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PubMed2004

Topology of large-scale engineering problem-solving networks.

The last few years have led to a series of discoveries that uncovered statistical properties that are common to a variety of diverse real-world social, information, biological, and technological networks. The goal of the present paper is to investigate the statistical properties of networks of people engaged in distributed problem solving and discuss their significance. We show that problem-solving networks have properties (sparseness, small world, scaling regimes) that are like those displayed by information, biological, and technological networks. More importantly, we demonstrate a previously unreported difference between the distribution of incoming and outgoing links of directed networks. Specifically, the incoming link distributions have sharp cutoffs that are substantially lower than those of the outgoing link distributions (sometimes the outgoing cutoffs are not even present). This asymmetry can be explained by considering the dynamical interactions that take place in distributed problem solving and may be related to differences between each actor's capacity to process information provided by others and the actor's capacity to transmit information over the network. We conjecture that the asymmetric link distribution is likely to hold for other human or nonhuman directed networks when nodes represent information processing and using elements.

Journal Article↗
PubMed1982

Accountability, efficiency, and the "bottom line" in non-profit organizations.

Financial reporting by non-profit organizations deals only with accountability for propriety and regularity, and ignores output measurement. The development of output measures of a physical or index nature offers a means of relating dollar costs to output in the form of cost-efficiency or cost-effectiveness measures, but does not provide any measure of the absolute value or worthwhileness of such programs. This fundamental absolute value question should be asked of all non-profit programs and documented to the greatest possible extent in budgetary submissions, and subsequent control and audit. In public sector non-profit programs, the posing of this question requires information on consumer demand other than in aggregative and imprecise form through the political process, and much improved information on the cost side. Eliciting demand information is feasible in the case of public programs with separable benefits by the use of a variety of pricing techniques, direct or imputed, whether or not the service in question is ultimately financed on a user-pay basis. The problem of eliciting demand is more difficult in the case of public goods, but improved demand information can be obtained, ideally by an approach such as the use of a Clarke tax. The argument can be extended to encompass questions of income distribution, stabilization, regulation and tax policy. Recent developments in program evaluation in the federal government are important, but remain deficient in failing to address the question of absolute value.

Accounting↗
PubMed1992

America's children: economic perspectives and policy options.

American children are worse off than those in the previous generation in several important dimensions of mental, physical, and emotional well-being. During the 1960s cultural changes adversely affected children while their material condition improved substantially. By contrast, material conditions deteriorated in the 1980s, especially among children at the lower end of the income distribution. Public policies to improve the material condition of children require a transfer of resources from households that do not have children to those that do. Government programs such as tax credits and child allowances are more efficient and equitable than employer-mandated programs.

Adult↗
PubMed1994

Health and social inequality in Europe.

In most European countries health has been shown to be linked to social circumstances--gradients in health status have persisted for decades, despite major changes in the principal causes of death. In central and eastern Europe life expectancy has stagnated since the mid-60s, whereas in the West it has increased; but even in the West it is related to income distribution. Social differences in mortality in men are three times as large in some countries as in others, and are influenced by factors other than conventional risk factors. Substantial declines in mortality and morbidity could result from a narrowing of health inequalities even when differences in health risk between social groups are comparatively small. Policies to reduce health inequalities can be introduced in smaller communities and organisations such as the school and workplace. National policies are variable; factors generating inequalities require action across several policy areas.

Europe↗
PubMed1997

Self reported poor health and low educational level predictors for mortality: a population based follow up study of 39,156 people in Sweden.

OBJECTIVE: To analyse the relative risk (RR) of mortality for people who reported poor health or had low educational level. SETTING: Sweden. DESIGN: A random sample of 39156 people was interviewed face to face by Statistics Sweden from 1979-85. The dependent variable was total mortality. Independent variables were sex, age, marital status, and socioeconomic position, defined as educational level, type of housing tenure, and health status. This study was designed as a follow up study ranging from 1 January 1979 to 31 December 1993. Information on the dependent variables was obtained from the central cause of death register. Respondents were linked to the register by the Swedish personal registration number. Person-years at risk were calculated from the date of the interview until death, or for those who survived, until the end of the follow up period. Data were analysed in relation to gender and age (25-29 years and 60-74 years) in a proportional hazard model in order to estimate RR. RESULTS: During follow up 2656 men and 1706 women died. Men and women in both age groups who reported poor health status at the interview had a strongly increased risk of dying during the follow up period (RR = 2.05 (95% confidence interval 1.72, 2.31) and RR = 1.91 (1.74, 2.10) for men, and RR = 2.34 (1.94, 2.83) and RR = 1.80 (1.61, 2.02) for women for the younger and older age groups respectively) when simultaneously controlled for age, marital status, education, and housing tenure. Living alone, renting an apartment, and low educational level (< or = 9 years) were also associated with increased mortality risks for men and women in both age groups. CONCLUSION: Poor self reported health was a strong predictor for total mortality. Furthermore, in Sweden, a country well known for the equality of its income distribution, there are inequalities in health with higher total mortality risks for people with a low educational level and those who are not owner-occupiers.

