Nigeria

The study analysed the relationship between government expenditure, economic growth, inflation and interest rate in Nigeria. The high inflation and interest rate with high government expenditure has been a problem for the Nigerian economy. Secondary data from 1986 to 2022 were collated from the Central Bank of Nigeria Statistical Bulletin and analyzed using multiple regression analysis. The results showed a positive relationship between inflation rate, government expenditure and Gross Domestic Product (GDP). This means that as inflation and government expenditure increased, real gross domestic product (GDP) would increase while there existed an inverse relationship between interest rate and gross domestic product (GDP), which implies that as interest rate increased, GDP would decrease. The test for the model fitness using adjusted R2 indicated the predictor values accounted for 95 per cent variations in the dependent variable (GDP). The study therefore recommended that monetary and fiscal authorities should regulate government expenditure by targeting a contractionary fiscal policy which decreases the amount of government expenditure in a bid to tackle inflationary trends. The government should aim at inflation targeting through a single-digit interest rate which could encourage the private sector to accumulate funds to be used to augment government efforts in regulating stability in the economy. Besides, even though the structural inflation facing the country did not have a very significant effect on the domestic economy concerning government expenditure and its impact on GDP, this should be resolved by dismantling all rigidities and bottlenecks such as the war against insecurities and herdsmen that have been distorting farming and agricultural output in Nigeria of late.

Educational Intervention Improves Female Athlete Triad Awareness in Female Collegiate Swimmers

Introduction: The Female Athlete Triad (Triad) is characterized by high energy expenditure and low caloric intake, leading to dysregulation of menstruation and bone metabolism. Triad-associated relative energy deficiency in sport (REDs) adversely affects performance and mental health. Risk factors are underrecognized in swimmers, who are less likely to present with bone stress injuries because of swimming’s non-weightbearing nature. Our objective was to quantify knowledge about the Triad and REDs among collegiate swimmers and demonstrate the value of educational intervention. Methods: Members of two Division III women’s varsity swim teams completed a Qualtrics survey, consisting of 35 Triad and REDs questions, and 13 demographics questions. Participants then attended an in-person, 20-minute educational session focused on Triad risk factors and prevention, after which they completed a post-session survey. The post-session survey contained 13 additional questions using a Likert scale, where 1=Strongly Agree and 5=Strongly Disagree. Pre- and post-session data were analyzed using Microsoft Excel. Results: Thirty-one swimmers were included. Pre-session, 9.7% of respondents named one or more Triad components, compared to 96.8% after (p&lt;0.0001). 9.7% could define the REDs acronym pre-session, compared to 87.1% after (p&lt;0.0001). Participants better understood the Triad post-session (mean Likert score=1.23) and found the session helpful (mean=1.23), but in a hypothetical scenario, felt relatively uncomfortable contacting medical staff about Triad symptoms (mean=1.87, p=0.0002). Of the 35.5% who believed they may be experiencing Triad components, 72.7% indicated the session motivated them to seek help. Conclusions: Female collegiate swimmers’ low baseline Triad and REDs knowledge improved significantly after an educational intervention. Survey responses highlighted the importance of heightened Triad awareness, but also its continued stigmatization. The session encouraged swimmers with self-identified Triad symptoms to seek help, underscoring the importance of continued education efforts, especially in sports where the Triad is underrecognized.

Impact Assessment of Integrated Pest Management Technology on Kharif Paddy Cultivation in Vidarbha Region of Maharashtra, India

