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PubMed1983

A method for disaggregate household forecasts.

A method for making household forecasts is proposed "which yields both the total number of households and the number present in any predetermined subgroup of households. The method presupposes that incomplete information is available on the transitions of persons between various age and household categories over a period of time. The forecasting method is capable of spelling out the consequences for the prognoses of adding different amounts of external information to the computations. Such information may include population forecasts by age and sex, trend-based information like restrictions on the size distribution of households, econometric relations between household formation and incomes, etc." The forecasting method is described in theoretical terms. "This description includes the use of information-theoretic arguments to adjust the forecast to external data. The theoretical development is illustrated by an application of the method to data for the Stockholm region [of Sweden]. In relation to this application an outline is given of the use of the methodology for long-term projections."

Demography↗
PubMedDate not supplied

Medicaid/SCHIP cuts and hospital emergency department use.

This paper uses data from the 2000-01 and 2003 Community Tracking Study household surveys to examine how decreases in enrollment in Medicaid and the State Children's Health Insurance Program (SCHIP) and increases in the number of uninsured people would affect the volume and distribution of emergency department (ED) use among low-income people. A decrease in Medicaid/SCHIP enrollment would lead to an increase in ED visits by the uninsured but little change in overall ED volume. The results suggest that cost containment efforts that reduce eligibility and enrollment will achieve cost savings largely by reducing access and shifting costs away from Medicaid/SCHIP.

Adolescent↗
PubMed1999

Physicians can make a difference with smokers: evidence-based clinical approaches. Presentation given during the Symposium on Smoking Cessation at the 29th World Conference of the IUATLD/UICTMR and Global Congress on Lung Health, Bangkok, Thailand, 23-26 November 1998. International Union Against Tuberculosis and Lung Disease.

Tobacco use poses one of the greatest public health challenges globally. This paper reviews the role of the physician as a key figure in promoting tobacco control and prevention. The physician is in a prime position to assist patients to stop smoking because of the high rate of contact with the general public. His/her efforts can contribute towards stemming the projected increase in smoking prevalence and resulting mortality and morbidity from cigarette-related diseases. However, the doctor is not taking full advantage of this window of opportunity to identify smokers and provide stop smoking advice. Evidence of physicians' and general practitioners' success in advising patients to stop smoking is presented. In general, clinical trials have reported abstinence rates of 5% to 10% for brief advice, and 20% to 36% for more physician involvement in providing advice and counselling. Nicotine replacement therapies (gum and patch) and other pharmacological treatments are useful adjuncts to physicians' advice to quit. Three evidence-based approaches available for the physician to use are described: 'Smokescreen for the 1990s in Australia', 'Smoking Cessation Clinical Practice Guideline' in the USA, and 'Guidelines on Smoking Cessation for General Practitioners and Other Health Professionals' in Europe. The information and resources that we have produced in industrialised countries must be translated, made culturally appropriate and distributed to physicians around the world, particularly in low income countries, so that they can fulfil their vital function of assisting patients to stop smoking.

Evidence-Based Medicine↗
PubMed1976

[The prevalence of alcoholism (abuse and dependence) in the state of Bremen].

UNLABELLED: An attempt was made to establish the prevalence of alcoholism in the State of Bremen in 1973. A sample of the adult population was sent a questionnaire. The selection of questions was based on the principles of the WHO definition of 1952 and on dependence on alcohol. Amount of drinks, behavior, psychosocial consequences and dependence on alcohol were gone into. The assessment of answers was weighted. RESULTS: When very strict criteria are applied, alcoholism existed among 2-2.5% of the population samples. With slightly less strict criteria which probably correspond more closely with reality, it was 3-4%. This, calculated for the whole population of Bremen, shows a prevalence of at least 1.6-2%, probably 2-3%. Alcoholism is not evenly distributed between sexes, age groups, social status and income-groups. The relation between men and women is 2 to 1. Most alcoholics are found among those aged 16-29 years and among unskilled workers, in the income group between 800 and 1399 DM p/month and among those not stating their income. The smallest number of alcoholics was in the group between 40 and 49 years old, among people not in top positions of the civil service or in business and in the lowest income group (less than DM 800 p/month). It is remarkable that no difference was found to be related to educational standards.

Adolescent↗
PubMed1982

Survey of chiropractic in Dade County, Florida.

