Primary care: the driver in health care reform

The changes occurring in the health care industry have resulted in a cost-quality competition that has not been present in the past. Because of this competition, managed care is a growing way of financing and providing health care to the people of the United States. Managed care depends heavily on competent primary care physicians. Because primary care physicians are in short supply, the status and financial rewards of primary care practice are increasing. The primary care physician will be the dominant force in medical practice in the immediate future. He or she is capable in a managed setting of resolving the perceived problems of the health care industry in responding to the drivers of health care reform. Costs are reduced while quality is maintained. Access to health care is improved, and fragmentation of health care is significantly lessened.     

Bias in graduated life table functions

Survival proportions and expectations of life estimated directly from observed crude mortality rates are usually unbiased. Estimates of survival proportions and expectations of life obtained from graduated mortality rates at individual ages tend to be positively biased, although the actual bias is small for reasonably large experiences.     

A METHOD FOR DETERMINING THE ASYMPTOTIC EFFICIENCY OF SOME SEQUENTIAL PROBABILITY RATIO TESTS

This paper gives a method for decomposing many sequential probability ratio tests into smaller independent components called “modules”. A function of some characteristics of modules can be used to determine the asymptotically most efficient of a set of statistical tests in which a, the probability of type I error equals β, the probability of type II error. The same test is seen also to give the asymptotically most efficient of the corresponding set of tests in which a is not equal to β. The “module” method is used to give an explanation for the super-efficiency of the play-the-winner and play-the-loser rules in two-sample binomial sampling. An example showing how complex cases can be analysed numerically using this method is also given.     

A discrete-time two-sex age-specific stochastic population program incorporating marriage

A discrete-time two-sex stochastic population model is developed. All entities (single males, single females, or couples) are grouped according to their ages, and during a unit time interval, each entity has a choice of several outcomes with fixed conditional probabilities. The model assumes that the number of marriages between men aged x and women aged y is equal to the minimum of the number of men aged x desiring marriage with a woman aged y and the number of women aged y desiring marriage with a man aged x. It follows that if a large excess of males of a11 ages is maintained in the population, the female component grows as a multi-type Galton-Watson process. Under such circumstances, the females have perfect freedom in their choice of marriage partner, and the use of a multi-type Galton-Watson process is very realistic. The same result is true for the male component of the population. Ir there are no males (or females) , no marriages take place, so the model is realistic on this score also. A complex computer program is described, and a detailed numerical example given.     

Changes in mental well-being,blood pressure and total cholesterol levels during workplace reorganization: The impact of uncertainty

The aim of this study was to investigate the effects of uncertainty caused by large-scale workplace reorganization, on psychological well-being, blood pressure and total cholesterol levels. Employees (98 women and 86 men) were assessed four times, at approximately 6-monthly intervals, twice before and twice after reorganization. Self-reported psychological well-being was at its lowest level shortly prior to reorganization, as predicted. Greater self-reported uncertainty about one's own future occupational situation was associated with a bigger reduction in mental well-being before reorganization, as was role ambiguity after reorganization. Systolic blood pressure was elevated over initial levels just prior to reorganization, and shortly after reorganization, but at the final assessment was not significantly different from initial levels. A bigger increase in systolic blood pressure was seen in those reporting greater future job uncertainty before reorganization, and in those who started a new job or who reported greater role ambiguity after reorganization. Diastolic blood pressure was also significantly elevated over initial levels just before reorganization, but this effect became nonsignificant once changes in body mass index were statistically controlled. Total cholesterol also reached its highest level just prior to reorganization, but this effect was not significant. It is concluded that workplace reorganization caused significant increases in distress and in systolic blood pressure and that uncertainty contributed to these effects.     

U.K. Foot and Mouth Disease: A Systemic Risk Assessment of Existing Controls

This article details a systemic analysis of the controls in place and possible interventions available to further reduce the risk of a foot and mouth disease (FMD) outbreak in the United Kingdom. Using a research‐based network analysis tool, we identify vulnerabilities within the multibarrier control system and their corresponding critical control points (CCPs). CCPs represent opportunities for active intervention that produce the greatest improvement to United Kingdom's resilience to future FMD outbreaks. Using an adapted ‘features, events, and processes’ (FEPs) methodology and network analysis, our results suggest that movements of animals and goods associated with legal activities significantly influence the system's behavior due to their higher frequency and ability to combine and create scenarios of exposure similar in origin to the U.K. FMD outbreaks of 1967/8 and 2001. The systemic risk assessment highlights areas outside of disease control that are relevant to disease spread. Further, it proves to be a powerful tool for demonstrating the need for implementing disease controls that have not previously been part of the system.