The Eastern Vidarbha region consist of Bhandara, Gondia, Gadchiroli and Chandrapur and some part of the Nagpur district is famous for specialized farming and paddy as major crop. The total area in Maharashtra state was 15.53 lakh hectares with annual production 34.81 lakh tons of rice (Anonymous 2023-24). About 80.00 per cent gross cropped area in this region is under paddy. IPM has been proved to be a cost minimization technique. Losses in Paddy yield the tune 10 to 25 per cent occurs due to attack of insect pest and disease. Being the topic of such high importance from cultivators point of view, the research topic has been selected i.e. Impact Assessment of Integrated Pest Management technology on Kharif Paddy cultivation in Vidarbha region of Maharashtra State its economic investigation in different level of adoption of IPM technologies. The study was carried out with the main goals of determining the extent to which recommended technology has been adopted in Kharif paddy production by using principle component analysis approach and for develop the composite index, examining the input utilization of Kharif paddy at varying levels of IPM adoption, and workout cost effectiveness and profitability of kharif paddy at different level of adoption of IPM technology. The study was conducted in the districts of Gadchiroli in the Vidarbha region of Maharashtra State, India. Three tahasil, Gadchiroli, Chamorshi and Dhanora were chosen from these districts, and a total of 120 farmers were selected from seven villages, namely Gadchiroli, Indala, Hirapur, Chamorshi, Krishna Nagar, Heti, Kanartola. The primary data, which cover the years 2023–2024. Total 120 farmers, 25 farmers were classified as high adopters, 76 farmers were classified as medium adopters, and 19 farmers were classified as low adopters. As a result of input usage, the group with a high adoption level utilized the most human labour. Farmyard manure is used most in the high adopter group (49.87 quintal per hectare), followed by low adopters (31.73 qtl/ha) and medium adopters (34.45 qtl/ha) because the farmers can apply only owned farm FYM. The reasons of lower used of FYM, due to shortage of cattle’s population. The reasons of low adopter, high expenditure of Integrated pest management components was the 89.00 per cent farmers can use chemically control that means 2 to 3 spraying was use in kharif paddy in low adopter group. The B:C ratio at Cost ‘A1’ was 1.79, 1.85 and 1.92 in low, medium and high adopters, respectively, while B:C ration at Cost ‘C2’ for low, medium, high adopter were 1.12,1.19,1.25 respectively. The results concluded that the low adopters group are not making more profit. It indicates that, as adoption of technology increases the yield level of crop and so that the net returns also increases. The reduction in per quintal production cost at Cost ‘C2’ over low adopter group were Rs. 188.06/-. Paddy productivity has been reported increased by 19.84 per cent with the reduction in the cost of Rs. 7375.89 in high level of adoption of Integrated Pest Management Technology. The findings of the present study with regards to overall adoption of integrated pest management practices of paddy by paddy growers were observe for wide adoption of IPM technology in Kharif Paddy, Government should take initiative for production of bio-agents and available the pheromane trap and yellow sticky trap through establishing unit in Government Agricultural Offices and Krishi Vigyan Kendra and encourage the rural youth for establishing Units at taluka level.

Financial integration and economic growth in Africa

The main objective of this article is to assess the link between financial integration and economic growth in African countries during the period 1990-2017. To achieve this goal, we used a dynamic panel model using the generalized method of moments (GMM) in first difference with threshold effects on a sample of 29 African countries. The results of the estimates reveal, on the one hand, that the countries that benefit from the benefits of financial integration on economic growth are those with high trade and financial openness, high human capital, low inflation, democratic regime, and high public expenditure. On the other hand, these results indicate that financial integration is associated with a low probability of surviving a banking crisis in the countries studied. Thus, the governments of African countries must implement policies aimed at a progressive liberalization of trade and financial activities, coupled with the implementation of macroeconomic stability policies and the improvement of the quality of the institutional environment, which determines the impact of financial integration on economic growth.

Innovations in Preconception Care: Optimizing Health for All Individuals.

Optimizing the overall health of individuals prior to pregnancy can improve both pregnancy and lifelong health outcomes. Despite extremely high financial expenditure on birth in the United States, maternal and infant mortality rates continue to rise. Moreover, significant racial and ethnic disparities persist in perinatal health outcomes. Preconception care, or health care provided before or between pregnancies, has the capacity to meet these challenges. Preconception care can be integrated into every health care visit, including visits with primary care, reproductive health, and mental health care clinicians. Increasing awareness among clinicians of the benefits of preconception care and equipping them with innovative strategies to implement this care into practice, the number of people receiving optimal care could be increased. Recent innovations in preconception care include group care, health applications (apps), reminders in electronic health records, social marketing campaigns, social media movements, community-based partnerships, health care policy and access, and improving public and clinician education on preconception health topics. Ultimately, improving preconception health is best done in partnership between the consumer and clinician. Midwives, whose care is person-centered and partnership-focused, are well positioned to champion the innovation and implementation of equitable preconception care. The purpose of this State of the Science review, therefore, is to synthesize the literature on recent evidence-based innovations that may be used to improve preconception health and counseling.

The Burden of Inpatient Hospitalizations with Cardiac and Cerebrovascular Diseases in Patients with Type 1 Diabetes: Insights from the National Inpatient Sample in the US.

