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PubMed2003

Houseofficers' reactions to media coverage about the sequencing of the human genome.

After the announcement that sequencing of the human genome was nearly complete, media coverage was extensive. In light of ample evidence that the media are a primary source of health and science information, even for health professionals, media portrayals are often inaccurate or misleading, and discoveries that emanate from sequencing the human genome are likely to influence future health care, it is important to assess physicians' interpretations of media coverage about the human genome announcement. This paper describes the reactions of a sample of new physicians in the United States to this announcement, as well as the content of the stories they read or heard. Semi-structured surveys were distributed to all incoming houseofficers during Orientation at one major academic medical center. Eighty-one percent of 190 houseofficers returned a survey; 123 completed surveys were analyzed. Fifty-four percent of respondents thought the media message was only positive and 21% thought it was negative or mixed. Participants who reported radio as their media source were less likely to recall positive messages (p<0.05). Sixty-five percent and 76%, respectively, had positive perceptions of the impact of the accomplishment on people and on the medical profession. Overall, 48% were enthusiastic and 52% were guarded about the accomplishment. Enthusiasm was related to being an adult primary care houseofficer (p=0.07) or to having heard about it on television or in the newspaper (p<0.05). Of the 36 stories analyzed, newspaper and television reports focused more on medical implications and radio reports focused more on ethical issues. The degree of enthusiasm about the accomplishment reflects the content of the media coverage, and, at least for adult primary care houseofficers, probably reflects the increasing relevance of genetic discoveries to medical practice. Since physicians obtain much of their health and science information from the media, they can play an instrumental role in helping their patients interpret media coverage of advances in genetics and their impact on health care. However, this will require that physicians develop an appreciation of the newsmaking process, and how subtle interactions between politics, the media and science influence the "framing" of media coverage.

Academic Medical Centers↗

PubMed1993

Exposure to violence and presence of depression among low-income, African-American youth.

Distributional properties and correlates of the Children's Depression Inventory (CDI) were presented for a sample (n = 221) of low-income, African-American youths between 7 and 18 years of age. The results showed that younger children and those living in a household without their mother reported more depressive symptoms. Regression analyses revealed that victims of violence reported more depressive symptoms. However, chronic exposure to violence, in the form of witnessing violent acts, was not significantly related to depression. On further inspection, it was discovered that witnessing violence had a negative effect on depression. This finding, although somewhat unexpected, may be the result of some youths possessing a set of extraordinary coping mechanisms that help to insulate them from negative environmental experiences.

Adaptation, Psychological↗

PubMed1998

Ventilation Flow Organization for Efficient Elimination of Contaminated Air.

Displacement ventilation and well-organized ventilation flow structures are emphasized. Perhaps the biggest advantage of displacement ventilation is its increased effectiveness in removing pollutants from a ventilated space and the efficient use of ventilation air. Several questions on how the systems should be designed to achieve optimal efficiency are still unanswered. Small variations in room geometries and air supply arrangements can totally change the conditions. Results from this investigation show the importance of an even distribution of the incoming supply air, numerically calculated age-of-air values and the influence of residual tracer concentrations on measured mean values for the age of air.

Journal Article↗

PubMed2004

Social justice and the global economy: new challenges for social work in the 21st century.

The globalization of the economy creates new challenges for social work in the arenas of social and economic justice. This article outlines social justice issues related to the debt crisis of the Global South and sweatshops. A presentation of colonial precursors is followed by a detailed examination of these global institutions with an emphasis on the vulnerability, disempowered status, and exploitation of poor people of the Global South. Connections with global inequities in wealth, income, and the distribution of resources are made explicit. The article explores domestic social justice problems as possible points of connection with these issues. Finally, the authors give recommendations for social work education, advocacy, and activism.

Asia, Southeastern↗

PubMed1996

Capitating multispecialty groups.

This article addresses the issues a medical group must consider when entering into a capitation agreement with a managed care organization. It discusses the potential risks of capitation contracts and how those risks can be limited. In addition, keys to successful contracting are explored. Specific considerations outlined include choosing a contracting partner, determining the capitation rate and contract terms, and managing risk. Internal issues regarding the distribution of capitation income, physician incentives and risk pools, and management information systems are also addressed in the article.

Ambulatory Care Information Systems↗

PubMed1982

Organisation of ambulatory care by consumers.