Adult↗
PubMed2003

Excess winter mortality in Europe: a cross country analysis identifying key risk factors.

OBJECTIVE: Much debate remains regarding why certain countries experience dramatically higher winter mortality. Potential causative factors other than cold exposure have rarely been analysed. Comparatively less research exists on excess winter deaths in southern Europe. Multiple time series data on a variety of risk factors are analysed against seasonal-mortality patterns in 14 European countries to identify key relations Subjects and setting: Excess winter deaths (all causes), 1988-97, EU-14. DESIGN: Coefficients of seasonal variation in mortality are calculated for EU-14 using monthly mortality data. Comparable, longitudinal datasets on risk factors pertaining to climate, macroeconomy, health care, lifestyle, socioeconomics, and housing were also obtained. Poisson regression identifies seasonality relations over time. RESULTS: Portugal suffers from the highest rates of excess winter mortality (28%, CI=25% to 31%) followed jointly by Spain (21%, CI=19% to 23%), and Ireland (21%, CI=18% to 24%). Cross country variations in mean winter environmental temperature (regression coefficient (beta)=0.27), mean winter relative humidity (beta=0.54), parity adjusted per capita national income (beta=1.08), per capita health expenditure (beta=-1.19), rates of income poverty (beta=-0.47), inequality (beta=0.97), deprivation (beta=0.11), and fuel poverty (beta=0.44), and several indicators of residential thermal standards are found to be significantly related to variations in relative excess winter mortality at the 5% level. The strong, positive relation with environmental temperature and strong negative relation with thermal efficiency indicate that housing standards in southern and western Europe play strong parts in such seasonality. CONCLUSIONS: High seasonal mortality in southern and western Europe could be reduced through improved protection from the cold indoors, increased public spending on health care, and improved socioeconomic circumstances resulting in more equitable income distribution.

Climate↗
PubMed1997

Urbanisation and psychiatric admission rates in The Netherlands.

This article discusses the possible links between urbanisation, demographic variables and psychiatric admission rates. Inpatient psychiatric admission rates were determined for the 647 Dutch municipalities. Then urbanisation was determined using 'area address density', a unit of measurement developed by the Dutch Central Statistical Office. Five degrees of urbanisation are distinguished. Twenty-nine demographic variables which might have a theoretical link with admission rates were collated for all municipalities. The results show that standardised total admission rates increase with urbanisation. The mean admission rate for the least urbanised municipalities is 2.02 per 1000 resident population, the rate for the most urbanised municipalities is 3.72 per 1000. It was then found that the prevalence of demographic risk factors increased with urbanicity. At the same time, it was found that almost all demographic variables correlated with admission rates. A multiple regression mode--which accounts for 22% of variance--shows that income distribution, address density and mortality all contribute significantly to the variance in admission rates for the 647 Dutch municipalities.

Adolescent↗
PubMed1997

Prevalence, incidence and stability of drinking problems among whites, blacks and Hispanics: 1984-1992.

