The health status of elderly people and the new direction of health services

The projected increase of people in Japan aged 75 years and older in the years to come implies the increase of the disabled elderly. Thus, the core of societal preparation for the aging of the population is generally considered to be the expansion of services for the disabled elderly. However, gerontological studies on the health status of the elderly conducted in Japan show that the prevalence of disability is quite low and even decreasing. Relative to the services for the disabled elderly, preventive services for the healthy elderly have long been overlooked. In 1994, the Metropolitan Tokyo Government organized a task force to develop a new health education program as the preventive health service for the healthy urban elderly. A preliminary plan outlining the health education program--consisting of propagation with a booklet, on-the-job training of practitioners, and development of new curricula and teaching materials--was proposed by the authors for discussion within the task force. Although the inquiry has just begun and the plan is still nascent, it seems adequate to fit the needs for preventive health services in the near future.     

Marketing and the medical specialist in the managed care environment

Marketing means more than just communicating or advertising to potential patients; marketing means identifying your customers and working to meet or exceed their expectations. There are five key areas of a marketing plan: (1) Establish the foundation, beginning with your mission statement; (2) Assess your marketing environment by internal and external research; (3) Target your efforts, looking at image and perception; (4) Develop your particular mix of product, price, place of distribution, and promotion; and (5) implement and evaluate your marketing process. This article discusses the importance of a marketing plan for the medical specialist and highlights the features unique to a practice working in a system of capitated reimbursement. Applying these principles will help to demonstrate added value, protect the fundamental role of the patient-physician relationship, ensure that our efforts are aligned with professional missions and goals, and ultimately increase profitability and professional success.     

Retirement patterns in Hong Kong: a censored regression analysis

This paper provides an overview of retirement patterns in Hong Kong on the basis of limited data. A censored regression model is used to infer the retirement age from people‘s current retirement status and their current age. This model is equivalent to a restricted probit model, and the interpretation of parameters is straightforward. The results clearly show a negative income effect on the retirement decision. The retirement age seems to be positively related to lifetime earnings but negatively related to the rate of decline of earnings with age. JEL classification: C24, J14, J26 Received May 6, 1996 / Accepted February 5, 1997     

Modeling household fertility decisions with generalized Poisson regression

This paper models household fertility decisions by using a generalized Poisson regression model. Since the fertility data used in the paper exhibit under-dispersion, the generalized Poisson regression model has statistical advantages over both standard Poisson and negative binomial regression models, and is suitable for analysis of count data that exhibit either over-dispersion or under-dispersion. The model is estimated by the method of maximum likelihood. Approximate tests for the dispersion and goodness-of-fit measures for comparing alternative models are discussed. Based on observations from the Panel Study of Income Dynamics of 1989 interviewing year, the empirical results support the fertility hypothesis of Becker and Lewis (1973). Received January 7, 1997 /Accepted April 3, 1997     

Mortality Risk Perceptions: A Bayesian Reassessment

"This study uses data on perceived and actual mortality risks to test several alternative Bayesian models of the factors influencing risk beliefs. The analysis...indicates that while the hazard rate for the individual age group is an influential factor, the overall population death rate and the discounted expected number of life years lost due to the cause of death are also influential in affecting risk perceptions.... The predictive power of a linear perception model increases with the level of the risk and is least accurate for very small risks."     

"No TEBA...forget TEBA": the plight of Malawian ex-migrant workers to South Africa, 1988-1994

"This article is about the process of socioeconomic transformation in rural Malawi. It examines the survival strategies and enterprising spirit of Malawian migrant workers and their households. It argues that the strategies of these people often went beyond survival in the provision of basic necessities.... In March 1988, the South African Chamber of Mines stopped a century-old tradition of recruiting migrant workers from Malawi. This has arrested and put to a halt a process of accumulation taking place in the households of the returned migrant workers in the rural economy. Thus, the effects of the retrenchment of the workers will spread from the migrant and his family through the economic and social wellspring of all sectors of rural communities and their commercial lives."     

Evaluation design for a community prevention trial. An environmental approach to reduce alcohol-involved trauma

The Community Prevention Trial was 5-year effort to reduce alcohol-involved injuries and death through a comprehensive program of community awareness and policy activities. The three experimental communities were of approximately 100,000 population each (one in Northern California, one in Southern California, and one in South Carolina). Matched comparison communities were used for each experimental community. This article describes the evaluation approach used in a program that sought to change environmental factors not a specific population or target group. This approach demanded unique evaluation approaches for determining overall community aggregate effects, that is, distal outcomes, as well as changes in key mediating variables, that is, process effects. The problem of trending and lagged effects of community prevention programs are discussed.     

Summing up. Recommendations and experiences for evaluation of community-level prevention programs

This article provides recommendations and observations about evaluation of a locally based prevention project to reduce problems at a total community or aggregate level. The shift from targeting specific individuals or subpopulations to the overall structure and environment of a community is most demanding. Evaluation tools and analysis techniques have lagged behind program development because community-level interventions are not linked to a specific target group who can be separately studied. Thus assumptions about using random assignment and/or comparison communities as means to control for confounding variables are weakened when the unit of analysis is the community itself and dependent measures are subject to trending and the effects of history.     

Implementation and process evaluation of a student "school-as-community" group. A component of a school-based drug abuse prevention program

Little documentation exists regarding the functioning of formalized adolescent groups as drug abuse prevention agents. Two studies are described that were conducted at high schools whose students are at high risk for drug abuse. Twenty-one schools were randomly assigned to one of three conditions: (a) standard care, (b) classroom drug abuse education only, or (c) classroom plus school-as-community. Results of the first study indicated that the school-as-community component--which involved weekly meetings and periodic events at seven schools--was implemented as planned, drug abused focused, and perceived as productive in discouraging drug abuse. In the second study, staff in the classroom plus school-as-community condition self-reported involvement in the greatest number of community activities across the school year, compared with staff from the other two conditions. These two studies support the feasibility of formalized groups of high-risk youth to promote drug-free events.     

Prevalence of gambling among Minnesota public school students in 1992 and 1995

The purposes of this study were to examine the prevalence of gambling among youth, compare rates of gambling between 1992 and 1995, and determine what levels of gambling frequency may be considered common and uncommon. The two samples included 122,700 Minnesota public school students in the 6th, 9th, and 12th grades in 1992; and 75,900 9th and 12th grade students in 1995. Students were administered the Minnesota Student Survey, a 126-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple content domains, including gambling behaviors. The same questionnaire, with minor revisions to the gambling items, was administered in both 1992 and 1995 to students in their classrooms by the Minnesota Department of Education. There were slight decreases in overall gambling rates from 1992 to 1995. The majority of students gambled at least once during the past year. However, most did not play any game on a weekly/daily rate and did not report any problems associated with their gambling. Gender, grade, and race effects were found for gambling frequency. Boys gambled more often than girls, and 9th and 12th grade students gambled more often than 6th grade students. Asian American and White students reported lower rates of gambling frequency than Mexican/Latin American, African American, and American Indian students. From a statistical standpoint (i.e., beyond the 97.7 percentile), it may be considered in the uncommon range for girls to play two or more games at a weekly/daily rate, and for boys to play four or more games at a weekly/daily rate. Variables associated with gambling frequency included antisocial behavior, gender, and alcohol use frequency. Although the finding that gambling did not increase from 1992 to 1995 is encouraging, this is the first generation of youth to be exposed to widespread accessability to gambling venues and gambling advertising and it will be important to continue monitoring the prevalence of youth gambling.