Mobile safety cameras: estimating casualty reductions and the demand for secondary healthcare

We consider a fully Bayesian analysis of road casualty data at 56 designated mobile safety camera sites in the Northumbria Police Force area in the UK. It is well documented that regression to the mean (RTM) can exaggerate the effectiveness of road safety measures and, since the 1980s, an empirical Bayes (EB) estimation framework has become the gold standard for separating real treatment effects from those of RTM. In this paper we suggest some diagnostics to check the assumptions underpinning the standard estimation framework. We also show that, relative to a fully Bayesian treatment, the EB method is over-optimistic when quantifying the variability of estimates of casualty frequency. Implementing a fully Bayesian analysis via Markov chain Monte Carlo also provides a more flexible and complete inferential procedure. We assess the sensitivity of estimates of treatment effectiveness, as well as the expected monetary value of prevention owing to the implementation of the safety cameras, to different model specifications, which include the estimation of trend and the construction of informative priors for some parameters.     

Yarning about gambling in Indigenous communities: an Aboriginal and Islander Mental Health Initiative

Gambling impacts upon the health, wellbeing and finances of many people throughout Australia. This study aimed to explore the socioeconomic and cultural factors linked with gambling in urban and remote Indigenous settings in the Northern Territory to inform the development of a gambling public health strategy. The Aboriginal and Islander Mental Health Initiative developed a semi‐structured questionnaire with Aboriginal partner organisations following consultation. Indigenous consumers of substance use treatment facilities participated in focus group discussions and key informant interviews were conducted with nine service providers at two time points, a year apart. Participants described key strengths in community as family, health and culture, while key worries included substance misuse, health concerns and family disharmony. Regulated gambling and card playing were also identified as important community worries. Financial and family concerns and addictive behaviour were seen as negative consequences of gambling. There was increasing concern linked with card playing and electronic gaming machines and an increased call for awareness campaigns, support from government for change and greater regulation. The findings of this study provide the most recent insight into attitudes, behaviours and consequences linked with Indigenous gambling in the Northern Territory.     

Migrant Selection and the Health of U.S. Immigrants From the Former Soviet Union

Few prior studies have investigated the health of U.S. immigrants from the former Soviet Union (FSU). Utilizing data from the 2000 U.S. census and the 2000–2007 National Health Interview Survey (NIHS), we compare levels of disability of FSU immigrants with U.S.-born whites (ages 50–84). Our findings suggest an “epidemiologic paradox” in that FSU immigrants possess higher levels of education compared with U.S.-born whites, but report considerably higher disability with and without adjustment for education. Nonetheless, FSU immigrants report lower levels of smoking and heavy alcohol use compared with U.S.-born whites. We further investigate disability by period of arrival among FSU immigrants. Changes in Soviet emigration policies conceivably altered the level of health selectivity among émigrés. We find evidence that FSU immigrants who emigrated during a period when a permission to emigrate was hard to obtain (1970–1986) displayed less disability compared with those who emigrated when these restrictions were less stringent (1987–2000). Finally, we compare disability among Russian-born U.S. immigrants with that of those residing in Russia as a direct test of health selectivity. We find that Russian immigrants report lower levels of disability compared with Russians in Russia, suggesting that they are positively selected for health despite their poor health relative to U.S.-born whites.     

Discussion: Case of Colette

The case of Colette is discussed with “reading” considered as a metaphor for the process of thinking about the traumatic experiences to which Colette has been subject. From this perspective, there is a parallel between her work with Dr. Ganzer and her struggles around attending her program’s reading class. Consideration is given to issues around termination in public sector clinical work.