The DYNAMO-HIA Model: An Efficient Implementation of a Risk Factor/Chronic Disease Markov Model for Use in Health Impact Assessment (HIA)

In Health Impact Assessment (HIA), or priority-setting for health policy, effects of risk factors (exposures) on health need to be modeled, such as with a Markov model, in which exposure influences mortality and disease incidence rates. Because many risk factors are related to a variety of chronic diseases, these Markov models potentially contain a large number of states (risk factor and disease combinations), providing a challenge both technically (keeping down execution time and memory use) and practically (estimating the model parameters and retaining transparency). To meet this challenge, we propose an approach that combines micro-simulation of the exposure information with macro-simulation of the diseases and survival. This approach allows users to simulate exposure in detail while avoiding the need for large simulated populations because of the relative rareness of chronic disease events. Further efficiency is gained by splitting the disease state space into smaller spaces, each of which contains a cluster of diseases that is independent of the other clusters. The challenge of feasible input data requirements is met by including parameter calculation routines, which use marginal population data to estimate the transitions between states. As an illustration, we present the recently developed model DYNAMO-HIA (DYNAMIC MODEL for Health Impact Assessment) that implements this approach.     

Reduced-hours careers in medicine: A strategy for the professional community and the family

This paper discusses the part-time professional career option, a career alternative thought to promote work-family integration, and asks whether this alternative would increase responsiveness to fluctuations in the demand for professionals. For illustrative purposes, we focus on the current oversupply of physicians in the United States, and discuss: (a) existing strategies to reduce this supply; (b) how current full-time schedules restrict professionals' ability to successfully combine work and family; and (c) the potential consequences of promoting part-time careers for the professional community and for families. Este papel describe la opcion de la carrera profesional tiempo medio, una carrera alternativa que se supone provee la integracion de trabajo y familia y hace la pregunta si esta alternativa aumentaria respuestas a altas y bajas en la demanda de profesionales. Para ilustrar, enfocamos en la actual sobre fuente de medicos en los Estados Unidos y discutimos: (a) estrategias existentes para reducir esta fuente; (b) como horarios de tiempo completo existentes resrictan a profesionales que equivale a la abilidad de positivamente combinar el trabajo y la familia; y (c) las consecuencias potenciales de promover carreras a tiempo medio para la comunidad profesional y sus familiares.     

Childhood abuse and neglect in severely dependent female addicts: homogeneity and reliability of a Swedish version of the Childhood Trauma Questionnaire

This study explores the psychometric characteristics of childhood experiences ('Barndomsupplevelser'), using a Swedish translation of the 53–item version of the Childhood Trauma Questionnaire (CTQ). Fifty–five female addicts, treated in a compulsory–care setting, completed the questionnaire. Homogeneity and reliability were studied using principal component analyses (PCA) and Cronbach's alpha. The test was submitted to content analysis. Nearly all (94.5%) had experienced childhood abuse or neglect. The internal consistency is high. The 4–factor solution corresponded to the subscales of emotional and physical abuse (combined), of sexual abuse and of emotional neglect, while the items in the physical neglect subscale were distributed to several factors. In the 5–factor solution, this subscale was divided into two factors. Content analyses of these factors point to other meanings than physical neglect. The CTQ (Swedish translation) was found to have high consistency and homogeneity in four of the five subscales (emotional, physical and sexual abuse, and emotional neglect), while the subscale on physical neglect may need revision. The new 28–item brief version seems to be an improvement, with regard to these problems.     

Challenging the courtesy bias interpretation of favorable clients' perceptions of family planning delivery

Favorable client perceptions of provider's interpersonal behavior in contraceptive delivery, documented in clinic exit questionnaires, appear to contradict results from qualitative evaluations and are attributed to clients' courtesy bias. In this study, trained simulated clients requested services from Ministry of Health providers in three countries. Providers excelled in courteousness/respect in Peru and Rwanda; in India, providers were less courteous and respectful when the simulated clients chose the pill. Privacy and two-way communication were less prevalent in all three countries. The findings challenge the courtesy bias interpretation. Global results from qualitative studies may have expressed the views of the minority of clients who are not treated well by providers.     

Vaginal birth after caesarean: Views of women from countries with low VBAC rates

Problem and background

Vaginal birth after caesarean section is a safe option for the majority of women. Seeking women’s views can be of help in understanding factors of importance for achieving vaginal birth in countries where the vaginal birth rates after caesarean is low.

Women’s Agency in Egypt,Jordan, and Tunisia: The Role of Parenthood and Education

Population Research and Policy Review - Women in Middle Eastern and North African countries continue to report low levels of agency, despite their increasing educational attainment and declining...