This survey of the members of the Dade County Chiropractic Society of Miami, Florida was initiated with the encouragement and under the supervision of the Dade County Health Systems Agency (HSA). The purpose of the survey was to obtain information relative to the inclusion of chiropractic into future health planning to be conducted by the HSA. The survey was divided into a "Physicians Survey" obtaining information on location, office hours, gross income, total patient visits and type of practice of the doctor, and a "Patient Survey" obtaining information on age, sex, ethnic origin, residence, and payment source of the patients. Clinical information on initial complaints, diagnoses, treatment, referrals, and amount of care was also obtained. It was found that chiropractors work an average of 31.7 hours per week with a gross annual income of $74,750.00 (1979). The male-female distribution of patients was equal and the average patient age was 43.4 years. Anglocaucasian category comprised 80.2% of the patient sample. Nearly 50% of all chiropractic patients pay for services rendered out of their own pocket. Of the primary diagnosis, 81.3% related to the spine. The study concludes that the practice of chiropractic in Dade County is very similar to the practice of chiropractic in general.

Chiropractic↗
PubMed2004

Depressive symptoms: how do adolescents compare with adults?

PURPOSE: To compare depressive symptoms between U.S. adolescents and adults. METHODS: Data are from the National Longitudinal Study of Adolescent Health (N = 18,488), the Americans' Changing Lives Project (N = 3,164), and the National Health and Nutrition Examination Survey I (N = 3,023). Depressive symptoms were assessed with items from the Center for Epidemiologic Studies-Depression (CES-D) Scale, operationalized as present or persistent. Multivariate regression analyses were used to assess correlates of depressive symptoms within each sample. RESULTS: Older adolescents reported the highest symptom presence, but symptom persistence was similar between adolescents and young to middle aged adults. The oldest adults reported the lowest symptom presence but the highest symptom persistence. For adolescents and for adults, low household income and ethnic minority status were the most consistent multivariate correlates of depressive symptoms. CONCLUSIONS: Older adolescents experience more depressive symptoms than adults and comparable symptom persistence, suggesting that these adolescents may be at the highest risk for depression. This risk may be especially pronounced among economically disadvantaged ethnic minority adolescents.

Adolescent↗
PubMedDate not supplied

An approach to the detection of malnutrition in rural children using socio-economic indices and level of education of mother as proxy.

The hypothesis that social indices and educational level of mother are potential sources of childhood malnutrition was tested in Kampumbu, Zambia. Hemoglobin, hematocrit, protein and albumin levels in children were studied in relation to malnutrition. Six hundred and fifty rural children (306 males and 344 females) aged one and fourteen years exposed to various types of diet and environmental factors were selected randomly. Data on economic status, diet environment and educational attainment as well as other demographic information were collected. The major epidemiological findings were that the difference in the distribution of malnourished children by socio-economic status (as measured by income) and hypochromotrichia, oedema or stomatitis was significant (X2 = 4.1, P less than 0.025), and the relative odds were significantly greater than unity at 0.05 level. Similarly, there was a very significant difference (X2 = 7.4, P less than 0.005) in the distribution of malnourished children by socio-economic status (as measured by house grades) and hypochromotrichia, oedema or stomatitis. The estimated relative odds were significantly greater than unity at 0.05 level. Other variables, including age, history of hookworm, were not found to be determinants of risk for malnutrition.

Adolescent↗
PubMed1977

The supply of physicians and physicians' incomes: some projections.

This study identifies trends that will lead to a dramatic increase in the number of active physicians in the United States during the next decade. The supply of active medical doctors (MDs) and doctors of osteopathy (DOs) as well as active post-graduate MDs and DOs in the U.S. is projected to increase by approximately 50 percent in the decade ending in 1985. The number of active physicians per 100,000 population is similarly expected to increase by approximately one-third. The production of surgical specialists, in particular, appears to be excessive. In response, the average length of physician graduate training programs is anticipated to be shortened as more MD and DO graduates enter shorter, general practice residencies. The authors expect that the effects of this projected increase in the supply of physicians may relieve geographic disparities in physician distribution, rationalize the organization of medical practice, and reduce physicians' incomes relative to other professional groups and possibly in absolute terms. The projected increases in the supply of physicians will give the federal government much more flexibility and bargaining power should it choose to implement a national health insurance program with salaried physicians.

