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PubMed1998

Creative payment strategy helps ensure a future for teaching hospitals.

The Colorado Medicaid Program in years past relied on disproportionate share hospital (DSH) payment programs to increase access to hospital care for Colorado citizens, ensure the future financial viability of key safety-net hospitals, and partially offset the state's cost of funding the Medicaid program. The options to finance Medicaid care using DSH payments, however, recently have been severely limited by legislative and regulatory changes. Between 1991 and 1997, a creative Medicaid refinancing strategy called the major teaching hospital (MTH) payment program enabled $131 million in net payments to be distributed to the two major teaching hospitals in Colorado to provide enhanced funding related to their teaching programs and to address the ever-expanding healthcare needs of their low-income patients. This new Medicaid payment mechanism brought the state $69.5 million in Federal funding that otherwise would not have been received.

Colorado↗
PubMedDate not supplied

Statistical approach for risk assessment of aflatoxin sampling plan used by manufacturers for raw shelled peanuts.

Processed food manufacturers often use acceptance sampling plans to screen out lots with unacceptable levels of contamination from incoming raw material streams. Sampling plan designs are determined by specifying sample sizes, sample preparation methods, analytical test methods, and accept/reject criteria. Sampling plan performance can be indicated by plotting acceptance probability versus contamination level as an operating characteristic (OC) curve. In practice, actual plan performance depends on the level of contamination in the incoming lot stream. This level can vary considerably over time, among different crop varieties, and among locales. To better gauge plan performance, a method of coupling an OC curve and crop distributions is proposed. The method provides a precise probabilistic statement about risk and can be easily performed with commercial spreadsheet software.

Aflatoxins↗
PubMed1975

Evaluation of a hospital controlled substances distribution system.

The distribution and control system for controlled drugs at a 500-bed hospital was evaluated. The time requirements of the system for pharmacy and nursing, the drug control procedures used, and the income and expenses of the system were evaluated. It was concluded that the system appears to offer full accountability, but it makes a heavy time demand on pharmacy and nursing. Time requirements could be reduced through a computerized system or by use of a certificate of disposition form that incorporates a charge voucher.

Barbiturates↗
PubMed1996

Alcohol consumption and community hospital admissions in the United States: a dynamic regression analysis, 1950-1992.

The annual time-series analysis examines the impact of changes in per capita alcohol consumption (NIAAA,AEDS) on changes in community hospital admission rates (AHA) in the United States from 1950 to 1992 (n = 43). Increases in per capita alcohol consumption were expected to increase hospital admission rates contemporaneously and several years thereafter following an exponential risk function. Distributed lag models based on differenced data controlling for changes in: (1) per capita cigarette consumption; (2) private hospital insurance coverage; (3) the drinking age population; (4) per capita disposable personal income; and (5) health care regulatory interventions show a contemporaneous effect of per capita alcohol consumption on hospital admission rates. The time-series analyses imply that between 22-26% of US community hospital admissions are alcohol related. A comparable analysis indicates that per capita alcohol and tobacco expenditures contribute to approximately 28% of US community hospital admissions. The absence of statistically significant lagged effects is inconsistent with an exponentially declining risk functions. However, the contemporaneous effects of per capita alcohol and tobacco consumption suggest that a reduction in smoking and drinking will produce quick reductions in morbidity and hospitalizations.

Alcohol Drinking↗
PubMed2004

National and regional prevalence of self-reported epilepsy in Canada.

