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At least 73 records · Page 4Linked to original sources
PubMed1992

Small area analysis of surgery for low-back pain.

Rates of spine surgery (discectomy, laminectomy, fusion) vary several-fold among "small areas" such as counties or hospital market areas. To ascertain why this is so, an analysis was conducted of variability in rates among counties in the State of Washington (N = 39). Since, unlike previous published reports, this study excluded patients with cancer, major trauma, and infection, as well as those with cervical and thoracic procedures, rates in this study pertain specifically to the problem of low-back pain. Six classes of variables to explain variability among county rates were defined: I) percentage of the labor force in heavy labor and transportation occupations; II) socioeconomic conditions; III) neurologic and orthopedic surgeon density; IV) occupancy rate of back surgery hospitals; V) primary payer and VI) health care availability. In all, the effect of 28 explanatory variables was tested. In doing so, the authors took into account the possibility of spurious correlation. The rate of surgery for low-back pain varied nearly 15-fold among counties. The explanatory variables that were tested, however, accounted for only a minor part of the variability. The hypothesis that "physician practice style factor" accounts for the major part is explored; potential properties of practice style factor are specified for further testing.

Back Pain↗
PubMed2002

Risk adjustment for hospital use using social security data: cross sectional small area analysis.

OBJECTIVES: To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. To establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses. DESIGN: Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination. SETTING: Northern Ireland. MAIN OUTCOME MEASURE: Intensity of use of inpatient services. RESULTS: After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas. CONCLUSIONS: This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula.

Adult↗
PubMed2002

Disparities in mammography screening in rural areas: analysis of county differences in North Carolina.

The extent to which targeted mammography programs have impacted women in rural areas is not well defined. We investigated mammography screening rates among 843 women age 50 and over from a population-based sample in four predominantly rural eastern North Carolina counties. We examined age, race, education level, county of residence, health insurance, and the self-reported completion of mammography in the past year using contingency tables and logistic regression. African American females aged 65 years or older had the lowest reported mammography rates (42%), while white females aged 50 to 64 had the highest rates (58%). Uninsured women and those with less education were less likely to have received a mammogram. Logistic regression demonstrated that age, education, and health insurance were significant predictors of mammography completion. A county-level analysis revealed that three counties had similar rates and one county had substantially lower rates. A higher-than-expected rate of screening-mammography completion among African American women was noted in one predominantly rural county served by a breast cancer screening program. Logistic regression analysis confirmed that county was a significant predictor for mammography completion. In separate regressions run by race, county remained a significant predictor for African American women but not for white women. Differences in mammography screening appear to persist in some predominantly rural areas and are related to age, race, education, and health insurance. Programs that target hard-to-reach women with efforts tailored specifically to their needs may be effective in reducing persistent racial differences.

Black or African American↗
PubMed2003

Changing trends of HIV-related hospitalizations: a small area analysis in Illinois, 1994-2000.

This paper describes the characteristics of HIV-related hospitalizations in Illinois and compares these to nationally available data. We used HIV-related hospitalization data abstracted from an administrative dataset maintained by state mandate. Overall, HIV-related hospitalizations decreased in Illinois between 1996 and 2000. The proportion of hospitalizations for infants also decreased. However, trend analyses indicated that both the proportion of hospitalizations involving females and the mean age of hospitalized patients increased while the proportion of hospitalizations ending in mortality and the average charge per hospitalization decreased during the observation period. Small area analyses found significant regional variations in the proportion of hospitalizations ending in in-hospital mortality, costs of a hospitalization and rate of decline in the percent of hospitalization over time. Compared to national data, HIV-related hospitalizations in Illinois were more expensive, less likely to end in mortality and less likely to involve females. These results indicate that evaluation of data at several geographic levels can provide healthcare policy makers with essential information at each level of analysis.

Adolescent↗
PubMed1992

An area analysis of child injury morbidity in Auckland.

The geographical distribution of child injury morbidity in Auckland between 1982 and 1987 was examined. Analysis of total injury, pedestrian injury and vehicle occupant injury, with the census area unit as the basic spatial entity revealed distinct variations in child injury morbidity by census area unit. Morbidity rates were above average in parts of the central urban area and South Auckland and below average on the North Shore. Total injury morbidity and pedestrian injury morbidity rates were strongly correlated with census area unit unemployment rates, which were used as a measure of socio-economic deprivation. Geographical areas with high rates of child injury morbidity, to which injury prevention resources can be directed, were identified. In particular, the results suggest that injury prevention programmes should be targeted at socio-economically disadvantaged communities.

