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Biomedical subjects

D Parkin

Publications and source records attributed to D Parkin.

At least 55 records · Page 3Linked to original sources
PubMed1992

Cancer mortality among Polish migrants to France.

Cancer risk in the Polish-born population of France has been compared to that in Poland and in native French subjects (born in France), using mortality data from the period 1979-1985. The Polish-born community in France is a long-established one--most migration occurred during the 1920s--so that for many cancer sites the cancer pattern is closer to that of French natives than that in Poland (eg oral cavity, oesophagus, large bowel, gall bladder, uterus, leukaemia). Polish migrants, however, retain their characteristically high rates of cancer of the stomach and lung (in men), and low rates of breast and prostate cancer. The Polish-born community has a characteristic pattern of residence (living mainly in the Nord and the Pas-de-Calais) and occupational status (a higher proportion of 'workers' than the French-born); these are important confounding factors which can mask the true differences in risk for several sites (larynx, oesophagus, large bowel) if no adjustment is made during analysis.

Adolescent↗
PubMed1991

Cancer in Italian migrants.

Migration of Italians to other parts of the world has a long history and has involved very large numbers of individuals. The study of the health consequences of this migration is made possible by the availability of statistics on mortality and morbidity, both in Italy and in the host countries, and of social and economic information on the various Italian communities abroad. The results of the major studies are reviewed, comparing the rates in immigrants with those in the host countries and in Italy. The differences in cancer rates between Italian and local-born populations--for stomach cancer in both sexes, and for cancer of the colon, lung, and breast in females, and for prostate cancer--are consistent with the direction of differences between rates in Italy and those in the host countries. For colon and rectum cancer in males, there are unexpected findings in most of the United States' studies. Analysis by duration of residence shows changes in the risk for several sites in males, but not in females, according to length of stay in the host country. This finding possibly reflects greater stability of habits and lifestyle in females compared to males.

Australia↗
PubMed1991

Chiropody and the QALY: a case study in assigning categories of disability and distress to patients.

Quality adjusted life years (QALYs) are claimed to be a universal means of measuring output from health care interventions. However, existing QALY research has been carried out mainly in 'high-tech', life extending areas of health care. This paper presents an application of QALY measurement to a 'low-tech' life-quality enhancing area of health care, chiropody. Information on changes in quality of life following chiropody interventions was elicited from both practitioners and patients. We found the apparently low benefit, but low cost service of chiropody to be a potentially cost-effective use of NHS resources. Methodological issues are also addressed relating to the assignment of patients to health states, and whether practitioners' or patients' assessments of changes in quality of life should be used.

Aged↗
PubMed1991

Case mix measures for ambulatory care.

Resource management in Ambulatory Care is recognized as an increasingly important area for development by many countries, and there has been much interest in the part that Case Mix Measures (CMMs) can play in this. There are a number of possible approaches to case mix, and several measures already exist. However, these are at present mainly still at the development stage and all are North American in origin. This paper reviews the role and state of the art of ambulatory CMMs and reports on an initial evaluation of the Ambulatory Visit Group (AVG) methodology using European data. Although the AVG grouper works under limited conditions, important questions remain concerning its validity and usefulness.

Ambulatory Care↗
PubMed1989

Blood coagulation profile in long-term hormone replacement therapy with mestranol.

The coagulation profile of oophorectomised women on long-term (15 yr) hormone replacement therapy with mestranol (30 micrograms/day) is compared to that of women on long-term placebo. Analysis of these data showed no significant difference in prothrombin time, partial thromboplastin time or in anti-thrombin III level in these groups.

Adult↗
PubMed1987

A radioimmunoassay for metoclopramide.

