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S Birch

Publications and source records attributed to S Birch.

At least 19 recordsLinked to original sources
PubMed2000

A cost-benefit analysis using a willingness-to-pay questionnaire of intranasal budesonide for seasonal allergic rhinitis. Rhinocort Study Group.

BACKGROUND: The cost-benefit of intranasal steroids for the treatment of seasonal allergic rhinitis is unknown. OBJECTIVE: To determine the cost-benefit of intranasal budesonide for seasonal allergic rhinitis. METHODS: Subjects who were symptomatic for a baseline period of 7 to 10 days were randomized to receive intranasal budesonide by Turbuhaler (400 microg) (n = 121) or aqueous spray (256 microg) (n = 121) once daily for 4 weeks. A willingness-to-pay questionnaire that measured benefits of treatment was administered before and at study completion. Costs were collected and compared with benefits. RESULTS: Subjects were willing to spend on average $15.89/wk (range $1 to $75) to alleviate the problems of seasonal ragweed rhinitis. Eighty percent of subjects felt that, with treatment, rhinitis had less of an impact on their lives, compared with previous years. The mean willingness-to-pay for the drug used during another ragweed season was $12.95/wk. This was 92% (95% CI, 85% to 100%) of the pre-treatment estimate. There was no relationship between an indirect assessment of income and willingness-to-pay estimates. The benefit was greater than the cost by a mean of $5.80/wk (95% CI, $3.52 to 8.08), P < .0001. There was no difference in costs, willingness-to-pay, or cost-benefit comparing delivery modes. A sensitivity analysis revealed the conclusions were robust. CONCLUSIONS: Intranasal budesonide is cost-beneficial in the treatment of seasonal allergic rhinitis and a willingness-to-pay questionnaire may provide a useful method to assess a therapy's benefit.

Administration, Intranasal↗
PubMed2000

Needs-based primary medical care capitation: development and evaluation of alternative approaches.

OBJECTIVE: To develop and evaluate alternative methods of adjusting primary medical care capitation payments for variations in relative need for health care among enrolled practice populations. METHODS: We developed alternative needs-based capitation formulae and applied them to a sample of capitation-funded primary care practices to assess each formula's performance against a reference standard of capitation payments based on age, sex and self-assessed health status of the enrolled populations. The alternative formulae were based on: (1) age and sex; (2) age, sex and individually-measured socioeconomic characteristics; (3) age, sex and socioeconomic characteristics imputed from census data for enrollees' neighbourhood of residence; (4) age, sex and standardized mortality ratio for enrollees' neighbourhood of residence. RESULTS: Age/sex-adjusted capitation payments for the six practices studied ranged from 10% higher to 18% lower than the reference standard payments. Capitation formulae based on socioeconomic and mortality data did not perform consistently better than the current age/sex-based formula. CONCLUSIONS: Primary medical care capitation payments adjusted only for age and sex do not reflect the relative health care needs of enrolled practice populations. Our alternative formulae based on socioeconomic and mortality data also failed to reflect relative needs. Methods that use other approaches to adjusting for differences in relative need among enrolled populations should be investigated.

Adolescent↗
PubMed2000

Heterogeneity in the determinants of health and illness: the example of socioeconomic status and smoking.

Systematic variations in health and illness among social groups have persisted and, in some cases increased, in many countries in spite of improvements in the availability of, and access to, health care services. Health policy makers have responded by showing increasing interest in non-clinical determinants of health as a way of explaining the observed systematic variations in health and illness. Yet health care and non-health care "factors" are often seen as competing for society's scarce resources in the production of health. The purpose of this paper is to augment this traditional approach to understanding the determinants of health in populations by exploring heterogeneity in the smoking-health relationship between social groups. Logistic regression analyses were performed using data from the 1992-93 Santé Quebéc survey, a weighted random sample of the non-institutionalized population of the province of Québec, Canada (N = 23,564). The findings suggest that the likelihood of reporting health as poor or fair was greater for smokers than non-smokers. However, the difference between smokers and non-smokers was significantly greater among groups of the population with low incomes and without employment, but significantly less among sub-groups with lower levels of education. These findings suggest that the identification, evaluation and implementation of health care programmes need to pay greater attention to the interface between social, behavioural and clinical determinants of health.

