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PubMed2007

Probability estimation when some observations are grouped.

This paper considers the use of additional questions for decreasing survey non-response rates and an approach for estimating a probability based on the results obtained. In a survey, the respondents are asked to answer an original question and follow-up questions, where the answers for the follow-up questions are grouped answers for the original question. For example, respondents are asked to provide an exact number of incidents, but in cases of 'Do not know' or 'Refuse' responses, they are subsequently asked to pick an answer from a less specific categorical scale. The new estimator obtains smaller variance asymptotically and does not depend on a distribution family. This method is applied to income questions in a survey regarding injury prevention and behaviours. Another application is survey data on intimate partner violence, where some amendments were applied for incorporating post-stratification weights and for using non-random grouping. For additional illustration, an example of parameter estimation on artificially generated data is presented.

Data Collection↗
PubMed2002

Decline of neural tube defects cases after a folic acid campaign in Nuevo León, México.

BACKGROUND: Nuevo León is a state in northeastern Mexico, near the border of Texas. Mean mortality rate from 1996-98 due to anencephaly cases was 0.6/1,000. In 1999 a surveillance program for the registry and prevention of neural tube defects (NTD) cases was initiated. METHODS: Cases were obtained from hospitals and OB-GYN clinics by immediate notification, death certificates, or fetal death registries. Only isolated cases of NTD were included. In August 1999 a folic acid campaign was initiated with the free distribution of the vitamin to low-income women with a recommendation to take a 5.0-mg pill once a week. Number of cases and rates from 1999 to 2001 were compared (chi(2) test). RESULTS: After 2 years there has been a significant reduction in the number of cases and rates. In 1999 there were 95 NTD cases and in the years 2000 and 2001 there were only 59 and 55 respectively (P < 0.001). NTD rate decreased from 1.04/1,000 in 1999 to 0.58/1,000 in 2001. Anencephaly and spina bifida rates decreased from 0.55/1,000 to 0.29/1,000 and from 0.47/1,000 to 0.22/1,000 respectively, from 1999-2001. Decrease of female cases was higher than male cases for both phenotypes. CONCLUSION: After 2 years there was a 50% decrease in the incidence of anencephaly and spina bifida cases with a significant reduction of infant mortality and disability. These results encourage us to propose the use of a single tablet of 5.0-mg of folic acid per week as an alternative to supplementation on a daily basis.

Anencephaly↗
PubMed1982

Neighborhood characteristics and hospital closures. A comparison of the public private and voluntary hospital systems.

This paper analyzes the neighborhood distribution of hospital closures in New York City between 1970 and 1981. Discriminant analysis procedures are used to compare the social, economic and health status characteristics of neighborhoods in which hospitals have closed with those of neighborhoods in which facilities have remained open. The results show that overall hospital closures have had a substantial distributional impact, with facilities in low-income, high infant mortality neighborhoods having the highest rates of failure. Closures of voluntary hospitals occurred most frequently in disadvantaged neighborhoods; whereas municipal and proprietary hospital closures showed no differential neighborhood impact. Implications for the geographical accessibility to various groups to health care and for the efficiency and cost of hospital services are discussed.

Catchment Area, Health↗
PubMed2004

Prevalence of excessive daytime sleepiness and associated factors in a Brazilian community: the Bambuí study.

BACKGROUND AND PURPOSE: Population-based studies of excessive daytime sleepiness (EDS) among adults residing in communities in developing countries are scarce. The objectives of the present study were to determine the prevalence of EDS in a Brazilian town with 15,000 inhabitants (Bambuí, MG), and the socio-demographic characteristics associated with it. PATIENTS AND METHODS: In this study, 87.3% of 1221 randomly selected individuals aged 18+ participated. EDS was defined as the presence of sleepiness during the previous month, occurring three or more times per week, with consequent impairment of daily activities. RESULTS: EDS was reported by 16.8% of the participants. There was no association with age groups (P=0.978). Higher prevalence of EDS was seen for women than for men in the following age groups: 18-29, 45-59 and 60+. After adjustment for gender, only family income was associated with EDS. Complaints of insomnia and the use of medicine to improve sleep during the previous month were more frequent among individuals with EDS than among those without it. Among those with EDS, 46.3% had been symptomatic for more than 1 year; 25 (2.34%) reported use of medication at some time in their lives to improve EDS. CONCLUSION: Social differences (represented by a lower family income) were an observed factor in the distribution of EDS, as were gender and insomnia. The high prevalence of EDS indicates that it is an important health problem, even in a small community of a developing country.

