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PubMed2004

United States coronary mortality trends and community services associated with occupational structure, among blacks and whites, 1984-1998.

This paper examines the association between US county occupational structure, services availability, prevalence of risk factors, and coronary mortality rates by sex and race, for 1984-1998. The 3137 US counties were classified into five occupational structure categories; counties with the lowest percentages of the labor force in managerial, professional, and technical occupations were classified in category I (5-16%), counties with the highest percentages were in category V (32-59%). Directly age-adjusted coronary heart disease (CHD) mortality rates, for aged 35-64 years, (from vital statistics and Census data), per-capita services (County Business Patterns), and the prevalence of CHD risk factors (Behavioral Risk Factor Surveillance Surveys data) were calculated for each occupational structure category. CHD mortality rates and the prevalence of risk factors were inversely monotonically associated with occupational structure categories for white men and women but not among black men and women. Numbers of producer services for banking, business credit, overall business services and personnel/employment services were 2-12 times greater in category V versus I counties. Consumer services such as fruit/vegetable markets, fitness facilities, doctor offices and social services were 1.6-3 times greater in category V versus I counties. Residential racial segregation scores remained high in most areas despite declines during 1980-1990; occupational segregation by race and gender were shown indicating continued institutional racism. An ecological model for conceptualizing communities and health and the overall influence of state and national occupational structure is discussed; intervention strategies such as decreased wage disparities and 'living wage' standards and development is discussed.

Adult↗
PubMed2004

Multigenerational family structure in Japanese society: impacts on stress and health behaviors among women and men.

Rapid population aging in Japan has led to rising demands for informal care giving. Traditionally, care giving for aging parents has fallen disproportionately on the shoulders of women living in multigenerational households. However, rising labor force participation by Japanese women, declining marriage and fertility rates, and women's changing expectations have combined to produce unprecedented strains on traditional multigenerational households where care giving to elders traditionally takes place. In this paper, we explored gender-specific relationships between family structure, stress and worries, and health behaviors, using linked data from two national surveys conducted in Japan: the 1995 Comprehensive Survey of the Living Conditions of People on Health and Welfare, and the 1995 National Nutrition Survey. We found that women in multigenerational households reported more care-giving worries, and also less future health and financial worries. Living with parents was associated with protective health behaviors (less smoking, less heavy drinking), but also more sedentary behavior among women, while men in "sandwich" families (i.e., living with both parents and children) reported heavier smoking. The association of family structure and health behavior was not mediated by worries. Living alone was associated with worse health for women. These findings suggest gender-specific patterns of worries and health behaviors that reflect both the health-protecting and health-damaging effects of living in multigenerational households.

Adult↗
PubMed2006

A decision support system for the operational planning of solid waste collection.

This study presents the conception, modeling, and implementation of a decision support system applied to the operational planning of solid waste collection systems, called SCOLDSS. The main functionality of the system is the generation of alternatives to the decision processes concerning: (a) the allocation of separate collection vehicles, as well as the determination of their routes and (b) the determination of the daily amount of solid waste to be sent to each sorting unit, in order to avoid waste of labor force and to reduce the amount of waste sent to the landfills. To develop the computer system, a combination of quantitative techniques was used, such as: simulation of discrete events and algorithms/heuristics for vehicle allocation and routing. The system was developed using the Borland Delphi environment and the commercial software Arena to carry out the simulations. We also present a computational study with real-life data from the solid waste collection in Porto Alegre, Brazil, in which we show that the results provided by the computational system outperform the operation planning currently adopted.

Algorithms↗
PubMed2003

The magnitude and cost of global blindness: an increasing problem that can be alleviated.

PURPOSE: To identify the potential effect on global economic productivity of successful interventions, that are planned as part of the "VISION 2020-right to sight" initiative. The initiative aims to eliminate avoidable blindness. DESIGN: This study used economic and epidemiologic modeling. METHODS: Existing data and assumptions about blindness prevalence, national populations, gross domestic product (GDP) per capita, labor force participation, and unemployment rates were used to project the economic productivity loss associated with unaccommodated blindness. RESULTS: Without extra interventions, the global number of blind individuals would increase from 44 million in the year 2000 to 76 million in 2020. A successful VISION 2020 initiative would result in only 24 million blind in 2020 and lead to 429 million blind person-years avoided. A conservative estimate of the economic gain is $102 billion. CONCLUSIONS: The VISION 2020 initiative has the potential to increase global economic productivity.

Adolescent↗
PubMed1988

Highly-skilled international migrants, careers and internal labour markets.

