Changes in mammography use: economic, need, and service factors.

OBJECTIVES. The purpose of this study was to document changes in mammography use between 1987 and 1990 and assess the relationship of use to selected economic, need, and health system factors. METHODS. Independent random-digit-dialed telephone surveys of women between 52 and 75 years of age were conducted. RESULTS. Between 1987 and 1990, the proportion of women who had had a mammogram in the past year increased from 31% to 51%. Though income was significantly related to overall patterns of use, it was not associated with recent mammogram use in 1990. Women with a family history of breast cancer reported greater use at both times, as did women who reported having a regular physician (particularly a gynecologist or internist). When all other variables were controlled for, women were over nine times more likely to have had multiple and recent mammograms in 1990 than in 1987. CONCLUSIONS. Mammography use dramatically increased between 1987 and 1990. There were strong relationships between the type of regular physician and mammography screening and between economic and personal history and repeated and recent mammography use.     

Race and mammography use in two North Carolina counties.

OBJECTIVES: This study investigated racial differences in mammography use and their association with physicians' recommendations and other factors. METHODS: The study used 1988 survey data for 948 women 50 years of age and older from the New Hanover Breast Cancer Screening Program. Racial differences in terms of physician recommendation, personal characteristics, health characteristics, and attitudes toward breast cancer and mammography were examined. Factors at least minimally associated with race and use were included in multivariate logistic regression analyses to examine the effect of race while controlling for other factors. RESULTS: In comparison with White women. Black women were half as likely to report ever having had a mammogram (27% vs 52%) and having a mammogram in the past year (17% vs 36%). Black women also significantly less often reported physician recommendation (25% vs 52%). Although Black and White women differed significantly in other characteristics, multivariate logistic regression analyses indicated that physician recommendation accounted for 60% to 75% of the initial racial differences in mammography use. CONCLUSIONS: Understanding physicians' recommendations for breast cancer screening is a critical first step to increasing mammography use in disadvantaged populations.     

Anthropometric indicators of breast cancer risk in postmenopausal women in Hawaii

As part of a case-control study of breast cancer in Hawaii, self-reported data on height, weight at various ages, breast size, shoe size, and triceps skinfold thickness were collected from 138 Japanese postmenopausal cases, 134 Caucasian postmenopausal cases, 154 Japanese neighborhood controls, and 142 Caucasian neighborhood controls. In a multiple covariance analysis, cases of both ethnic groups were slightly heavier (at all ages) and more obese (based on a weight-corrected-for-height index) than were controls, although none of the differences was statistically significant. Among the Japanese only, cases were also taller, had a greater body surface area (computed from the height and weight data), and had a larger shoe size than did the controls. The latter finding was statistically significant (p less than 0.05). Odds ratios were computed by multiple logistic regression analysis and revealed no additional relationships; however, there were suggested dose-response gradients for height, weight at age 20, and body surface area in the Japanese women and for breast size in the Caucasian women. A further analysis of risks based on changes in relative body weight between young adult life (age 20) and current age was also negative. Overall, these findings offer only weak support for an association between weight or obesity and breast cancer risk and suggest that anthropometric indices are at best very indirect indicators of true etiologic factors for breast cancer.     

甘肃省伤害住院患者疾病经济负担趋势性分析

目的 了解甘肃省伤害住院患者疾病经济负担的趋势性变化,为制定伤害的干预措施提供科学依据.方法 对甘肃省整群抽取的2所综合医院1994 - 2008年收治的13 227例伤害住院患者住院费用情况进行回顾性分析.结果 1994 - 2008年甘肃省伤害住院患者的平均住院天数为12.19 d,人均和日均住院费用分别为4 075.58和331.39元;相关分析结果表明,平均住院天数与年份呈负相关关系(rs=-0.88,P=0.00),人均和日均住院费用均与年份呈正相关关系(P ＜0.01);1994 -2008年伤害住院患者潜在工作损失年(WYPLL)为7 934.60人年,男性和女性分别为6 576.60和1 358.00人年;1994 - 2008年伤害住院患者人均潜在工作损失年(AWYPLL)为26.90人年,男性和女性分别为27.06和26.12人年,伤害住院患者WYPLL与年份呈正相关(rs=0.90,P=0.04);AWYPLL与年份无相关性(P＞0.05);伤害住院患者的人均间接经济损失从1994- 1996年的63 846.70元增长至2006 - 2008年的269587.80元,间接经济损失与年份呈显著正相关(rs=0.97,P=0.01).结论 甘肃省伤害住院患者经济负担呈逐年上升趋势.     

