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PubMed1993

Available epidemiologic data on New York's Latino population: a critical review of the literature.

The increasing diversity of New York's Latino population creates complex challenges for the health care provider and planner, such as how to plan for divergent health risks, disease patterns, and health behaviors. However, most research on Latinos has been done in the southwestern United States. This paper reviews the epidemiologic data published since 1980 on Latino groups in New York State. The review covers the following areas: maternal and child health, infectious diseases, depression, tobacco and substance use, chronic diseases, neoplasms, and mortality statistics. We compare New York data with studies done in other areas of the United States. We identify serious methodological shortcomings in the epidemiological assessment of New York's Latino population, including (1) imprecise definition of "Latino," (2) misclassification, (3) census undercount of minority groups, and (4) lack of data on socioeconomic status. We argue that the epidemiological and cultural diversity of Latino groups demands the inclusion of such variables as place of birth, length of stay, and language preference in research and service statistics. This would facilitate targeted program planning and help to determine environmental, sociopolitical, behavioral, and genetic influences on diseases.

Adult↗
PubMed1997

Children's health care use in the Healthy Kids Program.

BACKGROUND: In 1990, the Florida Legislature established the Florida Healthy Kids Corporation to implement the concept of school enrollment-based health insurance coverage for children. The county school districts are used as a grouping mechanism to negotiate health insurance policies. The Florida Healthy Kids Corporation negotiates contracts with health maintenance organizations (HMOs) to assume financial risk and to provide health care services at each program site. In 1994, there were five sites with four different participating HMOs. Assessing quality of care is particularly important when contracting with HMOs because of the perception that financial and utilization review arrangements may restrict the enrollees' access to needed health care. One essential component of health care quality is the extent to which health care services are used in a manner consistent with the expected pattern of use for the population of enrolled children. The purpose of this study is to compare children's health care use across five different Florida Healthy Kids Program sites. Specifically, we compare the enrollees' actual health care use across HMO settings and program sites to the expected health care use based on the enrollees' case-mix. METHODS: Each HMO provided child-specific health care use data including Physician's Current Procedural Terminology codes and International Classification of Diseases, 9th Revision codes. We used the Ambulatory Care Groups (ACGs) software to compare the children's actual health care use to the expected health care use at each site adjusted for case-mix. Several steps were then taken to determine if the children were receiving the anticipated number of health care visits based on their diagnoses. First, we divided the average number of encounters at each site by the group average across all of the sites, without adjusting for the case-mix of the enrollees. We then divided the average number of visits at each site by the expected number of visits based on the case-mix adjustment. A value of 1.00 means that the actual use and the expected use are identical. Values below 1 indicate underuse and values over 1 indicate overuse of health care services. Statistical comparisons of the actual versus expected average health care use across the five sites were performed by deriving the appropriate chi2 statistics. RESULTS: A census of all children (N = 14 688) enrolled in the Florida Healthy Kids Program at each of the sites for 6 months or longer were included in the analysis. The average number of health care encounters across all sites for a 12-month time period was 2.98 +/- 4.6 visits. After adjusting for the case-mix of the enrollees in each site using the ACG software, several of the five sites differed from one in a statistically significant way. However, these statistical assessments must be tempered with assessing the practical magnitude of the observed differences. CONCLUSIONS: The number of public and private efforts to insure children who are not eligible for Medicaid and whose parents cannot purchase private insurance has grown dramatically. These programs are vital for ensuring financial access to care for uninsured children. However, it is essential that such programs are not viewed as merely cost containment efforts. Assessing the degree to which children receive the health care services they need across multiple delivery settings is an essential yet challenging component of quality assurance. Generally, our analysis indicates that children in the Florida Healthy Kids Program are receiving the amount of health care expected based on their health care needs; which is one component of a high-quality health care program.

Child↗
PubMed1988

School-based clinics: their role in helping students meet the 1990 objectives.

