AMP, ADP, and ATP Concentrations Differentially Affected by Meat Processing, Manufacturing, and Nonmeat Ingredients.

Given its presence in a wide spectrum of soils relevant to food process hygiene, the biological metabolite adenosine triphosphate (ATP) is used as a target for surface hygiene assessments in food processing facilities. Yet, ample evidence demonstrates that ATP is depleted into adenosine di- (ADP) and monophosphate (AMP) homologs resulting in a loss of sensitivity for ATP-based hygiene assays. Yet, there are few studies that denote the degree of these shifts under routine processing conditions such as those encountered during various meat processing steps that may likely alter redox potential and adenosine profiles (e.g., tissue/cellular disruption, application of reducing additives, fermentation, or thermal treatment steps). In this study, meat samples were collected from homogenized beef tissue treated with nonmeat ingredients (sodium chloride, sodium nitrite, sodium erythorbate, natural smoke condensate, and sodium acid pyrophosphate) during manufacture at predetermined steps, and from retail meat products purchased from local markets. Concentrations of ATP, ADP, AMP, and AXP (sum concentration of all homologs) in a lab setting and in situ meat processing venues were determined and compared. Greater differences in AXP were seen during manufacture, where ADP generally comprised ∼90% as a mole fraction of AXP across all treatments, with the exception of the final cook step where AMP predominated. ATP concentrations averaged 2 log values lower than ADP and AMP. Adenosine profiles in retail samples followed similar trends with minimal ATP concentrations with ADP predominant in uncooked samples and AMP predominant in cooked samples. Resultingly, meat processing steps during product manufacture will alter AXP-reliant test sensitivities which should be considered when such technologies are utilized for hygiene verification in meat processing.

Quantities of Adenylate Homologues (ATP+ADP+AMP) Change over Time in Prokaryotic and Eukaryotic Cells.

Rapid assays for the assessment of the hygienic state of surfaces in food and medical industries include the use of technologies designed to detect the presence of the metabolite ATP. ATP is a critical metabolite and energy source for most living organisms; therefore, the presence of ATP can be an indicator of surface hygiene based on the presence of soil or food residues associated with inadequate cleaning. The concentrations of ATP vary based on an organism's metabolic state, thus potentially influencing the sensitivity of ATP-based assays. However, little has been published detailing the quantitative changes of ATP to the adenylate homologues ADP and AMP nor the quantitative and cumulative fate of these homologues over time as the metabolic state remains in flux. The objective of this study was to quantify the individual and cumulative (AXP) concentrations of these three adenylate homologues over defined time periods in selected eukaryotic tissue and prokaryotic cell cultures of significance to hygiene. ATP concentrations differed substantially across these selected variables of time and source. The 1- to 3-log reductions in ATP concentrations over time were highly affected by organism type. In general, ADP became the predominate adenylate in eukaryotic tissue, and AMP was the predominate adenylate in the prokaryotic cells at later time points in each study. Total AXP concentrations dropped in general, reflective primarily of the loss of ATP. The results of ATP-based techniques for hygiene surveillance will vary as a function of the amount of cellular material present and the metabolic state of such material.

Willingness to pay for drug rehabilitation: implications for cost recovery.

OBJECTIVES: This study estimates the value that clients place on methadone maintenance and how this value varies with the effectiveness of treatment and availability of case management. We provide the first estimate of the price elasticity of the demand for drug treatment. METHODS: We interviewed 241 heroin users who had been referred to, but had not yet entered, methadone maintenance treatment in Baltimore, Maryland. We asked each subject to state a preference among three hypothetical treatment programs that varied across three domains: weekly fee paid by the client out-of-pocket ($5-$100), presence/absence of case management, and time spent heroin-free (3-24 months). Each subject was asked to complete 18 orthogonal comparisons. Subsequently each subject was asked if they likely would enroll in their preferred choice among the set of three. We computed the expected willingness to pay (WTP) as the probability of enrollment times the fee considered in each choice considered from a multivariate logistic model that controlled for product attributes. We also estimated the price elasticity of demand. RESULTS: The median expected fee subjects were willing to pay for a program that offered 3 months of heroin-free time was $7.30 per week, rising to $17.11 per week for programs that offered 24 months of heroin-free time. The availability of case management increased median WTP by $5.64 per week. The price elasticity was -0.39 (S.E. 0.042). CONCLUSIONS: Clients will pay more for higher rates of treatment success and for the presence of case management. Clients are willing to pay for drug treatment but the median willingness to pay falls short of the estimated program costs of $82 per week. Thus a combined approach of user fees and subsidization may be the optimal financing strategy for the drug treatment system.