A radioimmunoassay for the anti-emetic drug, metoclopramide, in the pmol range was developed. The immunogen was prepared by photolytic coupling of metoclopramide to bovine serum albumin. A crosslinking reagent, N-hydroxy-succinimidyl-4-azidobenzoate, was first reacted with serum albumin through nucleophilic substitution. Ultraviolet irradiation (lambda greater than 300 nm) of the photoactive serum albumin conjugate in the presence of metoclopramide resulted in covalent attachment of the drug to the protein. An 125I-labelled metoclopramide derivative was prepared by diazotisation of the aromatic amine group and substitution of the resultant diazo group with 125I-. Binding data of the antibody with radioiodinated metoclopramide gave a linear Scatchard plot indicative of a homogeneous antibody population. A dissociation constant of 3 X 10(-11) mol/l was calculated for the antigen-antibody interaction. The antibodies showed negligible cross-reactivity with lignocaine which is structurally closely related to metoclopramide.

Albumins↗
PubMed1987

Aggregate health care expenditures and national income. Is health care a luxury good?

It is well known that a strong relationship exists between national expenditures on health care and national income. This has been used to suggest that health care is a luxury good, and that factors such as the type of health care delivery system in a country are of little importance in determining expenditure levels. This paper argues that these implications rely upon the application of microeconomic analysis to macroeconomic data, and that this is not appropriate. As well as raising questions about the inferences drawn from previous studies, new empirical evidence is presented which casts some doubts on previous findings. International comparisons are based on Purchasing Power Parity rather than exchange rate conversions, underlining the importance of prices as well as quantities in the relationship, and leading to the conclusion that the aggregate data show health care to be, if anything, a necessity rather than a luxury good.

Australia↗
PubMed1985

The demand for dental care: an assessment.

This paper reviews the existing literature on the demand for dental care and assesses its implications for the U.K., where such analysis has been lacking to date. The characteristics of the U.K. dental system are briefly outlined, and some observations on the theory of the demand for dental care are made. The main part of the paper consists of a review of empirical work, most of which is North American or Scandinavian. It is concluded that there is as yet no consensus on several empirical matters of major importance. Areas for future research, both in the U.K. and more widely, are presented.

Cost-Benefit Analysis↗
PubMed1979

Distance as an influence on demand in general practice.

A survey of general practice in the London borough of Lambeth was analysed to discover how the distance from a patient's home to a medical facility affects the utilisation of that facility. It was shown that distance has a negative effect on utilisation for all population groups except men aged 15 to 64. The effect was especially marked for women, for the elderly, and for Social Classes III, IV, and V, which are the groups with highest utilisation rates. Some diagnostic groups singled out for analysis showed the same effect. These results are related to other studies and to an economic theory seeking to explain patterns of demand.

Adolescent↗
PubMed1974

An outbreak of streptococcal sore throat and rheumatic fever in a Royal Air Force training camp; significance of serum antibody to M-associated protein.

A large outbreak of streptococcal sore throat in a Royal Air Force Training Camp resulted in five cases of rheumatic fever among the 16- to 18-year-old apprentices, and one case in a 33-year-old airman. The most prevalent type of group A streptococcus isolated from throat swabs was M-type 5 and there was serological evidence that at least four of the rheumatic fever (R.F.) cases were due to this type.Among the patients with uncomplicated throat infection the anti-streptolysin O (ASO) and anti-deoxyribonuclease B (anti-DNAase B) responses were in general rather low, even where there was evidence of protective antibody against type 5. However, a combination of the results of the ASO and anti-DNAase B tests gave an estimate of the extent of streptococcal infection 15-25% higher than did either test alone.The titres of antibody to M-associated protein (MAP) were >/= 60 in all the R.F. patients, and in about 50% of the other patients with ASO titres >/= 200. This figure is unusually high compared with data from several other outbreaks of streptococcal infection due to different serotypes and also greatly exceeds comparable figures for cases of sporadic sore throat and acute glomerulonephritis.

Adolescent↗
PubMedDate not supplied

Investigating hospital efficiency in the new NHS: the role of the translog cost function.

