Program planning for family planning services

This exchange of opinions was occasioned by an article which appeared in the October 1969 Perspectives under the title Family Planning Services in the U.S.: a National Overview, 1968. Mr. Sieverts criticizes the article as follows. The ratio of unmet need claimed to available facilities is considered not properly stated in that all indigent girls and women from their midteens through their midforties do not need such services every year and that clinic services do not represent the total of such services available. Many have no such need. The private physician and hospital clinic provide much service. Development of new services should also consider demands, resources, and alternative solutions. Other health services must also be coordinated. Mr. Jaffe's defense follows. The stated need is an approximation by applying the Dryfoos-Pulgar-Varky (DPV) formula to the 1966 census figures. The need figure which results is about 5 million out of a total of over 8 million poor and near-poor women in the age group 15-44. This estimate is considered reasonably accurate. The number included but not in need is partially offset by some below the age of 18 who are also in need. Poor families have relatively less access to private physicians than others. This is shown by the number of women who deliver their babies on the ward service of hospitals without the presence of a private physician. Also, private physicians tend to give less attention to contraception for low income patients than do clinics. Many women depend on nonmedical and unreliable birth control measures. Family planning is not a one-time educational process. Revisits, continuing supervision, and check-up examinations are advocated particularly for IUD users and those taking pills. With current contraceptive technology adequate family planning services contemplates care extending for most of the patient's reproductive years. Resources require allocation. The study rests on the findings that the poor have a higher incidence of unwanted fertility than the nonpoor with significant adverse health and social consequences for both the individual and society. The study was a systematic attempt to achieve a national goal of providing modern family planning services to all who need and want them but cannot afford private care.     

Geriatric planning: planning for our elderly

The objective of this article is to persuade policy-makers that we can improve planning for our elderly. An alternative model is presented--The Geriatric Centre--with location based upon city neighbourhoods, suburban and rural communities, and having neighbourhood responsibility, accountability and a comprehensive service delivery.     

Survival analysis techniques

Statistical methods known as survival analyses are useful for analyzing time-related events, in which time from a benchmark event to an endpoint is the focus of interest. Survival analysis describes not only patient survival statistics (as suggested by the name), but also other dichotomous outcomes such as time of remission, time of breastfeeding, etc. This paper discusses survival analysis techniques, commenting and comparing their utilization, especially in the field of oncology. It also presents and discusses types of epidemiological studies and data sources to which this type of analysis is applied. The authors take into account the difference between hospital-based or clinical series and population-based approaches. Interpretation of results is also discussed.     

Aging and Survival

The aim of this thesis was to explore the influence of social, biobehavioural, and genetic factors on survival in old age.

Three large databases comprising Swedish elderly were analysed. Study I was performed on a nationwide random sample originally collected in 1954 by Statistics Sweden for a government commission on elderly affairs. It comprised non-institutionalised persons, 67 years and older. Study II and Study III were based on data prospective longitudinal population study of elderly in Göteborg, the H70-investigation. The analyses were performed mainly on a random sample of 70-year-old persons, which was compiled in 1971/1972. In Study IV, data on centenarians were collected from official publications from Statistics Sweden. Data oldest part of the Swedish Twin Registry was used in Study V. This registry was compiled in 1961 and includes like sexed twins born between 1886 and 1925 of which 10,505 twin pairs were included.

The common objective for all studies in this thesis is survival, expressed as length of life or as age at death.

The results show that there is no single factor nor is there a specific set of factors that can be identified as the best predictor of survival. Related variables can be systematised into higher level domains. As an alternative to the use of a set of specific variables for predicting survival/death, a number of risk domains can be utilised. Survival capacity is dependent on the shared influence of factors from various domains like health, cognition, mobility, lifestyle, activities, social networks, etc. Deficits in one domain can be compensated by great capacities in other domains. A good predictor of survival reflects the effects of a complex network of factors. A measure of lung capacity proved to possess this quality and was the single best variable to predict survival among all those variables included in these studies.

Among the centenarians an increased mortality rate was observed during the winter season. At these high ages the level of vigour is low and minor environmental stress will be enough to cause death.

The twin studies showed that about one third of the variance of longevity can be explained by genetic effects, and two thirds of the variance are due to environmental effects. The genetic effect seems to diminish in importance in old ages.     

Pandemic planning

During the previous century, three influenza A pandemics occurred with a variable severity. The two latter were explained by a genetic re-assortment and false alarms without pandemic spread were observed later by the same mechanism or by direct animal infection. The likelihood that such an event occurs again is high and each country has to be prepared for facing what could be a catastrophe. The last event in Hong Kong in 1997 where six persons died, has allowed refining the definitions and phasing a pandemic threat from the moment that a novel virus is discovered. WHO implemented 50 years ago a large network of surveillance with five collaborating centres, including the animal influenza centre of Memphis, and 110 national influenza centres. These centres are encouraged to prepare or improve a national contingency plan that could reduce importantly medical and socio-economic consequences of an influenza A pandemic. Countries or regions are recommended to use these guidelines that provide a framework for preparing an appropriate and proportionate response.