This paper deals with how consumers arrange their ambulatory care in a system such as the United States which offers many possible choices. Patterns of the different affiliations (sources) that people maintain throughout the year for ambulatory care are formed. The data were obtained in interviews in a sample survey of Rhode Island households conducted in 1974. Although most people in the sample (89.5 per cent) cluster with one to three sources of care, there were over 80 people with four or more affiliations. For those persons with a large number of affiliations, the provider sets become quite varied. Two conceptual typologies are formed, one focusing on type (private physicians versus places) and the other focusing on both the speciality of the physicians involved and the number of different affiliations involved. The United States, at least in theory, maintains a 'free market' health care system. Are there limitations of choice imposed by differential distributions of knowledge, income or age? A wide array of social, demographic, and illness variables were examined to determine their relationship to the patterns.

Ambulatory Care↗

PubMed1999

Alzheimer's disease symptom severity in blacks and whites.

OBJECTIVE: In order to determine whether there are racial differences in Alzheimer's Disease (AD) symptom severity and vascular comorbidities, we compared African-American (black) and Caucasian (white) patients with AD from similar socioeconomic backgrounds at the time the disease was first recognized. DESIGN: Cross-sectional observational study from a population-based dementia registry. PARTICIPANTS: Patients were enrolled from an HMO base population of 23,000 persons more than age 60 in Seattle, Washington. This study examines 453 subjects with probable AD (38 blacks (mean age 76.5, SD 6.4), and 415 whites (mean age 79.7, SD 6.7)). MEASUREMENTS: Measured were patient demographics, age at onset of AD, AD symptom duration, Mini-Mental State Exam (MMSE) score, Blessed Dementia Rating Scale, presence of psychiatric symptoms, and vascular comorbidities. RESULTS: Blacks had significantly lower mean cognitive scores (MMSE = 17.2, SD 5.6) compared with whites (MMSE = 20.2, SD 5.2, unpaired t test P < .01). The significant racial difference in MMSE scores persisted after controlling for education, duration of AD symptoms, age, and ADL impairment. Blacks and whites did not differ significantly regarding gender distribution, education level, income, or percent with early age of onset of AD. No statistically significant race-related differences were found in impairments in activities of daily living or symptoms of paranoia, hallucinations, or agitation. Blacks had significantly higher rates of hypertension (56%) compared with whites (34%) (Fisher's exact test, P = .013), but the rates of stroke and ischemic heart disease were similar. CONCLUSIONS: Despite uniform detection methods and controlling for reported duration of dementia symptoms, measured cognitive impairment is significantly more severe when AD is recognized in blacks compared with whites. The significantly higher prevalence of hypertension among black AD cases was not associated with excess cerebrovascular disease comorbidity. This study highlights a need for normative measurements of cognitive function in minority AD groups in order to distinguish differential cognitive symptom severity from possible measurement bias.

Activities of Daily Living↗

PubMedDate not supplied

Provider group characteristics & quality report card performance: a cross-sectional study in a managed care setting.

We describe 1 health plan's annual, incentive-based, provider group quality report card (Scorecard) and identify trends in Scorecard performance among 142 California provider groups. We explore variation in Scorecard performance by provider group characteristics. Scorecard evaluates provider groups on standardized measures of performance including preventive screening, patient satisfaction, and quality management operations and infrastructure. In a cross-sectional study, we use linear regression to measure associations between provider group characteristics and performance on the 1997 Scorecard. Provider group performance trends (1996-1997) revealed improvement on 6 Scorecard indicators. Regional differences in performance were also shown. Multivariate results indicate that group location in northern California (P = .01), IPA (independent practice association) status (P = .02), older group age (P = .02), and higher mean patient age (P < .01) were independently associated with higher 1997 Scorecard total scores. Member education was marginally associated with performance. Group size, member income, and gender distributions were not independently associated with Scorecard performance. Results of this study suggest that (among Blue Cross of California's contracted provider groups) older, more established groups; groups located in northern California; IPAs; and groups with a patient demographic mix characterized by higher than network average mean age and a lower than network average proportion of members with a college education or greater were more likely to perform well on Scorecard.

Adult↗

PubMed1996

The effect of race and ethnicity on the use of selected health care procedures: a comparison of south central Los Angeles and the remainder of Los Angeles county.