This study aimed to evaluate the burden and impact of cardiac and cerebrovascular disease (CCD) on hospital inpatients with type 1 diabetes mellitus (T1DM). This is a retrospective nationwide cohort study of people with T1DM with or without CCD in the US National Inpatient Sample between 2016 and 2019. The in-hospital mortality rates, length of stay (LoS), and healthcare costs were determined. A total of 59,860 T1DM patients had a primary diagnosis of CCD and 1,382,934 did not. The median LoS was longer for patients with CCD compared to no CCD (4.6 vs. 3 days). Patients with T1DM and CCD had greater in-hospital mortality compared to those without CCD (4.1% vs. 1.1%, p < 0.001). The estimated total care cost for all patients with T1DM with CCD was approximately USD 326 million. The adjusted odds of mortality compared to patients with non-CCD admission was greatest for intracranial hemorrhage (OR 17.37, 95%CI 12.68-23.79), pulmonary embolism (OR 4.39, 95%CI 2.70-7.13), endocarditis (OR 3.46, 95%CI 1.22-9.84), acute myocardial infarction (OR 2.31, 95%CI 1.92-2.77), and stroke (OR 1.47, 95%CI 1.04-2.09). The burden of CCD in patients with T1DM is substantial and significantly associated with increased hospital mortality and high healthcare expenditures.

Learning accurate and efficient three-finger grasp generation in clutters with an auto-annotated large-scale dataset

With the development of intelligent manufacturing and robotic technologies, the capability of grasping unknown objects in unstructured environments is becoming more prominent for robots with extensive applications. However, current robotic three-finger grasping studies only focus on grasp generation for single objects or scattered scenes, and suffer from high time expenditure to label grasp ground truth, making them incapable of predicting grasp poses for cluttered objects or generating large-scale datasets. To address such limitations, we first introduce a novel three-finger grasp representation with fewer prediction dimensions, which balances the training difficulty and representation accuracy to obtain efficient grasp performance. Based on this representation, we develop an auto-annotation pipeline and contribute a large-scale three-finger grasp dataset (TF-Grasp Dataset). Our dataset contains 222,720 RGB-D images with over 2 billion grasp annotations in cluttered scenes. In addition, we also propose a three-finger grasp pose detection network (TF-GPD), which detects globally while fine-tuning locally to predict high-quality collision-free grasps from a single-view point cloud. In sum, our work addresses the issue of high-quality collision-free three-finger grasp generation in cluttered scenes based on the proposed pipeline. Extensive comparative experiments show that our proposed methodology outperforms previous methods and improves the grasp quality and efficiency in clutters. The superior results in real-world robot grasping experiments not only prove the reliability of our grasp model but also pave the way for practical applications of three-finger grasping. Our dataset and source code will be released.

A new suggestion to marine gold extraction: Utilizing reduced graphene oxide membranes within seawater desalination processes

Traditional mining practices not only cause severe environmental issues, but also face the problem of insufficient production capacity of gold to meet its growing demand. The proposed alternative strategies for gold production, such as the extraction of gold from seawater, still keep a formidable challenge due to their strong dependence on adsorbent materials with high capacity, selectivity, and sensitivity, while also needing to meet the demands of being environmentally friendly and cost-effective. In practice, the direct extraction of gold from seawater is limited by its extremely low yield and high energy expenditure. However, if the combination of gold extraction techniques with seawater desalination can substantially reduce the energy consumption, the extraction of gold from seawater will become economical and feasible. In this paper, we evaluate the feasibility of marine gold extraction using reduced graphene oxide membranes (rGOM) during the seawater desalination process. The rGOM can adsorb almost all Au3+ from the solutions with trace concentrations of Au3+ ranging from 10 ppb to 200 ppb. The adsorption quantity is linearly related to the concentration, indicating that the adsorption capacity of rGOM is much higher than the total amount of Au3+ in the solution. Additionally, the rGOM can selectively adsorb 99 % of Au3+ in the mixed solution while hardly adsorbing other common elements in seawater. More importantly, the rGOM exhibits the long-term stability over 30 days when being immersed in the solution, making it directly compatible with the existing seawater desalination processes. These specific properties allow the rGOM to be an ideal candidate for combining the extraction of gold from seawater with seawater desalination processes. Our findings provide a methodology for enhancing the economic efficiency of the extraction of gold from seawater and hold promise for addressing the problem of gold scarcity.

Internet of Things-Based Robust Green Smart Grid

Renewable energy sources play a critical role in all governments’ and organizations’ energy management and sustainability plans. The solar cell represents one such renewable energy resource, generating power in a population-free circumference. Integrating these renewable sources with the smart grids leads to the generation of green smart grids. Smart grids are critical for modernizing electricity distribution by using new communication technologies that improve power system efficiency, reliability, and sustainability. Smart grids assist in balancing supply and demand by allowing for real-time monitoring and administration, as well as accommodating renewable energy sources and reducing outages. However, their execution presents considerable problems. High upfront expenditures and the need for substantial and reliable infrastructure changes present challenges. Despite these challenges, shifting to green smart grids is critical for a resilient and adaptable energy future that can fulfill changing consumer demands and environmental aims. To this end, this work considers developing a reliable Internet of Things (IoT)-based green smart grid. The proposed green grid integrates traditional grids with solar energy and provides a control unit between the generation and consumption parts of the grid. The work deploys intelligent IoT units to control energy demands and manage energy consumption effectively. The proposed framework deploys the paradigm of distributed edge computing in four levels to provide efficient data offloading and power management. The developed green grid outperformed traditional grids in terms of its reliability and energy efficiency. The proposed green grid reduces energy consumption over the distribution area by an average of 24.3% compared to traditional grids.

