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PubMed1994

A review of state legislation on DNA forensic data banking.

Recent advances in DNA identification technology are making their way into the criminal law. States across the country are enacting legislation to create repositories for the storage both of DNA samples collected from convicted offenders and of the DNA profiles derived from them. These data banks will be used to assist in the resolution of future crimes. This study surveys existing state statues, pending legislation, and administrative regulations that govern these DNA forensic data banks. We critically analyzed these laws with respect to their treatment of the collection, storage, analysis, retrieval, and use of DNA and DNA data. We found much variation among data-banking laws and conclude that, while DNA forensic data banking carries tremendous potential for law enforcement, many states, in their rush to create data banks, have paid little attention to issues of quality control, quality assurance, and privacy. In addition, the sweep of some laws is unnecessarily broad. Legislative modifications are needed in many states to better safeguard civil liberties and individual privacy.

Advisory Committees↗
PubMed1992

One approach to tracking state and local health spending.

National health system reform proposals continue to emphasize states' shared responsibility for their citizens' health care. In view of this increased interest, this Data Watch examines how much state and local governments spend for health care, using primarily data from the U.S. Bureau of the Census. Significant discrepancies exist between these data and other sources of state and local health spending data. Nevertheless, census data are the most comprehensive source of information on state and local spending. In the 1980s the gross rate of state spending on health was exceeded only by spending on corrections; later reports indicate that health has now overtaken corrections. Health and hospital spending varies widely among states, ranging from $1.79 per $100 of personal income in New York (after federal funding and charges are subtracted) to $0.36 per $100 in Nebraska. Continued work is needed to unravel the differences between data sources and to improve the collection and use of data at the state and local levels.

Budgets↗
PubMed1996

Oral contraceptives and primary liver cancer: temporal trends in three countries.

OBJECTIVE: To determine if vital statistics support a temporal association between the introduction of oral contraceptives (OC) and the incidence of, and mortality from, primary liver cancer in three countries from different regions of the world. METHODS: We used Cancer Incidence in Five Continents, volumes I-VI, for incidence data on primary liver cancer in the United States and Japan. The Centre for Epidemiology in Stockholm provided the incidence data for Sweden. We obtained mortality data for the U.S. from Vital Statistics of the United States, for Japan from The World Health Statistics Annual, and for Sweden from Swedish government sources. We compiled data on the prevalence of OC use in all three countries from multiple sources, including the National Survey of Family Growth, The Population Council, and original articles. RESULTS: Despite several hundred million woman-years of exposure to OCs, primary liver cancer incidence and mortality rates among women have not changed substantially in the United States. In Sweden, another country with extensive OC use, the primary liver cancer incidence trends in women paralleled those of men. The incidence of, and mortality rate from, primary liver cancer is gradually rising in Japan, where OC use has been negligible. CONCLUSION: Population-based data from three industrialized countries with very different patterns of oral contraceptive use provide no support for a measurable effect of OCs on primary liver cancer. Although case-control studies from developed countries have suggested an increase in risk, if such an effect does exist, the public health impact appears to be negligible.

Contraceptives, Oral↗
PubMed2005

Defining the cost of the Egyptian lymphatic filariasis elimination programme.

BACKGROUND: Lymphatic filariasis (LF) is targeted for global elimination. LF elimination programmes in different countries, including Egypt, are supported financially by national and international agencies. The national programme in Egypt is based on mass drug administration (MDA) of an annual dose of a combination of 2 drugs (DEC and albendazole) to all endemic villages. This study aimed primarily to estimate the Total and Government costs of two rounds of MDA conducted in Egypt in 2000 and 2001, the average cost per person treated, and the cost share of the different programme partners. METHODS: The Total costs reflect the overall annual costs of the MDA programme, and we defined Government costs as those expenditures made by the Egyptian government to develop, implement and sustain the MDA programmes. We used a generic protocol developed in coordination with the Emory Lymphatic Filariasis Support Center. Our study was concerned with all costs to the government, donors and other implementing parties. Cost data were retrospectively gathered from local, regional and national Ministry of Health and Population records. The total estimates for each governorate were based on data from a representative district for the governorate; these were combined with national programme data for a national estimate. RESULTS: The overall Total and Government costs for treating approximately 1,795,553 individuals living in all endemic villages in the year 2000 were USD 3,181,000 and USD 2,412,000, respectively. In 2001, the number of persons treated increased (29%) and the Total costs were USD 3,109,000 while Government costs were USD 2,331,000. In 2000, the average Total and Government costs per treated subject were USD 1.77 and USD 1.34, respectively, however, these costs decreased to USD 1.34 and USD 1.00, respectively in 2001. The coverage rate was 86.0% in 2000 and it increased to 88.0% in 2001. CONCLUSION: The Egyptian government provided 75.8% of all resources, as reflected in the Total cost estimates, and international agencies contributed the rest. Such data highlight both the commitment of the Egyptian government and the significance of the contributions of international bodies toward the LF elimination programme.