The purpose of this study was to compare the use of eight hospital-based procedures (appendectomy, cesarean section, coronary artery angioplasty (PTCA), coronary artery bypass grafting (CABG), carotid endarterectomy, hysterectomy, mastectomy, and transurethral prostate resection) in South Central Los Angeles (SCLA) to the remainder of Los Angeles County. The authors used age- and gender-adjusted procedure rates and population-weighted multivariate regression techniques, adjusting for illness proxies, physician distribution, hospital distance, income, and ethnicity variation to quantitate the effect of SCLA residence. Four procedures were performed at significantly lower rates among residents of SCLA: PTCA, CABG, carotid endarterectomy, and cesarean section. In multivariate regression models, SCLA was also a significant predictor for appendectomy, mastectomy, and transurethral prostatectomy (TURP). The SCLA effect was diminished but not eliminated when ethnicity variables were incorporated into regression models. The use of selected procedures by residents of SCLA frequently differs from that of residents of the remainder of Los Angeles Country. Some differences are not attributable to level of health, income, ethnicity, or the availability of medical resources.

Adult↗

PubMed1998

Levels and patterns of alcohol consumption using timeline follow-back, daily diaries and real-time "electronic interviews".

OBJECTIVE: This study was designed to compare the Timeline Follow-Back (TLFB) to daily and real-time assessments of drinking. Our purpose was to evaluate overall correspondence and day-to-day agreement between these two methods among both problem and moderate drinkers. METHOD: In Study 1, problem drinkers (n = 20) reported their alcohol consumption daily during 28 days of brief treatment. In Study 2, moderate drinkers (n = 48), recruited from the community, used a palm-top computer to record their drinking for 30 days. In both studies participants completed the TLFB covering the recording period. RESULTS: Participants in Study 1 reported fewer drinking days, fewer drinks per drinking day and fewer total drinks per day on the TLFB, and those in Study 2 reported fewer drinks per drinking day, fewer ounces per drinking day, fewer total drinks per day and fewer total ounces per day. The magnitude of the difference, however, was modest. There was considerable between-person variation in day-to-day correspondence of TLFB and the daily and real-time reports. Neither person characteristics (gender, education and income) nor the distributional characteristics of drinking (including average consumption, variation) predicted concordance between TLFB and real-time reports. CONCLUSIONS: The Timeline Follow-Back method captured overall levels of drinking quite well compared to a 28-day daily diary and a 30-day electronic interview. Vast individual differences in day-to-day correspondence suggest that the TLFB may be less useful for detecting patterns of consumption.

Adult↗

PubMed1999

Delimitation of homogeneous regions in the UNIFESP/EPM healthcare center coverage area based on sociodemographic indicators.

CONTEXT: The drawing up of adequate Public Health action planning to address the true needs of the population would increase the chances of effectiveness and decrease unnecessary expenses. OBJECTIVE: To identify homogeneous regions in the UNIFESP/EPM healthcare center (HCC) coverage area based on sociodemographic indicators and to relate them to causes of deaths in 1995. DESIGN: Secondary data analysis. SETTING: HCC coverage area; primary care. SAMPLE: Sociodemographic indicators were obtained from special tabulations of the Demographic Census of 1991. MAIN MEASURES: Proportion of children and elderly in the population; family providers' education level (maximum: > 15 years, minimum: < 1 year) and income level (maximum: > 20 minimum wages, minimum: < 1 minimum wage); proportional mortality distribution RESULTS: The maximum income permitted the construction of four homogeneous regions, according to income ranking. Although the proportion of children and of elderly did not vary significantly among the regions, minimum income and education showed a statistically significant (p < 0.05) difference between the first region (least affluent) and the others. A clear trend of increasing maximum education was observed across the regions. Mortality also differed in the first region, with deaths generated by possibly preventable infections. CONCLUSION: The inequalities observed may contribute to primary health prevention.

Aged↗

PubMed1988

Within month variability in use of soup kitchens in New York State. p4.

This paper describes the variation in use of soup kitchens throughout the month using data from the New York State Nutritional Surveillance Program. Excluding November, December, and May, when holiday meals created a different pattern of use, number of meals served in soup kitchens generally increased toward the end of the month, averaging 43 per cent higher for Upstate and 14 per cent higher for New York City in the last week as compared to the first week of the month. The overall increase throughout the month and difference in the magnitude of increase between Upstate and New York City corresponds to the timing of income maintenance benefits distribution. Distribution of most public assistance benefits occurs at the beginning of each month in Upstate, whereas it is staggered in New York City throughout the month.