Accidents, Traffic↗
PubMed2006

Size of delivery unit and neonatal outcome in Sweden. A catchment area analysis.

BACKGROUND: Quality of perinatal care was evaluated in relation to size of delivery unit and size of catchment area for deliveries. METHODS: Neonatal outcome, measured as neonatal mortality, low Apgar scores at 5 min, and the occurrence of respiratory disorders and cerebral palsy was analyzed during a 15-year period from 1985 to 1999 inclusive. Figures were derived from the Swedish Medical Birth Registry and the Hospital Discharge Registry. Odds ratios were estimated for the different outcomes in relation to size of delivery unit (actual and estimated number of births) and the provision of a pediatric department at the hospital. Seven possible confounders were considered: year of birth, maternal age, parity, smoking during pregnancy, gestational age, parental cohabitation, and maternal body mass index. RESULTS: Neonatal mortality was significantly higher for infants in families living within the catchment area of the smallest units without a pediatric department. Small differences in the occurrence of respiratory disturbances and Apgar scores are probably due to diagnostic differences. There were no differences in the incidence of cerebral palsy. Neonatal mortality continued to decrease during the observation period. CONCLUSIONS: Differences were minor, pointing to a fairly homogeneous quality of perinatal care and an efficient referral system for risk pregnancies. Mortality continues to decrease in spite of a reduction in the number of units caring for deliveries.

Adult↗
PubMed1995

Replacing residents with midlevel practitioners: a New York City-area analysis.

Reducing the number of residency positions in U.S. teaching hospitals poses special problems for New York City-area hospitals, which rely heavily on residents to deliver patient care services. This study analyzes the costs of replacing residents with midlevel practitioners under proposals considered in 1994 by Congress to limit the number of first-year training positions and alter the configuration of primary care physicians and specialists produced. The study found that, depending on the replacement strategy used, the proposals could require New York City-area hospitals to hire thousands of midlevel practitioners and other staff, costing a minimum of $242 million annually, to cover patient care services.

Allied Health Personnel↗
PubMed1999

Relation of bimanual coordination to activation in the sensorimotor cortex and supplementary motor area: analysis using functional magnetic resonance imaging.

The aim of this study was to analyze how functional activation in the supplementary motor area (SMA) and sensorimotor cortex (SMC) is related to bimanual coordination using functional magnetic resonance imaging. Subjects included 24 healthy volunteers, 15 of whom were right-handed and 9 left-handed. Three kinds of activation tasks, all of which required the repetitive closing and opening of a fist, were performed: unimanual movement of the nonpreferred hand (task A); simultaneous, agonistic movement of both hands (task B); simultaneous, antagonistic movement of both hands (task C). The SMA activation during task C was more pronounced than that during the other two tasks for right and left handers. The results suggested that the activation of the SMA, at least during a simple motion used in the present study, was little influenced by whether the motion was unimanual or bimanual but instead how the bimanual motion was composed of the motion element of a single hand. The SMC activation during task C was significantly larger than that during task B, whereas hemispheric differences in the activation were not found. This indicated that the complexity of the bimanual movement also affected the SMC activation.

Adult↗
PubMedDate not supplied

Methods of cost-effectiveness analysis: areas of consensus and debate.

Methods of evaluating socioeconomic relationships have evolved over many years, and a number of specific approaches have been developed. Among the techniques available, cost-effectiveness analysis (CEA) has emerged as the most widely used and accepted method. Yet, despite considerable effort by the analytical community to refine this technique into one more useful for making health policy decisions, much debate and confusion still persist among analysts, readers, and policy-makers concerning methods standards and the overall usefulness of CEA in resource allocation decision making. Thus the purpose of this paper is to summarize, critically examine, and comment on existing recommended methods for socioeconomic evaluation of health care interventions. In particular, we examine an exhaustive set of component methods within the general area of cost-effectiveness and comment on areas of apparent consensus and debate. Our review reveals many areas of agreement and many yet to be resolved. Analysts generally agree on the components of the overall framework for an analysis; basic methodologic principles; the general treatment of costs; the principle of marginal analysis; the need for and general approach to discounting; the use of sensitivity analysis; the extent to which ethical issues can be incorporated; and the importance of choosing appropriate alternatives for comparison. The principal areas in which disagreement still persists are choice of study design, measurement and valuation of health outcomes including conversion of health outcomes to economic values, transformation of efficacy results into effectiveness outcomes, and the empirical measurement of costs.