Investigating quality attributes and consumer acceptance of uncured, no-nitrate/nitrite-added commercial hams, bacons, and frankfurters.

Increasing demands for natural, organic, and/or preservative-free foods have resulted in the consumer availability of uncured, no-nitrate/nitrite-added processed meat and poultry products. A comprehensive understanding about the quality and sensory attributes of commercially available uncured products is unclear. The objective of this study was to determine if quality and sensory differences exist between uncured and cured meat products. Five different commercial brands (Brands A to E; 4 uncured, no-nitrate/nitrite-added, and 1 nitrite-added) of 3 product types (hams, frankfurters, and bacons) were obtained from retail supermarkets. The samples were evaluated for color, pigment content, pH, lipid oxidation, residual nitrate and nitrite content, and consumer acceptance. All brands from all product types evaluated, except for 1 bacon (Brand B), had cured color, aroma, and flavor attributes similar to the nitrite-added control (Brand E). All product types and brands contained residual nitrate and residual nitrite except for Brands B and D bacons (< 1 ppm nitrite). Lipid oxidation as measured by 2-thiobarbituric acid reactive substances revealed a large variation in the occurrence of lipid oxidation both between and within product types, with frankfurters reporting the highest levels. Color measurements indicated the majority of the brands within each product type were similar to the control. Consumer sensory ratings for surface/lean color, aroma, flavor, texture, and overall acceptance determined that variation existed. Brand E (nitrite-added control) and 1 uncured, no-nitrate/nitrite-added brand for each product type were not different (P > 0.05) for overall acceptance and received higher scores (P < 0.05) than all other brands within each product type.

Effects of varying levels of vegetable juice powder and incubation time on color, residual nitrate and nitrite, pigment, pH, and trained sensory attributes of ready-to-eat uncured ham.

Vegetable juice powder (VJP) and a starter culture containing Staphylococcus carnosus have been identified as necessary ingredients for the manufacture of uncured, no-nitrate/nitrite-added meat products with quality and sensory attributes similar to traditional cured products. The objectives of this study were to determine the effects of varying concentrations of VJP and incubation time (MIN-HOLD) on quality characteristics, including lipid oxidation, color, and cured meat pigment concentrations, of ham over a 90-d storage period, compare residual nitrate and nitrite content, and determine if differences exist in sensory properties of finished products. Four ham treatments (TRT) (TRT 1: 0.20% VJP, 0 MIN-HOLD; TRT 2: 0.20% VJP, 120 MIN-HOLD; TRT 3: 0.35% VJP, 0 MIN-HOLD; TRT 4: 0.35% VJP, 120 MIN-HOLD) and a sodium nitrite-added control (C) were used for this study. No differences (P > 0.05) were observed between TRTs and C for CIE L*, a*, b*, and cured color measured by reflectance ratio. Lipid oxidation (TBARS) for combined TRTs and C revealed little change over time while the C had less (P < 0.05) lipid oxidation than TRTs 2 and 4 for combined days. No differences (P > 0.05) were reported for cured pigment concentration between TRTs and C. Trained sensory panel intensity ratings for ham and vegetable aroma, and flavor, color, and firmness showed that a high concentration (0.35%) of VJP resulted in the highest scores for undesirable vegetable aroma and flavor. Treatment combinations with a low concentration (0.20%) of VJP were comparable to the C for all sensory attributes.

Effects of vegetable juice powder concentration and storage time on some chemical and sensory quality attributes of uncured, emulsified cooked sausages.

