Risky behavior among Black Caribbean and Black African adolescents in England: How do they compare?

Objectives. Black Caribbean and Black African adolescents in England face academic and social challenges that might predisposition them to engaging in more risky behavior. This study explored the growth trajectories of risky behavior among adolescents in England over 3 years (14/15, 15/16, and 16/17 years of age) to determine the extent to which ethnic groups differed.

Design. Data were taken from the Longitudinal Study of Young People in England database (N = 15,770). This database contained eight different ethnic groups. Risky behavior was defined by an 8-item scale that represented three classes of risky behavior. Individual theta scores for risky behavior were calculated for individuals at each time point and modeled over time. Interaction terms between sex, year, ethnicity, and class were also examined.

Results. Findings confirmed previous research that showed ethnic group differences in means. They also demonstrated that there are differences in slopes as well, even after controlling for class. In fact, class appeared to have a reverse effect on the risky behavior of black adolescents. Further, Black adolescent groups were not engaging in higher levels of risky behavior as compared to white adolescents (the dominant population). In actuality, Mixed adolescents engaged in the highest levels of risky behavior which was a notable finding given that the Mixed group has recently began to receive a more focused attention by scholars and the government of England.

Conclusion. It is important that social workers and policy-makers recognize ethnicity in making general preventative decisions for adolescents. Second, class does not have a common effect on adolescent problem behaviors as often believed. Finally, black adolescents’ communities might contain important protective factors that ought to be extensively explored. Conversely, Mixed adolescents’ communities might contain more risk factors that ought to be addressed.     

Shrinking areas and mortality: an artefact of deprivation effects?

There is evidence that mortality rates are highest in areas that are experiencing population decline, and researchers have recommended that this should be accounted for in health resource allocation. This research finds a significant negative association between population change and mortality for small areas in Scotland, which remains when low social class is accounted for. However, this relation disappears when the area deprivation is accounted for. It is suggested that it is more important to account for deprivation than population change in health resource allocation.     

How do Medicare physician fees compare with private payers?

Under the new fee schedule, Medicare physician fees are 76 percent of private fees. Consistent with the intent of payment reform, Medicare physician fees more closely approximate private fees for visits (93 percent) than for surgery (51 percent) and in rural areas as compared with large metropolitan areas. Variation in private fees across the country is considerably greater than it is for Medicare fees. Consequently, Medicare fees are most generous in areas that compare least favorably with the private market because private fees in these areas are well above average. These results shed light on the impact of the fee schedule and on the implications of using Medicare payment methods as part of a broad-based health reform.     

Health care delivery systems for older adults: How do the Netherlands and Lebanon compare?

Older individuals are given low priority compared to other age groups in many societies and geriatric care is not well-developed in many countries. With the global trend in population aging, the increasing number of older adults can be expected to challenge already-fragile health care facilities. Health care systems vary greatly from one country to another. Based on common research interests and through an educational exchange program between the University of Groningen (the Netherlands) and the American University of Beirut (Lebanon), a project was started to compare the Dutch and Lebanese health care delivery systems for older individuals, demonstrate their strengths and pitfalls, and draw from their resemblance and differences pivotal conclusions leading to positive change. In particular we examined the nursing homes, geriatric medicine and insurance coverage, and pension plans of both countries.     

Shrinking areas and mortality: An artefact of deprivation effects in the West of Scotland?

A number of studies have shown that mortality rates are highest in areas that are experiencing population decline. A recent study suggests that this relationship disappears when area deprivation is accounted for. We extend this research to consider the relationship between population change and mortality in five Health Boards in the West of Scotland-a region with some of the worst mortality rates in Europe. For the area as a whole and all five Health Boards separately, we find a significant negative association between population change and mortality, but in each case this relationship disappears when small area deprivation is accounted for. This confirms our previous conclusion that it is more important to account for deprivation than population decline in health resource allocation.     

Income inequality and old-age mortality in Sweden: do regional development and lagged effect matter?

We designed a retrospective cohort study for exploring the impact of municipality-level income inequality, based on the Gini 1986, 2004 indices, on all-cause old-age mortality among the older Swedish population during 2005–2009. We controlled for the confounding effects of individual and regional correlates and the lag effects of inequality by using multilevel logistic regression. The effects of income inequality were not consistent across age cohorts and, among the youngest cohorts, were negligible. This study reiterates that individual-level economics rather than the immediate or lagged effects of income inequality matter more for old-age mortality, even after controlling for individual and regional factors.     