Cost-Benefit Analysis↗
PubMed2000

[Prevalence of infection by hepatitis viruses in a rural area. Analysis according to risk factors and alcohol consumption].

OBJECTIVES: To evaluate the prevalence of serum markers of hepatitis A, B and C viruses in a rural area according to risk factors and alcohol consumption. METHODS: Transversal study of unselected subjects living and working in a rural area. Each subject included was asked to fill out an anonymous self-administered questionnaire dealing with his own risk factors, sexual behaviour and alcohol consumption. A blood sample was collected for detection of HBsAg, anti-HBc, anti-HBs, anti-HAV and anti-HCV antibodies. RESULTS: Three hundred three subjects with a mean age of 48 years were included. Main risk factors for viral infection were: blood transfusion (9.4%), intravenous drug addiction (0.73%), acupuncture (17.5%), tattoos (5. 8%), past hospitalizations (71.5%), homosexuality (1.1%), conjugal unfaithfulness (11%), sexual partners >5 (21.3%). Most subjects with at risk sexual behaviour had sexual relations without protection. Anti-HAV prevalence was 87.2% (95% confidence interval 83.4-91.0%). None of the subjects was HBsAg positive and 6.0% (confidence interval 4.7-8.7%) had anti-HBV antibodies. HBV prevalence was correlated to homosexuality only. Two subjects (0.67%, confidence interval 0-1.6%) without any identified risk factor had anti-HCV antibodies. There was no correlation between serum viral marker positivity and an excess alcohol consumption (>80 g of ethanol/d) which was present in 46 subjects. However HBV prevalence was 28.6% in the seven subjects who had been treated for alcoholism; these 7 subjects had a highly at risk sexual behaviour. CONCLUSION: In a rural area, infection by HAV is very frequent. The prevalence of HBV and HCV did not greatly differ from that observed in the general and urban population. The frequent failure to use protection in subjects with at risk sexual behaviour reinforces the need of prevention programs in rural areas.

Adult↗
PubMedDate not supplied

Small area analysis of low birth weight.

Birthweight is a broad indicator of health and socio-economic development in a population. This study was designed to examine small area patterns in the incidence of low birthweight in Dublin for the years 1986-89 and to explore the relationship between low birthweight and socio-economic factors. A number of district electoral divisions with a significantly raised incidence of low birthweight were identified. These were mainly in areas with a high proportion of local authority housing. There was significant positive correlation between the incidence of low birthweight and male unemployment, percentage of population in social classes 5 & 6 and proportion of population covered by medical cards, and a significant negative correlation with percentage of population in social classes 1 & 2 and number of cars per house. Forward stepwise multiple regression showed that the proportion of population covered by medical cards was the best predictor of low birthweight, but it only explained 22% of the total variance. These findings are consistent with previous work published in the international literature and provide evidence of an association between socioeconomic disadvantage and poor health in Dublin.

Employment↗
PubMed1996

Immunization status of children on school entry: area analysis and recommendations 1991.

The objective of the study was to examine the immunization status of children entering school as of September 1990 in two selected school districts in the Pittsburgh area. Immunization levels were determined by review of the students' school health/immunization records using AAP recommendations for age-appropriate vaccines for these children at the onset of the study. A telephone survey of parents was then conducted. Reasons for lack of adequate immunizations and demographic data were examined in the survey. Two hundred eighty-one records were reviewed. Only 122 (43%) of children were fully immunized (FI) according to the recommendations used. From the total, 237 (84%) families were successfully contacted by telephone; 109 (46%) children from this subset were FI. Both districts were similar for immunization status and demographic data. Seventy-one percent of the children were missing DTP, 48% HIB, and 44% OPV. All children had at least one MMR. The mean age of the children was 5.4 years (SD = 0.35). Potential missed opportunities for immunization were identified. Ninety-six percent (n = 237) of students not fully immunized (NFI) had seen a physician at least once within the past year and 65% within the past six months. Parental lack of knowledge for the need for vaccines was the reason most often identified by parents (58%) for their child's missing vaccine(s). A significant number of children in this study were found to be lacking recommended immunizations for age at entry to school despite a recent physician visit. Although many were still within the recommended age range for receiving needed immunizations, a large number of their parents stated that they did not know further vaccines were needed. Contrary to previous reports, cost, access, illness, and mobility were not identified by parents as reasons for missing vaccines in their children. Future efforts targeting immunization must emphasize better education of parents and physicians.