Journal Article↗
PubMed2001

Involving the 'consumer' in the evaluation of dental care: a philosophy in search of data.

Recent initiatives by the government of the United Kingdom have led to an increasing interest in patient and public participation in the evaluation and design of healthcare. (1,2) To date this has largely concentrated on the identification of the views of service users of both the treatment they have received, and of what could be called the structural dimensions of service provision, for example ease of access, waiting times, availability of treatment facilities, priorities in care and so on. (3,4) In this article I shall explore three broad questions: Who counts as a 'consumer' and what do we want to know from them? How do we go about ascertaining their views? How do we use information on the views of consumers in planning services and providing care?

Dental Care↗
PubMed1990

On the supply of physicians.

The congressionally created Council of Graduate Medical Education is conducting a study to assess the adequacy of the current and future supply of physicians in six specialties. The study is revising and updating the needs-based method used by the Graduate Medical Education National Advisory Committee and using this method to project the requirements for physicians for the next two decades. Projections on the supply of physicians will be based on the latest data from the federal government's Bureau of Health Profession's health manpower model. Previous physician manpower studies are reviewed to provide a historic perspective and a frame of reference for the variables, data sources, and assumptions being considered by the Council of Graduate Medical Education study.

Forecasting↗
PubMedDate not supplied

Nordic privatization and private healthcare.

The role of the private sector in public healthcare systems is much debated, but there is little research to inform the debate. In the Nordic countries the extent and type of private sector involvement is largely unknown and the changes and the consequences have not been studied. This paper presents a conceptual framework and some limited data about the changing private-public mix and privatization in the Nordic countries between 1985 and 2000. The data suggest a small increase in both private financing and provision which has accelerated in recent years, especially in specific healthcare fields such as diagnostic centres, dentistry, primary medical care and care for older people. The overall increase is small, but large in certain sectors. Differences between the countries can only be understood in relation to their historical, financial, economic and political context, even though there are many commonalities. Impact also is context dependent, but the findings do show a cross-country pattern of a willingness to experiment and a change in underlying assumptions. The findings show a more extensive interpenetration of private and public than previously recognized but more research is required, especially about changes in recent years about which data are scarce. The paper considers the factors driving these trends, the likely larger changes in the next 10 years and the possible consequences for patients, professionals, managers and governments. It notes the different ways governments can control or influence finance and provision. It proposes that the Nordic and other governments improve regulation and data collection about the private sector and consider influencing private providers through partnership arrangements, rather than leaving the developments to be shaped by growing consumer demands or market logic alone.

Economic Competition↗
PubMed2003

Inter-generation differences in foot morphology: aging or secular change?

Inter-generation differences in foot dimensions were examined using ANCOVA to determine whether aging or secular change is the more important causal factor. In examining the results, bone size was assumed not to change after the end of linear growth, while foot arches were assumed to become flatter rather than higher if there were any changes in skeletal structure. Changes in overall body build according to age were examined using statistical data collected by the government through population-follow-up. Secular changes in foot length (FL) and foot breadth, diagonal (FB) as well as the changes with age in FB were examined using data measured at ages younger than 50 years. The effects of overall body build were examined using the body mass index (BMI). Compared to the 1970 group (birth year: 1960-78) of the same FL, the 1930 group (birth year: 1909-39) had larger foot circumferences, wider breadth measurements, higher dorsal arches and ball, and greater toe 5 angle, but had shorter fibular instep lengths and shorter 5th metatarsal bones. The 1930 groups tended to have larger FB than the 1970 group of the same foot circumference. No inter-generation differences were observed in the heights at the medial and lateral malleoli, toe 1 angle, or the relationship between FB and heel breadth. These findings are discussed in terms of the effects of weight increase after the end of linear growth, changes in skeletal structure, overall body build as young adults, socioeconomic status during the growth period, as well as differential growth rates of foot bones. The conclusions are 1) changes in foot length and longitudinal arches due to aging are negligible, 2) the large circumferences, breadths, and higher dorsal arches and ball of the 1930 group for their foot length are better explained by their robust bones than by the increase in soft tissue after the end of linear growth, and 3) the larger FB of the 1930 group for their foot circumference is partly explained by their shorter fibular instep length. As a whole, factors affecting growth (secular change) are more important than changes after the end of growth (aging) in the inter-generation differences in foot morphology.