Sharing of clinical data in a maternity setting: How do paper hand-held records and electronic health records compare for completeness?

Background

Historically, the paper hand-held record (PHR) has been used for sharing information between hospital clinicians, general practitioners and pregnant women in a maternity shared-care environment. Recently in alignment with a National e-health agenda, an electronic health record (EHR) was introduced at an Australian tertiary maternity service to replace the PHR for collection and transfer of data. The aim of this study was to examine and compare the completeness of clinical data collected in a PHR and an EHR.

Methods

We undertook a comparative cohort design study to determine differences in completeness between data collected from maternity records in two phases. Phase 1 data were collected from the PHR and Phase 2 data from the EHR. Records were compared for completeness of best practice variables collected The primary outcome was the presence of best practice variables and the secondary outcomes were the differences in individual variables between the records.

Results

Ninety-four percent of paper medical charts were available in Phase 1 and 100% of records from an obstetric database in Phase 2. No PHR or EHR had a complete dataset of best practice variables. The variables with significant improvement in completeness of data documented in the EHR, compared with the PHR, were urine culture, glucose tolerance test, nuchal screening, morphology scans, folic acid advice, tobacco smoking, illicit drug assessment and domestic violence assessment (p?=?0.001). Additionally the documentation of immunisations (pertussis, hepatitis B, varicella, fluvax) were markedly improved in the EHR (p?=?0.001). The variables of blood pressure, proteinuria, blood group, antibody, rubella and syphilis status, showed no significant differences in completeness of recording.

Conclusion

This is the first paper to report on the comparison of clinical data collected on a PHR and EHR in a maternity shared-care setting. The use of an EHR demonstrated significant improvements to the collection of best practice variables. Additionally, the data in an EHR were more available to relevant clinical staff with the appropriate log-in and more easily retrieved than from the PHR. This study contributes to an under-researched area of determining data quality collected in patient records.

     

Nowhere to play? The relationship between the location of outdoor play areas and deprivation in Glasgow

Childhood obesity is rising and this rise has been linked to a decrease in physical activity. Access to appropriate facilities for physical activity is a key determinant of participation. This paper investigates the provision of outdoor play areas for children in relation to area deprivation in Glasgow, Scotland. Analysis of the distribution of outdoor play areas showed significantly higher mean number of play areas per 1000 child population in more deprived areas. However, despite the apparent advantage of deprived areas in terms of actual number of play areas, the quality of play areas in different types of areas may warrant further exploration.     

How do trends in smoking prevalence among Indigenous and non‐Indigenous Australian secondary students between 1996 and 2005 compare?

Objective: To compare trends in smoking prevalence between 1996 and 2005 among Indigenous and non-Indigenous secondary students across Australia.
Methods: Representative random samples of secondary students aged 12-17 years completed self-report anonymous surveys. Questionnaires assessed any cigarette smoking in lifetime, and smoking in past month, week and on at least three of the previous seven days. Intention to smoke in the next 12 months was assessed on a 7-point scale. Students self-identified as being of Aboriginal or Torres Strait Islander descent.
Results: Three to four per cent of students identified as being Indigenous at each survey. Smoking was more common among Indigenous than non-Indigenous students. Between 1996 and 2005, the proportion of smoking declined among both Indigenous and non-Indigenous students. However, among 12-15 year olds, the rate of decline was different for the two groups. Among non-Indigenous students in this age group, prevalence decreased steadily between 1996 and 2005. Among Indigenous students, the decrease mainly occurred between 1999 and 2002. Smoking intention was higher for Indigenous than non-Indigenous students. The mean intention decreased between 1996 and 2005 among both student groups.
Conclusions: Smoking prevalence decreased among both Indigenous and non-Indigenous students between 1996 and 2005.
Implications: Reductions in Indigenous students' tobacco use and intentions coincided with a period of increased tobacco control activity, suggesting that these activities may positively influence smoking behaviours.     

Dying younger in Scotland: Trends in mortality and deprivation relative to England and Wales, 1981–2011

Given previous evidence that not all Scotland's higher mortality compared to England & Wales (E&W) can be explained by deprivation, the aim was to enhance understanding of this excess by analysing changes in deprivation and mortality in Scotland and E&W between 1981 and 2011. Mortality was compared by means of direct standardisation and log-linear Poisson regression models, adjusting for age, sex and deprivation. Different measures of deprivation were employed, calculated at different spatial scales. Results show that Scotland became less deprived compared to E&W between 1981 and 2011. However, the Scottish excess (the difference in mortality rates relative to E&W after adjustment for deprivation) increased from 4% higher (c.1981) to 10% higher in 2010–12. The latter figure equates to c. 5000 extra deaths per year. The increase was driven by higher mortality from cancer, suicide, alcohol related causes and drugs-related poisonings. The size and increase in Scottish excess mortality are major concerns. Investigations into its underlying causes continue, the findings of which will be relevant to other populations, given that similar excesses have been observed elsewhere in Britain.     

