Analysis approaches to community evaluation

Analysis approaches to the evaluation of community interventions must be sensitive to a wide variety of analytic contaminants that may bias the statistical assessment of changes in outcome measures. These contaminants include model misspecifications related to failures to control for community-specific time trends, temporal autocorrelated errors in equations, spatial autocorrelated errors among geographic units, and other failures of unit independence otherwise indexed by estimated intraclass correlations. Although an enormous amount of progress has been made toward the solution of many of these analytic problems over the past years, the contemporary evaluator of community interventions is left with a number of unenviable design and analysis choices; choices that inevitably force an assessment of the relative threats of different sources of error to the internal and external validity of the evaluation. This article describes the choices made for the evaluation of the Community Trial Project outcome data.     

People behaving badly

With every cigarette we smoke, every fat-filled snack we consume, and every lap we don't take around the track, we risk our health. This state-by-state look at what we do and don't do reveals poor health practices wherever you look.     

Partner patterns in the sexual behavior of unmarried,rural Thai men

"After a brief discussion of related studies of Thai youths' attitudes toward sexual activity, data from a 1988 national survey of young males (ages 15-24) about their family planning knowledge, attitudes, and practices are used to document the age pattern of sexual initiation, the prevalence of youths' encounters with commercial sex workers, the prevalence of their experience with non-commercial partners...and the degree to which the two patterns--commercial and noncommercial--are 'networked' because young men engage in both types of sexual activity. Finally, background characteristics of male youths that are associated with these patterns of sexual activity are examined."     

Excessively pronated feet: a health hazard to developing children

There is a serious misconception on the part of the public as well as amongst a great number of professionals to equate the problem of flatfoot with excessively pronated feet in growing children. This is a matter of grave concern since flatness of the arch of the foot can be a normal or abnormal finding in foot posture, whereas the excessively pronated foot is flattened as part of a pathological structural malposition. This inherent biomechanical defect is commonly present in the great majority of human children and is the basic reason for most postural pathology of the lower extremity.Excessive pronation of the feet in children should in no way be interpreted as a normal condition to be automatically outgrown. As a matter of fact, Whitman, the famous Orthopaedic Surgeon, noted in 1917 in his text Orthopaedic Surgery that pronation of the feet commonly seen in children is more likely to worsen than improve over the years. This paper presents the probable cause of the condition, treatment and prevention of the problem and recommendations for the future.The deforming foot posture known as excessive pronation is familiar to Podiatric Medicine and to Medicine generally. Yet, in spite of this familiarity, only an insignificant number of the millions of children in our country receive the simple available help required to minimize the problem.The Podiatric profession has within its grasp the wherewithal to correct this situation, through education and counseling of parents, through cooperation with pediatricians and other professionals and by utilizing technological advances in children's footgear and orthotics. It is the intention of this paper to provide an overview of the literature and history associated with the problem of excessive pronation in children, as well as to suggest some simple techniques for improving this situation.Dr. Tax is an international renowned consultant to many Podiatric Hospital amon which is the Veterans Administration in New Jersey, New York College of Podiatric Medicine, Ohio College of Podiatric Medicine. He has written and lectured extensively on the subject of children and problems with their feet.     

Subsidized elderly housing: public-private partnerships on the brink

Starting in the early 1960s, the federal government joined with the private-sector housing developers in a partnership: in return for subsidized mortgages and tax benefits, developers would rent to low- and moderate-income tenants. Today, many elderly people live in these "publicly subsidized" units. The initial agreement, however, held out an escape clause: after 15 to 20 years, for-profit developers that wanted to end the partnership could prepay their mortgages, leaving tenants in those buildings "at risk" of rent increases and/or evictions. This article discusses that partnership, its options for dissolution, and the current solutions to the problem of the expiring agreements, including a moratorium, vouchers, and incentives. The compromise legislation responds to all interested parties--owners, current and would-be tenants, local governments, tax-payers--through a multi-stage sequence of dissolution, yet such a finely tuned, acutely sensitive legislative solution may not work easily or efficiently.     

How well is debt managed by nonprofits?

Little is known about why nonprofits accrue debt, how much they owe, and whether the funds they borrow are used productively. This article distinguishes between productive, problematic, and deferred debt. Employing a data base representative of 114,726 tax-filing charitable nonprofits in the United States in 1986, it examines the pervasiveness of nonprofit debt and the relation between this debt and nonprofit financial health. The analysis finds that over 70 percent of the nonprofits hold debt, the distribution of this debt is highly concentrated, and the level of debt and leverage varies with asset size and type of activity. Nonprofits with higher leverage and absolute debt levels are financially healthier than those with lower levels. While the analysis does not determine whether financially stronger nonprofits are better able to borrow, the results support the view that borrowing in the nonprofit sector is economically efficient.     

Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.