"This paper is addressed to the interplay of careers and internal labour markets (ILMs) in explaining the international migration of professional and technical personnel, particularly within transnational corporations (TNCs). It begins by reviewing the current state of the theoretical art, focusing on five main elements: the international spatial division of labour; the concept of career; the organization of ILMs; the lubrication of the migration system by recruitment, placement and relocation agencies; and reintegration of returning expatriates. There follows a discussion of selected aspects of the volume and characteristics of ILM migrations among the highly-skilled, using government, employer organization's and individual company data."

Demography↗
PubMed1991

Developmental aspects of child care.

As increasing numbers of women have entered the labor force, increasing numbers of children, particularly infants and toddlers, have become active participants in child care. Research and opinion regarding the effect of child care on infant emotional and social development is conflicting. Most infants in child care are securely attached to their parents; however, there is an increased risk of insecure attachment in infants in child care when compared to infants in home care. Participation in child care has been associated with both positive and negative outcomes in relation to social development. High-quality child care is associated with improved child outcome. The quality of child care can be assessed by characteristics such as low child-to-staff ratio, small group size, and training of child care providers. Families are in need of a greater variety of options to meet goals of economic stability and child rearing. It is the role of the pediatrician to monitor child well-being, to objectively advise parents as consumers of child care, and to encourage the availability of high-quality care to all children.

Child↗
PubMed1996

Professionalism, responsibility, and service in academic medicine.

BACKGROUND: Academic medical centers have responded to health care reform initiatives by launching a series of strategic plans designed to maintain patient flow and reduce hospital expenditures. Thought is also being given to processes by which the faculty can individually and collectively adjust to these changes and maintain morale at a time when reductions in the labor force and pay cuts are virtually certain. Physicians are concerned because managed care threatens their autonomy and jeopardizes the traditional ways in which they have carried out their multiple missions. Some doctors believe that it will become increasingly difficult to obtain genuine satisfaction from their job. METHODS: The strategies that academic medical centers have begun to use to address the numerous challenges posed by a system of health care based on managed competition are reviewed. Potential mechanisms by which academic departments can continue to find fulfillment in an environment that threatens their traditional missions and values are discussed. RESULTS: A study of the social and historical origins of medicine in the United States reveals that the introduction of corporate medicine in the United States was destined to happen. Strategies implemented by academic medical centers in response to managed care include building an integrated delivery network, the acquisition of primary care practices, increasing cost-effectiveness, and creating physician-hospital organizations. Emphasis must be placed on integrating traditional core values (excellence, leadership, and innovation) with newer values such as patient focus, accountability, and diversity. A shift from rugged individualism to entrepreneurial teamwork is crucial. These reforms, although frightening at the onset, can serve to reaffirm our commitment to academic medicine and preserve our mission. CONCLUSIONS: The evolving managed care environment offers unique opportunities for academic medical centers to shape and positively impact health care delivery in the twenty-first century. In a reconfigured model that combines core values with newer values, university-based physicians can continue to reap the intangible rewards derived from patient care, research, and education.

Academic Medical Centers↗
PubMed1998

Diverging patterns with endogenous labor migration.

"The standard neoclassical model cannot explain persistent migration flows and lack of cross-country convergence when capital and labor are mobile. Here we present a model where both phenomena may take place.... Our model is based on the Arrow-Romer approach to endogenous growth theory. We single out the importance of a (however weak) scale effect from the size of the workforce.... The main conclusion of this simple model is that lack of convergence, or even divergence, among countries is possible, even with perfect capital mobility and labor mobility."

Demography↗
PubMed2003

The shortage of registered nurses and some new estimates of the effects of wages on registered nurses labor supply: a look at the past and a preview of the 21st century.

The US and many other countries are in the midst of a severe shortage of registered nurses (RNs). Labor supply models for currently trained RNs are estimated by gender and marital status using the 1992, 1996, and 2000 data from the National Sample Surveys of Registered Nurses. This analysis extends earlier work by Link (Res. Labor Econ. 13 (1992) 287) which provided labor supply estimates for 1960, 1970, 1977, 1980, 1984, and 1988. Since the methodology and variables employed in the present study are the same as those used by Link, the empirical literature on RN labor supply is brought together for the last 40 years. Moreover, comparisons are made with other studies in the literature of the labor supply of nurses and females in the general population. Results for the key variables are consistent over the different data sets and consistent with earlier work by Link. The RN's own wage had minor effects on both labor force participation and hours worked given participation. The RN wage is still an important variable since it has a significant and positive effect on the number of people who enter first-degree nursing programs in the US. These results are important to policy-makers in light of the current shortage of RNs.

Adult↗
PubMed2002

Charting a course for the future of women's health in the United States: concepts, findings and recommendations.