Adolescent↗
PubMed2006

The effects of governing board configuration on profound organizational change in hospitals.

This study extends the literature on governing boards and organizational change by examining how governing board configurations have influenced profound organizational change in U.S. hospitals, and the conditions under which such change occurs. Hospitals governed by boards that more closely resembled a corporate governance model were more likely to experience positive changes such as diversification and merger and less likely to undergo negative changes such as closure. Organizational performance influenced change, but largely independent of governance configurations. Only in the case of closure did we find that governance configuration operated jointly with organizational performance.

Data Collection↗
PubMed2003

Assessing the effects of substance abuse among applicants for TANF benefits: the outcome of a demonstration project in Florida.

This paper examines an attempt by the State of Florida to devise a mechanism for determining the level of drug use among TANF recipients and to determine the extent to which such use affects employment, earnings and use of government services by TANF beneficiaries. Data from tests administered by substance abuse testing providers were combined with information from Medicaid, Food Stamp, cash assistance and Unemployment Insurance files to examine differences between the two groups. The findings suggest that the procedures employed by the State of Florida did not produce reliable estimates of the level of drug use among TANF beneficiaries. The data did show very small differences in employment, earnings, and use of government services between individuals who tested positively and those who tested negatively for substance abuse. In addition, evidence is presented that suggests that there is very little difference in employment, earnings and use of government services between users of different kinds of drugs.

Employment↗
PubMed1995

National survey of dental caries status and treatment needs in Nigeria.

Data on dental caries status and treatment needs among Nigerians were obtained for planning purposes. Details of male and female subjects of all ages from model urban and rural local governments in each state were obtained and a quota sample of about 100 subjects was selected in each local government area (N = 4692). Data were collected using WHO criteria. Chi-square test was used to analyze differences between frequencies. Results from different states were pooled together according to their Primary Health Care (PHC) classification. Percentages of decayed teeth (DT) were: 30, 43, and 44 per cent respectively for subjects aged 12, 15, and 35-44 years old. Percentage DT showed significant (P < 0.01) variation between zones, although the rural/urban differences were not consistent in all ages and significant (P = 0.01) differences were reported for 12 and 15 year olds. Mean DMFT in the respective ages were 0.7, 1.3 and 2.5. The level of restorative care (FT/DMFT) was very low, being 1.5, 1.6 and 1.2 percent for the respective ages. Percent MT/DMFT increased with age. Extrapolating from sample estimates, 7.3 and 22.9 million Nigerians were projected to need dental extraction and conservative care respectively. There is a need to develop an oral health system that includes screening the population and treating those in need of care. Consideration should be given to the training of Expanded Function Dental Auxiliaries.

Adolescent↗
PubMed2005

The tissue microarray data exchange specification: a document type definition to validate and enhance XML data.

BACKGROUND: The Association for Pathology Informatics (API) Extensible Mark-up Language (XML) TMA Data Exchange Specification (TMA DES) proposed in April 2003 provides a community-based, open source tool for sharing tissue microarray (TMA) data in a common format. Each tissue core within an array has separate data including digital images; therefore an organized, common approach to produce, navigate and publish such data facilitates viewing, sharing and merging TMA data from different laboratories. The AIDS and Cancer Specimen Resource (ACSR) is a HIV/AIDS tissue bank consortium sponsored by the National Cancer Institute (NCI) Division of Cancer Treatment and Diagnosis (DCTD). The ACSR offers HIV-related malignancies and uninfected control tissues in microarrays (TMA) accompanied by de-identified clinical data to approved researchers. Exporting our TMA data into the proposed API specified format offers an opportunity to evaluate the API specification in an applied setting and to explore its usefulness. RESULTS: A document type definition (DTD) that governs the allowed common data elements (CDE) in TMA DES export XML files was written, tested and evolved and is in routine use by the ACSR. This DTD defines TMA DES CDEs which are implemented in an external file that can be supplemented by internal DTD extensions for locally defined TMA data elements (LDE). CONCLUSION: ACSR implementation of the TMA DES demonstrated the utility of the specification and allowed application of a DTD to validate the language of the API specified XML elements and to identify possible enhancements within our TMA data management application. Improvements to the specification have additionally been suggested by our experience in importing other institution's exported TMA data. Enhancements to TMA DES to remove ambiguous situations and clarify the data should be considered. Better specified identifiers and hierarchical relationships will make automatic use of the data possible. Our tool can be used to reorder data and add identifiers; upgrading data for changes in the specification can be automatically accomplished. Using a DTD (optionally reflecting our proposed enhancements) can provide stronger validation of exported TMA data.

