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PubMedDate not supplied

Abortion in Vietnam: measurements, puzzles, and concerns.

This report summarizes current knowledge about abortion in Vietnam, drawing upon government statistics, survey data, and fieldwork undertaken by the author in Vietnam throughout 1993 and part of 1994. The official total abortion rate in Vietnam in 1992 was about 2.5 per woman, the highest in Asia and worrisome for a country with a still-high total fertility rate of 3.7 children per woman. Vietnamese provinces exhibited substantial variation in both the rate of abortion and the type of procedures performed. Among the hypotheses explored to explain Vietnam's high rate of abortion are the borrowing of family planning strategies from other poor socialist states where abortion is common; current antinatal population policies that interact with a lack of contraceptive alternatives; and a rise in pregnancies among young and unmarried women in the wake of recent free-market reforms. Because family-size preferences are still declining, abortion rates may continue to increase unless the incidence of unwanted pregnancy can be reduced, a goal that Vietnamese population specialists are seeking to achieve.

Abortion, Legal↗
PubMed2000

Improved management of radiotherapy departments through accurate cost data.

BACKGROUND AND PURPOSE: Escalating health care expenses urge governments towards cost containment. More accurate data on the precise costs of health care interventions are needed. We performed an aggregate cost calculation of radiation therapy departments and treatments and discussed the different cost components. MATERIALS AND METHODS: The costs of a radiotherapy department were estimated, based on accreditation norms for radiotherapy departments set forth in the Belgian legislation. RESULTS: The major cost components of radiotherapy are the cost of buildings and facilities, equipment, medical and non-medical staff, materials and overhead. They respectively represent around 3, 30, 50, 4 and 13% of the total costs, irrespective of the department size. The average cost per patient lowers with increasing department size and optimal utilization of resources. Radiotherapy treatment costs vary in a stepwise fashion: minor variations of patient load do not affect the cost picture significantly due to a small impact of variable costs. With larger increases in patient load however, additional equipment and/or staff will become necessary, resulting in additional semi-fixed costs and an important increase in costs. A sensitivity analysis of these two major cost inputs shows that a decrease in total costs of 12-13% can be obtained by assuming a 20% less than full time availability of personnel; that due to evolving seniority levels, the annual increase in wage costs is estimated to be more than 1%; that by changing the clinical life-time of buildings and equipment with unchanged interest rate, a 5% reduction of total costs and cost per patient can be calculated. More sophisticated equipment will not have a very large impact on the cost (+/-4000 BEF/patient), provided that the additional equipment is adapted to the size of the department. That the recommendations we used, based on the Belgian legislation, are not outrageous is shown by replacing them by the USA Blue book recommendations. Depending on the department size, costs in our model would then increase with 14-36%. CONCLUSION: We showed that cost information can be used to analyze the precise financial consequences of changes in routine clinical practice in radiotherapy. Comparing the cost data with the prevailing reimbursement may reveal inconsistencies and stimulate to develop improved financing systems.

Belgium↗
PubMed1994

Board members' influence on the government-nonprofit relationship.

This study examines whether, how, and under what conditions nonprofit boards of directors influence the government and voluntary sector relationship. The survey responses of executive directors and board presidents in a randomly selected sample of 400 nonprofit organizations indicate that boards are not bystanders in the contracting relationship with government. Rather, many boards play multiple roles, simultaneously enhancing interdependence and maintaining the boundary between state government and nonprofits.

Data Collection↗
PubMed2005

[Evolution of the nutritional status of six years old Chilean children (1987-2003)].

BACKGROUND: As a consequence of the epidemiological transition in Chile, the nutritional status of the population has changed notoriously. AIM: To study the changes in the nutritional status of six years-old Chilean children from 1987 to 2003. MATERIAL AND METHODS: The computer data base of a government institution in charge of the School Lunch Program (JUNAEB) was used. It contains data on weight, height, sex and date of birth of six years old children, in the years 1987, 1990, 1993, 1996, 2000, 2001, 2002 and 2003. RESULTS: The data of approximately 80,000 children was analyzed. Both weight and height increased over the study years. There was a significant reduction in the number of children with weight deficit but also an increase in the proportion of children with obesity. Stunting was also reduced. The proportion of children with HAZ over 2 SD increased from 0.76 in 1987 to 2.2% in 2003. The prevalence of obesity has not increased since the year 2000. CONCLUSION: The stabilization in the prevalence of obesity is a positive finding, considering its adverse consequences for health.