The JHU Women's and Children's Health Policy Center, with the federal Maternal and Child Health Bureau, undertook a review of the health of women in the United States and invited experts to develop recommendations on health policy, programs, practices and research. The review included published research, program reviews, and policy reports on women's physical health, mental health, and health behaviors, and on the effects of health services, systems and financing on their health. Based on trends in age, ethnic background, education, labor-force participation, marriage and childbearing among women, the results of the reviews, and the experts' consultation, several recommendations were made for a forward looking agenda. They included the need: (1) to focus broadly on women's health, not just during pregnancy; (2) for comprehensive, integrated programs and services addressing women's unique needs; (3) for integrated programs and services across the lifespan; (4) for better provider training about women's unique health needs, the differential effects of particular problems on them, and the consequences of chronic health problems heretofore considered primarily male problems; (5) to eliminate social policies that single out women, particularly pregnant women, for punitive actions; (6) to promote social policies that ensure economic security for women; and (7) for vigorous public health leadership to shape the women's health agenda, recognizing the social and economic context of their lives. The social and economic trends among women in the US and the recommendations for a women's health agenda have relevance to other developed countries as well.

Developed Countries↗
PubMed2003

From home to hospital and back again: economic restructuring, end of life, and the gendered problems of place-switching health services.

Economic restructuring in the health services industry in the USA exemplifies general patterns of economic change propelled by neoliberalism, especially industry privatization, diminished social services, and dependence on "flexible" labor and management regimes. Combined with the widespread entry of women into the labor force, an aging population, and minimal assistance for high quality long-term care at the end of life, these economic and social conditions raise a set of difficult policy questions for health services planning. Set in these broad contexts, this paper situates access to and experience of health services in the home, the hospital, and nursing facility, to demonstrate how economic changes have relocated and redefined health services in ways that distinctively impact how people experience the places where they receive care. This place switching of health services externalizes costs of subacute and "daily life care" (the so-called custodial care) to the sphere of the individual, their family, and communities. The theoretical analysis uses current geographical and philosophical approaches to place and space, and considers the tensions between institutionally managed health care space, and the patient's experience of receiving health services in place. The place/space dilemma of health services provision is examined through several interrelated subjects: long-term care at the end of life, gendered characteristics of care giving, the limitations of Medicare and Medicaid, historical changes in hospital length of stay, the restructuring of nursing practices, and the "no-care zone". The analysis is based on examples of stroke and incontinence care to demonstrate the importance of considering place and space issues in health care planning.

Aged↗
PubMed1998

Epidemiology of childhood burns in the burn unit of Ain Shams University in Cairo, Egypt.

Childhood burns in Egypt are a significant problem, especially in families of low socioeconomic status. These families live in overcrowded flats, which lack proper hygiene and tend to use kerosene stoves, which lack any safety measures. Three hundred and five burned children presented to the burn unit of Ain Shams University over a 20 month period. Proportionately more boys than girls were injured. There was an increase in the incidence between the ages of 4 to 6 years. Scalds formed 56.7% of the cause of burns, while 38.6% were due to flame. In 3 and 1.6% the cause of burn was electrical and chemical, respectively. 20 patients were victims of industrial accidents showing a major problem of entrance of children between 8-15 years of lower socioeconomic class into the labor force. 87.2% of the patients had minor burns while 13 children (4.3%) died of the consequences of burns during the period of the study.

Adolescent↗
PubMed1987

Normal reproductive parameters in large "California-style" dairies.

Reproductive parameters are important in evaluating modern dairy management performance. Successful dairying results from constant attention to daily events, requiring more sensitive and immediate measurements of performance. Definitions of formulas, numerators, denominators, and population included or excluded are essential for proper interpretation and comparison of results. Veterinarians understanding these statistics and indexes, and using stratification of data to investigate production losses, will serve their clients well. My advice is to approach a herd with a perceived reproductive problem by evaluating these parameters; they are the means of determining if a problem exists and, if so, where it is. Find out how the various parameters are calculated so your interpretation will be correct. Herds with average days in milk of less than 165, culling rates below 25 per cent, and a milking rate of 85 per cent or more do not have long-term reproductive problems. If management techniques fail to achieve these levels, first look at those areas involving people. Conception rates measure all the components that, when multiplied, equal fertility: insemination technique, semen quality, heat detection accuracy, and the cow factors involved. Poor conception rates require investigation into these areas individually. Heat detection intensity leading to prolonged days in milk at first service is another common finding. Comparison of inseminators and sires may identify a problem area. Cow factors require more intense investigation to determine their cause. Use the information outlined in the periparturient period to assist you. In most cases, a combination of failures in many of the independent factors creates the problems in reproduction that we encounter. A large data base including all the information discussed and additional information is necessary to define, correct, and monitor reproductive management performance. Since performance ultimately is determined by the quality of the labor force, ongoing monitoring for accountability and education is necessary for success.