Service statistics and observations from site visits across the country indicate that school-based clinics (SBCs) may be having an impact on several of the problems targeted in the 1990 health objectives, including unplanned pregnancy and substance abuse. At least 120 junior and senior high schools in 61 communities are currently operating or developing clinics. Growth is attributed to increasing concern about high-risk youth, especially among educators in their roles of "surrogate parents"; to disillusion with categorical interventions and a movement toward more comprehensive services; and to student, parent, school, and community approval of the new programs. This article describes the comprehensive school-based clinic model, including its history, organizational strategies, school/community partnerships, and services.

Adolescent↗
PubMed1991

Scottish dentists' use of and opinions regarding bitewing radiography.

This study examined Scottish dentists' claimed use of and opinions regarding bitewing radiography. Information was obtained from a questionnaire sent to all dentists practising in Scotland in 1987 and from national statistics published in the Annual Reports of the Dental Practice Boards in the UK. The response rate to the questionnaire was 72% (926 general dental practitioners and 201 clinical community dental officers). Respondents considered radiography to be of value for the detection of approximal caries, assessment of caries progression and evaluation of alveolar periodontal support. They considered it to be of less value for a variety of other tasks, including detecting occlusal caries, unerupted teeth or calculus. One hundred and fifty-eight dentists (15% of respondents) claimed not to have taken any bitewings of their 12-year-old patients in the preceding year. Those respondents who did claim to have exposed some bitewings said that approximately one-quarter of this patient group had received the examination in the past year. The overall Health Service statistics appear to confirm that the utilization of radiography by dentists practising in Scotland is somewhat lower than that by dentists in England and Wales, a factor which requires further investigation.

Attitude of Health Personnel↗
PubMedDate not supplied

A comparison of census and family planning program data on contraceptive prevalence, Indonesia.

Indonesian family planning (FP) service statistics indicate that three out of five couples of childbearing age nationwide are now using modern contraception provided by the FP program. The 1980 Indonesian Census provided a unique opportunity to cross-check the FP program's contraceptive prevalence figures for every province. The results of that comparison indicate considerable variation, particularly in Java, between the FP program estimates of numbers of current users and the census estimates. Possible explanations for these differences are sought in the FP program approach to estimation of prevalence levels from acceptor data, and by examining the possibility of census underestimation of prevalence levels.

Adolescent↗
PubMedDate not supplied

The correlation between family planning program inputs and contraceptive use in Indonesia.

Using 1980 Census and 1986 service statistics program inputs, this paper evaluates the net correlation of socioeconomic, region, and program variables with 1987 contraceptive prevalence and method-specific use rates for Indonesian regencies and municipalities. The region variables--primarily, though not exclusively, reflecting program design and maturity--correlate most strongly with the contraceptive prevalence rates. Field-worker activities, field-worker supervisor activities, and community-based distributors also have a correlation with these rates. Pill use is highest in the areas that are predominantly Islamic and least developed, whereas the pattern is reversed for use of the IUD, condom, and other modern methods (mainly female sterilization). The findings are assessed in terms of their implications for policymaking.

Community Health Services↗
PubMed1980

Teaching family planning management and evaluation skills.

In the last several years the need for training schemes in family planning programme administration has become increasingly apparent with the rapid growth of family planning services throughout the world. This paper reports on the development and use of a series of 16 practical classroom training exercises designed for teaching planning, management and evaluation skills. Each exercise can be introduced, worked and discussed in a morning or an afternoon. It is available in an individual booklet, which contains worksheets, blank tables and step-by-step instructions for working the exercise, along with a discussion of the skills being taught. Topics covered include demographic rates and concepts, the Dryfoos-Polgar-Varkey formula, risk factor analysis, target-setting, case load forecasting, service statistics, contraceptive supplies, manpower planning, couple-year of protection, cost-effectiveness, contraceptive use-effectiveness, life table techniques, numerator analysis, fertility pattern method, sampling methods and questionnaire design. These curriculum materials concentrate on imparting through the medium of actual experience a series of specific management techniques of a quantitative nature that will enhance the ability of the trainees to plan, administer and evaluate any family planning programme anywhere in the world. The exercises in this series have been tested in the family planning training programmes at Columbia University and at Downstate Medical Center in New York. They have also been used in WHO workshops in Thailand and Tanzania and in training programmes in France, Kenya and Nicaragua.

