Population health. More than the sum of the parts?

The past decade has seen an upsurge of interest in the development of summary measures of population health. Almost invariably the measures have relied on "rolling up" individual level health data such as mortality data or life expectancy data. The approach, however, of treating population health as a synthesis of aggregated individual level data is a historical and statistical convenience. Although there has been some debate in the literature about whether one should also examine the equity of the distribution of health, the general practice has been to treat the level of a population's health and the distribution of health within a population as separate issues. Without recourse to contentious notions of equity, this paper examines the possibility of treating populations as more than simply the sum of their parts by combining individual level health data with population level data about the distribution of health. This approach may provide policy makers with additional ways of thinking about what it means to improve a population's health.     

Could U.S. hospitals go the way of U.S. airlines?

The market for hospital services, like global markets in general, is becoming more competitive. Increased price transparency and focused competition can squeeze out inefficiencies, restraining prices and making some consumers better off. But competition can have a dark side. U.S. hospitals can treat Medicare and Medicaid patients at less than cost, care for the uninsured, and provide other money-losing services because they can cross-subsidize. By 2025 the need for general hospitals to cross-subsidize will greatly in-crease, but their ability to do so will be diminished. U.S. hospitals could begin to resemble U.S. airlines: severely cutting costs, eliminating services, and suffering financial instability.     

Current status of the problem of poliomyelitis in the municipality of São Paulo. 1968

The problem of poliomyelitis in the county of S?o Paulo, Brazil, was studied from 1933 to 1967. It emphasizes the period of 1962 to 1967, when the author analizes the relation between the variation in the incidence of the disease and the mass vaccination campaigns with the live virus vaccine attenuated accomplished at that time. Based on the data presented he concludes that in 1967, when the morbidity rate by poliomyelitis was 0.6 for 100,000 inhabitantes, it was possible to get the control of that disease in the county of S?o Paulo.     

Clinical inquiries. What is the most effective management of acute fractures of the base of the fifth metatarsal?

For acute Jones' fractures in recreationally active patients, early intramedullary screw fixation results in lower failure rates and shorter times to both clinical union and return to sports than non-weightbearing short leg casting (strength of recommendation [SOR]: A, based on 2 randomized controlled trials [RCT]). Non-weightbearing short leg casting achieves union in 56% to 100% of patients but can require prolonged casting (SOR: B, based on 2 prospective cohorts and multiple retrospective, follow-up studies). Stress fractures were not included in this review. For avulsion fractures of the fifth metatarsal tuberosity, a soft Jones' dressing allows earlier return to pre-injury levels of activity than rigid short leg casting (SOR: B, based on a lower-quality RCT).     

History of the J.E. Purkynĕ Czech Medical Society

The author presents some basic data from the time of the foundation of the Czech Physicians Society (1862), the predecessor of the present Czech J. E. Purkyn? Medical Association. Its beginnings date back to the year 1949. The author mentions also data associated with the foundation of the present Society of Epidemiology and Microbiology of the Czech J. E. Purkyn? Medical Association.     

On the wrong side of the tracts? Evaluating the accuracy of geocoding in public health research.

OBJECTIVES: This study sought to determine the accuracy of geocoding for public health databases. METHODS: A test file of 70 addresses, 50 of which involved errors, was generated, and the file was geocoded to the census tract and block group levels by 4 commercial geocoding firms. Also, the "real world" accuracy of the best-performing firm was evaluated. RESULTS: Accuracy rates in regard to geocoding of the test file ranged from 44% (95% confidence interval [CI] = 32%, 56%) to 84% (95% CI = 73%, 92%). The geocoding firm identified as having the best accuracy rate correctly geocoded 96% of the addresses obtained from the public health databases. CONCLUSIONS: Public health studies involving geocoded databases should evaluate and report on methods used to verify accuracy.     

Have you M.E.T. the future of better patient safety?

Hospitals across the nation are organizing Medical Emergency Teams to respond rapidly to patients in crisis. Even this early in the trend, the evidence is clear: lives are saved.