Economics, Medical↗
PubMed1977

The distribution of physician extenders.

As part of the Medicare Physician Extender Reimbursement Study, a mail survey was conducted of 5,572 physician extenders (PEs) to identify potential study participants. Analysis of survey results indicates that PEs are distributed disproportionately more often than physicians to primary care practices and to rural low income areas. However, there are substantial differences among types of PEs with regard to practice location and practice arrangement. The relationship between these findings and the distribution of other medical manpower and innovations is then discussed.

Nurse Practitioners↗
PubMed1994

Sharing prosperity across the age distribution: a comparison of the United States and Germany in the 1980s.

Using six waves of data from the Panel Study of Income Dynamics and the German Socio-Economic Panel we compare the relative economic well-being of Americans and Germans in the 1980s. Economic growth during the 1980s substantially improved the economic well-being of the average person in the both the United States and Germany. But the rewards were disproportionately distributed across age and gender. In both countries, the family incomes of the very old, the very young and women were lower and grew more slowly than did the income of other families. Social security policy in Germany was more successful than American policy in providing income security in old age. But, despite massive social security programs in both countries, older women were still the most vulnerable members of society, in part because of a substantial drop in the level of social insurance they received following the death of their spouse.

Adolescent↗
PubMed2005

The urban built environment and overdose mortality in New York City neighborhoods.

Accidental drug overdose continues to be a substantial cause of mortality for drug users. Characteristics of the neighborhood built environment may be important determinants of the likelihood of drug overdose mortality independent of individual-level factors. Using data from the New York City Office of the Chief Medical Examiner, we conducted a multilevel case control study using data on accidental overdose deaths as cases and non-overdose accidental deaths as controls. We used archival data from the New York City Housing and Vacancy Survey and the Mayor's Office of Operations to assess characteristics of neighborhood external (e.g. dilapidation of buildings) and internal (e.g. quality of utilities in houses) built environment. Multilevel analyses were used to assess the relations between the neighborhood built environment and the likelihood of overdose death. Six out of the eight characteristics of the external environment studied and three out of the six characteristics of the internal environment studied were significantly associated with the likelihood of fatal drug overdose in multilevel models after adjusting for individual-level (age, race, sex) and neighborhood-level (income, drug use) variables. Deterioration of the built environment, particularly the external environment, is associated with an increased likelihood of fatal accidental drug overdose. Disinvestment in social resources, psychosocial stressors, neighborhood differences in response to a witnessed overdose, and differences in vulnerability to the adverse consequences of drug use in different neighborhoods may explain the observed associations.

Adolescent↗
PubMed1990

Income level, gender, ethnicity, and household composition as predictors of children's school-based competence.

In the United States, being black, male, or growing up in a low-income and/or single-parent household have all been identified as risk factors for maladjustment during childhood. Interpretation of these findings is, however, often difficult because of the well-known associations among these variables. In the present study, we compared predictions of 3 different forms of children's competence from each of these 4 variables. In a sample of 868 black and white elementary school children from 2-parent and mother-headed 1-parent homes, we studied 3 aspects of school-based competence: conduct, peer relations, and academic achievement. Results showed that although the independent variables accounted for different amounts of variance in each domain of competence, income level and gender were better overall predictors of children's competence in conduct and peer relations than were ethnicity or household composition. Income level and ethnicity were better overall predictors of academic achievement than were gender or household composition, although each of the 4 variables made a significant contribution. Overall, income level and gender were thus the strongest predictors of children's competence. Black children were, however, more likely than white children to live in low-income homes. Our results thus highlighted some correlates of the unequal distribution of economic resources among black and white children growing up in the United States today.

Achievement↗
PubMed1999

Social Security, retirement incentives, and retirement behavior: an international perspective.