Uncured, no-nitrate/nitrite-added meat products can be manufactured with vegetable juice powder (VJP) and a starter culture containing Staphylococcus carnosus, resulting in quality and sensory attributes similar to traditional cured products. The 1st objective of this study was to determine the effects of varying concentrations of VJP and incubation times (MIN-HOLD) on quality characteristics, including lipid oxidation, color, and cured meat pigment concentrations, of emulsified-frankfurter-style-cooked (EFSC) sausages over a 90-d storage period. The 2nd objective was to compare residual nitrate and nitrite content resulting from different processing treatments and the 3rd objective was to assess sensory properties of finished products. Four EFSC sausage treatments (TRT) (TRT 1: 0.20% VJP, 30 MIN-HOLD; TRT 2: 0.20% VJP, 120 MIN-HOLD; TRT 3: 0.40% VJP, 30 MIN-HOLD; TRT 4: 0.40% VJP, 120 MIN-HOLD) and a sodium nitrite-added control (C) were used for this study. No differences for lipid oxidation (TBARS) between any TRTs and C or over time were observed. No differences (P > 0.05) for CIE L* values were found between TRTs. CIE a* and reflectance ratio values revealed that TRTs 2, 4, and C were redder than TRTs 1 and 3 at day 0. Trained sensory intensity ratings for cured aroma, cured color, cured flavor, uniform color, and firmness determined that all but TRT 1 were similar to C. These results indicate a longer incubation time (120 compared with 30 min) was found more critical than VJP level (0.20% or 0.40%) to result in products comparable to a sodium nitrite-added control.

If smoking increases absences, does quitting reduce them?

OBJECTIVE: This study examined the impact of smoking, quitting, and time since quit on absences from work. METHODS: Data from the nationally representative Tobacco Use Supplements of the 1992/93, 1995/96, and 1998/99 Current Population Surveys were used. The study included full time workers aged between 18-64 years, yielding a sample size of 383 778 workers. A binary indicator of absence due to sickness in the last week was analysed as a function of smoking status including time since quit for former smokers. Extensive demographic variables were included as controls in all models. RESULTS: In initial comparisons between current and former smokers, smoking increased absences, but quitting did not reduce them. However, when length of time since quit was examined, it was discovered that those who quit within the last year, and especially the last three months, had a much greater probability of absences than did current smokers. As the time since quitting increased, absences returned to a rate somewhere between that of never and current smokers. Interactions between health and smoking status significantly improved the fit of the model. CONCLUSIONS: Smokers who quit reduced their absences over time but increase their absences immediately after quitting. Quitting ill may account for some but not all of this short run impact.

Innovations in treatment for drug abuse: solutions to a public health problem.

Illicit drug use is an important public health problem with broad social costs. The low effectiveness of prevention efforts leaves treatment of drug dependence as one of the most powerful means of fighting illicit drug use. Treatment reduces drug use and crime and increases individuals' functioning. However, programs that treat drug dependence have high dropout rates and low completion rates. In addition, some individuals continue to use drugs while in treatment, and relapse is common. Furthermore, only a fraction of those who need treatment receive it. Recently, there have been important innovations that reduce barriers and increase effectiveness of treatment. These innovations include new pharmacological agents, novel counseling strategies, promising ways to motivate, and treatment in new settings. This paper describes standard treatments and recent innovations designed to increase (a) effectiveness of treatment, (b) motivation to seek care, (c) access, (d) retention, and (e) cost-effectiveness. We provide criteria on how these innovations should be evaluated in order to determine which should be adopted, funded, and transferred to existing and future treatment programs.

Can the Treatment Services Review be used to estimate the costs of addiction and ancillary services?