Food Services↗

PubMed1983

Patient management problems in general practice using a medical journal for self-assessment exercises.

A series of six patient management problems, with clinical case histories from the authors' own practices, was presented in a Norwegian medical journal (Utposten) during 1981 and the spring of 1982. The readers were asked to respond to a number of statements which related to each case history, using a 5-point rating scale. The answers were prepared from return forms mailed anonymously to the authors, leaving the doctors with copies of their own answers. The following issue of the journal then presented the distribution of all incoming answers by giving histograms and mean values of the ratings for each question. In addition, the case history author gave his own ratings, a review of the answers, and more details about the case. In this way the respondents were given a possibility of comparing their own diagnostic skills and management decisions with those of their colleagues. There was a total of 406 incoming answers from 243 different participants, among whom 210 were general practitioners or district physicians. Background characteristics of these doctors are discussed, as well as the results of an evaluation questionnaire. This experiment with problem solving by mail was well received by the readers, mainly as a supplement to their continuing medical education. The method in this study, which permits quantification of clinical decision, may be a useful tool for medical audit activities.

Adult↗

PubMedDate not supplied

[The measurement of inequalities in age of death: calculating the Gini Index based on mortality tables].

The Gini index has been used to gauge the concentration of different variables, including income, the mortality distribution and the spread of physicians. The use of the Gini index for gauging the inequalities in the age of death based on actuarial mortality data. For this purpose, the 1990 age and gender-related mortality figures for each Autonomous Community were used. The inequalities in the number of years lived are greater among males than among females throughout all of the Autonomous Communities. The Communities showing the longest life expectancies are those which have also been revealed to involved the least degree of inequality in the number of years lived, which therefore makes in possible to pinpoint health-care priorities in some cases. The Gini index can be applied to age-related mortality for gauging the degree of inequality in the age of death and to pinpoint age groups on which to place priority with regard to health-care measures.

Adolescent↗

PubMed2000

Variation in hospital discharges for ambulatory care-sensitive conditions among children.

OBJECTIVE: Ambulatory Care-Sensitive Conditions (ACSCs), conditions for which ambulatory care may reduce, though not eliminate, the need for hospital admission, have been used as an index of adequate primary care. However, few studies of ACSC have focused on children. We estimated national hospitalization rates for ACSC among children and examined the behavior of the index between subgroups of children. METHODS: We used data from the 1990-1995 National Hospital Discharge Surveys (NHDS), the US census, and the National Health Interview Survey (NHIS) to calculate hospital discharge rates. Rates were estimated as the number of condition-specific hospital discharges from the NHDS divided by the population at risk, as estimated from the US census and NHIS. RESULTS: Predictably, ACSC hospitalization rates were significantly higher among children who were younger, black, had Medicaid insurance, and lived in poorer areas compared with their counterparts. However, the relationship between ACSCs and income and the distributions of conditions within the index varied significantly between children. CONCLUSIONS: ACSCs may indicate disparities in access and utilization of health care, however, the differing behavior of the index between subgroups suggests that inferences from examining rates of ACSCs may not be comparable for all children.ambulatory care-sensitive conditions, hospitalization rates.

Adolescent↗

PubMed2001

The changing face of private retirement plans.