Adolescent↗
PubMed2001

Hospitalization rates as indicators of access to primary care.

Variations in hospitalization rates for selected conditions are being used as indicators of the effectiveness of primary care in small areas. Are these rates actually sensitive to problems in local primary care systems? This study examines the relationship between ambulatory care sensitive condition (ACSC) hospital admission rates and primary care resources and the economic conditions in primary care market areas in North Carolina in 1994. The data show a high degree of correlation between the rates and income but not primary care resources. The distribution of rates did agree with expert assessments of the location of places with poor access to health services. The data confirm that access to effective primary care reflected in lower rates of ACSC admissions is a function of more than the professional resources available in a market area. The solution to reducing disparities in health status may not lie within the health system.

Health Services Accessibility↗
PubMed2001

Possible electromagnetic interference with electronic medical equipment by radio waves coming from outside the hospital.

Electromagnetic interference (EMI) with electronic medical equipment by radio waves from mobile telephone handsets has been reported and is currently receiving wide attention. The possibility of EMI with electronic medical equipment by radio waves coming into the hospital has also been pointed out. But so far, there are no reports measuring the frequency distribution of electric field intensity induced by incoming radio waves. Therefore, we measured electric field intensity induced by radio waves coming into our 11-floor hospital, which was under construction. The maximum intensity observed was about 200 V/m at 2.79 GHz, from airport surveillance radar waves. The maximum intensity induced by radio waves from cellular phone base stations was 1.78 V/m. These data show that various frequencies of radio waves are common in this urban area, and that they induce strong electricfield intensity. This strong electric field intensity might cause EMI with electronic medical equipment. Measurement of the electromagnetic environment should be done by each hospital in urban areas to prevent EMI with electronic medical equipment.

Electric Power Supplies↗
PubMed2003

The impact of a program for systematically recognizing and rewarding academic performance.

PURPOSE: To describe an academic performance incentive system (APIS) and faculty perception of it; explore the impacts of incentive level, faculty rank, clinical practice volume, and administrative responsibility on academic productivity; and describe the APIS's use in maintaining congruence between department mission and activities. METHOD: A list of teaching, research, and academic service activities was developed, which full-time faculty (n = 33) used to report activities. Clinical faculty members received incentive income based on credits earned. APIS initially distributed 1% of practice plan receipts (subsequently increased to 3% and then 5%). Productivity was measured by differences in APIS points achieved. Satisfaction of all faculty participants was measured by survey. RESULTS: Faculty members (n = 20) who participated throughout averaged 22 credits per month (nine to 42 credits), and quarterly incentive bonuses ranged from 145 US dollars to 6,128 US dollars. Average credits earned per month were 24 for the 1% incentive, 23 for the 3% incentive, and 20 for the 5% incentive. Faculty members with administrative responsibilities were as productive academically as were their non-administrative counterparts. Senior faculty members were as productive as junior faculty. Faculty members who were more productive clinically were more productive academically. Seventy percent of respondents reported they were either very satisfied or somewhat satisfied with the APIS. Seventy-eight percent felt that the APIS accurately reflected their academic productivity. Most respondents (81%) felt that the amount of money allocated to the incentive system was appropriate (15% felt it should be increased and one respondent recommended reduction). CONCLUSIONS: The APIS system has been well accepted by faculty and allows for data-driven discussion of the department's mission and activities.

Efficiency↗
PubMed2004

Health disparities based on socioeconomic inequities: implications for urban health care.

Health is unevenly distributed across socioeconomic status. Persons of lower income, education, or occupational status experience worse health and die earlier than do their better-off counterparts. This article discusses these disparities in the context of urban medical practice. The article begins with a discussion of the complex relationship among socioeconomic status, race, and health in the United States. It highlights the effects of institutional, individual, and internalized racism on the health of African Americans, including the insidious consequences of residential segregation and concentrated poverty. Next, the article reviews health disparities based on socioeconomic status across the life cycle, beginning in fetal health and ending with disparities among the elderly. Potential explanations for these socioeconomic-based disparities are addressed, including reverse causality (e.g., being poor causes lower socioeconomic status) and confounding by genetic factors. The article underscores social causation as the primary explanation for health disparities and highlights the cumulative effects of social disadvantage across stages of the life cycle and across environments (e.g., fetal, family, educational, occupational, and neighborhood). The article concludes with a discussion of the implications of health disparities for the practice of urban medicine, including the role that concentration of disadvantage plays among patients and practice sites and the need for quality improvement to mitigate these disparities.