PURPOSE: The economic costs of addiction treatment and ancillary services are of great interest to substance abuse treatment providers, researchers, and policymakers. This paper examines whether a widely used treatment evaluation instrument, the Treatment Services Review (TSR), can be used to estimate the costs of addiction and ancillary services. METHODS: The fifth edition of the TSR (TSR-5) is carefully reviewed and critiqued for cost estimation purposes. Unit cost estimates and sources are presented for most of the service delivery units on the TSR-5, and important missing service measures are identified. A cost analysis method is proposed that is based on data from the TSR. RESULTS: A variety of unit cost estimates are offered so that researchers and practitioners will understand how this financial information is compiled. However, the investigation determined that the TSR-5 is not currently structured for a comprehensive cost analysis of treatment services. The potential benefits and limitations of the TSR-5 as a cost analysis tool are identified and explained. In addition, recommended changes to the TSR-5 are suggested and described. IMPLICATIONS: Although not originally developed for economic evaluation purposes, with some modifications and enhancements, the TSR is an instrument that is capable of facilitating an economic cost analysis of addiction treatment and ancillary services. By combining service utilization information from a revised TSR (i.e., TSR-6) with reliable unit cost estimates for those services, future evaluation studies will be able to provide more standardized estimates of the costs of addiction and ancillary services for different types of treatment clients. When joined with outcome data, the TSR-6, along with the proposed cost module, can also be used to determine cost-effectiveness and benefit-cost ratios for subgroups of patients and treatment components.

Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost.

OBJECTIVE: This study examined the differential efficacy and relative costs of two intensities of adjunctive psychosocial services--a day treatment program and enhanced standard care--for the treatment of opioid-dependent patients maintained on methadone hydrochloride. METHOD: A 12-week randomized clinical trial with 6-month follow-up was conducted in a community-based methadone maintenance program. Of the 308 patients who met inclusion criteria, 291 began treatment (day treatment program: N=145; enhanced standard care: N=146), and 237 completed treatment (82% of those assigned to the day treatment program and 81% of those receiving enhanced standard care). Two hundred twenty of the patients participated in the 6-month follow-up (75% of those in the day treatment program and 73% of those in enhanced standard care provided a follow-up urine sample for screening). Both interventions were 12 weeks in duration, manual-guided, and provided by master's-level clinicians. The day treatment was an intensive, 25-hour-per-week program. The enhanced standard care was standard methadone maintenance plus a weekly skills training group and referral to on- and off-site services. Outcome measures included twice weekly urine toxicology screens, severity of addiction-related problems, prevalence of HIV risk behaviors, and program costs. RESULTS: Although the cost of the day treatment program was significantly higher, there was no significant difference in the two groups' use of either opiates or cocaine. Over the course of treatment, drug use, drug-related problems, and HIV risk behaviors decreased significantly for patients assigned to both treatment intensities. Improvements were maintained at follow-up. CONCLUSIONS: Providing an intensive day treatment program to unemployed, inner-city methadone patients was not cost-effective relative to a program of enhanced methadone maintenance services, which produced comparable outcomes at less than half the cost.

Linking health-related quality-of-life indicators to large national data sets.

OBJECTIVE: This study investigated the feasibility and usefulness of linking algorithms for well known quality-of-life (QOL) indicators to large nationally representative databases. DESIGN AND SETTING: The National Medical Expenditure Survey (NMES) was utilised. We developed an algorithm to match the EuroQOL health indicator and drew on a previous match of the Health Utilities Index (HUI) in a companion paper. This process allowed the sensitivity and detail of health-related quality-of-life (HR-QOL) indicators to be combined with the benefits of large, nationally representative data sets. PATIENTS AND PARTICIPANTS: A total of 19,525 individuals aged 18 years and older (constituting a nationally representative sample of the non-institutionalised civilian population of the US contained within the 1987 NMES database) were investigated. INTERVENTIONS: Sensitivity analyses using several related specifications of each indicator were performed. We analysed the correlations of these alternatives for both the HUI and EuroQOL measures. Correlations between the HUI and EuroQOL measures were also examined. We investigated the construct validity by examining the performance of the HUI and EuroQOLs in empirical situations in which we had knowledge about the relationships (e.g. health decreases with age). MAIN OUTCOME MEASURES AND RESULTS: The benefits of HR-QOL measures can be achieved relatively cheaply and efficiently via linking rather than developing a large scale QOL survey. Although the NMES data allowed a good match with the EuroQOL and the HUI, the matches were not perfect. By examining the within-domain correlations and the between-domain correlations, we found that the alternate specifications within-domain were very similar and that the 2 HR-QOL indicators were comparable in many (but not all) aspects. CONCLUSIONS: The results of this study suggested good construct validity. Thus, linked HR-QOL measures of the types derived in this study may be useful in characterising the health of large populations, and in investigating the causes and consequences of health.