Body Height↗
PubMed1994

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: amendments to data bank regulations to comply with court order and technical correction--HRSA. Final regulations.

This final rule amends the existing regulations governing the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners (the Data Bank), codified at 45 CFR part 60, authorizing the reporting and release of information concerning: Payments made for the benefit of physicians, dentists, and other health care practitioners as a result of medical malpractice actions or claims; and certain adverse actions taken regarding the licenses and clinical privileges of physicians and dentists. This final rule revises sections 60.2 and 60.7 to require reporting only by entities which make medical malpractice payments, deleting the reference to reporting by persons (individuals). It also clarifies the reference to "professional society" in section 60.9.

Documentation↗
PubMed1996

A survey of population-based drug databases in Canada.

OBJECTIVE: To identify the population-based drug databases in Canada and to determine their comprehensiveness and accessibility for performing pharmacoepidemiologic and outcomes research. DESIGN: Survey (four-part mailed questionnaire). SETTING: Public and private third-party drug plans across Canada. PARTICIPANTS: All provincial and territorial drug plan or pharmacare managers as well as selected private plan managers including health benefit consultants, group insurers and claims adjudicators/pharmacy benefit managers (CA/PBMs). OUTCOME MEASURES: Patient, drug and pharmacy information; potential for electronic linkages to other provincial databases (e.g., physician, hospital, vital statistics); accessibility of information; population profile. RESULTS: Of the 32 recipients of the questionnaire 29 (91%) responded and 18 (56%) completed the survey. Most databases were reported to contain patient information (e.g., patient identification number, age, sex and medication history) and prescription drug information (e.g., drug identification number, strength, quantity and cost). Six provinces and one territory reported the capability to link to other databases (e.g., hospital and physician databases). One CA/PBM reported some links to selected long-term disability data. All of the government databases except those in British Columbia and the Yukon Territory allowed use of the data for research purposes. Manitoba and Saskatchewan included all residents of the province in their database; the others included selected groups (e.g., residents 65 years of age or older, people on social assistance or people covered by private group insurance). CONCLUSION: A number of public and private population-based databases are available for use in pharmacoepidemiologic and outcomes research.

Canada↗
PubMed1991

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners--PHS. Final regulations.

This final rule amends the existing regulations governing the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners (the Data Bank), codified at 45 CFR part 60, authorizing the reporting and release of information concerning: (1) Payments made for the benefit of physicians, dentists, and other health care practitioners as a result of medical malpractice actions or claims; and (2) certain adverse actions taken regarding the licenses and clinical privileges of physicians and dentists. This final rule revises section 60.12 to change the process for collecting user fees from eligible individuals and entities requesting disclosure of information from the Data Bank.

Databases, Factual↗
PubMedDate not supplied

Health promotion for older Americans in the 21st century.

OBJECTIVES: To provide a broad overview of the role of the individual, the physical environment, and the social environment on health and functioning in older adults (65 and older), and to highlight interventions and recommendations for action on each of these levels. DATA SOURCES: Published studies and government reports on health and functioning in older Americans and on the individual, social, and physical environmental contributors to health were identified through journal and government documents review and computer library searches of medical and social science data bases for 1980-1999. STUDY SELECTION: Preference was given to published studies and government reports that focused specifically on behavioral and environmental contributors and barriers to health promotion in Americans 65 and older and/or that highlighted creative interventions with relevance to this population. Both review articles and presentations of original research were included, with the latter selected based on soundness of design and execution and/or creativity of intervention described. DATA EXTRACTION: Studies were examined and their findings organized under three major headings: (1) behavioral risk factors and risk reduction, including current government standards for prevention and screening; (2) the role of the physical environment; and (3) the role of the social environment in relation to health promotion of older adults. DATA SYNTHESIS: Although most attention has been paid to the role of behavioral factors in health promotion for older adults, a substantial body of evidence suggests that physical and social environmental factors also play a key role. Similarly, interventions that promote individual behavioral risk reduction and interventions targeting the broader social or physical environment all may contribute to health in the later years. CONCLUSIONS: With the rapid aging of America's population, increased attention must be focused on health promotion for those who are or will soon be older adults. Promising intervention strategies addressing the individual, the physical environment, and the social environment should be identified and tested, and their potential for replication explored, as we work toward a more comprehensive approach to improving the health of older Americans in the 21st century.

Aged↗
PubMed1999

Income inequality and mortality in England.