Family Planning Services↗
PubMedDate not supplied

An assessment of the nine-month lactational amenorrhea method (MAMA-9) in Rwanda.

This report presents a secondary data analysis based on prospectively collected records gathered during a field assessment that was carried out in Rwanda in August 1993. The assessment used service statistics and follow-up interviews to evaluate the efficacy of a modified lactational amenorrhea method (LAM) as a nine-month introductory postpartum natural family planning method. The program, carried out by Action Familiale Rwandaise (AFR), reflects high efficacy of the method in a compliant sample that sought this method followed by another form of family planning. These results are promising and provide guidance for the extended use of LAM past six months. Programmatic findings suggest that studies be conducted of the contribution of extended LAM to improved weaning practices, the high efficacy of continued reliance on substantial lactation and amenorrhea beyond nine months, and male involvement in LAM and breastfeeding.

Algorithms↗
PubMed1993

Appropriateness of hospitalization in a Canadian pediatric hospital.

Allocation of limited resources in the Canadian health care system is hampered by a lack of studies addressing the appropriateness of the pediatric patient days in hospital. The authors retrospectively reviewed one hospital day per month in 1988, using a Pediatric Appropriateness Evaluation Protocol previously used in the United States. Of 878 inpatients, 852 charts were reviewed, and 26 charts were unavailable for study. The patients ranged in age from premature newborns to 20 years old. There were 475 medical days, 359 surgical days, and 18 patients to other services. Statistical significance was tested using the chi 2 test for contingency tables. Twenty-four percent of patient days were inappropriate. Younger children and shorter lengths of stay were more likely to result in appropriate hospital days. For infants younger than 60 days, 11% of days in hospital were inappropriate, 21% of days for infants between 2 months and 1 year of age, 25% for children between 1 and 5 years, and 36% for children older than 5 years of age. Children hospitalized 2 days or less had inappropriate hospital days accounting for 16% of the reviewed days. This increased to 33% for 3 to 14 days of hospitalization. Inappropriate hospital days did not vary significantly from month to month. Surgical patients had more appropriate hospital days than medical patients. Admission route (elective, emergency, or transferred from another hospital) did not affect the appropriateness of the subsequent day reviewed. It is concluded that inappropriate hospitalization in a Canadian pediatric hospital occurs only slightly more frequently than in an American pediatric hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Very brief psychological interventions with university students.

Annual college mental health service statistics reveal that 50% to 60% of all students served are seen for very brief psychological interventions--5 or fewer sessions. A substantial portion of the students benefit from these very brief contacts. The authors review the selection criteria for student and therapist that make very brief intervention possible. The student must be motivated for and seek a brief encounter and must enter the therapeutic relationship with the capacity for trust already in place and the professional qualifications of the therapist already established. The problem presented should be sufficiently clear and manageable to be resolved, or to begin being resolved, in a few sessions. Finally, the student must have the capacity for rapid insight and learning. The therapist brings to the relationship a belief in the value of very limited sessions, the capacity to develop a positive relationship quickly, and the ability to determine when it is appropriate to work in such a short time frame and to use the time most effectively. Four ways that students may benefit from very brief psychological interventions include (1) psychodynamic therapy, (2) crisis intervention, (3) mental health consultation, and (4) managed referral. Case illustrations and clinical methods are presented.

Adolescent↗
PubMed1998

Design and implementation of the United States National Animal Health Monitoring System 1995 National Swine Study.