PURPOSE: To assess the point prevalence of self-described epilepsy in the general population nationally, provincially, and in different groups of interest. METHODS: We analyzed data from two national health surveys, the National Population Health Survey (NPHS, N=49,000) and the Community Health Survey (CHS, N=130,882). Both surveys captured sociodemographic information, as well as age, sex, education, ethnicity, household income, and labor force status of participants. Epilepsy was ascertained with only one question in both surveys. "Do you have epilepsy diagnosed by a health professional?" (NPHS) and "Do you have epilepsy?" (CHS). Prevalences were age-adjusted by using national standard populations at the time of each survey. Exact 95% confidence intervals were obtained. RESULTS: In the NPHS, 241 of 49,026 subjects described themselves as having been diagnosed with epilepsy, yielding a weighted point prevalence of 5.2 per 1,000 [95% confidence interval (CI), 4.9-5.4]. In the CHS, 835 of 130,822 subjects described themselves as having epilepsy, yielding a weighted point prevalence of 5.6 per 1,000 (95% CI, 5.1-6.0). Trends in differences in prevalence among some Canadian provinces were observed. Prevalence was statistically significantly higher in groups with the lowest educational level, lowest income, and in those unemployed in the previous year. Prevalence also was higher in nonimmigrants than in immigrants. CONCLUSIONS: The overall and group-specific results are in keeping with those obtained in other developed countries by using different ascertainment methods. We discuss methodologic aspects related to the ascertainment of epilepsy in both surveys, and to the validity and implications of our findings.

Adolescent↗
PubMed2001

A low socio-economic status is an additional risk factor for glucose intolerance in high risk Hong Kong Chinese.

To examine whether a low socio-economic status (SES) is an additional risk factor for glucose intolerance in Hong Kong Chinese with known risk factors for glucose intolerance, a total of 2847 Chinese subjects (473 men and 2374 women) were recruited from the community for assessment. They had known risk factors for glucose intolerance including a previous history of gestational diabetes, positive family history of diabetes in first degree relatives and equivocal fasting plasma glucose concentrations between 7 and 8 mmol/l or random plasma glucose concentrations between 8 and 11 mmol/l. The 2847 subjects were classified according to their education levels and occupations: education group 1 = high school or university, group 2 = middle school, group 3 = illiterate or up to elementary school; occupational group 1 = professional or managerial, group 2 = non-manual, group 3 = manual, group 4 = unskilled, group 5 = housewife or unemployed. Different socio-economic groups were well represented in this selected population. The distribution of educational groups in this study was similar to that recorded in the 1991 Hong Kong Census. When analysed according to education levels and after adjustment for age, women in the lowest social class had the highest prevalence of diabetes, body mass index, blood pressure and plasma glucose concentrations. Men with the lowest education level had the highest prevalence of diabetes after age adjustment. The age-adjusted odds ratio (95% confidence intervals) of having diabetes was 2.3 (1.3. 4.3) in female subjects and 2.5 (1.2, 5.4) in male subjects with the lowest SES compared to subjects with the highest SES. When categorised according to occupation and after adjustment for age, women in the lowest social class had the highest prevalence of diabetes and glycaemic indexes. The age-adjusted odds ratio of having diabetes was 4.5 (1.9, 10.9) in female subjects with the lowest SES compared to those with the highest SES. The corresponding age-adjusted odds ratio in male subjects was 1.9 (0.9, 3.9) but this was not statistically significant. In conclusion, a lower socio-economic class, categorised either by occupational or educational level, was an additional risk factor for diabetes in Hong Kong Chinese who had known risk factors for glucose intolerance. These subjects should have increased priority for health education and regular diabetes screening. Our findings further emphasise the complex relationships between societal affluence, personal income and educational level.

Adult↗
PubMed2000

Smoke signs: patterns of tobacco billboard advertising in a metropolitan region.