The reforms to the United Kingdom's National Health Service (NHS) of recent years have greatly increased the role of economic incentives in the hospital sector. Hospitals now have to compete for the business of GP and health authority purchasers and are assumed to have an incentive to minimise costs. This makes the analysis of cost functions much more relevant than has previously been the case. The objective of this paper is to assess the potential usefulness of the translog cost function applied in the NHS internal market. Three main issues are identified that limit the role of this type of cost function in the internal market: the adequacy of the econometric model (including data quality); the assumptions underlying the model, and; the interpretation of economies of scale, marginal costs and economies of scope that can be derived from such a cost function. It is concluded that at present the application of translog cost function analysis in the NHS is of limited usefulness, but that it does indicate areas for further methodological research.

Economic Competition↗
PubMedDate not supplied

[Minimum data sets in ambulatory care].

A sensible and rational approach is necessary in order to match the growing requirements of information on the ambulatory care sector characterised by a big deal of complexity and variability. This must be applied to any initiative attempting to obtain any degree of harmonization in ambulatory care data sets. This paper summarises a conceptual aspect of the work undertaken by the project Measurement Characterization and Control of Ambulatory Care in Europe (McACE) sponsored by the Commission of the European Communities under the exploratory phase of the Advanced Informatics in Medicine (AIM) programme. Our approach places in the first priority the efficiency when assessing the information needs of the different actors trying to make a balanced approach between the costs of collecting and processing a specific item and its use. For this we performed a conceptual validation of the term Minimum Basic Data Set and its potential application to the Ambulatory Care Sector. It is suggested its substitution by the term Minimum Data Set as a part of a practical tool for promoting the harmonization of the information in ambulatory care.

Ambulatory Care Facilities↗
PubMedDate not supplied

The efficiency of Scottish acute hospitals: an application of data envelopment analysis.

Measurement of the efficiency of health services would aid the promotion of a better allocation of health care resources. Economic analysis suggests a number of ways of defining and measuring efficiency. However, this rarely informs measures used in health service management. This paper looks at the potential for the use in the United Kingdom's National Health Service of the linear programming based method of data envelopment analysis (DEA). DEA is applied to data from 75 UK acute hospitals. The results demonstrate the capacity of DEA to produce a user-friendly array of results, based on sound theoretical underpinnings. These range from the measurement of relative efficiencies to quantified suggestions as to how hospitals may improve efficiency, by examining both their own efficiency and that of comparable units. Information is provided both about individual hospitals and the sample as a whole. DEA is also able to distinguish between hospitals demonstrating differing returns to scale. Our findings suggest that, although still very much under development, DEA is usable and, given the weakness of current means of measuring efficiency in the National Health Service, that DEA has a strong claim for further consideration.

Data Interpretation, Statistical↗
PubMedDate not supplied

Abnormal serum lipoprotein levels as a risk factor for the development of human lenticular opacities.

AIM: To determine whether an association exists between the different plasma lipoprotein constituents and the prevalence of lenticular opacities in dyslipidaemic subjects. METHODS: Adult patients (n = 115) of both genders were included if their fasting total serum cholesterol concentrations exceeded the 95th percentile of normal or their serum low-density lipoprotein (LDL): high-density lipoprotein (HDL) ratios exceeded 5. Patients were excluded if they suffered from any condition known to cause, or predispose them to, elevated lipoprotein levels or lenticular opacification. Lenticular changes were assessed by means of a slit-lamp through the fully dilated pupil. RESULTS: An extremely strong association (p<0.0001) was found to exist between HDL cholesterol levels and the development of lens opacities. Below an HDL-C level of 1.5 mmol/l subjects had a seven-fold higher calculated probability of falling in the lens opacity subgroup than those with HDL-C levels above 1.5 mmol/l [odds ratio =7.33 (95% CI = 2.06-26.10; p = 0.0001)]. An equally strong association was found between high (>5) LDL:HDL ratios and the development of lens opacities (p<0.0003). The risk of falling into the cataract subgroup if the individual's LDL:HDL ratio exceeded 5 was 2.35 (95% CI = 1.09-5.04; p = 0.014). CONCLUSION: This study strongly suggests that an association exists between low levels of HDL cholesterol and high LDL:HDL ratios on one hand and the development of adult lens opacification on the other.

Adolescent↗