Association Between the Nutritional Quality of Food Purchases and Household Food at Home Expenditures in Mexico

BackgroundPoor-quality diets are a major risk factor for noncommunicable diseases. Few studies in Mexico have tested whether higher expenditures are needed to purchase high-quality food. ObjectiveThe objective of the study was to assess how dietary quality of food purchases was associated with household food at home expenditures. DesignThis study was a secondary analysis of cross-sectional data from the National Household Income and Expenditure Survey (EncuestaNacional de Ingresos y Gastos de los Hogares [ENIGH] 2018). Participants/settingThe study included 74 469 households with information on food and beverage purchases in Mexico in 2018. Main outcome measuresQuarterly household food at home expenditures by adult equivalent (AE) for all food groups that were scored with the Global Dietary Quality Score (GDQS) for food purchases expressed in dollars/quarterly/AE. Statistical analyses performedAdjusted generalized linear models were used to evaluate the association between GDQS for food purchases (expressed in tertiles: low, mid, and high) and quarterly food expenditures. The analyses were performed at the national level by place of residence and income quintile. ResultsAt the national level, the difference in food expenditures between the high- and the low-GDQS groups was +$13.85/AE. By place of residence, the difference between the high- and the low-GDQS groups was +$17.31/AE in urban and +$5.12/AE in rural areas. For income quintile 1 (lowest), there was a statistical difference of –$4.79/AE and +$43.25 for quintile 5 (highest). ConclusionsQuality of food purchases can be associated with higher or lower expenditures depending on the specific food purchased. High GDQS is associated with lower expenditures among the lowest-income households as they purchase less expensive options compared with high-income households.

Comparative Analysıs of Out-Of-Pocket Health Expenditure Across Countries of Different Income Groups

The objective of this study is to conduct a comparative analysis of the proportion of out-of-pocket health expenditures (OOPHE) in total health expenditure for countries across various income groups. The study utilizes data from the World Bank database between 2010 and 2019, compiled and analyzed in Excel. In 2019, there was a 4% increase in the low-income group, an 18% increase in the lower middle-income group, a 63% increase in the upper middle-income group, and a 36% increase in the high-income group when compared to the year 2010. When OOPHE per capita is analysed separately, we can observe that the high-income countries group has the highest expenditure (14%), but it is the group with the lowest share in total health expenditures. Given higher levels of out-of-pocket health expenditures in low- and lower-middle-income countries, significant disparities are apparent among income groups. To ensure more equitable access to healthcare, countries must reduce financial burdens on individuals by understanding the distinctions and implementing appropriate policies.

Health Literacy Level of Patients Applying to Chest Diseases Outpatient Clinic and Related Factors: The Case of A Selected Training and Research Hospital

Health literacy is an important skill and capacity that affects individuals' ability to make decisions about their health and manage their health. It is associated with low health literacy, unnecessary outpatient clinic visits, high health expenditures, late diagnosis, and risky health behaviors. This research was conducted with 373 patients who applied to the Chest Diseases outpatient clinic of a training and research hospital in Istanbul. 20.4% (n=76) of the participants had low health literacy and 49.9% (n=186) had middle health literacy. According to the gender of the patients, while there was no significant difference in access to treatment health services, total score and self-efficacy subscale dimensions, the median of the health promotion subscale dimension was higher in women than in men and was found to be statistically significant. Statistically significant differences were found in access to treatment health services, health protection development, total score and self-efficacy subscale dimensions according to the educational status of the patients. Statistically significant differences were found in access to therapeutic health services, health promotion, total score and self-efficacy subscale dimensions according to the occupation of the patients. Health literacy level was found to be low in one out of every four patients. Gender, educational status and occupation were found to be effective on health literacy level.