Physician assistants in occupational medicine: how do they compare to occupational physicians?

BACKGROUND: Physician assistants (PAs) have been present in occupational and environmental medicine (OEM) in the USA since 1971, yet remarkably little is known about their activity. METHODS: An administrative study of PA activities was undertaken and compared with the activities of physicians in the same occupational medicine setting. Patients were not triaged to either provider and all resources of care were recorded for the visit. An episode of care approach was used for the analysis. RESULTS: The characteristics of patients seen by each provider were similar in age, gender ratio and severity of injury. Physicians saw a mean of 2.9 patients/h and PAs 2.5, but PAs worked more hours and saw more patients per year than physicians. The average charge per patient visit and total charge for an episode of care were similar. Differences between PAs and physicians were seen in the areas of 'limited duty' duration given to patients and on average PAs prescribed 15 days and physicians 17 days. PAs referred a patient 19.7% of the time, while physicians referred 17.4%. Most of the referrals were to physical therapy. The salary of a physician, based on an hourly rate, was approximately twice as much as a PA. CONCLUSION: The use of PAs in OEM may represent a cost-effective advantage from an administrative standpoint. Clearly, more research is necessary in determining the role and utilization of PAs in OEM and how they may improve the delivery of physician services.     

Which is the best deprivation predictor of foetal and infant mortality rates?

This study investigates which, if any, population-based indicator of deprivation best predicts foetal and infant mortality rates in England. For the year 1995, the deprivation levels of 364 English Local Authorities were compared; using the three commonly used indicators, Jarman score, Townsend score and percentage unemployed. The predictive value of these for stillbirth, neonatal and infant mortality rates was then calculated. The three deprivation indicators were highly inter-correlated (r=0.866-0.924). For each mortality rate, the correlation with deprivation did not differ significantly for the three indicators of deprivation. We conclude, when comparing these outcomes in different areas of England, that any of the three deprivation indicators may be used to adjust for deprivation.     

How does the quality of care compare in five countries?

International data on quality of medical care allow countries to compare their performance to that of other countries. The Commonwealth Fund International Working Group on Quality Indicators collected data on twenty-one indicators that reflect medical care in Australia, Canada, New Zealand, England, and the United States. The indicators include five-year cancer relative survival rates, thirty-day case-fatality rates after acute myocardial infarction and stroke, breast cancer screening rates, and asthma mortality rates. No country scores consistently the best or worst overall. Each country has at least one area of care where it could learn from international experiences and one area where its experiences could teach others.     

Disparities in infant mortality: what's genetics got to do with it?

Since 1950, dramatic advances in human genetics have occurred, racial disparities in infant mortality have widened, and the United States' international ranking in infant mortality has deteriorated. The quest for a "preterm birth gene" to explain racial differences is now under way. Scores of papers linking polymorphisms to preterm birth have appeared in the past few years. Is this strategy likely to reduce racial disparities? We reviewed broad epidemiological patterns that call this approach into question. Overall patterns of racial disparities in mortality and secular changes in rates of prematurity as well as birth-weight patterns in infants of African immigrant populations contradict the genetic theory of race and point toward social mechanisms. We postulate that a causal link to class disparities in health exists.     

The gender gap in mortality: How much is explained by behavior?

In developed countries, women are expected to live about 4–5 years longer than men. In this paper, we develop a novel approach to gauge the extent to which gender differences in longevity can be attributed to gender-specific preferences and health behavior. We set up a physiologically founded model of health deficit accumulation and calibrate it using recent insights from gerontology. From fitting life cycle health expenditure and life expectancy, we obtain estimates of the gender-specific preference parameters. We then perform the counterfactual experiment of endowing women with the preferences of men. In our benchmark scenario, this reduces the gender gap in life expectancy from 4.6 to 1.4 years. When we add gender-specific preferences for unhealthy consumption, the model can motivate up to 89 percent of the gender gap. Our theory offers also an economic explanation for why the gender gap declines with rising income.