OBJECTIVE: To use geographic information systems data and analyses to describe locations and characteristics of tobacco billboards in a large metropolitan area, and to assess the extent to which tobacco companies are locating billboards in close proximity to minority neighbourhoods and schools. DESIGN: Observational study of billboards in a large metropolitan region. SETTING: City and county of St Louis, Missouri. PARTICIPANTS: All stationary billboards in the city and county of St Louis were eligible to be observed, with the exception of bus stop and street side retail advertising signs (for example, cigarette advertising at gas stations). A total of 1239 non-blank billboards were observed. All data were collected in early 1998. MAIN OUTCOME MEASURES: Tobacco and non-tobacco billboard geographic distribution; billboard type and product brand frequencies; and billboard neighbourhood characteristics. RESULTS: Almost 20% of the billboards contained tobacco advertising. Four of the top five and nine of the top 22 brands displayed on billboards were tobacco products. Billboards were located in all areas of St Louis except for the communities with the highest average incomes. Tobacco billboards were more likely to be found in low income areas and areas with a higher percentage of African Americans. Images of African American figures on tobacco billboards were concentrated in the most heavily African American populated regions of the city. Approximately 74% of all billboards in the city of St Louis were within 2000 feet (700 metres) of public school property. CONCLUSIONS: Tobacco products were the single most heavily advertised type of product on billboards in St Louis. The geographic distribution of tobacco billboards, as well as the types of images found on these billboards, is consistent with the hypothesis that tobacco companies are targeting poor and minority communities with their advertising. Methods employing geographic information systems are a powerful technique for examining outdoor tobacco advertising.

Advertising↗
PubMed1979

The resilience of British household diets during the 1970s.

The 1979s saw rapid increases in prices, including food prices, but incomes also increased rapidly. Many other factors, such as the growth in home-freezer ownership, could also have affected dietary habits. Yet the National Food Survey shows that although less food is now bought for use in the home (9.5 MJ/person/day compared with 10.7 MJ in 1970), the overall distribution of the diet between meat, fish, dairy products, cereals, sugar, fats, fruit and vegetables remained comparatively steady. Greater changes in consumption of foods within the same broad groups had little effect on overall nutrient intakes, so that the nutritional quality of the diet (measured as nutrients/MJ) actually increased.

Economics↗
PubMed2002

[Are the "elderly" living at the expense of the "young"? Remarks on the burden distribution between "generations" in an aging population from the economic perspective].

Public and scientific discussion on the effects of an aging population is often biased: aging is primarily seen as an economic burden. Increasing contribution rates in pension schemes, health and long-term care insurance are highlighted. This paper tries to provide a more balanced view. The distinction between a cross-sectional and a longitudinal view already gives different information on distributional effects. Labeling older people as "economically inactive" is a much too narrow perspective focused on the activity on the labor market only. Other types of work are neglected such as caring for children or frail elderly as well as economic activities from wealth, consumption as well as paying taxes to finance public expenditure. The approach of "generational accounting" is also narrow, focusing on public expenditure, social insurance contributions and only some types of taxes, but not dealing with private, especially intrafamily transfers. In economic terms, a comprehensive approach is needed regarding the effect of institutions and measures on the economic situation of cohorts. The role of investment in human capital is mentioned as a decisive factor for productivity in a country. Further education and retraining of older workers is one important element. An integrative approach dealing with the different fields of activities is needed when analyzing the intergenerational as well as the intragenerational distribution. This requires an elaborated and differentiated reporting of distributional effects. This important precondition, however, does not exist in Germany.

Aged↗
PubMedDate not supplied

Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.

This article describes the risks and protective factors for symptoms of depression in pregnancy among low-income African American and Caucasian women. Data were collected from 130 women who were between 16 and 28 weeks' gestation and enrolled in an urban prenatal clinic. The questionnaires used in the face-to-face interviews consisted of sociodemographic items, the Beck Depression Inventory (BDI-II), the Prenatal Psychosocial Profile (PPP), 3 items from the Jarel Spiritual Well-Being Scale, the Spiritual Perspective Scale, and 4 items on health risk behaviors. Twenty-seven percent of the women reported depressive symptoms at levels indicating risk for clinical depression. However, there were no significant differences between African American and Caucasian women. Sociodemographic factors accounted for 13% of the variance (P < .01) in BDI-II scores. Psychosocial and behavioral risk factors accounted for an additional 19% of the BDI-II variance (P < .001), and psychosocial and spiritual resources accounted for 7% of the variance (P < .001), resulting in these variables accounting for 54% of the total variance in BDI-II scores. Higher levels of stress, lower levels of self-esteem and social support, and higher religiosity had a significant relationship with more symptoms of depression. This supports the need to routinely screen for and to assess factors associated with depressive symptoms in pregnant low-income women.