Cities↗
PubMed2005

Concepts of risk in dental public health.

The purpose of this paper is to review the concepts of risk as we use them today in dental public health practice, and to suggest that we should broaden our view of risk. Use of terms like risk factor in the literature can be quite vague, and it is recommended that a clear definition of that and related terms be adhered to. A broader view of risk in dental research would take in the concepts of social determinants of health and population health. While some progress has been made in our understanding of these issues, better knowledge would give the public health administrator more readily available information to use in program planning. The skewed distribution of caries in the high-income countries has led to the emergence of targeted prevention programs toward those considered to be at high risk. In public health programs, targeting at the individual level is not practical: the risk assessment methods are not yet sufficiently precise, and even when individuals are identified there are practical problems with schools and with the children themselves. (For private practice, however, high-risk child patients can be identified as those with at least one approximal lesion in permanent teeth.) For public health purposes, an argument is made for geographic targeting, i.e. identification of areas of social deprivation where whole schools or school districts can be targeted. Geographic targeting is something between individual targeting and whole-population approaches. Ideally, geographic targeting would supplement population measures like water fluoridation and dental health education. Examples of geographic targeting from Ohio and New York are presented as illustrations.

Adolescent↗
PubMed1992

Kerala State, India: radical reform as development.

Kerala State in southwestern India has achieved some of the third world's best rates of life expectancy, literacy, and infant mortality, despite one of the lowest per capita incomes. Especially notable is the nearly equal distribution of development benefits to urban, rural, male, female, high-caste, and low-caste sections of the populations. An even population distribution, a cosmopolitan trading history, and the development of militant worker and small farmer organizations led by dedicated activists provide the main explanations for Kerala's achievements. Land reform has redistributed wealth and political power from a rich elite to small holders and landless laborers. Public food distribution at controlled prices, large-scale public health actions, accessible medical facilities, and widespread literacy combine with and reinforce each other to maintain and expand Kerala's achievements. Serious unemployment threatens the Kerala experiment, but Kerala nonetheless offers important lessons to development planners, policymakers, and third world activists.

Communism↗
PubMed1997

The contribution of repellent soap to malaria control.

A study about the acceptability, protective efficacy, effectiveness, and cost of a repellent soap containing 20% diethyltoluamide and 0.5% permethrin was carried out on the Pacific coast of Ecuador and Peru, where malaria is endemic and the transmission is seasonal. The malaria vectors were Anopheles albimanus, An. punctimacula, and An. pseudopunctipennis in Ecuador and An. albimanus in Peru. Comparing the hourly mosquito bites on human subjects with and without the protection of the repellent soap, it showed that inactive, protected subjects were bitten 94.2% less than unprotected controls 2 hr after application of the soap. This protective efficacy was reduced to 81% after 6 hr. In persons physically active for 3 hr after application, the efficacy of the soap was 67% in the fourth hour after application and 52% in the sixth hour after application. Sweating decreased the protective efficacy of the soap even more. In a community-based malaria control program, the soap was introduced by community health promoters. Acceptance was good when it was given free of charge but reduced dramatically when it was sold. People used the soap mainly because of the nuisance of mosquitoes. The application was generally done correctly. However, no significant impact on the incidence of malaria episodes could be shown when comparing intervention communities with control communities, either in Ecuador, where the proportion of Plasmodium falciparum cases was high, or in Peru, where P. vivax was the only species of Plasmodium seen. This can probably be explained by the limited use of soap and the shift of mosquito bites from users to nonusers of the repellent soap. The cost of a soap program would be $4.60 (USA) per person per year, which seems to be quite high in terms of cost of soap and its distribution related to people's low cash income. The implications of the introduction of repellent soap into a control program are discussed.

Animals↗
PubMed2004

Caseview_HUN: easy DRG overview.

Several hospital management tools are currently used by the DRG financial system. Each case is classified into a DRG group, so it is necessary to know the distribution of hospital or departmental cases into DRG groups, and to follow the variances of this distribution. The DRG's properties include the income and expenses related to each case. There are differences in the profitability of the cases, depending on their DRG. It is important to know own expenses and the recuperated costs for every case. There are several systems for data collecting and analysis in hospitals, depending on existing hospital information systems and management. We can, however, be sure, that a DRG data collection system works in every department, because it is the basis of assessing income. The tool, which is shown in this article, facilitates an overview of the DRG, presenting the hospital's or other healthcare provider's own data. These services are supported by a platform-independent, accessible Internet application.

