"Our babies shall not die": a community's response to medical neglect

The free neighborhood health center in a Midwest U.S. town was developed in response to a report that indicated that infant mortality rates were higher for the Black community than for the community-at-large. The health center soon took on the full range of health problems brought by clients regardless of client's race, ethnicity, or income. The processes for managing health care problems in an environment where racism was the rule rather than the exception are considered in this study.     

Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps,and social equity considerations

The Royal Government of Cambodia recently launched its National Social Protection Policy framework to strengthen and expand social security and assistance. To inform social health protection policy, we examine socio-economic survey data and administrative coverage data to assess the coverage potential of existing coverage mechanisms and current gaps; and compare equitable contribution rates. Over 53 per cent of the population currently has no social health protection coverage mechanism, and about 16 per cent of the population who do have access to a mechanism are not yet enrolled. Current expansion efforts focus on the formal employee scheme, primarily benefiting individuals from higher income households. In addition, recent coverage expansion to some informal workers leaves significant gaps, particularly among the informal sector. We find out-of-pocket health care expenditure to be an excessive share of income among lower wealth quintile individuals and conclude they are financially vulnerable. Finally, we illustrate that an equitable approach to individual, monthly health care contributions among the lower three quintiles has a severely limited potential for revenue generation, and collection costs could exceed the amount collected. Therefore, we recommend that vulnerable groups should be exempted from contribution payments as social health protection is expanded.     

A generalized Bayesian nonlinear mixed‐effects regression model for zero‐inflated longitudinal count data in tuberculosis trials

In this paper, we investigate Bayesian generalized nonlinear mixed‐effects (NLME) regression models for zero‐inflated longitudinal count data. The methodology is motivated by and applied to colony forming unit (CFU) counts in extended bactericidal activity tuberculosis (TB) trials. Furthermore, for model comparisons, we present a generalized method for calculating the marginal likelihoods required to determine Bayes factors. A simulation study shows that the proposed zero‐inflated negative binomial regression model has good accuracy, precision, and credibility interval coverage. In contrast, conventional normal NLME regression models applied to log‐transformed count data, which handle zero counts as left censored values, may yield credibility intervals that undercover the true bactericidal activity of anti‐TB drugs. We therefore recommend that zero‐inflated NLME regression models should be fitted to CFU count on the original scale, as an alternative to conventional normal NLME regression models on the logarithmic scale.     

Applications and Implementation: AN EXPERIMENTAL COMPARISON OF CELLULAR (GROUP TECHNOLOGY) LAYOUT WITH PROCESS LAYOUT

This study compares different strategies for arranging machines in a facility. Computer simulation of two different machine shops was used to compare process layout (the arrangement of groups of machines where the machines within a group are interchangeable) to cellular layout designed using group technology concepts (the use of manufacturing cells where each cell contains different types of machines dedicated to the production of similar parts). Four layout strategies, including process layout, cellular layout, and two hybrid layouts, were compared in two machine-shop models. The shops that used cellular layouts had shorter setup times, lower machine utilization, and shorter distances traveled, on average. The shops with process layout, however, had better performance on queue-related statistics such as work-in-process inventory level and average flow time. This suggests that a well-organized traditional job shop may be able to achieve overall performance that at least is comparable to that of the same shop using cellular (group technology) layout.     

Trends in Women's Career Patterns and in Gender Occupational Mobility in Britain

This paper uses retrospective data from the SCELI surveys to make a detailed investigation of changing career patterns and gender differences in occupational status over the period 1946–86. A summary variable is developed and used to examine the relationships between changing employment trends and respondents' occupational status. Occupational status, as the Hope-Goldthorpe scale value, is measured throughout the life-course and changes over time are examined. The main findings of the study are that despite the increase in women's qualifications and the proportion of women in the workforce, their human capital has not greatly increased although their careers have become increasingly variable. Men and childless women experience occupational status increasing over life-course and time but part-time employed women do not. Class of origin is more important to status for men than for women, while qualifications are important for both. Women's careers are increasingly affected by discontinuity and part-time employment.     

A criterion-referenced multidimensional job-related model prediction capability to perform occupations among persons with chronic pain

OBJECTIVE: The purpose of this prospective study was an exploration of the construct of the criterion-referenced multidimensional job-related model (CMVA) aimed for predicting patients' with chronic pain capability to perform occupations. METHODS: The study samples were 1) participants (n=84) who at present were not performing employed work (median sick-listing period 12 months) because of chronic pain and 2) participants (n = 104) who at present were performing employed work at least 20 hours of a workweek. The participants had experiences of 40 different occupations classified into five of the occupational categories of Jist's Enhanced Dictionary of Occupational Titles. Data were collected through ten assessment instruments and a structured interview, comprising 54 variables and 465 items. Data were analyzed using multiple regression with forward entering of variables. RESULTS: The CMVA model (Adjusted R^2 0.777, F (4, 183) = 164.067; p<0.001) was able to explain 78% of the variance. CMVA contained the aspects; "the work demands-variable, the person-variable of work life values, the environment-variable of social support and the two occupational performances-variables; self-perceived capability to perform work tasks/the simulated work tasks". CONCLUSIONS: The construct of CMVA was robust suggesting that among persons with chronic pain, the predictors focusing on their capability to perform occupations are of great importance.