Adolescent↗
PubMed2004

Design and testing of an interactive smoking cessation intervention for inner-city women.

The purpose of this study was to design and test the usability of a computer-mediated smoking cessation program for inner-city women. Design and content were developed consistent with principles of user-centered design. Formative and summative evaluation strategies were utilized in its testing. The summative evaluation was designed to test usability in a naturalistic environment. A sample of 100 women who receive care at an inner-city community health center participated in the study. Average time for completing the computer program was 13.9 minutes. Participants reported a high level of satisfaction with usability of the program. Standardized instruments to measure cognitive processes of change related to smoking were completed at baseline and at 1 week. Participants reported a decrease in favorable attitudes toward smoking (P=0.014) and an increase in cognitive change processes at follow-up (P=0.037). These results indicate that interactive computer technology is acceptable to, and potentially useful for, promoting smoking cessation in low-income women.

Adult↗
PubMed2004

Dental pain prevalence and association with dental caries and socioeconomic status in schoolchildren, Southern Brazil, 2002.

The objective of this study was to assess the relation between dental pain, dental caries and socioeconomic status among 12- and 13-year-old schoolchildren enrolled in a public school in Florianópolis, SC, Brazil in 2002. This study was a cross-sectional study involving 181 schoolchildren. Dental pain experience was the dependend variable analyzed. Socioeconomic data of the children's families were obtained through a questionnaire. Dental caries experience was registered according to the DMFT index (WHO, 1997). The field workteam consisted of an examiner and a recorder. The statistical analysis was performed using the chi-square test and the non-conditional multiple logistic regression. The response rate was 93.4%. The intraexaminer agreement measured on a tooth by tooth basis was high (kappa > 0.73). Dental pain prevalence was 33.7% (CI95% 26.0-42.0). The multiple regression analysis, adjusted by sex and other variables, showed that children with DMFT > 1 presented 2.9 (OR CI95% 1.4-6.1, p < 0.01) more chances of having dental pain when compared with those with DMFT < or = 1. Children whose mother's schooling level was equal or less than 4 years presented 2.5 (OR CI95% 1.2-5.6, p = 0.02) more chances of having dental pain when compared with others whose mothers had more than 5 years of schooling and, finally, children whose family income was up to U$ 67.00 showed 3.2 (OR CI95% 1.2-8.4, p = 0.02) more chances of having dental pain when compared with the ones whose families had higher income. High levels of caries attack, low mother schooling level and low family income were associated to dental pain.

Adolescent↗
PubMed2003

Elements in the hair of non-mining workers of a lignite open mine in Neyveli.

Trace elements are analyzed in the human scalp hair to assess the extent of body burden of pollution. The levels of seven elements (Cd, Cr, Cu, Mn, Ni, Pb and Zn) were determined in the hair of fishermen from Pondicherry, students and businessmen from Madras and non-mining workers from Neyveli lignite open mine. When compared between them, significantly high concentrations of Cd in the non-mining workers from Neyveli and Pb in both the students and businessmen from Madras were observed, thereby indicating environmental source of Cd and Pb pollution. The low Zn level was observed in the fishermen indicating their low nutritional source. In addition to the different residential areas, age, diet, smoking habit and family income of subjects are other factors influencing the concentrations of elements in the hair.

Adolescent↗
PubMed1993

Oral health status and treatment needs of non-institutionalized persons aged 60+ in Adelaide, South Australia.

There has been a growing recognition of the need to obtain information about the oral health of older Australians. The aim of this report is to provide descriptive epidemiological information about the oral health and treatment needs of non-institutionalized older adults in Adelaide. Data from interviews with 178 persons aged 60+ were obtained from a pilot study. Clinical data were available for 106 persons who participated in oral examinations. Among the 52.9 per cent of dentate persons, the prevalence of root decay (27.1 per cent) was slightly higher than coronal decay (23.6 per cent). Some 28.1 per cent of dentate persons had a serious periodontal condition, defined as the presence of four or more teeth with at least 5 mm or more of periodontal attachment loss and periodontal pocketing of 4 mm or more at one or more of those teeth. The majority of persons (83.8 per cent) wore one or two dentures. Disorders associated with dentures were frequent, affecting 77.4 per cent of upper denture wearers and 72.5 per cent of lower denture wearers. Persons who were older, who had lower educational attainment or lower household incomes were disadvantaged in aspects of oral health status and dental caries. However, there were no consistent associations between chronic medical conditions and oral disorders. Despite the high prevalence of oral impairment, reflecting extensive disease activity in the past, high levels of untreated disease were relatively uncommon. Instead, a high prevalence of oral disorders created a substantial need for basic forms of dental treatment in this group.