BACKGROUND: Despite the increasing evidence that income inequality causes reductions in life expectancy in developed countries, this relationship has not been explored in the United Kingdom, where local income data are not routinely available. We have surmounted this problem by employing an ecological design which applies national income data to local mortality and occupational data. METHODS: This ecological, cross-sectional study used 1991 mortality and Census data on the 366 English local government districts, and 1991 New Earnings Survey data for England, to determine the independent effect of income inequalities within English local authorities on the variation in all cause mortality between them. The subjects were all men and women recorded as economically active in the 1991 Census. We carried out linear regression analyses between all cause, all ages standardized mortality ratios, income inequality indexes and mean income levels of the local government districts. Results Both income inequality and mean income were independently associated with mortality. CONCLUSIONS: It is likely that income inequality makes an independent contribution to life expectancy in English local authorities. This finding adds further to the international evidence supporting the potentially positive health impact of increasing the scale of redistributive fiscal policies.

Cross-Sectional Studies↗
PubMed2003

A re-analysis of Price's "Islam and human rights: a case of deceptive first appearances".

Daniel Price in his analysis of Islamic Political Culture and Human Rights concluded that "... government rooted in Islam does not facilitate the abuse of human rights." A re-analysis of his data for 23 Islamic governments demonstrates otherwise. There is a significant trend (p<.03), despite the low statistical power available in only 23 cases, for an inverted quadratic relationship between Islamic Political Culture and Human Rights. Among the nations scoring low on Islamic Political Culture, the correlation between the two variables is -.01 (ns); among those scoring high on Islamic Political Culture, the correlation shifts to -.78 (p<.02). At lower scores for Islamic Political Culture, there may indeed be little relationship between Political Culture and Human Rights; however, at higher scores there appears to be a significant relationship between increasing Islamic Political Culture and a decline in Human Rights. The data suggest that extreme applications of Sharia law (if not any secular or religious legal system) may have serious implications for human rights--or at least, Western Euro-American conceptualizations of human rights. At the same time, support for human rights may increase as Islamic governments shift from mostly secular to moderate applications of Islamic law.

Human Rights↗
PubMed1990

Measurement of health status in the 1990s.

The use of health-related quality of life measures, especially those based on function, are likely to increase during the next decade. This increase, however, is most likely to occur in clinical research and clinical practice. Unless the necessary political will, resources, data, and policy researchers coexist, there will be relatively little advance in the use of health status measures for decision-making and policy. This prediction is based on the observation that policy research tends to rely on available national data, that currently these data provide limited information about health status, and that there appears to be insufficient interest and resources to broaden data collection or to develop methods that incorporate a broad spectrum of health outcomes (e.g. death, impairment, functional status, and perceptions) into a single instrument or measure of health on large populations and communities. This state of affairs is particularly unfortunate as we face a decade in which available health and medical care may become more limited and social inequity in access and health status may become more marked. The effect of social inequities and restrictions to health care on the health of the nation cannot continue to be determined with reference only to the structure and process of the health care system. Health and quality of life outcomes are what count. And, these outcomes cannot be determined without appropriate and inclusive measures of health-related quality of life. Of course, we hope our prediction is wrong and that the motivation and resources will be found to help resolve methodologic issues in the measurement of population health status and quality of life and to provide the necessary data. We hope that government agencies, employers, and private providers will begin to collect health-related quality of life data on the constituents and populations they serve. Even if these data are imperfect or primitive, the effects of improving accessibility and quality of health care can only be assessed adequately in terms of the health-related quality of life of the nation.

Community Health Services↗
PubMedDate not supplied

Using large data bases in nursing and health policy research.

Concern about the quality, cost, and outcomes of health care has become a driving force in health policy research. The growing accessibility of large clinical and administrative health care data bases has led to an interest in using such data in health policy research. Clinical data bases are created by providers of care and contain data about episodes and outcomes of care, usually organized as patient records. Administrative data bases contain data about indirect care processes such as insurance claims processing, vital event recording, and quality assurance. Clinical and administrative data bases may contain millions of records, consist of data from multiple sites, and often have missing data issues that must be considered by researchers. These and other characteristics of large data bases require special data manipulation and analytic techniques. Large data bases have been used in epidemiological studies, risk assessment, and technology assessment and to study variations in caregiver practice patterns. Because the use of large data bases by nurse researchers has been constrained by the lack of nursing-relevant data in them, there is a need to reach consensus on useful and feasible nursing data elements and to include those data in ongoing data collection efforts by government agencies and private organizations.

Bias↗