Bacterial Capsules↗
PubMed1993

Positive serology for Lyme borreliosis in patients with juvenile rheumatoid arthritis in a Lyme borreliosis endemic area: analysis by immunoblot.

Juvenile rheumatoid arthritis (JRA) and the arthritis of Lyme borreliosis in children can mimic each other. As false positive reactions are frequent in ELISA for Lyme borreliosis, they cannot be used reliably to make the distinction. Ninety-nine children diagnosed as having JRA at a children's hospital in an endemic area were evaluated by ELISA and immunoblot for antibodies to Borrelia burgdorferi. Sera from 9% were positive by ELISA, 5 of which showed bands on immunoblot. None met criteria for positive immunoblot. The antigenic basis of false positive ELISA was most frequently a reactivity to both 21 and 41 kDa. Analysis by immunoblot can help to definitively exclude Lyme borreliosis in children presenting with JRA in an endemic area.

Adolescent↗
PubMed2005

The role of routine culture for tuberculosis during bronchoscopy in a nonendemic area: analysis of 300 cases and review of the literature.

BACKGROUND: Many centers routinely culture bronchoscopy samples for mycobacteria, even when tuberculosis (TB) is not strongly suspected. The value of this practice is poorly defined in areas with a low prevalence of TB. METHODS: A retrospective observational study was conducted in tertiary care, university-affiliated medical center and included 300 consecutive patients who underwent a bronchoscopy examination. The findings for acid-fast bacillus (AFB) staining and culture were reviewed, and data on demographic characteristics, presenting symptoms, old TB, autoimmune status, and chest x-ray results were collected from the files. RESULTS: The study included 175 men (58%) and 125 women, with a mean age of 62 +/- 25 years. Eight cultures (2.67%) grew mycobacteria: 4 (1.33%) Mycobacterium tuberculosis and 4 (1.33%) nontuberculous mycobacteria (NTM). Thus, the incidence of TB was 4 of 300 (1.33%) patients. There were no cases of positive AFB smear or culture in patients with atelectasis, pulmonary mass, or hemoptysis with normal chest x-ray. One of the 22 patients (5%) with diffuse pulmonary nodules had active TB as did 3 of the 134 patients (2.24%) with pulmonary infiltrates. All 4 patients with NTM had pulmonary infiltrates. The use of a cost-effective diagnostic strategy in our series, wherein testing would have been ruled out for patients without a clinical suspicion of TB and radiologic findings of a pulmonary mass (n = 107, 35.6%), would have saved the system US $5350. CONCLUSION: The findings highlight the importance of an effective strategy for routine TB cultures during bronchoscopy in patients from nonendemic areas in whom TB is not suspected, especially those with pulmonary mass.

Academic Medical Centers↗
PubMed1987

Unemployment and mortality: a small area analysis.

It has been claimed that unemployment affects the health and thus the mortality of the unemployed, their families, and other members of their communities. This paper examines the relation between mortality and the unemployment experiences of small areas which vary in the extent to which their unemployment levels have changed in recent years. Quarterly numbers of unemployed, classified by age, sex, duration of unemployment, and unemployment office for 1977-81, have been aggregated to correspond to Family Practitioner Committee areas (FPCs), for which population and mortality data had been collected for a different study. There was little variation in long term (greater than 6 months) unemployment trends prior to July 1980, but subsequently there were large variations between FPCs in the rate of increase in unemployment rates. Mortality data for suicide, ischaemic heart disease, cerebrovascular disease, and all causes were examined for the period 1975-83. When the mortality trends of FPCs with different unemployment experiences were compared, no statistically significant differences in trends were found, although areas with greater increases in unemployment appeared to have slightly worse mortality trends for suicide, ischaemic heart disease, cerebrovascular disease, and total mortality for men in the younger age groups. If changes in the level of unemployment do have an effect on changes in trends in mortality levels, this effect is not of sufficient magnitude to be statistically significant with the sample available, in spite of the fact that it included the whole of England and Wales.

Adult↗