Diagnosis-Related Groups↗
PubMed1990

What dental phobics say about their dental experiences.

Previous surveys have indicated that there is a substantial proportion of dentally anxious individuals in the general population. Many of these individuals avoid contact with dentistry as much as possible, while fearful individuals who present themselves for treatment are probably too uncomfortable or too afraid to make their views known. Consequently, a study of the feelings and attitudes of a group of dental phobics was carried out as part of a larger study of the efficacy of psychological treatments for excessive dental anxiety. The subjects were recruited by means of a newspaper advertisement and asked to complete a questionnaire designed to obtain information regarding their dental experiences and attitudes. Twenty-three individuals provided enough data for analysis. They were distributed widely in terms of age, education, income levels, and general fearfulness. They reported less satisfaction with the level of understanding or acceptance found in the last dentist they had seen than with the dentist's level of technical competence and the diagnostic information they received. Dental phobics who had been to a dentist in the past year were generally more satisfied with their dentist than those who had not. It is suggested that a good dentist-patient relationship based on understanding and acceptance is an important factor in overcoming the avoidance of fearful patients.

Adult↗
PubMed1993

The shape of dental practice is changing.

Changes in federal income tax regulations have altered dramatically the distribution of dental practice arrangements. While there may be fewer tax rationales for corporate arrangements, they continue to offer some protection in cases of malpractice litigations.

Dentistry↗
PubMed1977

Governmental population incentives: ethical issues at stake.

Governmental incentives to influence population-related decisions are examined in terms of the ethical issues at stake. A typology of incentive schemes is presented, and ethical implications of various incentives are discussed. It is argued that, in a just scheme, a progressive, negative incentive or fee, calculated as a surtax on a modified income tax or an equivalent standard, would distribute burdens equally. A set of guidelines for ethical evaluation of incentive schemes is proposed.

Contraception Behavior↗
PubMed1999

The horizontal equity of health care in New Zealand.

OBJECTIVE: Given that 'equal access for equal need' is a clearly articulated goal of the New Zealand public health system, this study is an attempt to determine if access to public health care services in New Zealand is, for people of equal health need, independent of income. METHOD: Information on health status, income and health service utilisation for just over 6,000 New Zealanders was obtained from the national Household Health Survey 1992-93. Using standardised expenditure concentration curves and a concentration index, the distribution of health service use by individuals in different income groups, as a proxy for access, was illustrated and quantified. RESULTS: The results suggest either appropriate or slightly excess use of services by the poor given their estimated health need. Due to analytical problems caused by data deficiencies, these results must be regarded as tentative. CONCLUSION: For the period under study, no evidence was found to indicate significant access barriers to publicly funded health care for people on different incomes. This study has served to demonstrate one approach to measuring inequality and analysing the relationship between inequality and inequity. Given the reforms to the health sector since 1993, ongoing monitoring of equity of access to health care services is essential. IMPLICATIONS: Given the income-related disparities in health that do exist, the public health community should endeavour to develop techniques to monitor the delivery of publicly funded health care to ensure that further inequity is not borne by the poor.

Adolescent↗
PubMed2006

Financial stress, smoking cessation and relapse: results from a prospective study of an Australian national sample.

AIMS: Our aim was to examine the association between financial stress and subsequent smoking cessation among smokers, and relapse among ex-smokers. DESIGN AND PARTICIPANTS: Data came from the first two waves of the Household Income and Labour Dynamics in Australia (HILDA) survey. The size of the subsample of smokers was 2076, and that of ex-smokers was 2717. Data collection was based on face-to-face interviews. MEASUREMENT: Eight questionnaire items (e.g. difficulty paying electricity, gas or telephone bills and going without meals due to shortage of money) were used to construct a nine-point financial stress index. FINDINGS: Smokers with more financial stress were less likely to quit, with the odds of quitting reducing by 13% (95% CI: 4-21%; P = 0.008) per unit of the financial stress index. Ex-smokers with more financial stress were more likely to relapse (P < 0.001). CONCLUSIONS: Special programmes may have to be implemented to counter the potentially adverse effects of tobacco price increases on smokers who have financial stress and fail to quit smoking.

Adolescent↗