Intensity level in crosstraining sessions in obese women: a real-world study

Objective: The objectives were to measure psychophysiological responses during crosstraining sessions in obese women, focusing on heart rate (HR), blood pressure (BP), caloric expenditure, and perceived effort (RPE). Additionally, it examined the relationship between caloric expenditure and effort intensity. Methods: This real-world observational study involved ten obese women (average age: 31.5 ± 6.2 years, BMI: 34.2 ± 3.7 kg/m², crosstraining experience: 5.3 ± 3.4 months). Participants underwent three individual crosstraining sessions. Each session's training type and duration were recorded. BP was measured before and after, along with HR at rest, average HR, peak HR, and RPE post-workout. Internal load and caloric expenditure were calculated. Results: Among 30 observed sessions, there were no significant differences in training duration by type. Caloric expenditure averaged 272.3 ± 76 kcal. Systolic BP increased significantly (from 129 ± 8 mmHg to 160 ± 16.5 mmHg), as did diastolic BP (from 90.3 ± 6.7 mmHg to 113.6 ± 14.9 mmHg, p &lt; 0.001). Mean HR was 136.9 ± 14.8 bpm (73.6 ± 7.3% of HRmax), and peak HR reached 181.9 ± 12.1 bpm (97.8 ± 6.1% of HRmax). Participants spent more time at or above 80% of predicted HRmax. Mean RPE was 5.7 ± 2.2 a.u., significantly correlating with exercise time above ≥90% of HRmax (r = 0.37; p = 0.046, effect size = 0.39). Conclusions: Crosstraining sessions in obese women raised BP, induced high caloric expenditure, and imposed significant cardiorespiratory demands, classifying these sessions as high-intensity. This intensity closely correlates with energy expenditure. Keywords: Heart Rate; Aortic Pressures; High-Intensity Interval Training; Sport; Obesity; Crosstraining.

Kajian Pelaksanaan Gerakan Tanam Jagung Panen Sapi (TJPS) Dalam Meningkatkan Nilai Tukar Petani (NTP) Di Desa Manusak, Kabupaten Kupang, Provinsi Nusa Tenggara Timur

Corn and cattle are the main commodities in dry land farming in East Nusa Tenggara (NTT), with corn as a food source and cattle as a source of income. This province has vast dry land potential, namely 1,734,488 H, but its utilization is still less than optimal. The Cattle Harvest Corn Planting Program (TJPS) was launched to increase corn production, cattle population and farmer welfare.This research analyzes the Farmer Exchange Rate (NTP) in Manusak Village, Kupang Regency, and the factors that influence it, as well as examining government policies in supporting the efficiency of the corn-cattle farming system. Qualitative methods through interviews, observations and text analysis are used to understand farmers' experiences in farming.The results show that the NTP in the Gacinda and Leselik farmer groups is different: Gacinda has a higher NTP than Leselik, which is caused by differences in corn production costs and yields. In conclusion, corn productivity and costs incurred affect farmer welfare, with high expenditures potentially reducing NTP.

The struggle that is phenylketonuria: What do the patients and caregivers suffer from.

To assess stress levels and life hardships of patients with phenylketonuria and their parents. Between January 2020 and June 2020, 156 patients with PKU and their parents who arrived for regular examinations were included. Parents were asked to complete the parenting stress index, Zarit Burden Scale, and the Strengths and Difficulties Questionnaire (SDQ), and children over the age of 11 were asked to fill the Rosenberg Self-Esteem Scale, the State-Trait Anxiety Inventory, and the SDQ. We found a significant negative correlation between the Rosenberg Self-Esteem Scale and age at diagnosis (r = -0.27, P = .035), mother's age (r = -0.33, P = .009), and father's age (r = -0.38, P = .004). There was a significant positive correlation between the State-Trait Anxiety Inventory and patient's age (r = 0.36, P = .006), mother's age (r = 0.29, P = .031) and father's age (r = 0.38, P = .024). In the child form of the SDQ, emotional problems were significantly positively correlated with serum phenylalanine (Phe) levels at diagnosis (r = 0.35, P = .036), total points were significantly positively correlated with serum Phe levels at clinical examination (r = -0.34, P = .004), and social problems were significantly negatively correlated with the father's age (r = -0.34, P = .047). We found a significant positive correlation between the Zarit Burden Scale and number of siblings (r = 0.195, P = .023). In the parent form of the SDQ, emotional problems were significantly positively correlated with patient age (r = 0.217, P = .032), peer problems were significantly positively correlated with age at diagnosis (r = 0.211, P = .037), behavioral problems (r = 0.203, P = .045), and attention deficit and hyperactivity (r = 0.203, P = .045) were significantly positively correlated with serum Phe levels at diagnosis. Phenylketonuria is difficult to cope with both for the patients and their parents because of diet obligation, high expenditures for the formulas required for the diet, requirement of regular clinical examinations, and possible development of mental disability and psychiatric disorders. Patients and their families should be psychologically evaluated and support should be provided if needed.