Escalating rates of early retirement are imposing fiscal pressure on retirement systems around the world. In some developed countries, the labor-force participation rates of men ages 60-64 have fallen by 75 percent over the last three decades. One explanation for this striking decline is social security program provisions which create disincentives to continued labor-force participation by older workers. There are substantial differences among developed nations in the labor-force participation of older workers. While two-thirds of 60-year-old American males are working, only one-quarter of men that age are working in Belgium. Over the entire 55-65 age range, 63 percent of American males are working, compared with only 40 percent of French males and 33 percent of Belgians males. There is strong evidence that the early retirement provisions of social security systems in developed countries determine the modal age of retirement. There is a strong relationship between early retirement ages and labor-force withdrawal rates; for example, in France, 60 percent of those working at the early entitlement age of 60 leave the labor force at that age. The core of this analysis is the construction of "implicit tax/subsidy rates" on additional work at older ages through each nation's social security system. These rates measure the change in a worker's retirement wealth entitlement from delaying retirement for one year, relative to the amount that would have been earned over that year. The U.S. Social Security system has an actuarial adjustment for delayed benefits claiming and other features that avoid financial incentives to leave the labor force at age 62 for a married worker, there is a slight disincentive to work for single workers and high wage earners. However, at ages 65 and older there is a stronger incentive to leave the labor force, with implicit tax rates on work of 19 percent for married workers and 33 percent for single workers. By comparison, other nations do not have actuarially fair adjustments, and as a result impose substantial taxes on additional work at older ages. In several countries, implicit tax rates on work at older ages approach or exceed 100 percent. This is because by delaying retirement, workers forgo benefits which often replace close to their full wage, in addition to having to pay the high payroll taxes required to finance generous social security benefits. There is a striking correlation across nations between high implicit tax rates on additional work and low labor-force participation rates among older workers. This suggests that social security program incentives are an important determinant of retirement. These findings have important policy implications for reforming social security programs in the United States and abroad. Policymakers must consider how program reforms will affect incentives for continued work at older ages.

Actuarial Analysis↗
PubMed1972

A study of optimum population levels--a progress report.

The purpose of this study is to explore different approaches and to develop a methodology that will allow a calculation of "optimum levels of population." The discussion is specialized to the United States, but the methodology should be broad enough to handle other countries, including less-developed countries. The study is based on economics, but with major inputs from the areas of technology, natural resources management, environmental effects, and demography. The general approach will be to develop an index for quality of life (IQL or Q-index) and to maximize this index as a function of level and distribution of population. The technique consists of a reshuffling of national income accounts so as to be able to go from the Gross National Product (GNP) to the index for quality of life, plus a careful discussion of what is and what is not to be included. The initial part of the study consists of a projection of the index for quality of life as population level increases and as population distribution changes, under the assumption of various technologies, particularly as these relate to the consumption of minerals, energy, and other natural resources. One would expect that as economic growth continues, an increasing fraction of expenditures would be for the diseconomics produced by population growth and economic growth. This study should be useful by providing a rational base for governmental policies regarding population, both in the United States and abroad. Another application of the study is to technology assessment, by measurement of the impact on economic well-being through the introduction of new technologies. Therefore, one can gauge the necessary and desirable investments in certain new technologies. In general, mathematical models resulting from this study can become useful diagnostic tools to analyze the consequences of various public and private policy decisions.

Demography↗
PubMed1994

Panic and panic disorder in the United States.

OBJECTIVE: The goal of this study was to determine the prevalence of DSM-III-R panic disorder and to describe its correlates. METHOD: The study was part of the National Comorbidity Survey, the first psychiatric epidemiologic survey of the entire U.S. population and the first to use DSM-III-R criteria for diagnosis. The 8,098 survey respondents, aged 15-54 years, were given the Composite International Diagnostic Interview. For this report, the data on panic were analyzed, and from them the prevalence of panic disorder and related experiences in the U.S. population was estimated. RESULTS: About 15% of the survey respondents reported the occurrence of a panic attack over their lifetimes, and 3% reported a panic attack in the preceding month. About 1% met the DSM-III-R criteria for panic disorder in the month preceding the interview. Panic attacks and panic disorder had a bimodal age distribution and were associated with female sex and lower educational achievement. Fifty percent of the survey respondents with panic disorder reported no symptoms of agoraphobia. The pattern of prevalence of correlated sociodemographic factors was similar for persons with panic attacks, panic disorder, and panic disorder with agoraphobia. CONCLUSIONS: There appears to be no obvious threshold for the diagnosis of panic disorder. Panic disorder and agoraphobia, although highly comorbid, also occur separately.

Adolescent↗
PubMedDate not supplied

Income growth and future poverty rates of the aged.