Adult↗
PubMed1999

Vocal recognition in the spotted hyaena and its possible implications regarding the evolution of intelligence.

Spotted hyaenas, Crocuta crocuta, are gregarious carnivores whose social lives share much in common with those of cercopithecine primates. We conducted playback experiments to determine whether free-living hyaenas are capable of identifying individual conspecifics on the basis of their long-distance vocalization, the 'whoop'. When prerecorded cub whoops were played to mothers and other breeding females (controls), mothers responded significantly more vigorously to whoops of their own cubs than did controls. We also tested the hypothesis that specific vocal recognition abilities are based on kinship in this species. Listeners that were related to the whooping cub responded more vigorously to recorded vocalizations than did unrelated individuals, with response intensity in some cases increasing directly with the size of the coefficient of relatedness (r). Our final goal was to determine whether control animals in these experiments can recognize third-party social relationships among other group members, an ability demonstrated by vervet monkeys, Cercopithecus aethiops, in similar playback experiments conducted by earlier investigators. In contrast to vervets, control females in the present experiments were no more likely to look at the mother of the whooping cub than at other control females after playback. This suggests that hyaenas may accomplish many of the same social feats as do vervets without possessing the ability to recognize third-party relationships. If confirmed in other domains of hyaena social life, our findings have important implications regarding selection pressures favouring the evolution of intelligence. Copyright 1999 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1999

Zhong Yi acupuncture and low-back pain: traditional Chinese medical acupuncture differential diagnoses and treatments for chronic lumbar pain.

Little attention has been given to selecting treatments in clinical trials of acupuncture. Yet in order to perform objective tests of this procedure, it is crucial that the selected treatments are considered representative of the style of practice being tested. We examined 16 traditional Chinese medicine (TCM) acupuncture texts or treatment articles to determine the consistency of diagnosis and recommended treatment for chronic low-back pain. Although 24 diagnostic patterns were described by 1 or more texts, only 4 patterns were described by at least half of the texts. Most texts (12/16) described only 3 or 4 patterns. These could be categorized into 3 broad types: cold, damp, wind, heat channel obstruction patterns; kidney vacuity patterns (sometimes differentiated into yang and yin patterns); and blood (or blood and qi) stasis patterns. Several acupuncture points were recommended by most texts regardless of the diagnosis, whereas other acupoints were recommended for specific diagnostic patterns. There was, however, substantial variation between texts in recommended acupoints, with less than 20% of all acupoints recommended by half or more of the texts. This varibility will make it difficult to select TCM treatments for clinical trials of chronic low-back pain that have wide applicability. We believe that examining treatment patterns in actual clinical practice is crucial in this situation. We suggest that this method of selecting treatments should be part of the process used when selecting treatments for all clinical trials of acupuncture, regardless of the style of practice.

Acupuncture Therapy↗
PubMed1999

Willingness to pay and the valuation of programmes for the prevention and control of influenza.

In this paper, we consider the role of willingness to pay (WTP) as a method for measuring the impact of healthcare programmes on population well-being. Alternative methods of outcome valuation, such as quality-adjusted life-years (QALYs), measure values through individuals' willingness to trade off a particular commodity, future life. Moreover, the method of valuation fails to incorporate several dimensions of benefit relevant to measuring well-being that are particularly important in programmes aimed at the prevention and control of influenza. In contrast, WTP provides a broad method of valuation based on individuals' willingness to trade off a much wider range of commodities. In addition, WTP incorporates externalities and uncertainty within individual valuations. We show that the main limitations of the WTP approach are not avoided by adoption of the QALY approach.

Attitude to Health↗
PubMed1999

Preference based measurements in dentistry: a review of the literature and recommendations for research.

Clinical outcomes are used routinely in dental clinical practice to determine whether or not a patient has exhibited improvement following treatment. While these measures can be useful in comparing therapies in disease specific terms, they do not incorporate outcomes which may be of interest to patients. Preference based outcome measurements, on the other hand, take into account an individual's life style, overall well being and economic resources. There is a number of preference based measures available from the medical field, many of which have been adapted for use in a dental setting. This paper outlines the strengths and weaknesses of these preference based measures, using examples from the dental literature when available. Particular emphasis is placed on an economic tool known as contingent valuation or 'willingness to pay' as a potential technique in the measurement of dental preferences.