Drinking, problem drinking, and productivity.

This chapter surveys and critiques the recent economic literature dealing with the relationships between labor market productivity and alcohol use and misuse. The focus here is twofold. First is to present and discuss the relevant conceptual issues that must be appreciated in assessing such relationships. Second is to summarize and assess the empirical findings that have been offered in the literature.

Linking the health utilities index to National Medical Expenditure Survey data.

Measures of health-related quality of life (HR-QOL) are becoming increasingly important in assessing the effects of chronic illness and healthcare interventions designed to treat them. Obtaining measures of HR-QOL for a nationally representative sample of individuals would enhance understanding of health status in the US, and promote further study of the economic causes and effects of health status. This study reports on our efforts to link a prominent HR-QOL scale, the Health Utilities Index Mark I (HUI), to the National Medical Expenditure Survey (NMES). Six distinct algorithms were constructed for linking the HUI to NMES. These alternative linkage algorithms yielded HUI measures that were highly intercorrelated (p = 93 to 99%). Multivariate regression analyses performed to predict variations in HR-QOL revealed that the HUI exhibited good predictive validity--the HUI demonstrated lower quality of life for a variety of chronic illnesses, and wealthier individuals and better educated individuals had a higher quality of life. In contrast to some previous HR-QOL research, the present analysis demonstrates that: (i) cancer is negatively and significantly related to quality of life; and (ii) smoking is negatively and significantly related to quality of life. Overall, the results suggest that the HUI linkages to NMES provide reliable and valid measures of quality of life. As such, items from the NMES can be grouped and linked in such a way as to obtain health state utility values. These values should be of use to those who wish to understand the global health of the US population for policy-making efforts.

Women and work: tipplers and teetotalers.

We seek to understand better the puzzling finding that, for women, alcoholism appears to be positively associated with the probability of being employed. Using the 1988 Alcohol Survey of the National Health Interview Survey, we find that this association holds for white women only. For white women, alcoholism and early drinking are associated with higher educational attainment, a smaller family size and a lower probability of being married. In turn, these human capital indicators are associated with greater labour supply, thus helping to explain the curious positive relationship between alcoholism and employment for women. An advance in this paper over our previous work is to examine life-time abstention from alcohol and its association with employment and human capital variables. We find that lifetime abstention is associated with lower employment, unemployment and education and greater propensity to be married for both white and non-white women.

[Ruptured abdominal aortic aneurysm]. / Aneurysma aortae abdominalis cruens.

In the years 1990-1994, 43 patients with ruptured abdominal aortic aneurysms (RAAA) were operated on at the Department of Vascular Surgery of the Na Homolce Hospital in Prague. Men outnumbered women, average patient age was 70 years. The mean delay between onset of symptoms and hospital admission counted 27 hrs. Prior to transportation, one half to two thirds of patients went through at least two types of confirmative evaluation (CAT, ultrasound, angiography) and/or were referred via two or more hospital departments. In two thirds of patients profound shock with oligoanuria and hypotension were found. Anuria/hypotension proved to occur in a significantly lower rate in later survivors compared to later dead (11.8% vs. 23.5%: p < 0.05). Persistent hypotension during surgery together with eventual resuscitation as well as free blood found within the abdominal cavity showed up as further ominous factors. Renal failure was the leading postoperative complication (51.2%) with 27.9% of patients requiring hemodialysis after repair. Sepsis (25.6%), pneumonia (20.9%) and hemorrhage (13.9%) followed. Twenty-six patients were lost (60.5%) either within the first hours and days after surgery because of irreversible hemorrhagic shock or between the second and fourth week due to the sequels of organ failure and sepsis. In our cohort, regardless of age, sex, concomitant disease or the type of surgery, the patient's status on admission determined his/her further destiny. Urgent transfer to a specialized center going hand in hand with prompt and effective reanimation steps are the patient's only hope for survival.