AIDS-Related Complex↗
PubMed1997

Frequency and duration of absence from work as functions of work force characteristics.

The processes of sick-leave inception and work resumption are governed by many interrelated factors. Hence conventional univariate models of these processes do not provide an adequate basis for explanation and prediction. In this study, multivariate models were used to fit absenteeism data for a large government department. The variables considered were the age, sex, and grade of the employees concerned; the day, month, and year of inception of sick leave or resumption of work; the section in which the employees worked and the size of that section. The models were used to predict the rates of sick-leave inception and work resumption in a test set of employees. The predicted inception rates appear to agree well with the observed values.

Adult↗
PubMed2006

Oral health care in Canada--a view from the trenches.

PURPOSE: Concern is increasing over the effect of lack of access to oral health care on the oral health, and hence general health, of disadvantaged groups. In preparation for a national symposium on this issue, key informants across Canada were canvassed for their perceptions of oral health services and their recommendations for improving oral health care delivery. This paper reports the results of that survey. METHOD: A questionnaire was constructed to address problems facing agencies with responsibility for meeting the oral health care needs of people receiving government assistance, the underhoused and the working poor. The survey was sent to 200 agencies, government and professional organizations. Data from the returned questionnaires were entered into a Statistical Package for the Social Sciences database and analyzed. Responses from Ontario were compared with those from the rest of Canada, those from government organizations were compared with others and results were examined by cultural nature of clients and by type of organization. RESULTS: In assessing the positive aspects of oral health care, 84% of respondents agreed that public programs were useful and 81% felt that dentists offer good care. However, 77% disagreed that preventive care is accessible and that access to dentists and dental specialists is easy. More Ontarians than others thought that there are few alternative settings for care delivery (95% vs. 83%) and that the poor feel unwelcome in dental offices (83% vs. 70%). The issues most commonly identified were the need for alternative delivery sites, such as community health centres where service delivery could be affordable, accountable and sustainable; the need for oral health to be recognized as part of general health; regulatory issues (e.g., expanding practice opportunities for non-dentist oral health care providers and removing restrictions on other dental health professionals in providing basic care to the financially challenged); and training. DISCUSSION: The survey helped to identify access and care issues across the country. There was considerable agreement that lack of access to dental care services is an important detriment to the oral and general health of many Canadians. Respondents believe that dental health is isolated from general health.

Canada↗
PubMed1997

Improving the efficiency of district hospitals: is contracting an option?

A world-wide revolution in thinking about public sector management has occurred in recent years, termed the 'new public management'. It aims to improve the efficiency of service provision primarily through the introduction of market mechanisms into the public sector. The earliest form of marketization in developed countries has tended to be the introduction of competitive tendering and contracts for the provision of public services. In less wealthy countries, the language of contracting is heard with increasing frequency in discussions of health sector reform despite the lack of evidence of the virtues (or vices) of contracting in specific country settings. This paper examines the economic arguments for contracting district hospital care in two rather different settings in Southern Africa: in South Africa using private-for-profit providers, and in Zimbabwe using NGO (mission) providers. The South African study compared the performance of three 'contractor' hospitals with three government-run hospitals, analysing data on costs and quality. There were no significant differences in quality between the two sets of hospitals, but contractor hospitals provided care at significantly lower unit costs. However, the cost to the government of contracting was close to that of direct provision, indicating that the efficiency gains were captured almost entirely by the contractor. A crucial lesson from the study is the importance of developing government capacity to design and negotiate contracts that ensure the government is able to derive significant efficiency gains from contractual arrangements. In other parts of Africa, contracts for hospital care are more likely to be agreed with not-for-profit providers. The Zimbabwean study compared the performance of two government district hospitals with two district 'designated' mission hospitals. It found that the two mission hospitals delivered similar services to those of the two government hospitals but at substantially lower unit cost. The nature of the contract between government and missions was implicit rather than explicit and of long standing. On the whole the mission organizations felt the informal nature of the agreement was advantageous, though the government plans to introduce service contracts at district level with all hospitals, both government and mission. The paper concludes by identifying concerns raised by the case-studies that are of relevance to other countries considering the introduction of explicit contractual arrangements for district hospital provision.

Contract Services↗