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Biomedical subjects

S Birch

Publications and source records attributed to S Birch.

At least 19 recordsLinked to original sources
PubMed2003

Environmental influences on healthcare expenditures: an exploratory analysis from Ontario, Canada.

STUDY OBJECTIVE: This paper explores the relation between healthcare expenditures (HCEs) and environmental variables in Ontario, Canada. DESIGN: The authors used a sequential two stage regression model to control for variables that may influence HCEs and for the possibility of endogenous relations. The analysis relies on cross sectional ecological data from the 49 counties of Ontario. MAIN RESULTS: The results show that, after control for other variables that may influence health expenditures, both total toxic pollution output and per capita municipal environmental expenditures have significant associations with health expenditures. Counties with higher pollution output tend to have higher per capita HCEs, while those that spend more on defending environmental quality have lower expenditures on health care. CONCLUSIONS: The implications of our findings are twofold. Firstly, sound investments in public health and environmental protection have external benefits in the form of reduced HCEs. Combined with the other benefits such as recreational values, investments in environmental protection probably yield net social benefits. Secondly, health policy that excludes consideration of environmental quality may eventually result in increased expenditures. These results suggest a need to broaden the cost containment debate to ensure environmental determinants of health receive attention as potential complements to conventional cost control policies.

Air Pollution↗
PubMed2002

Opportunity costs and uncertainty in the economic evaluation of health care interventions.

Considerable methodological research has been conducted on handling uncertainty in cost-effectiveness analysis. The current literature suggests the concepts of net health benefits and cost-effectiveness acceptability curves to circumvent the technical shortcomings of cost-effectiveness ratio statistics. However, these approaches do not provide a solution for the inherent problem that the threshold cost-effectiveness ratio itself is unknown. The authors suggest analysing uncertainty in cost-effectiveness analysis by directly addressing the concept of opportunity costs using the decision rule described by Birch and Gafni (1992) and introduce a new graphical framework (the "decision making plane") for communicating with policy makers.

Budgets↗
PubMed2002

Reviews of acupuncture for chronic neck pain: pitfalls in conducting systematic reviews.

This paper examines some of the problems specifically associated with conducting research into acupuncture and how this can lead to further problems with subsequent systematic reviews. Studies for the treatment of chronic neck pain have been used as examples of how presented information can be misleading to an acupuncture-naive reader and how researchers must be sensitive to these problems when compiling their inclusion and exclusion criteria. The problems associated with scoring trials are discussed and further work to increase the scope of scoring mechanisms is recommended in order to produce meaningful systematic reviews in the future.

Acupuncture Therapy↗
PubMed2002

Patient preferences and the measurement of utilities in the evaluation of dental technologies.

Advances in life sciences that are predicted in the 21st century will present many challenges for health professionals and policy-makers. The major questions will be how to allocate resources to pay for costs of new technologies and who will best benefit from advances in new diagnostic and treatment methods. We review in this paper the concept of utility and how it can be applied and expanded to provide data to help health professionals make decisions that are preferred by patients and the public at large. Utility is a measure of people's well-being or preferences for outcomes. The measurement of utilities of a new diagnostic technology, for example, can be carried out with the use of simple methods that do not incorporate all of the uncertainties and potential outcomes associated with providing the test, or with more complex methods that can incorporate most uncertainties. This review describes and critiques the different measurement methods of utilities.

Attitude to Health↗
PubMed2002

Health human resource planning for the new millennium: inputs in the production of health, illness, and recovery in populations.

HHRP needs to be sensitive to demographic changes in both population and provider groups. Analyses aimed at refining and improving the way in which demographic change is incorporated into HHRP will continue to enhance health human resource policies. However, the demographic basis of much HHRP fails to consider the effects of other changes in society that impact on the need for care in the population and the provision of care. In this paper the importance of introducing a production-function approach to HHRP has been presented. In some cases, existing data may be available to complement the demographic analyses with consideration of these broader issues. However, in other cases the ability to improve existing approaches will require the collection of new data. Although collecting additional data will involve costs, this is the price of improving HHRP exercises.