Employment, unemployment, and problem drinking.

The misuse of alcohol is estimated to result in enormous economic costs, composed largely of reduced labor market productivity. However, there has been debate on this issue. The purpose of this paper is to help to resolve this debate by presenting sound structural estimates of the relationship between measures of problem drinking and of employment and unemployment. The analysis is based on the 1988 Alcohol Supplement of the National Health Interview Survey. We find that for both men and women, problem drinking results in reduced employment and increased unemployment.

Disability compensation and work among veterans with psychiatric and nonpsychiatric impairments.

OBJECTIVE: This study examined the relationship of Department of Veterans Affairs disability compensation payments and employment among veterans with psychiatric disorders and veterans whose impairments were nonpsychiatric. METHODS: Data from a 1987-1988 national survey of Vietnam-era veterans (N = 1,634) were used to evaluate the relationship between compensation payments and employment. The employment activity of veterans whose application for benefits was rejected was compared with that of veterans who were awarded benefits. Multivariate analytic techniques were used to control for health status and other factors that also influence an individual's decision to work. RESULTS: Veterans who received compensation of less than $500 a month were no less likely to work than were rejected applicants. Overall, the effect of compensation payment was significant but modest: each additional $100 a month was associated with a 2 percent decline in the number of veterans who worked, a decline of an hour a week in the number of hours worked, and a reduction of $1,000 a year in estimated employment income. No significant differences were observed in the relationship between disability payments and employment among veterans with psychiatric disorders and those with other functional impairments. CONCLUSIONS: The association of disability compensation with nonparticipation in the labor force is generally small, except at high levels of payment, and is no greater for veterans with psychiatric disorders than for those with nonpsychiatric impairments.

Alcoholism and income: the role of indirect effects.

The potential pathways by which alcoholism might affect income are examined using data on males from the New Haven site of the Epidemiologic Catchment Area (ECA) data set to illustrate important indirect, and direct, effects of alcoholism on income. The detrimental indirect effects occur through reduction of educational attainment and increased probability of divorce. Because both educational attainment and marriage positively influence income, the adverse impact of alcoholism on both of these variables translates into lower income for alcoholics. The implications should lead researchers to distinguish more carefully between the direct and indirect costs of this condition. Policy analysts also should explore the financial impact of early onset when they look at overall costs. Because this has often been underestimated, fewer resources are devoted to prevention and treatment of alcoholism than a considered awareness of the problem would indicate is warranted.

The emergent problem of ambulance misuse.

STUDY OBJECTIVE: The primary objective was to determine whether rates of ambulance misuse varied systematically by type of health insurance. The secondary objective was to determine whether the level of service provided in the ambulance varied by ambulance company ownership. DESIGN: Survey. SETTING: A 175-bed community hospital in central Connecticut. PARTICIPANTS: One hundred forty-five records were selected randomly for study from the records of the 488 patients presenting to the hospital emergency department within a 45-day period. OUTCOME MEASURES: The urgency of presenting complaint and the use of life support measures within the ambulance were obtained from each ambulance run form. Type of health insurance, clinical data, and disposition were obtained from ED records. Ambulance use was deemed unnecessary if the patient's presenting complaint was nonurgent, the patient was ambulatory, and the patient was not ultimately hospitalized. Advanced life support measures were deemed unnecessary if they were applied to patients with nonurgent complaints. RESULTS: Patients with private insurance made appropriate use of ambulances in 77.8% of cases, patients with Medicare did so in 65.8% of cases, and patients with Medicaid did so in 14.7% of cases. These results were statistically significant at P < .001. Among patients with Medicare, ambulance misuse was more common among nursing home residents. Approximately 20% of the observed misuse was related to alcohol intoxication. Although it did not reach statistical significance, we noted a higher frequency of inappropriate use of advanced life support measures in patients brought to the ED by a private ambulance service than for those brought by a municipal service. CONCLUSION: Ambulance misuse is common in the studied community and may be related to the broader problem of the provision of care to the poor or otherwise underserved. Our results raise several interesting questions for further research.