OBJECTIVE: This article reports on the prevalence, incidence and stability of dependence-related problems and social consequences from drinking among whites, blacks and Hispanics between 1984 and 1992. METHOD: A probability sample of 1,777 whites, 1,947 blacks and 1,453 Hispanics from the U.S. adult household population was interviewed in 1984. In 1992 a subsample consisting of 788 whites, 723 blacks and 703 Hispanics was reinterviewed. Interviews averaging 1 hour in length were conducted in respondents' homes by trained interviewers. RESULTS: The prevalence of a number of alcohol-related problems, the stability and incidence of dependence-related problems and the incidence of social consequences from drinking are higher among Hispanic than among white men. Dependence-related problems are more stable among black than among white men. Among women, the incidence of dependence-related problems and social consequences from drinking is higher among blacks than whites. Hispanic women have a higher incidence of social consequences from drinking than white women. Having a problem at Time 1 correlates only moderately with having a problem at Time 2, independent of ethnicity. CONCLUSIONS: In general, Hispanics and blacks continue to be more at risk than whites for developing a number of alcohol-related problems. These two ethnic groups should be the focus of renewed efforts to address alcohol problems and inequalities in income distribution, employment, education and lack of access to adequate health care.

Adolescent↗
PubMed1996

[Demographic profile and health conditions of the elderly in a community in an urban area of southeastern Brazil].

Some specific characteristics of the aging of the Brazilian population in different areas, states and communities all over the country, have shown significant variations. Historical series of demographic and health indicators for the population in their sixties and over in Brazil, state of S. Paulo and in the municipal district of Araraquara are listed as follows: level of education and urban population growth rate, income distribution, mortality rates and main causes of death. In 1991 the aged constituted were 7.8% of the Brazilian population and 9.7% in Araraquara community. The elderly population (of 70 years of aged and above) as a proportion of the whole, has increased and already stands for 40%. The same trend holds good for both the proportion of aged within the urban population and their level of education which increased to 90% in 1991. The main causes of death are chronic degenerative diseases which have replaced the infectious illness: first, the diseases of the circulatory system (which account for more than 40% of all deaths) and the neoplasms (which let to 15% of the deaths). On the basis of these health and demographic data relating to people of 60 years of age and over, this study suggests some procedures for the improvement of the quality of the assistance given to the target population: a) the assistance give to the aged should be improved by providing gerontological training for general physicians and nurses, both of public and private clinics; b) the already existing educational activities for the aged, for health workers and for teachers of secondary education should be further developed; c) the number of day-hospitals should be increased for the purpose of avoiding unnecessary confinement so as maintain the low rate of institutionalization in homes for the elderly (0.7% in Araraquara). It is reported that at least 35% of the aged population in this area is entitled to private health assistance, which brings out the importance of including such services in the local health programs for this group.

Aged↗
PubMed2005

[Relationship between intestinal parasites in food handlers and epidemiological factors in the city of Florianópolis, Santa Catarina, Brazil].

The presence of intestinal parasites and epidemiological aspects were evaluated in 238 workers from a fast food company and other individuals working in street markets and farmers' produce markets in the city of Florianópolis, Santa Catarina State, Brazil. Parasitological techniques used in this study were: Lutz, Baermann-Moraes, Graham, and Faust, and parasite infection rates were 42.85% and 47.06%, respectively. Socioeconomic factors such as income distribution, schooling, and occupational categories proved to be relevant in this context. Habitual daily intake of fruits and vegetables was the factor most heavily associated with infection. These data suggest that intestinal parasites are frequent among food handlers in this city and that there is a need for constant epidemiological surveillance through periodic parasitological tests and health education for this entire population segment.

Adolescent↗
PubMedDate not supplied

Overweight and obesity among mothers of malnourished children--Brazil--PNSN--1989.

OBJECTIVE: To evaluate the relationship between the nutritional status of the youngest child under 48 months of age (in families with the biological mother present) and their mothers among 3906 children selected from a sample of a national survey in 1989 (PNSN). RESULTS: Malnutrition was present in 5.8% of the children. From these, 21.8%, 60.9% and 17.3% had overweight/obese, eutrophic and malnourished mothers, respectively. Stratified analyses taking into account the regions, situation, income distribution and mother's educational level demonstrated that a lower proportion of malnourished children was concurrent with a higher proportion of overweight/obese mothers. The Kappa test evidenced a poor agreement between the nutritional conditions of the child-mother pairs (K < = 0.048). CONCLUSIONS: When the proportion of malnourished children decreased within the analyzed groups, the proportion of overweight/obese mothers increased. Such an epidemiological pattern indicates that within groups in which malnutrition is less prevalent, the proportion of children for whom a lack of food in the household is the main determinant factor for malnutrition is lower.

Adult↗
PubMed1985

Public opinion about doctors' pay.