Aged↗
PubMed1984

Population age structure and the size of social security.

"This paper uses a general overlapping generations model to analyze social security. Rather than focusing on intertemporal price and income considerations, however, the paper focuses on the effect of contemporaneous (same period) prices and income. The analysis shows that the old-age dependency ratio acts as a shadow price for old-age benefits. With this new shadow price, the equilibrium price and quantity of social security benefits and the level of the payroll tax rate are determined in a demand-supply framework with individual utility maximization. Three explicit demand functions (intergenerational contracts) are analyzed. The model is tested using [U.S.] time series data for the social security Old-Age and Survivors (OASI) program."

Adult↗
PubMed2000

Factors of patient satisfaction/dissatisfaction in a dental faculty outpatient clinic in Turkey.

OBJECTIVES: Being service providers, dental professionals should satisfy their consumers/dental patients. This study investigates satisfaction with dental care among the patients of a dental faculty outpatient clinic of a major university in Izmir, Turkey. METHOD: The study was performed on 1001 patients of whom 674 filled out the questionnaire containing sociodemographic items and open-ended questions to determine the factors of (dis)satisfaction. The open-ended questions were content analyzed, and each patient was scored according to his comments: "complaining: (0)", "both praising and complaining: (1)", "no comment: (2)", and "praising: (3)". Each factor that has an impact on the decision of the study sample was determined by statistical analyses of data, using student t-test, chi-square test, and multiple regression analysis. RESULTS: Most of the patients were highly educated (74.7%), had a high income (48.7%), and were young to middle-aged (73.1%). There was a well-balanced gender representation. The patient sample had sought care mostly for dental caries, periodontal diseases, problems with old restorations, and prosthetic rehabilitation. Of 1,001 patients, 38.6% were satisfied with the dental care they received, 23.8% were both satisfied and dissatisfied, 5% were dissatisfied, and 32.7% failed to comment. No significant differences were observed between the satisfaction/dissatisfaction scores and sociodemographic variables of the patients in the groups (P>0.05). The most important components of satisfaction were found to be "relationship between dentists and patients" (P<0.001), "organized service system" (P<0.001), and "scientific ability of dental personnel" (P<0.001). The most prominent complaints were "long treatment span" (P<0.001), "disorganized service system" (P<0.001), and "slowness of radiographical examination procedures" (P<0.001). CONCLUSIONS: Despite the significant variations among the cultural and ethnic structures of different societies, personal interactions have priority in establishing satisfying dental service.

Adolescent↗
PubMedDate not supplied

Social and demographic characteristics influencing adoption of female sterilisation.

This paper analyzes the relationship between the adoption of female sterilization and 3 social and modernization variables (education, income, and family type) and 2 demographic variables (number of living children and years of marriage) for a sample of 200. The influence of each of these 5 variables on female sterilization is studied by the percentage distribution method and the variance test. The data are analyzed by using the urban-rural and adopter-nonadopter classification. Results show that the social and modernization variables do not seem to influence the adoption of female sterilization among urban or rural households, but the demographic variables--number of living children and years of marriage--do seem to have a clear influence. Among rural households there are differences in these variables between adopters and nonadopters of female sterilization. There is a policy implication here: the government has to advocate the 2 child norm to all eligible couples in the early years of marriage and advise them to adopt sterilization after the birth of the 2nd child. This will go a long way in achieving the national target of the replacement level of reproduction by the year 2000.

Asia↗