Far eastern patterns of Mortality

Summary In this paper a mortality pattern is identified which has not previously been described by model mortality schedules and seems to have occurred only in populations in the Far East. Mortality schedules in Taiwan, Hong Kong, Singapore, and Korea during the past several decades have been characterized by excessively high death rates of men at the older ages. This excess mortality has progressively diminished and most recent death rates for men show only slight deviations from West model life tables. An examination of statistics on causes of death suggests that tuberculosis is at least partly responsible for the excess mortality of men.     

An integrated response to trauma in three post office businesses

Abstract

This paper looks at the way the UK Post Office has developed a core trauma care programme that is capable of being adapted to meet the needs of three of its businesses. The core programme includes an introductory stage that is involved in the selection and education of the workforce and the promotion of the programme; crisis management; manager debriefing; psychological debriefing; trauma counselling; and a final stage involving the evaluation of the programme and following up traumatized employees. The core programme was tailored to the needs of each of the three Post Office businesses, using information on the business operation, culture and policies of the businesses in the light of the nature and range of the traumatic incidents that affect their workforce.     

The potential impact of comparative effectiveness research on U.S. Health Care expenditures

Comparative effectiveness research (CER) has the potential to slow health care spending growth by focusing resources on health interventions that provide the most value. In this article, we discuss issues surrounding CER and its implementation and apply these methods to a salient clinical example: treatment of prostate cancer. Physicians have several options for treating patients recently diagnosed with localized disease, including removal of the prostate (radical prostatectomy), treatment with radioactive seeds (brachytherapy), radiation therapy (IMRT), or—if none of these are pursued—active surveillance. Using a commercial health insurance claims database and after adjustment for comorbid conditions, we estimate that the additional cost of treatment with radical prostatectomy is $7,300, while other alternatives are more expensive—$19,000 for brachytherapy and $46,900 for IMRT. However, a review of the clinical literature uncovers no evidence that justifies the use of these more expensive approaches. These results imply that if patient management strategies were shifted to those supported by CER-based criteria, an estimated $1.7 to $3.0 billion (2009 present value) could be saved each year.     

The relationship between childhood sexual abuse, complex post-traumatic stress disorder and alexithymia in two outpatient samples: examination of women treated in community and institutional clinics

Relationships between trauma variables, complex post-traumatic stress disorder (complex PTSD), affect dysregulation, dissociation, somatization, and alexithymia were studied in 70 women with early-onset sexual abuse treated in community-based private (n = 25) or clinic outpatient settings (n = 45). Measures were the Toronto Alexithymia Scale-20 and the Psychological Trauma Assessment Program. Compared with the community sample, the clinic sample (1) met diagnostic criteria for both lifetime and current complex PTSD; (2) showed correlations between current affect dysregulation, dissociation, and somatization with alexithymia; and (3) higher levels of alexithymia. Results suggest the clinic sample continued to experience current forms of suffering, risk, and vulnerability associated with early-onset sexual trauma. The findings may have implications regarding types of treatment available in community versus clinic settings.     

Exceptionalism and Internationalism: The Origins of American Social Science Reconsidered

This paper examines the international context in which American social science was institutionalized in the generation after the Civil War, following the foundation of the American Social Science Association in 1865. The ASSA was modelled on an influential British forum, founded eight years previously, the National Association for the Promotion of Social Science. A comparison of these two organisations from the 1860s to the 1880s allows consideration of British intellectual and political influences on the first American social scientists. It also helps in the identification of the social and political attitudes of the well-born, cosmopolitan, and high-minded American reformers attracted to social science at this time. The theme of American exceptionalism has recently been emphasized when considering the motives and intentions of early social science in the United States. It is argued here that the replication in America of models of the new discipline which were first developed in Britain, is indicative also of a self-conscious internationalism among the American social-scientific community of this period. In addition to an institutional comparison, the article examines the careers and ideas of several representative figures in this process of Anglo-American liberal transference, among them the physician Dr. Edward Jarvis, the feminist Caroline Healey Dall, the jurist David Dudley Field, and the famed British interpreter of American experience, James Bryce.     

New insights into the Far Eastern pattern of mortality

Some of the highest levels of excess mortality of males found anywhere in the world were present in several Far Eastern populations during the 1960s and 1970s but have progressively disappeared since that time. This study uses cause-of-death data to determine the diseases responsible for the existence and attenuation of these sex differences in Hong Kong, Singapore, and Taiwan. The results indicate that respiratory tuberculosis is the single most important underlying cause of the existence and attenuation of the pattern, that the role of liver diseases is not clear cut, and that other causes (such as cardiovascular diseases) are also important. A review of numerous risk factors yields no compelling reason why these populations experienced such large sex differences in mortality. However, it seems likely that public health and biomedical improvements (particularly those related to the reduction in mortality from tuberculosis) played a critical role in the attenuation of the Far Eastern mortality pattern.     

Achieve Boston: a citywide innovation in professional development

Achieve Boston is a broad-based collaborative effort to improve the overall quality of programs for children and youth by establishing a professional development infrastructure that supports those who work with young people during the out-of-school-time hours.     

Measurement of cumulative physiological dysregulation in an older population

The allostatic load framework postulates that an important pathway connecting the social environment with health involves biological responses to stressful stimuli and the subsequent dysregulation of interrelated physiological systems. We formulate a new measure for cumulative physiological dysregulation using a grade of membership model estimated with biodemographic data from a national sample of older Taiwanese persons. We investigate associations between the measure and physical, psychological, and cognitive function. The results provide insights into the relationships between a set of biological profiles and various health outcomes, identify limitations of earlier approaches, and underscore next steps in the development of improved for mulations of physiological dysregulation.     

Transition from home care to nursing home: unmet needs in a home- and community-based program for older adults

A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.     

Examining Associations between Occupation and Health by using Routinely Collected Data

When examining a large number of associations simultaneously, as happens when routinely collected data are used to assess associations between occupation and health, it is not obvious how best to identify associations requiring further investigation since some risks may be high, or low, by chance alone. We have developed an approach to deal with this problem which is relatively easy to apply and appropriate to applications where data are not too sparse. Observed to expected ratios are estimated using an empirical Bayes procedure. Anomalous associations can be seen as outliers in a normal probability plot of the log-ratios. The method is illustrated in the analysis of 252 000 cancers registered in men in England during 1981–87.