The United States Department of Agriculture's National Animal Health Monitoring System 1995 National Swine Study was designed to estimate management, health and productivity parameters on pig operations in the United States. Sixteen major swine-producing states that accounted for nearly 91% of June 1, 1995 swine inventory and nearly three-fourths of United States swine producers were included in the study. In the initial phase of the study, National Agricultural Statistics Service enumerators collected information from 1477 producers involved in all phases of swine production (farrowing, nursery, and grower/finisher). Of these, 405 operations with > or = 300 finisher pigs (with at least one finisher pig > or = 54 kg) participated in the subsequent component of the study, which involved on-farm visits by state and federal veterinary medical officers and animal health technicians, and which concentrated on the grower/finisher phase of production. Of those eligible to take part in the second phase of the study, participation was higher among independent producers (48.3%) than among contract producers (15.3%). Participation was also higher among operations that used advanced record-keeping systems (such as record cards for individual breeding hogs or a computer-based record-keeping system). Thus, study results could have been influenced by response biases. As a biosecurity measure, 40.5 +/- 2.1% of operations restricted entry to employees only. For operations that permitted non-employees to enter the premises, relatively few enforced other biosecurity measures on visitors (0.4 +/- 0.1% required feed-delivery personnel and livestock handlers to shower before entering the premises; 3.3+/- 0.9% required a footbath; and 7.0 +/- 1.5% required feed-delivery personnel and livestock handlers not to have visited another operation with pigs on that day). The most common method of waste storage (used by 49.9 +/- 3.8% of operations with > or = 300 finisher pigs) was below-floor slurry or deep pit.

Animal Husbandry↗
PubMed1993

Childhood thermal injuries in New Zealand resulting in death and hospitalization.

Thermal injury is a significant contributor to the overall problem of injury among children. Children are at greater risk of hospitalization due to thermal injury than any other age group, and their fatality rate is second only to those over 60 years of age. This study provides an overview of thermal injury in New Zealand children, age 0-14 years, resulting in death or hospitalization. Eighty-one thermal fatalities were identified from Health Statistical Services (HSS), Department of Health, data accessed for the 10-year period from 1978 to 1987. The records of the Coroners' Court, held by the Justice Department, were also accessed in order to gather additional information about the circumstances of fatal injury in each case. Thermal injury hospital admissions (n = 634) were identified from HSS data for the year 1988. Children were more likely to die in house fires than any other thermal injury event. Most house fires were started by smoking paraphernalia or electrical appliances. Two-thirds of the childhood thermal injury hospitalizations were due to contact with hot water, the most commonly identified source being a hot beverage. Thermal injury rates for New Zealand children are higher than reported overseas. Prevention strategies that have proven effective elsewhere are discussed with recommendations for New Zealand.

Adolescent↗
PubMed1997

Design and implementation of the United States National Animal Health Monitoring System 1994-95 Cattle on Feed Evaluation, and an evaluation of the impact of response biases.

The 1994-95 Cattle on Feed Evaluation was a cooperative project (sponsored by the United States Department of Agriculture) involving Washington State University, state agricultural departments, and several agencies of the United States Department of Agriculture). The project focused on cattle-on-feed operations in 13 states that accounted for over 85% of the United States cattle on feed inventory. Participants were selected from National Agricultural Statistics Service list frames. Questionnaires were administered by telephone to operations with a one-time capacity of fewer than 1000 cattle; larger operations were visited twice to administer questionnaires. The participation rate for the first phase of the study was 56.7%. Ninety-one percent of eligible operations completed the second phase of the study. Data summarized from this national study can be used to profile management practices on cattle-feeding operations in the United States. Differences between participants and non-participants did not appear to be great. However, one does need to be mindful of the fact that a small percentage of the producers accounted for the vast majority of feedlot cattle marketed when interpreting the results.

Animal Feed↗
PubMed1992

Incidence of facial fractures resulting in hospitalisation in New Zealand from 1979 to 1988.