Decision Making↗
PubMed1998

Screening for hypercholesterolaemia in primary care: randomised controlled trial of postal questionnaire appraising risk of coronary heart disease.

OBJECTIVES: To validate a self administered postal questionnaire appraising risk of coronary heart disease. To determine whether use of this questionnaire increased the percentage of people at high risk of coronary heart disease and decreased the percentage of people at low risk who had their cholesterol concentration measured. DESIGN: Validation was by review of medical records and clinical assessment. The questionnaire appraising risk of coronary heart disease encouraged those meeting criteria for cholesterol measurement to have a cholesterol test and was tested in a randomised controlled trial. The intervention group was sent the risk appraisal questionnaire with a health questionnaire that determined risk of coronary heart disease without identifying the risk factors as related to coronary heart disease; the control group was sent the health questionnaire alone. SETTING: One capitation funded primary care practice in Canada with an enrolled patient population of about 12 000. SUBJECTS: Random sample of 100 participants in the intervention and control groups were included in the validation exercise. 5686 contactable patients aged 20 to 69 years who on the basis of practice records had not had a cholesterol test performed during the preceding 5 years were included in the randomised controlled trial. 2837 were in the intervention group and 2849 were in the control group. MAIN OUTCOME MEASURES: Sensitivity and specificity of assessment of risk of coronary heart disease with risk appraisal questionnaire. Rate of cholesterol testing during three months of follow up. RESULTS: Sensitivity of questionnaire appraising coronary risk was 87.5% (95% confidence interval 73.2% to 95.8%) and specificity 91.7% (81.6% to 97.2%). Of the patients without pre-existing coronary heart disease who met predefined screening criteria based on risk, 45 out of 421 in the intervention group (10.7%) and 9 out of 504 in the control group (1.8%) had a cholesterol test performed during follow up (P<0.0001). Of the patients without a history of coronary heart disease who did not meet criteria for cholesterol testing, 30 out of 1128 in the intervention group (2.7%) and 18 out of 1099 in the control group (1.6%) had a cholesterol test (P=0.175). Of the patients with pre-existing coronary heart disease, 1 out of 15 in the intervention group (6.7%) and 1 out of 23 in the control group (4.3%) were tested during follow up (P=0.851, one tailed Fisher's exact test). CONCLUSIONS: Although the questionnaire appraising coronary risk increased the percentage of people at high risk who obtained cholesterol testing, the effect was small. Most patients at risk who received the questionnaire did not respond by having a test.

Adult↗
PubMed1998

Selective opportunistic screening for hypercholesterolemia in primary care practice.

OBJECTIVES: To assess the performance of selective opportunistic screening in a primary care group practice. DESIGN: Cross-sectional survey of coronary heart disease risk factors and retrospective chart audit of cholesterol testing. SETTING: Capitation-funded primary care group practice in Ontario, Canada. SUBJECTS: 7785 enrolled patients between the ages of 20 and 69 years. INTERVENTION: Protocol-based selective opportunistic screening program for hypercholesterolemia of 45 months duration. MAIN OUTCOME MEASURES: Targeting (proportion of screening tests that were appropriate), coverage (proportion of those meeting screening criteria who had a screening test performed), over-screening (proportion of those not meeting screening criteria who had a screening test performed), and screening ratio (likelihood that a screening test was performed on an individual who met screening criteria rather than one who failed to meet screening criteria). RESULTS: 64.7% of patients tested met the practice criteria for screening. 37.7% of patients who met the practice screening criteria were tested and 24.9% of those not meeting practice screening criteria had a cholesterol test performed. The screening ratio was 1.52. CONCLUSION: Our findings bring into question the effectiveness of opportunistic approaches to preventive care.

Adult↗
PubMed1998

Allocating resources in health care: alternative approaches to measuring needs in resource allocation formula in Ontario.