卫生部门社会效益和经济效益辩析

从经济学管理论和我国社会制度分析了邓小平提出“思想文化教育卫生部门，都要以社会效益为一切活动的唯一准则，它们所属的企业也要以社会效益为最高准则。”认为小平同志的提法具有严谨的科学性、准确性和深刻的政治含义，我们在工作中决不能违背这个理论原则。对卫生部门和物质生产部门的经济效益实现形式进行了科学的分析，卫生部门经济收益和经济效益是两个不同的概念，不能把收益当效益去追求。否则，就会把卫生机构引向邪路，这关系到经营管理的指导思想。只有树立正确的经营管理指导思想，才能正确贯彻执行邓小平理论原则。既是理论问题，又是实践问题     

A spatial analysis of social and economic determinants of tuberculosis in Brazil

We investigated the spatial distribution, and social and economic correlates, of tuberculosis in Brazil between 2002 and 2009 using municipality-level age/sex-standardized tuberculosis notification data. Rates were very strongly spatially autocorrelated, being notably high in urban areas on the eastern seaboard and in the west of the country. Non-spatial ecological regression analyses found higher rates associated with urbanicity, population density, poor economic conditions, household crowding, non-white population and worse health and healthcare indicators. These associations remained in spatial conditional autoregressive models, although the effect of poverty appeared partially confounded by urbanicity, race and spatial autocorrelation, and partially mediated by household crowding. Our analysis highlights both the multiple relationships between socioeconomic factors and tuberculosis in Brazil, and the importance of accounting for spatial factors in analysing socioeconomic determinants of tuberculosis.     

Cross-cultural issues in the use of socio-medical indicators.

Socio-medical indicators for the assessment of physical, psychological and social conditions have become increasingly popular as adjuncts to traditional clinical and epidemiological measures. Most such indicators have been developed in the U.S.A. or Great Britain and considerable problems may arise from attempts to use them in other cultures. The ambiguity inherent in the terms "health" and "illness" is compounded cross-culturally by differences in the meaning system of cultures, their values, expectations and historical development. Consideration of cultural differences must precede any attempt to adapt already existing instruments for use in a culture or within a sub-group whose members were not included in the development process. Reliability and validity of socio-medical measures can only be assumed after the closest attention has been paid to the technical, conceptual and linguistic issues which arise from translation. This paper details some of the issues involved together with an account of the practical problems arising from the translation of the Nottingham Health Profile into Arabic and Spanish.     

The use of mammography by survivors of breast cancer.

OBJECTIVES: Survivors of breast cancer are at high risk for development of a second breast cancer and are thus a group for whom annual mammography screening is recommended. However, survivors' use of mammography rarely has been examined. METHODS: We surveyed a representative population sample of survivors who lived in rural communities about their mammography use after cancer. RESULTS: Of these women, 30% had not received a mammogram in the preceding year. Predictors of mammography use included physician recommendation and whether the original cancer had been detected by mammography. CONCLUSIONS: Physicians should recommend mammography to survivors of breast cancer to ensure regular use.     

Using physician correspondence and postcard reminders to promote mammography use.

OBJECTIVES. In a health maintenance organization that mails letters to women recommending that they schedule mammograms, we conducted a randomized trial to evaluate simple methods of increasing the use of screening mammography. METHODS. Using a 2 x 2 factorial design, we tested the effects of (1) mailing the recommendation letter from each woman's primary care physician rather than from the program director and (2) sending a subsequent reminder postcard. RESULTS. Sending a reminder postcard nearly doubled the odds that women would get mammograms within 1 year (participate). The letter from the woman's personal physician had no effect. Attending a clinic more than 45 minutes from the screening center, being a current smoker, or being in fair or poor health were negatively associated with subsequently obtaining a mammogram. The odds of participation doubled if women had had previous mammograms. CONCLUSIONS. When preceded by written recommendations to schedule mammograms, reminder postcards effectively increased participation. Future randomized trials to promote use of screening mammography should compare interventions with a reminder condition.     