Public opinion about doctors' incomes was examined in a national random sample of 843 respondents; 70.1 per cent of those questioned felt physicians are overpaid. There was a high degree of agreement among various groups that physicians are overpaid, but older people and Whites were more likely to think so than younger people and other ethnic groups. People who believe that the United States is characterized by unequal educational opportunity, unfair income distribution, and limited resources were also more likely to think physicians are overpaid.

Adult↗
PubMed2001

Underuse of invasive procedures among Medicaid patients with acute myocardial infarction.

OBJECTIVES: The purpose of this study was to determine whether underuse of cardiac procedures among Medicaid patients with acute myocardial infarction is explained by or is independent of fundamental differences in age, race, or sex distribution; income, coexistent illness; or location of care. METHODS: Administrative data from 226 hospitals in New York were examined for 11,579 individuals hospitalized with a primary diagnosis of acute myocardial infarction. Use of various cardiac procedures was compared among Medicaid patients and patients with other forms of insurance. RESULTS: Medicaid patients were older, were more frequently African American and female, and had lower median household incomes. They also had a higher prevalence of hypertension, diabetes, lung disease, renal disease, and peripheral vascular disease. After adjustment for these and other factors, Medicaid patients were less likely to undergo cardiac catheterization, percutaneous transluminal coronary angioplasty, and any revascularization procedure. CONCLUSIONS: Factors other than age, race, sex, income, coexistent illness, and location of care account for lower use of invasive procedures among Medicaid patients. The influence of Medicaid insurance on medical practice and process of care deserves investigation.

Angioplasty, Balloon, Coronary↗
PubMed1997

In pursuit of "growth with equity": the limits of Chile's free-market social reforms.

The economic and social strategy developed by the democratic governments in Chile since 1990 has been based on the premise that free-market policies promoting growth and economic stability must continue, but should be combined with social policies designed to promote greater equality. This new set of policies produced quick and positive results in the context of strong economic growth. The reduction of poverty was its crowning achievement. However, not all the Concertación's redistributive efforts have enjoyed the same level of success. Inequalities in income distribution are again increasing. Significant segments of society, such as subsistence farmers, rural migrants to cities, women and youth who lack vocational training--as well as an important segment of the middle class that had been impoverished during the military regime--are being systematically marginalized from the benefits of economic growth and social policy. The fundamental problems of current Chilean social policy are rooted in the privatization of social sectors under the military government and the resulting dual model of social welfare.

Chile↗
PubMedDate not supplied

Nurse practitioners--co-providers of health care.

What single program can a group practice institute to increase patient satisfaction, contain costs, improve provider accessibility, expand patient education and other services, increase market share, and most importantly, improve the overall quality of patient care? Expanding the role of nurses as co-providers of care can do all this and more for your group. The experience over the past eight years of a large multispecialty group in central Illinois offers many lessons in the successful integration of a nurse practitioner/clinician program into a group practice. Discussed in this thorough report are the scope of practice, benefits to patients and the organization, and identification of issues needing further resolution: legality, third-party reimbursement, income, distribution, and control of practice.

Consumer Behavior↗
PubMed1984

Nurse practitioners in the medical group setting.

To be at the leading edge in today's rapidly changing world of health care and respond to increasing consumer demands, medical groups must be willing to implement new concepts. The utilization of nurse practitioners is one such concept. Before implementation, however, the idea should be thoroughly reviewed from all standpoints, including role of the practitioner, education and training, scope and areas of practice, legalities, billing, third-party reimbursement, record documentation, income distribution, and control of practice. Nurse practitioners in the medical group setting can be helpful in increasing patient satisfaction and improving quality of care.

Group Practice↗
PubMedDate not supplied

Building in a new era.

Is it reasonable to expect facility occupancy expenses to be 10% of revenues by 1990? If so, a group with static revenues of $10 million can expect a decline in distributable income of $250, 000 to $300, 000 a year.

Costs and Cost Analysis↗
PubMed1988

Managing managed care. Grouping together is the answer.

Working through an organization is the only way to manage in a managed care system. To be successful we need sophisticated management information systems, outstanding leadership and management, and a discretionary income distribution system. We must be willing to accept venture risk even though we will not win all the time. We must be aggressive in developing these systems. In order to survive, the successful organization will have to manage first, itself; second, the buyer of care; and third, its own image. It must also learn how to deal with the competition.

Data Collection↗