Animals↗
PubMed2002

Costs and outcomes of risperidone treatment in schizophrenia in the Czech Republic.

The increasing cost of pharmaceuticals in the Czech Republic has led to restrictions on the prescription of more expensive atypical antipsychotics. The aim of the study was to compare the costs and outcomes of using risperidone versus classical neuroleptics in treatment of schizophrenia in order to see if there was any cost advantage in restricting use of more recent antipsychotics. Sixty-seven patients (39 women) with a mean age of 34.6 years (S.D. = 9.74) suffering from schizophrenia or schizoaffective disorder were treated with risperidone while 67 patients (39 women) with the same diagnoses with a mean age of 35.7 years (S.D. = 9.91) received standard neuroleptics. Yearly direct medical costs and outcomes (indicated by the average Global Assessment of Functioning score) were assessed retrospectively in an open, intent-to-treat study by abstracting psychiatric outpatient charts. The outcomes were not significantly different between the treatment groups while the risperidone treatment was significantly more expensive than the therapy with standard neuroleptics. This result which appears to be inconsistent with the literature was caused by the cheap labor force in the Czech Republic. The difference between the followed treatments in the direct costs will probably become insignificant in the future when the country's economy will be more developed.

Adolescent↗
PubMed1997

Documented homicides and excess deaths: new insights into the scale of killing in the USSR during the 1930s.

"Getty, Rittersporn and Zemskov recently claimed that no more than 2 million people could have perished from collectivization, famine, execution, terror, and forced labor in the USSR during the 1930s. Prior demographic confirmation of this estimate was provided by Anderson and Silver who contended that killings were unlikely to exceed a few million and could not be more than 4.8 million victims. This essay disproves both these contentions by introducing new demographic evidence proving that Stalin killed at least 5.2 million Soviet citizens 1927-1938, with a best estimate in the vicinity of 10 million."

Cause of Death↗
PubMed1998

Community occupational structure, basic services, and coronary mortality in Washington state, 1980-1994.

OBJECTIVE: Examine the association between county occupational structure, public expenditures, services availability, prevalence of risk factors, and coronary mortality rates, for 1980-1994, in Washington state. DESIGN: Washington's 39 counties were classified into three occupational structure categories: counties with the lowest percentages of the labor force in managerial, professional, and technical occupations were classified in category I; counties with the highest percentages were in category III. Directly age-adjusted coronary heart disease (CHD) mortality rates, aged 35-64 years, (from vital statistics and Census data), per capita expenditures (Washington Department of Revenue data), per capita services (U.S. Statistical Abstracts data), and the prevalence of CHD risk factors (BRFSS data) were calculated for each occupational structure category. RESULTS: CHD mortality rates and the prevalence of risk factors were inversely associated with occupational structure. Per capita expenditures for health, social, and employment services were 2.2 times, and for schools and recreation were 1.4 times higher in category III vs. I counties. Per capita numbers of child care, job training, employment services, exercise facilities, schools, and medical services were 1.5-6.4 times greater in category III vs. I counties. CONCLUSIONS: Strategies to improve community living conditions and decrease economic disparities between counties may be important to decrease geographic differences in premature CHD mortality.

Adult↗
PubMed2000

Marital status and mortality: the national longitudinal mortality study.

PURPOSE: To examine the effect of marital status (married, widowed, divorced/separated, and never-married) on mortality in a cohort of 281,460 men and women, ages 45 years and older, of black and white races, who were part of the National Longitudinal Mortality Study (NLMS). METHODS: Major findings are based on assessments of estimated relative risk (RR) from Cox proportional hazards models. Duration of bereavement for the widowed is also estimated using the Cox model. RESULTS: For persons aged 45-64, each of the non-married groups generally showed statistically significant increased risk compared to their married counterparts (RR for white males, 1.24-1.39; white females, 1.46-1.49; black males, 1.27-1.57; and black females, 1. 10-1.36). Older age groups tended to have smaller RRs than their younger counterparts. Elevated risk for non-married females was comparable to that of non-married males. For cardiovascular disease mortality, widowed and never-married white males ages 45-64 showed statistically significant increased RRs of 1.25 and 1.32, respectively, whereas each non-married group of white females showed statistically significant increased RRs from 1.50 to 1.60. RRs for causes other than cardiovascular diseases or cancers were high (for white males ages 45-64: widowed, 1.85; divorced/separated, 2.15; and never-married, 1.48). The importance of labor force status in determining the elevated risk of non-married males compared to non-married females by race is shown. CONCLUSIONS: Each of the non-married categories show elevated RR of death compared to married persons, and these effects continue to be strong after adjustment for other socioeconomic factors.

Age Distribution↗