Maintaining or improving the welfare of the population is a complex issue involving individual and collective actions and institutions. Despite questions regarding the relevance of health care systems to these aims, they remain vital policy and treatment arenas with respect to curative and preventative regimes. As a component of social welfare, health care resources should be distributed equitably, according to need for health care. This paper evaluates alternative indicators of health status within Ontario against self-reported health as a means of allocating health care resources. Proxies of need for health care include standardized mortality ratios (based on the population aged 0-64) and a socioeconomic based indicator. Mortality indicators are found to be more closely correlated with self-reported health status than the socioeconomic indicator, suggesting that mortality is better able to reflect variations in health status and health care needs.

Adolescent↗
PubMed1998

Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment.

OBJECTIVE: This article examines the specific and nonspecific effects of Japanese acupuncture on chronic myofascial neck pain in a randomized single-blind trial. DESIGN: Forty-six patients were randomly assigned to receive relevant acupuncture, irrelevant acupuncture, or no-acupuncture control treatment consisting of nonsteroidal anti-inflammatory medication. The two acupuncture groups underwent comparable light shallow needling. The irrelevant acupuncture group received acupuncture at specific sites not relevant for cervical pain. OUTCOME MEASURES: The study measures included the McGill Pain Questionnaire-Short Form (SF-MPQ), the Short-Form Health Survey (SF-36), the Symptom Checklist 90-Revised (SCL-90-R), medication diary, and physiologic measures. The factors examined as predictors of outcome pain ratings were experience with, beliefs about, and knowledge of acupuncture before treatment; perceived efficacy, credibility, and logic of acupuncture; perceived competence of the acupuncturist; and painfulness of acupuncture. RESULTS: No differences were found among the three groups at baseline, except that the relevant acupuncture group reported having had more previous acupuncture treatments. No significant differences in terms of perceived credibility or perceived effectiveness of treatment were found between the two acupuncture groups. The relevant acupuncture group had significantly greater pre-/posttreatment differences in pain than the irrelevant acupuncture and control groups (p < .05). The nonspecific effects of confidence in the acupuncturist, willingness to try any treatment, mood, and physiologic effect of needling were not predictive of treatment outcome, whereas confidence in the treatment and past experiences with acupuncture did correlate significantly with a decrease in pain. CONCLUSIONS: Relevant acupuncture with heat contributes to modest pain reduction in persons with myofascial neck pain. Previous experience with and confidence in treatment help to predict benefit. Measurement of nonspecific effects of alternative therapy is recommended in future clinical trials.

Acupuncture Therapy↗
PubMed1998

A right to parenthood.

Many people regard parenthood as a 'right' to which they are entitled; this right is open to debate. Infertility can provoke a life-crisis leading to profound feelings of grief, loss and isolation. Each of us, as members of society, must acknowledge the pressure that we place upon individuals to parent, and particularly upon women. Fertility nurses in particular may be caught in the middle of a potentially enormous conflict of interests between the needs and desires of patients and the service provided by the NHS. Child health nurses need to be aware that infertility and the process of fertility treatment may have a significant impact on the parents' relationship with a child born as a result of treatment.

Adult↗
PubMed1998

Health years equivalents as a measurement of preferences for dental interventions.

OBJECTIVE: To test the feasibility and importance of measuring preferences among treatment choices using Healthy Years Equivalents (HYE). DESIGN: Development of scenarios for alternative approaches to caries treatment. Completion of category rating and standard gamble questions elicited in personal interviews. SETTING: The provision of dental care to children in a public-funded dental health clinic. PARTICIPANTS: Random sample of the adult population of Hamilton, Ontario. MAIN OUTCOME MEASURES: The percentage of the sample unable to complete the interviews, time taken to perform interviews, ease of understanding of interviews, correlation between rank ordering and HYE scores. RESULTS: Ninety-six per cent of the sample were able to complete the HYE exercise. Inconsistencies between HYE scores and rank orders implying preference reversal occurred in 6% of those completing HYE scores for the two scenarios. The additional time taken by the HYE was of the order of 17 minutes but increased with the age of the subject. Where problems occurred, they were related to the method of measurement or the sensitivity of the chosen scale as opposed to additional requirements of the HYE. There was some evidence that HYEs and QALYs produced different scores even in the context of chronic constant health states. CONCLUSIONS: HYEs are a feasible and important practical method of measuring preferences among interventions. Alternative utility-based approaches, such as willingness to pay, may be required to detect differences in modest improvements in temporary health states.

Adult↗