This article estimates the effects of 50 years of steady growth in incomes on poverty rates among the elderly. It assumes that the poverty threshold continues to be adjusted for inflation but not for increases in real incomes. Simulations with the March 1998 Current Population Survey indicate that if the benefit rules for Social Security and Supplemental Security Income (SSI) are not changed and if earnings and other sources of income in an otherwise unchanging population grow by 1 percent per year (the intermediate assumption about earnings growth used in the Social Security Trustees' Report), poverty among the elderly will decrease from 10.5 percent in 1997 to about 7.2 percent in 2020 and to 4.1 percent in 2047. These projected poverty rates are quite sensitive to both the assumption about earnings growth and the assumption that benefits are not further reduced to maintain solvency. This article quantifies the sensitivity of the results to these assumptions and discusses several other aspects that might affect future poverty rates--changes in other income components like SSI, earnings, and pensions; changes in longevity and marital patterns; and changes in the distribution of earnings.

Aged↗
PubMed1985

Clusters of cancer mortality in New Jersey municipalities; with special reference to chemical toxic waste disposal sites and per capita income.

The state of New Jersey (NJ), USA, has been thought to have an unusually high cancer mortality rate; this assumption has been based on 1950-1969 mortality data for NJ counties. This study presents an analysis of mortality from major cancers for NJ municipalities during 1968-1977, and correlates cancer mortality rates with several potentially relevant variables. Age-adjusted mortality rates for 13 major cancer sites for 194 municipalities of 10 000 or more people in 21 NJ counties were compared with cancer mortality in the US. Municipality rates were correlated with: distribution of chemical toxic waste disposal sites (CTWDS); annual per capita income; the rates of low birth weight, birth defects and infant mortality of NJ municipalities. Clusters of cancer mortality were observed in 23 municipalities in 10 counties in which a total of 98 age-adjusted cancer death rates were at least 50% above the national rate, and each of these municipalities had at least two race-sex-specific cancers in which the observed number of cancer deaths was greater than the expected number of deaths at the p less than 0.0005 level. Of these 98 excessive cancer death rates, 72% involved the gastrointestinal tract. Most of the municipalities are located in the highly industrialized densely populated northeastern part of the State. Correlation analyses showed a consistent and significant (p less than 0.05) negative correlation between income and cancer mortality in 11 of 12 cancers studied. These analyses also showed a significant positive association between 8 of 12 cancers studied and CTWDS in one or more subgroup populations and lesser associations with birth defects, low birth weight and infant mortality.

Breast Neoplasms↗
PubMed2001

Causes of tonsillar disease and frequency of tonsillectomy operations.

OBJECTIVE: To characterize the factors that influence the frequency of tonsillectomy and adenoidectomy operations. DESIGN AND SETTING: Nationwide questionnaire. Analysis of patients undergoing tonsillectomy or adenoidectomy at Helsinki University Central Hospital, Helsinki, Finland. PARTICIPANTS: Four hundred eighty-three of 819 individuals randomly selected from the Finnish National Public Registry. Two thousand two hundred thirty-one individuals younger than 30 years who underwent tonsillectomy (888 patients), adenotonsillectomy (294 patients), or adenoidectomy (1049 patients) at Helsinki University Central Hospital from January 1, 1997, through December 31, 1998. MAIN OUTCOME MEASURES: Age of the individual at the time of operation. Indication for the operation. RESULTS: The frequency of adenoidectomies was 24% (116 persons) and that of tonsillectomies 8% (39 persons) among the 483 individuals who returned the questionnaire. The frequency of tonsillectomy operations by age was multimodal; the frequency of tonsillectomies increased in preschool-aged children, declined thereafter, and increased again in teenagers. Tonsillar hyperplasia was the most frequent among children younger than 10 years, peritonsillar abscesses among teenagers, and chronic tonsillitis among individuals older than 20 years. The proportion of females was higher than males among teenaged patients. However, the cause and sex distribution could not explain the multimodality in the age-specific frequency. The age-specific frequency of tonsillectomies performed because of peritonsillar abscesses still followed a multimodal distribution. CONCLUSIONS: Factors relating to respiratory tract infections, maturation of the immune system, and the onset of puberty contribute to the cause of tonsillar disease. Distinct indications for tonsillectomy should be defined for preschool-aged children, teenagers, and individuals older than 20 years.

Adenoidectomy↗