Health inequalities in Seville, Spain: use of indicators of social deprivation and mortality in small areas

OBJECTIVES: To analyse the spatial distribution of social structure and mortality in Seville, and to examine the association between various social indicators and mortality. METHODS: Small areas of the city were typified on the basis of four social indicators, which were used to derive a social index. Overall mortality and cause of death were studied in two age groups (1+years and 1-64 years). Pearson's correlation coefficient was used to examine the relationship between the social indicators and mortality. RESULTS: Significant social and mortality differences, particularly in premature mortality of males, were found between the areas studied. However, when the basic health zones are grouped together by social level, these differences in mortality are not so clear. The social indicators that correlate most closely with mortality are unemployment and illiteracy. When the social index is used, the correlations are weaker. Premature death from trauma in males presents the highest coefficient of correlation with unemployment and illiteracy. CONCLUSIONS: The social index used in the present study places less emphasis on material differences than those used by Townsend et al. and Carstairs and Morris. Also, it was not possible to study mortality by individual neighbourhoods in this study. Both factors could have influenced the finding that the correlations between both types of indicator are weaker with the social index than with unemployment and illiteracy.     

Measuring the use of mammography: two methods compared.

Population studies often estimate mammography use using women's self-reports. In one North Carolina county, we compared self-report surveys with a second method--counting mammograms per population--for 1987 and 1989. Estimates from self-reports (35% in 1987, 55% in 1989) were considerably higher than those from mammogram counts (20% in 1987, 36% in 1989). We then confirmed 66% of self-reports in the past year. Self-reported use is more accurate regarding whether a woman has had a mammogram than when she had it, but self-reports accurately measure change over time.     

Measuring resource use in economic evaluations: Determining the social costs of mental illness

Concern over costs associated with mental disorders has led to an increase in the number of economic evaluations of treatment interventions; unfortunately, methods for measuring resource use have not kept pace with this concern. Although it is well-known that a significant proportion of the costs associated with mental illness are for resources other than treatment, program evaluators and researchers often count only treatment costs in cost-effectiveness comparisons. Further, existing methods for measuring resource use are plagued by faulty assumptions about resource use, poor validity and reliability, and difficulties quantifying resource use. The authors discuss these problems and suggest five ways of improving measurement of nontreatment resources: clarifying assumptions, using multiple data sources, flexible data collection strategies, methods for improving the accuracy of recall, and an episodic approach to measurement. Preparation of this article was supported by grant #R01-MH47567 from the National Institute of Mental Health. An earlier version of this article was presented to the annual meeting of the American Psychiatric Association, May 5, 1992 in Washington, DC.     

Changes in socioeconomic determinants of health: comparing the effect of social and economic indicators through European welfare state regimes

Aim

This study is aimed at comparing the effect of different measures of socioeconomic status on self-rated health throughout European welfare state regimes during the period 2002–2008, in order to study how diverse socioeconomic inequalities can vary our health over time.

Subjects and methods

This study uses the European Social Survey to compare the impact of three specific socioeconomic measures (income, education and occupational status) on self-rated health.

Results

The main finding to be highlighted is that the importance of education-related inequalities surpasses differences in income and occupational status, especially in southern and eastern countries. The relationship between income and self-rated health is stronger in liberal and social-democratic regimes, where labour market regulation is characterized by its flexibility and high liberalization. The impact of occupational status is moderate among liberal, social-democratic and conservative regimes, but lower in southern and eastern ones.

Conclusion

These findings support the existence of a contextual effect among welfare states that varies the impact of social and economic indicators in self-rated health over time.     

A genetic analysis of clubfoot in Hawaii

The roles of major genes and multifactorial inheritance in the etiology of clubfoot (talipes equinovarus) were investigated based on 365 nuclear families consisting of three major racial groups of Hawaiians, Caucasians, and Orientals in Hawaii. Complex segregation analysis was employed using the mixed model with four parameters: major gene displacement (t), degree of dominance (d), gene frequency (q), and heritability (H). Heterogeneity was evident among the racial groups in the pattern of segregation of clubfoot. The most plausible genetic model is the presence of major gene effects with the multifactorial component for the Hawaiian and Caucasian groups, whereas no major gene action is evident for the Oriental group.