Canada↗
PubMed2001

Acupuncture for osteoarthritis of the knee: a systematic review.

OBJECTIVE: To evaluate trials of acupuncture for osteoarthritis (OA) of the knee, to assess the methodologic quality of the trials and determine whether low-quality trials are associated with positive outcomes, to document adverse effects, to identify patient or treatment characteristics associated with positive response, and to identify areas of future research. METHODS: Eight databases and 62 conference abstract series were searched. Randomized or quasi-randomized trials of all languages were included and evaluated for methodologic quality using the Jadad scale. Outcomes were pain, function, global improvement, and imaging. Data could not be pooled; therefore, a best-evidence synthesis was performed to determine the strength of evidence by control group. The adequacy of the acupuncture procedure was assessed by 2 acupuncturists trained in treating OA and blinded to study results. RESULTS: Seven trials representing 393 patients with knee OA were identified. For pain and function, there was limited evidence that acupuncture is more effective than being on a waiting list for treatment or having treatment as usual. For pain, there was strong evidence that real acupuncture is more effective than sham acupuncture; however, for function, there was inconclusive evidence that real acupuncture is more effective than sham acupuncture. There was insufficient evidence to determine whether the efficacy of acupuncture is similar to that of other treatments. CONCLUSION: The existing evidence suggests that acupuncture may play a role in the treatment of knee OA. Future research should define an optimal acupuncture treatment, measure quality of life, and assess acupuncture combined with other modalities.

Acupuncture Analgesia↗
PubMed2001

Capitation and primary care in Canada: financial incentives and the evolution of health service organizations.

Alternative approaches to the funding, organization, and delivery of primary care have been the subject of ongoing discussion and debate in many industrialized nations for many years. One common recommendation has been to use capitation, as opposed to fee-for-service, as the payment method for physicians. In this study the authors use data from interviews with physicians and Ministry of Health officials to trace the evolution of Ontario's Health Service Organization (HSO) program, the only program of capitation-funded physician care in Canada. The program has developed in three phases: formation in the early 1970s, expansion in the late 1970s and throughout the 1980s, and restructuring in the 1990s. The analysis focuses on the perceptions and actions of policymakers and physicians who became involved with the program at different points in its evolution, and identifies how they perceived and responded to the financial incentives that were introduced to promote the program. This case study allows an examination of the shifting objectives, communications, perceptions, and responses of policymakers and stakeholders in changing contexts over a period of more than 20 years. The long history of the HSO program provides the opportunity to examine the factors that can cause financial incentives to go awry. The authors suggest how this case study offers lessons for financial incentive policymaking.

Attitude of Health Personnel↗
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

Health human resource planning in home care: how to approach it--that is the question.

In her paper, MacAdam refers to future challenges in health human resources for the home-care sector. This paper builds on her comments and discusses conceptual and practical approaches to future planning of health human resources. Necessary national data requirements are identified for this type of planning. The authors point out the limitations of traditional supply-side modelling and describe a new framework linking population health needs to outcomes that builds upon earlier conceptual work in needs-based, utilization-based and effective demand-based models.

Canada↗
PubMed2000

Preliminary results of a new method for locating auricular acupuncture points.

Auricular acupuncture is widely used for the treatment of cocaine addiction, and there is an urgent need to conduct controlled clinical research of this intervention. One impediment to this endeavor is the lack of an objective and reliable method for identifying the hypothesized active and control points. In order to address this issue, we conducted two studies employing a constant current electrical device and a novel probing technique. In the first study, we assessed the reliability of our technique for measuring electrical skin resistance points (acupuncture or non-acupuncture) on the body and auricles. In the second study, we analyzed and compared the measurements of skin resistance of auricular acupuncture and control zones in a group of cocaine abusing patients. Findings suggest that our measurement method produced reliable measurements, and that active acupuncture zones revealed a significantly different pattern of electrical skin resistance readings compared to control zones. This method may be useful for locating active and control points in controlled clinical trials of auricular acupuncture.

Acupuncture Points↗
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↗