The incidence and aetiology of facial fractures resulting in admission to public hospitals in New Zealand in 1987 were investigated retrospectively from data collected by the Health Statistical Services. Data were analysed by the age group, ethnic origin and gender of those affected. During 1987 the overall incidence of facial fractures was 47.9/100,000 of the population. The highest incidence was for Maori males at 152/100,000. A comparison with data for the period 1979 to 1988 showed a decrease for the population as a whole but an increase for those who declared themselves to be Maori. Assault was the most common cause of facial fractures resulting in hospitalisation for both males and females. Sport was the second most common cause of facial fractures with rugby football contributing two-thirds of these. These results indicate where future preventive measures should be targeted.

Adolescent↗
PubMed1991

Estimating maternal mortality in Djibouti: an application of the sisterhood method.

In many developing countries even crude estimates of the level of maternal mortality are lacking and the prospects of fulfilling this need using conventional sources of vital registration and health service statistics are not encouraging. The constraint this imposes on the effective planning, management and evaluation of the programmes now being launched to reduce these neglected deaths is self-evident. It is less obvious how the majority of developing countries can be expected to meet the call for reliable estimates of maternal mortality by 1995. The sisterhood method provides a means of obtaining population-based estimates using household surveys for data collection. This paper describes the application of the method in Djibouti in the context of a rapid multi-purpose household survey in difficult field circumstances. In recent years the reduction of the level of maternal mortality in developing countries has become a priority for both national governments and international agencies. Attention has been drawn to the wide range of levels within and between countries and to the huge discrepancies in the lifetime risk of maternal death for women in the developed compared with the developing world. This risk has been estimated to range from 1 in 19 in West Africa to almost 1 in 10,000 in Northern Europe.

Adolescent↗
PubMed1993

Epidemiology of spinal cord injury in New Zealand.

Spinal cord injury (SCI) is a catastrophic and costly result of both intentional and unintentional injury. We present data from the Health Statistics Services files of New Zealand for the year 1988 on the epidemiology of SCI resulting in morbidity. New Zealand has one of the highest rates of SCI in the western world and since 1979 this has been increasing. It occurs most often to young, caucasian men and is typically the result of motor transport crashes. The ethnicity adjusted rates show high rates for Maori males. Children in New Zealand have greater than 4 times the risk of an SCI than American children. The rehabilitation and hospital costs for SCI are among the highest for all injuries. There were a higher number of high cervical injuries than reported in previous series and 92% of SCI were incomplete indicating the high rehabilitation potential of the sample. Some measures are suggested to reduce the incidence of SCI.

Accidents, Traffic↗
PubMed1979

Normal values of transfer factor and transfer coefficients in healthy males and females.

A population study was performed to obtain local normal values of the transfer factor for a respiratory laboratory providing a routine hospital service. Statistical analysis of the results obtained showed similar results to those of previous investigators for the transfer factor and alveolar volume. The transfer factor was found to be dependent on height, age and sex, while the alveolar volume depended only upon height and sex. Unlike previous investigations, however, the present study showed that the transfer coefficient was the same for women as for men and was related solely to age.

Adolescent↗
PubMed1995

A survey of a Canadian on-line substance abuse prevention initiative for adolescents and young adults.

Electronic Zoot is a Canadian youth-oriented, computer bulletin board system based in Edmonton. The system is designed to teach its users about the risks associated with substance use and abuse. More than 600 of Electronic Zoot's users were surveyed to obtain demographic data and information about attitudes. The majority of the users of the system were male. Most users were between 11 and 25 years of age and a disproportionately high number were from rural communities. It was found that peer support was a primary component of this telehealth service. Statistically significant age differences revealed that the system's younger users were more likely than its older users to be influenced by the drug education message of the bulletin board system. In addition, it was noted that on-line surveys are easy to conduct and greatly facilitate the collection of longitudinal telehealth data.

Adolescent↗