A rapidly growing public policy concern facing the United States is whether future generations of retired Americans, particularly those in the "baby boom" generation, will have adequate retirement incomes. One reason is that Social Security's projected long-term financial shortfall could result in a reduction in the current-law benefit promises made to future generations of retirees. Another reason is that many baby boomers will be retiring with employment-based defined contribution (DC) plans, as opposed to the "traditional" defined benefit (DB) plans that historically have been the predominant source of employer-provided retirement income. These factors are likely to reduce the amount of life annuity benefits that future retirees will receive relative to current retirees, raising questions as to whether other sources of retirement income--such as individual account plans (DC plans and individual retirement accounts, or IRAs)--will make up the difference. This Issue Brief highlights the changes in private pension plan participation for DB and DC plans and provides some possible explanations for these changes. Results are presented from the Employee Benefit Research Institute's (EBRI) Retirement Income Projection Model that quantify how much the importance of individual account plans is expected to increase because of these changes. This Issue Brief also discusses the risk of outliving one's assets, since a greater fraction of pension wealth is projected to come from "nonguaranteed" sources. Results of the model are compared by gender for cohorts born between 1936 and 1964 in order to estimate the percentage of retirees' retirement wealth that will be derived from DB plans versus DC plans and IRAs over the next three decades. Under the model's baseline assumptions, both males and females are found to have an appreciable drop in the percentage of private retirement income that is attributable to defined benefit plans (other than cash balance plans). In addition, results show a clear increase in the income retirees will receive that will have to be managed by the retiree. This makes the risk of longevity more central to retirees' expenditure decisions. The implications of these model results for retirees are significant. First, individuals--rather than the pension plan sponsor--increasingly will have to manage their retirement assets and bear the risk of investment losses. Second, since most retirees' non-Social Security retirement income will be distributed as a lump sum or in periodic payements (from a defined contribution plan or IRA) rather than as a regular paycheck for life (from a defined benefit plan), retirees will need either to purchase an annuity from an insurance company or carefully manage their individual rate of spending in order to avoid outliving their assets.

Employment↗

PubMedDate not supplied

[Family life strategies and their relation with malnutrition in children under 2 years old].

OBJECTIVE: To identify the role of family life strategies on malnutrition in children aged 6-23 months of age. MATERIAL AND METHODS: This case-control study was conducted in 1998 in the municipality of Teolocholco, State of Tlaxcala, Mexico, among families with children aged 6-23 months of age. The sample was conformed by 105 cases and 210 controls. Family life strategies were grouped into five types: family composition, means and distribution of family income, family and social networks, and life preservation strategies. Malnutrition was classified according to height for age. Data were analyzed using logistic regression to obtain odds ratios and 95% confidence intervals. RESULTS: Data were collected from 605 families, for a total of 445 controls and 160 cases. The predictive model included mother's schooling, overcrowding, time elapsed between childbirths, per capita monthly income, and time devoted to child-rearing activities. CONCLUSIONS: Family life strategies determine children's nutritional status; understanding the influence of the family on the children's health status is necessary to develop effective programs aimed at improving the nutritional status of children.

Case-Control Studies↗

PubMedDate not supplied

[Risk factors associated with systemic lupus erythematosis in a Mexican population].

OBJECTIVE: To assess risk factors associated with systemic lupus erythematosus (SLE) in the Mexican population. MATERIAL AND METHODS: A case-control study was conducted on June 1996, at the Reumathology Clinic of Hospital de Especialidades del Centro Médico Nacional Siglo XXI (HE CMN), Instituto Mexicano del Seguro Social, in Mexico City. Cases were one hundred thirty subjects with four or more SLE criteria and disease evolution of +/- 5 years. Controls were hospitalized patients with acute diseases but without autoimmune diseases. Cases and controls were matched 1:1 by age and gender; both groups were evaluated by direct interview through a structured questionnaire. The following risk factors were assessed: genetic family history of SLE and connective tissue disease; socioedemographic (ethnicity, geographic distribution, education, monthly income); hormonal (use of oral contraceptives, replacement therapy and gynecoobstetric background); environmental (use of hair products, living with dogs, bacterial/viral infections, and allergies). Statistical analysis consisted of odd ratios (OR) with 95% confidence intervals (CI) and multivariate analysis using logistic regression. RESULTS: The multivariate model showed association with family history of SLE (OR 4.2, CI 95% 1.17-15.2), family history of connective tissue disorder (OR 2.6, CI 95% 1.15-4.5), use of oral contraceptives for more than one year (OR 2.1, CI 95% 1.13-4.3), repetitive pharyngitis (OR 2.1, CI 95% 1.18-3.6), and use of medications (OR 5.0 IC 95% 1.62-21.6). No association was found with socieconomic status, hair dye products, asthma, or allergies. CONCLUSIONS: Genetic factors, such as family history of SLE and connective tissue disease in first-degree relatives, persist as important factors in the development of SLE. Other factors, such as use of some drugs, oral contraceptives, and repetitive pharyngitis, may also favor the onset of disease in genetically susceptible hosts. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Adult↗