Mixed model for analyzing geographic variability in mortality rates

"A mixed model is proposed for the analysis of geographic variability in mortality rates. In addition to demographic parameters and random geographic parameters, the model includes additional random-effects parameters to adjust for extra-Poisson variability. The model uses a gamma-Poisson distribution with a random scale parameter having an inverse gamma prior. An empirical Bayes approach is used to estimate relative risks for geographic regions and annual rates for demographic groups within each region. Lung cancer in Missouri is used to motivate and illustrate the procedure."     

On estimating census undercount in small areas

"Net undercount rates in the U.S. decennial census have been steadily declining over the last several censuses. Differential undercounts among race groups and geographic areas, however, appear to persist. In the following, we examine and compare several methodologies for providing small area estimates of census coverage by constructing artificial populations. Measures of performance are also introduced to assess the various small area estimates. Synthetic estimation in combination with regression modelling provide the best results over the methods considered. Sampling error effects are also simulated. The results form the basis for determining coverage evaluation survey small area estimates of the 1900 decennial census."     

Medication management, antidepressant drugs, and the elderly: an overview.

1. Several factors may affect an elderly client's use of medications: polypharmacy, potentially leading to interactions; over-the-counter drugs taken without a physician's knowledge; noncompliance or poor compliance with medication regimens; and ageist beliefs. 2. Psychiatric nurses must be aware that the signs and symptoms they observe may be the result of normal physical or biological aging, psychosocial changes, disease-related changes, medication side effects, or a drug interaction. 3. Nurses must ask two questions when psychotropic drugs are used with elderly clients: What will be the onset, duration, magnitude, and characteristic action of a specific drug in an individual; and What are the characteristics of an "ideal" medication?     

Effective boards: how executive directors define and develop them

There is growing recognition in the nonprofit field that the executive director has a key role in determining whether the board of directors will function effectively. To aid executives in this vital role, two recent studies defined a "good board" from the point of view of two samples of executive directors of community agencies, then sought factors related to board performance as measured by this definition. In interviews, executives whose boards scored higher than their peers on this performance measurement related how they work with their boards in such areas as recruitment of new members, financial management, fundraising, and leadership development.     

Eliminating smoking from the workplace

Employers are more readily realizing that a nonsmoking policy in the workplace is a more effective way to run their businesses. They are recognizing costs such as productivity losses, increased health and life insurance costs, employer liability for diseases jointly linked to smoking and occupational exposures, absenteeism, passive smoking-induced health care costs among nonsmokers, workers' compensation, and fire losses. Concomitantly, employees are supporting policies that limit smoking to achieve a clean air environment. Former Surgeon General Koop's goal of "a smokefree society by the year 2000" is being recognized by more and more segments of society.     

Clinical program renovation management

The day-to-day management of medical practice is so heavily influenced by tactical imperatives that few physicians have the time to think strategically. Traditionally, the difference between tactics and strategy is not a major concern of most physician executives. The realm of tactics is the short run, when managers must make do with the fixed resources at hand. Strategy addresses the long run, when all resources and markets are variable. A tactical focus is understandable, maybe even acceptable, in industries where nothing challenges traditional approaches to production of an established product or service. However, medical care in the 1990s is changing so fast that a physician executive must devote an incredible amount of time and effort just to stay confused about what is going on.     

Immigrant fertility: an examination of social characteristics and assimilation

"This study compares the fertility patterns of foreign-born and native-born women in Canada and examines whether [the] same set of social characteristics accounts for differential fertility among both the groups. The study also assesses the importance of social characteristics and assimilation on immigrant fertility behavior. Two generations of currently married/cohabiting women with spouse present are analyzed using multiple regressions. The results reveal similar effects on fertility of social characteristics for foreign-born and native-born, while in the case of younger generations the effects are stronger."     

Small populations of the north: their problems and how to solve them

The authors examine the present conditions of 26 small, isolated populations living in the north of Russia. The total size of the population under consideration is 181,600, according to the 1989 Soviet census. The conclusion is that these populations are under severe threat of extinction and that there is no consensus about how to resolve their present predicament.